Victorine A Wood

The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists.

This paper describes preliminary studies on a screening test for aphasia which takes 3-10 minutes to complete and which is suitable for use by general practitioners, junior medical staff and other non-specialists. Data are presented to show that it is a reliable, valid assessment. Using cut-off values derived from normal people, the test is sensitive, but its specificity is limited by such associated factors as hemianopia. Using cut-off values derived from patients known to have aphasia, its specificity is improved. An abnormal result needs to be interpreted in the light of all available clinical information. The test should help identify patients with linguistic disturbance.

Therapy after stroke: amounts, determinants and effects.

This report investigates the amounts of physiotherapy and occupational therapy given to acute stroke patients over the first 6 months, the factors that determine how much therapy a patient receives, and the effects of therapy upon outcome. The study is based on 162 acute stroke patients referred to a stroke rehabilitation unit. In this group the average daily rate of treatment during active rehabilitation, for both therapies combined, was 46 minutes, with a maximum of 42 minutes a day for physiotherapy and 48 minutes a day for occupational therapy. The major factors associated with the amount of therapy given related to the severity of the stroke: more therapy was given to those with lower initial functional ability, worse sitting balance, or greater loss of use of arm or leg. This association with severity probably accounts for the association between therapy and shoulder disease. A minor factor governing the amount of therapy given was the patients degree of recovery: those who recovered less well received more therapy. It was not possible to demonstrate a specific beneficial effect of therapy.

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation:

Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure and community centres in the south-west of England. Subjects: Stroke survivors (median (IQR) time post stroke 10.3 (5.4—17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). Intervention: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. Method: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. Main measures: Primary outcomes: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. Analysis: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. Results: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (—1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (—0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was £296 (95% CI: —£321 to £913). Conclusion: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

Aphasia after stroke: a detailed study of recovery in the first 3 months

This is a prospective study of recovery of aphasia in 19 stroke patients selected from 117 consecutive hospital admissions by virtue of having significant aphasia and surviving 13 weeks. Aphasia was measured using the Frenchay Aphasia Screening Test (FAST) at frequent intervals from early after stroke. A wide variation in speed and extent of recovery was seen, particularly when compared with mean scores. Patients who made the most recovery had started to improve by 40 days post-stroke. An aphasic patients FAST score at 13 weeks post-stroke could be predicted from his first score (within 2 weeks).