Derick T Wade

Oxford Centre for Enablement · Neurological Rehabilitation

Patients with a prolonged disorder of consciousness have a neurological disorder. Few neurologists undertake assessment and management after the acute phase of the person’s illness, even though some of their patients with progressive neurological disorders become persistently unconscious. Their clinical evaluation and deciding on their best interes...

Introduction People with Parkinson’s disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement. Objective A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reacti...

Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they ca...

Background Exercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called ‘KOA pendulum therapy’ (KOAPT). Intraarticular h...

Background There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure. Objective To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity. Need A general rehabilitation theory would help res...

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive–behavi...

In this letter, I develop the recent proposal to choose a uniform name globally for our specialty ("A call for a single international name for the specialty"), suggesting it is premature and we must first agree on the core, central features characterizing a specialist. The question is, what is our specialty? The scope and content vary significantly...

Background The concept of rehabilitation potential emerged in 1950 as a way to select people for rehabilitation; it is also used to limit access to services. Objective To elucidate the meaning(s) of rehabilitation potential and whether it is valid in selecting patients for rehabilitation, whether as an inpatient, outpatient, or in the community....

What is rehabilitation? From 1994 to 2021, while I was privileged to be Editor of Clinical Rehabilitation, I explored this in editorials. I also encouraged and selected submissions that considered, in one way or another, the central features of rehabilitation. Why? Because when I started in rehabilitation, the general attitude among doctors and oth...

A recent article identified weaknesses in the management of patients with traumatic brain injury (TBI). The authors suggested some reasons but overlooked two of the reasons for the low quality of services: a lack of resources and a systemic failure to organise rehabilitation services. They suggested early involvement of a condition-specific service...

Background: In 2020, The London Royal College of Physicians published "Prolonged disorders of consciousness following sudden-onset brain injury: national clinical guidelines". In 2021, in the journal Brain, Scolding et al. published "a critical evaluation of the new UK guidelines". This evaluation focussed on one of the 73 recommendations in the N...

Background. In China, swinging the leg backwards and forwards is a commonly used therapy for people with osteoarthritis of the knee. One rationale is that movement without weightbearing may increase the range of movement by allowing a greater range of pian-free movement at the knee. There have been no studies evaluating its effectiveness. Before un...

Background Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. Methods Thi...

The problem Over 187 definitions of rehabilitation exist, none widely agreed or used. Why? The word Words represent a core concept, with a penumbra of associated meanings. A word means what is agreed among those who use it. The precise meaning will vary between different groups. Words evolve, the meaning changing with use. Other words may capture...

Objective To test the extent to which initial walking speed influences dual-task performance after walking intervention, hypothesising that slow walking speed affects automatic gait control, limiting executive resource availability. Design A secondary analysis of a trial of dual-task (DT) and single-task (ST) walking interventions comparing those...

The problem Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. History Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided...

Objective To establish the feasibility of a randomized, placebo-controlled trial to investigate the effect of a specific immunotherapy bacterial lysate OM-89 (Uro-Vaxom ® ) in reducing the frequency of urinary tract infections in people with neurogenic bladder dysfunction. Design A parallel-group, double-blind, randomized, placebo-controlled trial...

Objective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. Design Pilot randomised, controlled trial. Setting. Rehabilitation hospital. Subjects. In-patients with osteo-arthritis of the knee. Interventions: Either 1-3 small needle-knife treatments over 7 days or oral Celecoxib. All patients stayed...

After severe COVID-19 disease, many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principles of and evidence on rehabilitation will allow an effective response. These include a simple screening process; use of a multi-disciplinary expert team; four evi...

Problem Many services and professionals refer to themselves as providing rehabilitation. There is no agreed method for determining whether someone has specific expertise in rehabilitation. This makes it difficult for patients and payers to know whether professionals who claim to provide rehabilitation are specifically expert in rehabilitation. Con...

