Posts Tagged impact
[ARTICLE] Visual Impairment Following Stroke – The Impact on Quality of Life: A Systematic Review – Full Text PDF
Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.
Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intracranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.
Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.
Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.
[Press Announcements] FDA allows marketing of first-of-kind computerized cognitive tests to help assess cognitive skills after a head injury.
August 22, 2016
The U.S. Food and Drug Administration today permitted marketing of two new devices to assess a patient’s cognitive function immediately after a suspected brain injury or concussion. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric are the first medical devices permitted for marketing that are intended to assess cognitive function following a possible concussion. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury.
ImPACT and ImPACT Pediatric are not intended to diagnose concussions or determine appropriate treatments. Instead the devices are meant to test cognitive skills such as word memory, reaction time and word recognition, all of which could be affected by a head injury. The results are compared to an age-matched control database or to a patient’s pre-injury baseline scores, if available.
“These devices provide a useful new tool to aid in the evaluation of patients experiencing possible signs of a concussion, but clinicians should not rely on these tests alone to rule out a concussion or determine whether an injured player should return to a game,” said Carlos Peña, Ph.D., M.S., director of the division of neurological and physical medicine devices at the FDA’s Center for Devices and Radiological Health.
ImPACT software runs on a desktop or laptop and is intended for those ages 12 to 59, while the ImPACT Pediatric runs on an iPad and is designed for children ages 5 to 11. Only licensed health care professionals should perform the test analysis and interpret the results.
Traumatic brain injuries account for more than 2 million emergency room visits in the United States each year, according to the U.S. Centers for Disease Control and Prevention, and contribute to the deaths of more than 50,000 Americans. A significant percentage of these injuries are considered to be mild. A concussion is considered to be a mild traumatic brain injury.
The manufacturer submitted over 250 peer-reviewed articles, of which half were independently conducted clinical research studies. The research publications analyzed the scientific value of the ImPACT devices including the devices’ validity, reliability and ability to detect evidence of cognitive dysfunction that might be associated with a concussive head injury. The FDA concluded that these studies provide valid scientific evidence to support the safety and effectiveness of the ImPACT and ImPACT Pediatric devices.
The FDA reviewed the ImPACT device through its de novo classification process, a regulatory pathway for novel, low- to-moderate-risk medical devices that are first-of-a-kind, for which special controls can be developed, in addition to general controls, to provide a reasonable assurance of safety and effectiveness of the devices. The device is manufactured by ImPACT Applications, located in Pittsburgh, Pennsylvania.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
The current book starts with an overview of the past, by providing a brief history of how transcranial electrical stimulation has been used to enhance cognition and improve health. The rest of the book discusses current knowledge in the field, and provides an excellent overview of different lines of research, such as those in animals, healthy humans, and patients. The aim of this last chapter is to discuss further directions for research in the field of transcranial electrical stimulation (tES).
Over the different chapters it becomes clear that research using tES has demonstrated improvements in different cognitive and non-cognitive functions, ranging from perception and motor movement to attention, working memory, language, and mathematical abilities. These results show that such improvements are not limited to typical populations but can also affect young adults and the elderly, and neurological and psychiatric patients. These results are indeed promising, but suffer from some limitations that have been discussed in various of these chapters, as well as elsewhere (Pascual-Leone, Horvath, & Robertson, 2012; Rothwell, 2012). Some of these limitations include low sample size, artificial tasks with reduced ecological validity, lack of consistency in the montage that led to the enhancement effects, and need for replication. I will not extend the discussion on these points, as they are rather trivial and are not limited to the current field. Instead I will discuss what I perceive as the directions in which the field of tES should, and hopefully will, go. It was difficult deciding which sections to include in this respect, and I have chosen to limit our discussion to 10 sections. I will conclude the chapter with a brief discussion of the challenges that the field is facing.
[REVIEW] Background Concepts in Stroke Rehabilitation | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF
Essential to stroke rehabilitation is the accurate diagnosis and management of neurological deficits. Stroke affects the physical, psychological, and emotional health of the patient and often results in long-term disability. As well, stroke severity and location can impact the brain’s mechanisms of reorganization and the patient’s rehabilitation needs. This review focuses on post-stroke outcomes and the impact of rehabilitation. Various recovery models and time courses for specific functions are highlighted. As well, research concerning stroke rehabilitation’s role in cortical reorganization is reviewed.