Dennis S. Smith

Royal Rehabilitation Centre Sydney, Sydney, New South Wales, Australia

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Publications (10)23 Total impact

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    ABSTRACT: The aim of this study was to investigate a conventional battery of tests capable of assessing the presence of the component and extent of the lesions in patients with unilateral spatial neglect. Ninety-four patients who had unilateral spatial neglect with a stroke in right hemisphere were assessed on 12 traditional neglect batteries 4 weeks after the onset. Computerized tomography was also performed to investigate the possible anatomical relationships with each neglect battery. Factor analysis showed that the tests loaded significantly on five factors. There are not only visual scanning factors but also factors of imaging, visual judgement, visual cognition and effectiveness from left hemisphere in the unilateral spatial neglect. There are high correlations between each neuropsychological test and neglect batteries. Furthermore, lesions in the paraventricular white matter were associated with clock and person drawing tasks. Lesions in the occipital lobe were associated with reading, explaining and visual counting tasks. Lesions in the temporal lobe and the posterior limb of the internal capsule were associated with line bisection tasks. It is suggested that it is possible that there are some different components in unilateral spatial neglect. Failure in some tasks may predict different lesions in terms which include localization.
    Brain Injury 03/2001; 15(2):125-37. DOI:10.1080/026990501458362 · 1.81 Impact Factor
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    ABSTRACT: In this study, we examined twenty-five patients with left putaminal haemorrhage to investigate the relations between ideational apraxia (IA) and intracerebral haemorrhage. Apraxias were determined at 1 and 6 months after the stroke onset. Extension and volume of haematoma were examined with CT scan within 2 days of stroke onset. IA was present in 10 cases at 1 month and disappeared in 6 cases (transient IA) and persisted in 4 cases(persisted IA) at 6 months from the onset. Although the haematoma volume related to the existence of IA, there was no significant difference between transient and persistent IA. All three patients with the haematoma volume larger than 40 ml in the transient IA group were younger than 50 years old. All cases with persistent IA were older than 50 years old. Consequently, the existence of IA seems to be partially dependent on the haematoma volume which may cause the organic damage of subcortical white matter. However, patient's age is also important to determine the prognosis of IA. This maybe related to the nature of the haemorrhage and the mode of the onset. These factors remain to be determined.
    Journal of Clinical Neuroscience 08/2000; 7(4):309-11. DOI:10.1054/jocn.1999.0228 · 1.38 Impact Factor
  • Gillian K. Fox · Stephen C. Bowden · Dennis S. Smith ·
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    ABSTRACT: To examine the approaches to on-road assessment of driver competence in persons with brain impairment. Items examined were procedures, standardization, scoring methods, equipment requirements, and determination of fitness to drive. All studies identified through citation or Medline search. The studies reviewed were those published from 1971 to the present that examined driving competence after brain impairment, as measured by a driving test. A qualitative review of published studies reporting methodologies and authors' conclusions abstracted from sourced publications. Off-road driving assessments examine proficiency in operating a motor vehicle, but not ability to drive in traffic or accurate prediction of safe driving. On-road driving assessments have been used to examine the predictive validity of other driving assessment methods or the driving performance of subjects with brain impairment. Determining a subject's competence to drive is frequently a subjective evaluation. With a standardized driving test, a significant correlation between the objective driving score and the rater's global evaluation of fitness has been reported. Closed-course, off-road driving tests are recommended for examining vehicle operation skills and readiness for in-traffic evaluation only. This allows practice with any vehicle adaptations before on-road evaluation and identification of clients who are unsafe to proceed on-road. A practical driving test in traffic, with standardized route and driving maneuvers, is recommended for determining driver competence. Scoring of driving performance should be standardized, reliable, and specific, to identify deficient driving skills that may be amenable to training. Driving performance should be evaluated according to predefined criteria, and the judgment regarding competence should be closely related to this objective measure.
