Jacqueline Winter - Academia.edu (original) (raw)
Papers by Jacqueline Winter
EThOS - Electronic Theses Online ServiceGBUnited Kingdo
Disability and Rehabilitation, 2016
Aim: to explore the use, meaning and value of the term 'rehabilitation potential'. Method: The au... more Aim: to explore the use, meaning and value of the term 'rehabilitation potential'. Method: The authors of this commentary met to discuss concerns relating to the pressure on health service staff created by reduced length of stay in acute settings of those who have suffered a stroke and the need to determine the potential of a patient for rehabilitation in order to inform discharge arrangements. Points raised at this meeting were shared with an email group who over a 12 month period contributed to this paper. Results: The group agreed that: Given that there is very limited evidence to guide judgements regarding rehabilitation potential following stroke at an early stage the need for rehabilitation needs to be reviewed on a regular basis over a long period and that this needs to be reflected in clinical guidelines. Rehabilitation needs to be available in a broad range of care settings, in order that discharge from hospital is not equated with a lack of rehabilitation potential. Research related to rehabilitation potential needs to be conducted. This should examine influences of decision-making and and local policy on rehabilitation potential. The economic benefits of rehabilitation needs further exploration. Assessment of rehabilitation potential should be made more explicit and supported by appropriate evidence. Conclusion: Whilst further research is required to assist in determining the right time for people to benefit from formal rehabilitation this gives the impression that one dose of rehabilitation at a specific time will meet all needs. It is likely that a rehabilitation pathway identifying features required in the early stages following stroke as well as that required over many years in order to prevent readmission, maintain fitness and prevent secondary sequelae such as depression and social isolation would be beneficial.
Stroke, 2012
R ecent studies have attempted to disaggregate therapeutic intervention packages. However, what i... more R ecent studies have attempted to disaggregate therapeutic intervention packages. However, what is commonly referred to as the "black box" of therapy has yet to be comprehensively unpacked. It remains unclear how much therapy should be provided, who should provide it, and which patients should be targeted to maximize functional outcomes. This review seeks to assess the effectiveness of specific therapeutic interventions in the rehabilitation of the paretic upper limb poststroke. In particular, it aims to identify whether or not specific hands-on therapeutic interventions enhance motor activity and function.
Archives of Physical Medicine and Rehabilitation, 2013
To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in ... more To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in chronic stroke (>12mo) when upper limb (UL) "performance" has reached a clear plateau. Design: Replicated single-system experimental study with 8 single cases using A-B-A design (baseline-intervention-withdrawal phases); length of baseline randomly determined; intervention phase involved 6 weeks of daily MTS to the contralesional UL. Setting: Community setting, within participants' place of residence. Participants: Individual stroke survivors (NZ8; male-to-female ratio, 3:1; age range, 49e76y; 4 with left hemiplegia, 4 with right hemiplegia) discharged from ongoing therapy, more than 1 year post stroke (range, 14e48mo). Clinical presentations were varied across the sample. Interventions: Participants received up to 1 hour of daily (Monday to Friday) treatment with MTS to the UL for 6 weeks during the intervention (B) phase. Main Outcome Measures: Motor function (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index [MI] arm section) of the UL. Results: UL performance was stable during baseline for all participants. On visual analysis, improvements in motor impairment were seen in all participants, and clinically significant improvements in motor function were seen in 4 of 8 participants during the intervention phase. Latency between onset of intervention and improvement ranged from 5 to 31 days (ARAT) and from 0 to 28 days (MI). Improvements in performance were maintained on withdrawal of the intervention. Randomization tests were not significant. Conclusions: MTS appears to improve UL motor impairment and functional activity many months, even years, after stroke onset. Improvement can be immediate, but more often there is latency between the start of intervention and improvement; recovery can be distal to proximal.
EThOS - Electronic Theses Online ServiceGBUnited Kingdo
Disability and Rehabilitation, 2016
Aim: to explore the use, meaning and value of the term 'rehabilitation potential'. Method: The au... more Aim: to explore the use, meaning and value of the term 'rehabilitation potential'. Method: The authors of this commentary met to discuss concerns relating to the pressure on health service staff created by reduced length of stay in acute settings of those who have suffered a stroke and the need to determine the potential of a patient for rehabilitation in order to inform discharge arrangements. Points raised at this meeting were shared with an email group who over a 12 month period contributed to this paper. Results: The group agreed that: Given that there is very limited evidence to guide judgements regarding rehabilitation potential following stroke at an early stage the need for rehabilitation needs to be reviewed on a regular basis over a long period and that this needs to be reflected in clinical guidelines. Rehabilitation needs to be available in a broad range of care settings, in order that discharge from hospital is not equated with a lack of rehabilitation potential. Research related to rehabilitation potential needs to be conducted. This should examine influences of decision-making and and local policy on rehabilitation potential. The economic benefits of rehabilitation needs further exploration. Assessment of rehabilitation potential should be made more explicit and supported by appropriate evidence. Conclusion: Whilst further research is required to assist in determining the right time for people to benefit from formal rehabilitation this gives the impression that one dose of rehabilitation at a specific time will meet all needs. It is likely that a rehabilitation pathway identifying features required in the early stages following stroke as well as that required over many years in order to prevent readmission, maintain fitness and prevent secondary sequelae such as depression and social isolation would be beneficial.
Stroke, 2012
R ecent studies have attempted to disaggregate therapeutic intervention packages. However, what i... more R ecent studies have attempted to disaggregate therapeutic intervention packages. However, what is commonly referred to as the "black box" of therapy has yet to be comprehensively unpacked. It remains unclear how much therapy should be provided, who should provide it, and which patients should be targeted to maximize functional outcomes. This review seeks to assess the effectiveness of specific therapeutic interventions in the rehabilitation of the paretic upper limb poststroke. In particular, it aims to identify whether or not specific hands-on therapeutic interventions enhance motor activity and function.
Archives of Physical Medicine and Rehabilitation, 2013
To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in ... more To explore the effects of Mobilization and Tactile Stimulation (MTS) and patterns of recovery in chronic stroke (>12mo) when upper limb (UL) "performance" has reached a clear plateau. Design: Replicated single-system experimental study with 8 single cases using A-B-A design (baseline-intervention-withdrawal phases); length of baseline randomly determined; intervention phase involved 6 weeks of daily MTS to the contralesional UL. Setting: Community setting, within participants' place of residence. Participants: Individual stroke survivors (NZ8; male-to-female ratio, 3:1; age range, 49e76y; 4 with left hemiplegia, 4 with right hemiplegia) discharged from ongoing therapy, more than 1 year post stroke (range, 14e48mo). Clinical presentations were varied across the sample. Interventions: Participants received up to 1 hour of daily (Monday to Friday) treatment with MTS to the UL for 6 weeks during the intervention (B) phase. Main Outcome Measures: Motor function (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index [MI] arm section) of the UL. Results: UL performance was stable during baseline for all participants. On visual analysis, improvements in motor impairment were seen in all participants, and clinically significant improvements in motor function were seen in 4 of 8 participants during the intervention phase. Latency between onset of intervention and improvement ranged from 5 to 31 days (ARAT) and from 0 to 28 days (MI). Improvements in performance were maintained on withdrawal of the intervention. Randomization tests were not significant. Conclusions: MTS appears to improve UL motor impairment and functional activity many months, even years, after stroke onset. Improvement can be immediate, but more often there is latency between the start of intervention and improvement; recovery can be distal to proximal.