People with neurological disability present healthcare systems with a large range of complex problems covering many different domains and often lasting a long-time. Consequently, they need a large range of different professional staff, often from different organizations. These people will be considering different, small parts of the overall set of...

In the new edition of the Oxford Textbook of Neurorehabilitation all chapters have been updated to reflect advances in knowledge in the field of neurorehabilitation. It will be supplemented by additional chapters that reflect novel developments in the field of neurorehabilitation. During recent years there has been a strong evolution in the field o...

Background There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of...

Valid consent to healthcare treatments depends upon a person having the capacity to give it. The Mental Health Act not only requires a presumption of capacity but also expects clinicians to take reasonable steps to establish whether the patient lacks capacity. The facts are that (1) lack of capacity is common among hospital inpatients and people in...

Objective: To clarify the concept of best interests, setting out how they should be ascertained and used to make healthcare decisions for patients who lack the mental capacity to make decisions. Context: The legal framework is the Mental Capacity Act (MCA) 2005, which applies to England and Wales. Theory: Unless there is a valid and applicable...

Amaç: Ürdün Bilim ve Teknoloji Üniversitesi’nde (JUST) rehabilitasyon bilimlerinde fizyoterapist ve ergoterapistler için interdisipliner, yenilikçi bir uluslararası program klinik master programı oluşturulmaktı. Yöntem: Proje Erasmus+ KA2 projesi olarak Avrupa Birliği tarafından desteklenerek 2016 yılında başladı. Toplam altı üniversite projeye kat...

Background Patients with lower neurogenic bladder dysfunction are at an increased risk of suffering from recurrent urinary tract infections. Recurrent symptomatic urinary tract infection is occasionally treated with antibiotics as a prophylactic prevention strategy. This risks increasing the frequency of antibiotic resistance. National healthcare p...

The impact of flavonoids on fatigue has not been investigated in relapsing and remitting multiple sclerosis (RRMS). Objective To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS. Methods A randomised double-blind placebo-controlled feasibility study in people recently diagnose...

Zusammenfassung Die Geschichte kann durchaus die Zukunft erklären helfen. Ein kurzer Rückblick auf die bedeutende Entwicklung in der Neurologie zeigt, dass Neurologen eher per Zufall bereits auf dem Weg zu einer stärkeren Beteiligung an der neurologischen Rehabilitation sind.

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorder...

Objective: To determine the short-term effects of supplying hospital inpatients with earplugs and eye masks, preparatory to a full-scale trial. Design: A single-centre, open-label, two-arm, parallel group, randomized-controlled trial. Setting: A total of 13 medical and surgical wards in a large teaching hospital in the United Kingdom. Partici...

Objective To evaluate the tolerability of, adherence to and efficacy of a community walking training programme with simultaneous cognitive demand (dual‐task) compared to a control walking training programme without cognitive distraction. Methods Adult stroke survivors, at least 6 months after stroke with a visibly obvious gait abnormality or reduc...

Background The majority of stroke patients are inactive outside formal therapy sessions. Tailored activity feedback via a smartwatch has the potential to increase inpatient activity. The aim of the study was to identify the challenges and support needed by ward staff and researchers and to examine the feasibility of conducting a randomised controll...

Landmark judgment returns decision making to clinical teams and families. © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.

I only realised how much my osteoarthritic hip had altered my life after the operation enabled me to return to activities I did not know I had stopped. Identifying need for and benefit from treatments should focus on relative changes in experience and function, not on a person’s absolute state at a particular time.

Objective: To estimate the number of people in a prolonged disorder of consciousness (PDOC) who may need a formal best interests decision-making process to consider starting and/or continuing life-sustaining treatment each year in the population of a developed country. Method: Identification of studies on people with a PDOC giving information ab...

Background: Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activity in hospital inpatients. This study's goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels duri...

Abstract Background Dietary interventions including consumption of flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with MS (pwMS) have been performed. The hypothesis is tha...

