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2. Long COVID Is Not a Functional Neurologic Disorder.

Author

Davenport, Todd E., Blitshteyn, Svetlana, Clague-Baker, Nicola, Davies-Payne, David, Treisman, Glenn J., and Tyson, Sarah F.

Subjects
POST-acute COVID-19 syndrome, CHRONIC fatigue syndrome, MEDICAL personnel, CONVERSION disorder, COVID-19 pandemic
Abstract

Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for why long COVID should not be considered as a functional neurologic disorder. It will begin by discussing the parallel historical development of pathobiological and psychosomatic/sociogenic diagnostic constructs arising from a common root in neurasthenia, which has resulted in the collective understandings of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and functional neurologic disorder (FND), respectively. We will also review the case definition criteria for FND and the distinguishing clinical and neuroimaging findings in FND vs. long COVID. We conclude that considering long COVID as FND is inappropriate based on differentiating pathophysiologic mechanisms and distinguishing clinical findings. [ABSTRACT FROM AUTHOR]

Published
2024
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5. The assessment of posture and balance post-stroke

Author

Tyson, Sarah F. and De Souza, L. H.

Subjects
616, Stroke physiotherapy, Brunel Balance Assessment, ability
Abstract

Physiotherapy for people with stroke has been found to be beneficial but details of the most effective interventions are unclear. Further development of the evidence base for stroke physiotherapy is limited by a lack of clinical practice models, sensitive clinically based outcome measures and effective stratification techniques to characterise homogenous groups of subjects. These issues are addressed here with regard to balance and posture. These aspects were chosen because they form a cornerstone of stroke physiotherapy as they are thought essential for the rehabilitation of functional activities. A systematic review of assessment methods in the literature revealed a lack of measurement tools which met the utility criteria: reliability, validity, sensitivity to short-term change, suitability for a wide range of abilities, ease of use and suitability for different settings. This prompted the development of a new measurement tool. Firstly, a model of the clinical assessment process was developed using an adapted focus group method with neurological physiotherapists. This informed the content of a new measurement tool which combined an ordinal scale with functional performance tests- the Brunel Balance Assessment. The tool was evaluated in a series of studies involving 92 stroke patients. It was hierarchical (coefficient of reproducibility= 0.99, coefficient of scalability = 0.69), reliable (100% agreement) and valid as a measure of balance disability (r=0.58-0.97). The psychometric properties of the individual functional performance tests were also tested and found to be reliable (ICCs =0.88-1) and valid (r=0.32-0.63). Measurement error ranged 0-40% and the minimum change needed to detect true clinical change was calculated for each test. Balance disability, measured with the Brunel Balance Assessment, is heterogeneous with sitting, standing and stepping balance forming distinct levels of ability (p<0.027). Consequently, the BBA could be used to stratify people with stroke according to balance ability. Weakness, sensation and age were significant independent contributors to balance disability (r2=82.7%). Balance ability was a strong contributor to independence in ADL (p<0.0001). The findings of this thesis address the issues that have limited research into stroke physiotherapy with regard to balance disability. In relation to clinical practice, a robust measurement and stratification tool has been developed.

Published
2002

11. Case series of a knowledge translation intervention to increase upper limb exercise in stroke rehabilitation

Author

Connell, Louise A., McMahon, Naoimh E., Tyson, Sarah F., Watkins, Caroline L., and Eng, Janice J.

Subjects
Exercise -- Health aspects, Stroke (Disease) -- Research -- Care and treatment -- Physiological aspects, Extremities, Upper -- Physiological aspects, Arm -- Physiological aspects, Health
Abstract

Background and Purpose. Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. Case Descriptions. A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Outcomes. Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. Conclusions. This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes., It is widely accepted that a research-practice gap exists in physical therapy with regard to intensity of rehabilitation. (1-2) One potential explanation for this gap may be the way in [...]

Published
2016
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21. sj-pdf-1-nnr-10.1177_15459683211028243 – Supplemental Material for The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period

Author

Hammerbeck, Ulrike, Tyson, Sarah F., Samraj, Prawin, Hollands, Kristen, Krakauer, John W., and Rothwell, John

Subjects
FOS: Clinical medicine, 110308 Geriatrics and Gerontology, 110904 Neurology and Neuromuscular Diseases, Neuroscience
Abstract

Supplemental Material, sj-pdf-1-nnr-10.1177_15459683211028243 for The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period by Ulrike Hammerbeck, Sarah F. Tyson, Prawin Samraj, Kristen Hollands, John W. Krakauer and John Rothwell in Neurorehabilitation and Neural Repair

Published
2021
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28. Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function

Author

Tyson, Sarah F., Hanley, Marie, Chillala, Jay, Selley, Andrea B., and Tallis, Raymond C.