    Archives of Physical Medicine and Rehabilitation 11/1998; 79(10):1288-96. DOI:10.1016/S0003-9993(98)90277-5 · 2.57 Impact Factor
  • Michael S. Clark · Dennis S. Smith ·
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    ABSTRACT: This study examined the stroke knowledge of 60 stroke rehabilitation patients, 46 spouses, 25 family members, and 103 people in the general community. Changes in stroke knowledge with time, and determinants of stroke knowledge, were also examined. Clinical participants were assessed on acute admission, admission to and discharge from rehabilitation, and 6 and 12 months after discharge. Community participants were assessed once. Instruments used were the Stroke Care Information Test, Australian ADL Index, Frenchay Activities Index, Illness Behaviour Questionnaire and Zung Self-rating Depression Scale. The stroke knowledge of all participants, particularly patients, was poor, but improved with time. Better-informed patients were younger, had milder strokes, were less depressed, were less likely to develop abnormal illness behaviour, and made a better functional recovery than patients with poorer knowledge. Structured information programmes are needed for stroke patients and their families. Improved community awareness of stroke may help the prospects for recovery and quality of life for people who have strokes.
    Disability and Rehabilitation 03/1998; 20(3):90-6. DOI:10.3109/09638289809166061 · 1.99 Impact Factor
  • Michael S Clark · Dennis S Smith ·
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    ABSTRACT: To examine the relative effects of depression and abnormal illness behaviour (AIB) on long-term rehabilitation outcome following stroke. A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Ninety-four twelve-month stroke survivors who had undergone an inpatient rehabilitation programme. AIB was assessed using the Illness Behaviour Questionnaire, and depression with the Zung Self-Rating Depression Scale. The General Health Questionnaire and a visual analogue mood scale were also used. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Multivariate analysis of outcome controlled for age and stroke severity. AIB was a better predictor of functional competence and performance than either age or stroke severity, at rehabilitation discharge and both six and twelve months later. Depression was not related to functional competence and performance at any assessment, but was strongly predictive of an inactive lifestyle at both six and twelve months. By contrast, lifestyle activities were not related to AIB. Depression and AIB appear to have quite distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. The early recognition and treatment of AIB and depression is important for the ultimate social and functional outcomes of stroke rehabilitation patients.
    Clinical Rehabilitation 02/1998; 12(1):73-80. DOI:10.1191/026921598669567216 · 2.24 Impact Factor
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    ABSTRACT: Twenty-two patients with thalamic haemorrhage were examined to investigate the relationship between motor and cognitive function, and activities of daily living (ADL). Patients with unilateral spatial neglect had lower ADL scores on admission than patients without unilateral spatial neglect (Mean: 17.0 and 24.6, respectively; F = 4.38, df = 1, p < 0.05). Unilateral spatial neglect related to feeding, bowel control and transfer in Barthel index on admission. Patients with aphasia on admission had lower ADL at discharge than patients without aphasia on admission (Mean: 57.0 and 84.7, respectively; F = 7.70, df = 1, p < 0.05). Aphasia related to the bathing, toilet, stair climbing, dressing, and ambulation in Barthel index on discharge. There was a significant difference between the severity of paresis in upper and lower limb on admission and ADL at discharge. The two-way repeated measures ANOVA showed a significant difference between severity of paresis in lower limb and ADL improvement. It can be suggested that the most important predictor of outcome was paresis in lower limb, and not aphasia or unilateral spatial neglect.
    Disability and Rehabilitation 11/1997; 19(11):459-64. DOI:10.3109/09638289709166839 · 1.99 Impact Factor
  • Gillian K. Fox · Stephen C. Bowden · Guy M. Bashford · Dennis S. Smith ·
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    ABSTRACT: To examine driving competence in a group of drivers diagnosed with probable Alzheimer's Disease (AD) in terms of a standardized open road evaluation and expert judgments. To examine the validity of a standardized medical examination, including administration of the Mini-Mental Status Exam (MMSE), and a standardized neuropsychological assessment as predictors of open road driving performance. A prospective investigation with consecutively referred subjects. Coorabel Driver Assessment Centre, Royal Rehabilitation Centre Sydney, Australia. Nineteen subjects with a diagnosis of probable AD. A standardized clinical medical examination, a standardized neuropsychological assessment, and a standardized open road driving evaluation. The driving evaluation provided a correct driving actions score. The outcome measure was the expert judges' rating of overall driving competence, which was termed the final on-road result. Seven subjects passed the on-road driving evaluation, and 12 failed. MMSE was found to be a significant predictor of final on-road result. The physician's prediction, the neuropsychology test scores, and the neuropsychologist's prediction were not found to be significantly associated with the final on-road result. The on-road driving evaluation was a reliable test. Inasmuch as all subjects except one were still driving and all wished to continue to drive, it is important to note that 63.2% of subjects failed the on-road evaluation. Conversely, 36.8% were judged safe to drive, suggesting that AD diagnosis alone may be insufficient criteria for cessation of driving. A standardized road test may be the only appropriate means of determining driving competence in people diagnosed with AD.
