Browsing by Person "Smith, M."

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Achievement of simple mobility milestones after stroke
(Elsevier, 1999-04) Smith, M.; Baer, Gill
Abstract Objectives: To observe the mobility outcomes of an inpatient population of stroke patients grouped according to the Oxfordshire Community Stroke Project classification. Study Design: Mobility milestones-, standardized measures of functional movement, were used to examine mobility recovery. Participants: Two hundred thirty-eight stroke patients admitted to the Western General Hospital, Edinburgh. Main Outcome Measures: Times taken to achieve four mobility milestones: 1-minute sitting balance, 10-second standing balance, a 10-step walk, and a 10-meter walk. Results: For all subjects the median times to achieve the milestones were as follows: 1-minute sitting balance, day of stroke; 10-second standing balance, 3 days; 10-step walk, 6 days; and a 10-meter walk, 9 days. Subjects sustaining a partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct achieved the mobility milestones most rapidly and generally had a shorter hospital stay. Conclusions: A hierarchical pattern of recovery of mobility reflecting variation between subgroups was observed. Predicted timescales for recovery of mobility are suggested.
Does treadmill training improve walking after stroke - the long-term follow-up from a phase II randomised controlled trial.
(Wiley, 2009) Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa; Smith, M.
Introduction: A recent Cochrane review has indicated that current evidence for the effectiveness of Treadmill Training (TT) following stroke is inconclusive. This paper reports the 6 month follow up of mobility outcomes from a phase II feasibility randomised-controlled trial investigating an eight week TT programme with ambulant and non-ambulant people with sub-acute stroke. Method: Sub-acute stroke patients within 3 months of stroke onset were recruited from four stroke rehabilitation units. Randomisation based on side of lesion and initial independence or dependence in walking allocated participants to receive either an eight week programme of ''usual physiotherapy'' (control) or physiotherapy including TT (experimental). Mobility outcomes taken at baseline and 6 months after randomisation included: the Modified Rivermead Mobility Index (RMI); Functional Ambulation Classification (FAC); Timed Up and Go (TUG); 10 min walk test (10 mwt); and the 6 min walk test (6 mwt). Results: Seventy-seven participants were recruited, 39 were randomised to control, and 38 to experimental. At 6 months post randomisation, while both groups had improved their mobility scores, Mann-Whitney U-tests showed no significant differences between the groups for RMI (U=481.5; p=0.421); FAC (U=488; p=0.457); TUG (U=204; p=0.678); 10 mwt (U=262; p=0.956) or 6 mwt (U=194.5; p=0.892). Conclusion: The results indicated that while both groups improved their mobility scores from baseline measures, there were no statistically significant differences between the groups at 6 months. The amount and content of ''usual physiotherapy'' and TT is being analysed to determine whether this may be one of the influencing factors.
How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial
(Wiley, 2009) Smith, M.; Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa
Introduction: RCP Stroke Guidelines advocate treadmill training (TT) for gait rehabilitation post-stroke. The protocols described in previous studies were intensive, short-term and may not be feasible to deliver within a UK clinical setting. One aim of this Phase II study was to explore key elements of delivering TT in a clinical setting within the NHS. Method: As part of a randomised controlled trial over 8 weeks, participants with stroke were allocated to a control or experimental group. The protocol demanded that all participants received a minimum of three therapy sessions per week of which at least two were on the treadmill for experimental participants. A treadmill system with unweighing harness was used. The content of treadmill sessions was decided by the treating therapists and all parameters were recorded. Results: Seventy-seven participants were recruited with 39 randomised to the experimental group. Experimental participants received a median of two treadmill sessions per week, with an average total walking time on the treadmill of between 8 and 16 min/week, at a median speed of 0.6m/s. Use of a support harness by participants reduced from 49% in week 1 to 23% in week 8. Conclusion: Only the minimum number of treadmill interventions were delivered. Clinical staff cited staffing levels, number of staff required for safety and time required for harness application as some of the reasons for the limited TT. These findings suggest that it may not be feasible to deliver sufficient doses of TT within the current NHS clinical environment.
The incidence of cases of aphasia following first stroke referred to speech and language therapy services in Scotland
(2009) Law, J.; Rush, R.; Pringle, A.; Irving, A.; Huby, G.; Smith, M.; Conochie, D.; Haworth, C.; Burston, A.