Subjects
Stroke patients -- Surveys, Psychology and mental health, Surveys
Abstract

Objective: To characterize the nature of sensory impairments after stroke, identify associated factors, and assess the relationships between sensory impairment, disability, and recovery. Methods: Prospective cross-sectional survey of 102 people [...]

Published
2008
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29. The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment

Author

Tyson, Sarah F., Hanley, Marie, Chillala, Jay, Selley, Andrea B., and Tallis, Raymond C.

Subjects
Stroke (Disease) -- Research -- Physiological aspects -- Patient outcomes -- Complications and side effects, Disability -- Research -- Patient outcomes -- Complications and side effects, Equilibrium (Physiology) -- Research -- Physiological aspects, Psychology and mental health, Physiological aspects, Complications and side effects, Research, Patient outcomes
Abstract

Objective. To examine the influence of balance disability on function and the recovery of function after stroke and consequently to assess the predictive validity of the Brunel Balance Assessment (BBA). [...]

Published
2007

42. Balance disability after stroke

Author

Tyson, Sarah F., Hanley, Marie, Chillala, Jay, Selley, Andrea, and Tallis, Raymond C.

Subjects
Stroke (Disease) -- Risk factors -- Care and treatment -- Analysis, Disability -- Risk factors -- Physiological aspects -- Analysis -- Care and treatment, Rehabilitation -- Physiological aspects -- Methods -- Analysis, Health
Abstract

Background and Purpose. Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. Subjects. The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. Methods. Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects' stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. Results. A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. Discussion and Conclusion. Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability Key Words: Balance; Cerebrovascular accident., Stroke is the third most common cause of death ill the Western Hemisphere and the most common cause of adult disability (1); of the survivors, about 50% will have a [...]

Published
2006

46. Supplementary_file_I – Supplemental material for Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units

Author

Clarke, David J, Louisa-Jane Burton, Tyson, Sarah F, Rodgers, Helen, Drummond, Avril, Palmer, Rebecca, Hoffman, Alex, Prescott, Matthew, Tyrrell, Pippa, Brkic, Lianne, Grenfell, Katie, and Forster, Anne

Subjects
FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110314 Orthopaedics, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, Supplementary_file_I for Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units by David J Clarke, Louisa-Jane Burton, Sarah F Tyson, Helen Rodgers, Avril Drummond, Rebecca Palmer, Alex Hoffman, Matthew Prescott, Pippa Tyrrell, Lianne Brkic, Katie Grenfell and Anne Forster in Clinical Rehabilitation

Published
2018
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48. The self-reported needs of patients following subarachnoid hemorrhage (SAH).

Author

Dulhanty, Louise H, Hulme, Sharon, Vail, Andy, Patel, Hiren C, and Tyson, Sarah F

Subjects
ANXIETY, CONFIDENCE intervals, CONVALESCENCE, FATIGUE (Physiology), HEADACHE, LENGTH of stay in hospitals, MEDICAL needs assessment, MEMORY, NEEDS assessment, HEALTH outcome assessment, QUESTIONNAIRES, RESEARCH funding, SELF-evaluation, SUBARACHNOID hemorrhage, LOGISTIC regression analysis, CROSS-sectional method, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio
Abstract

Background: Despite advances in the acute care of subarachnoid haemorrhage, longer-term services remain under-developed. Clinical measures are commonly used to assess outcome and quality of life, but patient-reported needs and the extent to which they are met have not been measured. This information is essential to plan and develop evidence-based, patient-centred services. The aim of this study was to describe the frequency and type of self-reported met and unmet needs of subarachnoid haemorrhage survivors, explore whether these differ early and late in recovery and the factors associated with whether needs were met. Methods: A census cross-sectional postal survey of 400 subarachnoid haemorrhage survivors discharged from a large neurosurgical unit. The Self-Reported Needs after Stroke Questionnaire was modified and used to measure the self-reported needs of subarachnoid haemorrhage survivors and the extent to which they were met 1–2 years and 3–5 years post haemorrhage. Results: 203 (51%) participants responded: 122/260 (47%) from the early and 81/143 (57%) from the late cohort. 63% were female; mean age was 55 years. 86% of survivors reported one or more need, and 78% reported at least one unmet need (median 6, range 1–19). The most commonly reported need related to fatigue (66%). This and several other health needs were reported as unmet in over 80% of identified cases. We found no consistent factors that were associated with needs remaining unmet. Conclusion: Most subarachnoid haemorrhage survivors in both cohorts had unmet needs. Future research should aim to inform the development of post-discharge services to address the persistent long-term needs identified. Subarachnoid haemorrhage survivors report a number of needs 1-2 years and 3-5 years post haemorrhage. Needs relating to fatigue, memory, concentration, headache and anxiety were the most commonly reported. A large proportion of needs were described as unmet. The design of rehabilitation services for subarachnoid haemorrhage survivors should consider the self-reported needs described in this study. [ABSTRACT FROM AUTHOR]

Published
2020
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