    Journal of the American Geriatrics Society 09/1997; 45(8):949-53. DOI:10.1111/j.1532-5415.1997.tb02965.x · 4.57 Impact Factor
  • Dennis S. Smith · Michael S. Clark ·
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    ABSTRACT: Indices of activities of daily living (ADL) are commonly criticized for failing to yield other than functional information. We suggest an alternative approach in which tested functional ability (ADL competence) is distinguished from actual behaviour (ADL performance). A method of making these assessments, based on the Australian ADL Index, was trialled in a longitudinal study involving 130 patients admitted for rehabilitation following stroke. Twelve months after discharge from rehabilitation the total ADL performance score was higher, that is to say worse, than the total ADL competence score; further, there was no significant agreement between the competence and performance ratings for nine of the 17 activities. It appears that ADL competence and ADL performance can be distinguished both theoretically and empirically. Two case studies illustrate the usefulness of the performance assessment. We recommend the ADL performance assessment as an outcome measure in rehabilitation.
    Disability and Rehabilitation 02/1995; 17(1):15-23. DOI:10.3109/09638289509166623 · 1.99 Impact Factor
  • Heather J Jesshope · Michael S Clark · Dennis S Smith ·
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    ABSTRACT: The Rivermead Perceptual Assessment Battery (RPAB) was developed to identify deficits in visual perception. This study sought to examine the relationship of the RPAB to performance in activities of daily living (ADL), and to investigate the concurrent validity of the RPAB. Subjects were 101 stroke patients admitted for inpatient rehabilitation. The RPAB was administered on admission to rehabilitation; prior to this, the treating therapists used the RPAB categories to provide a consensus opinion of the presence of perceptual deficits. The Australian ADL Index was administered on admission to and discharge from rehabilitation. ADL performance improved for all patients during rehabilitation, but patients identified by the RPAB as having perceptual deficits performed more poorly at both admission and discharge than did patients without deficits. However, scores on individual RPAB categories and cognate ADL activities were not consistently related. There was little agreement between the RPAB and the therapists' expert opinion. This result was interpreted in the context of an informal evaluation, made by the testing therapist, of the reasons for failing individual subtests. It was concluded that diagnostic use of the RPAB should combine test scores with observations made during testing, and that the validity of the RPAB must still be questioned.
    Clinical Rehabilitation 05/1991; 5(2):115-122. DOI:10.1177/026921559100500205 · 2.24 Impact Factor
  • Heather J Cramond · Michael S Clark · Dennis S Smith ·
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    ABSTRACT: The Rivermead Perceptual Assessment Battery (RPAB) claims to be a standardized and validated test of visual perception. However, the published evidence suggests that several areas have not been considered by the authors of the test. One of these is whether the dominant or nondominant hand is used, particularly for those aspects of the test which require either pencil skills or the fine manipulation of objects. The purpose of this study was to conduct subtests of the RPAB on a group drawn from a nonclinical population to determine whether or not there are differences in performance between the dominant and nondominant hand. The study involved 35 first year university students who were right-hand dominant for writing. Each subject completed the four subtests twice, once with the right hand and once with the left. Statistically significant differences were found between right and left hand performance in both the score achieved and the time taken for right left copying shapes (RLCS) and right left copying words (RLCW), tests 11 and 12, and for time alone in cancellation (CA), test 15. No significant differences were found in 3D copying (test 13). Test 12 is of particular concern, as 24 subjects failed this test when using their nondominant hand. These findings have implications for the interpretation of test results when the RPAB is administered to stroke patients who, due to the nature and site of their lesions, may be forced to use the nondominant hand.
    Clinical Rehabilitation 08/1989; 3(3):215-221. DOI:10.1177/026921558900300306 · 2.24 Impact Factor