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Objective The role of dopamine agonist (DA) in restoring consciousness and cognition in recovery phase following acquired brain injury (ABI) is established (1-5). The role in later recovery is less well defined. We report a single case experimental design (SCED) trial of amantadine demonstrating improvement in function, six years following ABI. Method A scoring system based on established abilities in personal care and interaction was used to identify tasks with component actions, 34 actions in total, each ranked in terms of quality of response to a request or prompt. Actions were scored on maintenance dose amantadine; on withdrawal; and after reintroduction. Daytime sleep duration was also recorded. Results At 3rd and 5th weeks post withdrawal, deterioration was noted in 27 of 34 graded activities. At 3rd and 5th weeks following reintroduction, all but 3 grades returned to baseline or better. Afternoon sleep duration increased from 35 to 80 minutes during withdrawal period returning towards baseline on amantadine resumption. Conclusion We believe this provides evidence for benefit of amantadine in sustaining function following ABI. The SCED model used provides a template for others to use to identify comparable change in similar trials.

War and natural disaster have been spurs to the creation of rehabilitation services. The COVID-19 pandemic poses a different question for existing rehabilitation services: how best to respond to a disaster that is anticipated from afar, but whose shape has yet to take full form?Applying the 5-phase crisis management model ofContingency rehabilitation planning can be framed in a 5-phase crisis management model that includes (i) signal detection; (ii) prevention/preparedness; (iii) damage limitation; (iv) recovery; and (v) learning. We have reported the impact of COVID-19 on rehabilitation services within a Scottish context and shared some of our learning.COVID-19 has challenged healthcare worldwide and has served as an amplifier for the recognised ill effects of poverty and inequality. As rehabilitation clinicians, we are in a position to continue advocating for people facing disability, and also seeking and responding to signals of COVID-19's late effects in both COVID-19 and non-COVID-19 patients alike. IMPLICATIONS FOR REHABILITATION COVID-19 has resulted in unprecedented challenges in rehabilitation service planning. Contingency rehabilitation planning can be framed in a 5-phase crisis management model of

While most patients with an acquired brain injury (ABI) receive appropriate post-acute care and rehabilitation via established pathways from critical care units and tertiary neurosciences centres, a small number of these patients do fall through the cracks and end up in the general medical ward.

Inpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to "working-age" adults (65 years), with little evidence for outcomes for older adults involved with these services.The aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.A two-centre retrospective review was performed comparing patients aged65 and≥65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure+Functional Assessment Measure (UK FIM+FAM) scores and discharge destination.Six hundred and sixteen patients (32%≥65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] -2 to 15, P=0.112), but both UK FIM+FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2-13, P=0.006 and 0.10, 0.01-0.19, P=0.031 respectively). Older age was associated with discharge to long-term care (6%65 years; 11%≥65 years, xOlder adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.

It is not established whether the increased risk of stroke in patients with giant cell arteritis (GCA) is because of atherosclerosis, persistent arterial inflammation, or an iatrogenic effect of corticosteroids. This creates difficulties in choosing the most appropriate treatment. We report 2 patients with GCA who developed repeated strokes involving different arterial territories following initiation of corticosteroid therapy, despite resolution of cranial symptoms and normalization of inflammatory markers. Subsequent investigation suggested persisting arteritis as the cause of these strokes. The cases revealed the limitations of laboratory tests or imaging techniques in determining the cause of stroke in recently diagnosed GCA. There is a need to develop effective means of monitoring GCA activity and to determine the most effective treatment approach in this circumstance.

Anoxic brain injury (ABI) is a syndrome of diverse aetiology, most case series published to date being confined to ABI of a single aetiology or to a limited numbers of patients.This study performed a retrospective analysis on all patients admitted for rehabilitation following ABI over a 14-year period. It identified 93 cases and presents a summary of their clinical patterns and functional and psychometric outcome measures. In addition a database involving 584 patients admitted for rehabilitation following traumatic brain injury (TBI) during the same time interval was used to compare demographic, functional and cognitive patterns.Relative to TBI, there was a peak frequency of ABI in males aged 60 years and in females in their late 20s. ABI patients were referred later for rehabilitation, had similar lengths of stay, but made slower progress, with poorer outcomes and were more likely to be transferred to residential care. Those with ABI had more severe impairments on cognitive assessment relative to those with TBI, being particularly susceptible to impairments in memory, especially visual memory or short-term memory. Neurological impairments of speech and language were present in 72 patients; visual field loss in eight and cortical blindness in 10; six suffered myoclonus and 10 late epilepsy.