Background: Key to the provision of appropriate services is an understanding of the number of cases in a given population. This study examined the incidence of aphasia following first ever stroke. It was part of a larger study, the Aphasia in Scotland Study, which examined the provision of services for people with aphasia in Scotland. Aims: The present study examines the incidence of aphasia referred to speech and language therapy services in people who have experienced their first ever stroke. The specific questions addressed were: What is the incidence of aphasia following first ever stroke? What is the percentage of aphasia following first ever stroke? What are the crude figures for aphasia following first ever stroke by age? What are the crude figures for aphasia following first ever stroke by gender? What are the crude figures for aphasia following first ever stroke by severity? Methods & Procedures: All 14 health boards in Scotland were approached but only 3, NHS Borders, Orkney, and Shetland, were able to provide the level of information required. Respondents were asked to provide information about the age and gender and level of communication need of referred cases over a given year. Outcomes & Results: Results suggested that the incidence of aphasia following first ever stroke was found to be 54, 57, and 77.5 per 100,000, for NHS Borders, Orkney, and Shetland respectively. This is slightly higher than in other comparable studies. The percentage of new cases of aphasia following a first ever stroke across NHS Borders, Orkney, and Shetland was 19, 22, and 34% respectively. The variability across the three sites is probably a function of the potential effect of small changes in the relatively low numbers. The majority of cases were, unsurprisingly, over 65 years of age but a substantial minority-17% (Shetland), 26% (Borders) and 36% (Orkney)-were below 65 years of age. One third of new cases resulted in severe aphasia. Although the proportions of men and women with aphasia were similar, women tended to be older at the point at which they experienced their first stroke. Conclusions: The results are discussed in terms the practicalities of this sort of data collection exercise and the implications of the results for service delivery. There is a need for comparable local data collection exercises tied in to current epidemiological studies.
The recovery of walking ability and subclassification of stroke.
(Wiley, 2001) Baer, Gill; Smith, M.
BACKGROUND AND PURPOSE: The recovery of walking after a stroke is a key functional goal for many patients. Reports vary, but approximately 50-80% of patients will regain some degree of walking ability following stroke (Skilbeck et al., 1983). There are few data available to show whether different subclassifications of stroke have distinct patterns of gait recovery. The present paper describes the pattern of walking recovery in a population of stroke patients classified according to the Oxfordshire Community Stroke Project classification (Bamford et al., 1991). METHOD: A prospective observational study. Stroke patients (n = 238) admitted to the inpatient Stroke Rehabilitation Unit at the Western General Hospital, Edinburgh were initially included, with data for 185 patients ultimately available for analysis. Standardized measures of recovery of 10 steps and a 10-metre walk were used routinely to examine recovery time of walking ability. The main outcome measures consisted of days taken to achieve a 10-step walk, days to achieve a 10-metre walk, and initial and discharge gait velocity over 10 meters. RESULTS: Eighty-nine per cent of the sample (n = 164) achieved a 10-step walk in a median time of five days and a 10-metre walk in eight days. The median initial gait velocity was 0.45 m/s which improved by discharge to 0.55 m/s. Further analysis by subgroup revealed that subjects sustaining a partial anterior circulation infarct, lacunar infarct or posterior circulation infarct recovered significantly more quickly than those subjects with a total anterior circulation infarct (Kruskal Wallis test for days to achieve 10 steps (H = 22.524, N = 164, df = 3) p < 0.001; Kruskal Wallis test for days to achieve a 10-metre walk (H = 22.586, N = 164, df = 3) p < 0.001. CONCLUSIONS: An hierarchical pattern of recovery of gait was observed with definite variation between the subclassifications of stroke. It is suggested that further work needs to be undertaken to identify more accurately the factors that may influence the recovery of walking following stroke.
Treadmill Training to improve mobility for people with sub-acute Stroke: A Phase II Feasibility Randomised Controlled Trial
(SAGE, 2017-07-21) Baer, Gill; Salisbury, Lisa; Smith, M.; Pitman, J.; Dennis, M.
Objective: This phase II study investigated the feasibility and potential effectiveness of treadmill training versus normal gait re-education for ambulant and non-ambulant people with sub-acute stroke delivered as part of normal clinical practice. Design: A single-blind, feasibility randomised controlled trial. Setting: Four hospital-based Stroke units Subjects: Participants within three months of stroke onset. Interventions: Participants were randomised to treadmill training (minimum twice weekly) plus normal gait re-education or normal gait re-education only (control) for up to eight weeks. Main Measures: Measures were taken at baseline, after eight weeks intervention and at six months follow up. The primary outcome was the Rivermead Mobility Index. Other measures included the Functional Ambulation Category, 10 metre walk, six minute walk, Barthel Index, Motor Assessment Scale, Stroke Impact Scale and a measure of confidence in walking. Results: Seventy seven patients were randomised, 39 to treadmill and 38 to control. It was feasible to deliver treadmill training to people with sub-acute stroke. Only two adverse events occurred. No statistically significant differences were found between groups. For example, Rivermead Mobility Index, median (IQR): after eight weeks treadmill 5 (4-9), control 6 (4-11) p = 0.33; or six months follow-up treadmill 8.5 (3 -12), control 8 (6 - 12.5) p = 0.42. The frequency and intensity of intervention was low. Conclusions: Treadmill training in sub-acute stroke patients was feasible but showed no significant difference in outcomes when compared to normal gait re-education. A large definitive randomised trial is now required to explore treadmill training in normal clinical practice.