Background: Some research suggests that 40% of people in the vegetative state are misdiagnosed. This review investigates the frequency, nature and causes of reported misdiagnosis of patients in the vegetative state, focusing on the nature of the error. Method: A systematic review of all relevant literature, using references from key papers ident...

The biopsychosocial model outlined in Engel’s classic Science paper four decades ago emerged from dissatisfaction with the biomedical model of illness, which remains the dominant healthcare model. Engel’s call to arms for a biopsychosocial model has been taken up in several healthcare fields, but it has not been accepted in the more economically do...

Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the decision; and the exclusive focus on the patient, wit...

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim...

The biopsychosocial model outlined in Engel's classic Science paper four decades ago emerged from dissatisfaction with the biomedical model of illness, which remains the dominant healthcare model. Engel's call to arms for a biopsychosocial model has been taken up in several healthcare fields, but it has not been accepted in the more economically do...

Objective: To pilot a method for routine outcome data collection one year after admission to a major trauma centre, to determine current outcomes, and to identify possible methodological improvements. Design: A postal questionnaire audit. Setting: A major trauma centre in the United Kingdom. Subjects: In total, 355 patients known to be alive...

Objective: To report on the control group of a trial primarily designed to investigate exercise for improving mobility in people with Parkinson's disease (pwP). The control group undertook a handwriting intervention to control for attention and time spent practising a specific activity. Design: Secondary analysis of a two-arm parallel phase II r...

Background: A cardiac arrest can lead to hypoxic brain injury, which can affect all levels of functioning. Objective: To investigate 1-year outcome and the pattern of recovery after surviving a cardiac arrest. Methods: This was a multicenter, prospective longitudinal cohort study with 1 year of follow-up (measurements 2 weeks, 3 months, 1 year...

Background Evidence for longer term exercise delivery for people with Parkinson's disease (PwP) is deficient. Aim Evaluate safety and adherence to a minimally supported community exercise intervention and estimate effect sizes (ES). Methods 2-arm parallel phase II randomised controlled trial with blind assessment. PwP able to walk ≥100 m and with...

Background: Survivors of a cardiac arrest often have cognitive and emotional problems. As a cardiac arrest is also an obvious life-threatening event, other psychological sequelae associated with surviving such as spirituality may also affect quality of life. Objectives: To determine the relationship between spirituality, coping and quality of li...

Objectives: To review publications in Clinical Rehabilitation over the last 30 years, discerning the original goals and whether they were met, and describing major trends over the 30 years. Methods: Personal review, backed up by data from 'most read' articles and 'most cited' articles, from yearly lists of all controlled trials published in the...

In 1993, the UK High Court decided that Tony Bland was unaware of himself and his environment, had no interest in medical treatment and allowed withdrawal of treatment. Subsequently, the court has reviewed all cases of stopping feeding and hydration in people with a prolonged disorder of consciousness. Their focus has been on determining whether th...

This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of profession...

The last editorial suggested that rehabilitation needed to involve the patient in learning, and depended upon a group of professionals to identify what actions might help the patient, and to undertake or arrange the necessary actions. In many cases there will be both a wide variety of actions needed from a reasonably large number of people and orga...

Background: Evidence from systematic reviews demonstrates that multi-disciplinary rehabilitation is effective in the stroke population, in which older adults predominate. However, the evidence base for the effectiveness of rehabilitation following acquired brain injury (ABI) in younger adults has not been established, perhaps because this scenario...

This editorial considers how healthcare systems should approach the problems associated with ongoing, persistent symptoms and limitations on a person's ability to undertake activities. It starts from the premise, established in the first editorial, that the current reliance on the biomedical model of health and illness is no longer 'fit for purpose...

This editorial reviews the evidence behind the following hypotheses. (1) People with disabilities often do not receive the input from health care services they would benefit from and should expect. (2) Hospitals managing problems arising from disease also have increasing problems managing the disabilities of their patients, with recovery and discha...

This editorial reviews the evidence behind the following hypotheses. (1) People with disabilities often do not receive the input from health care services they would benefit from and should expect. (2) Hospitals managing problems arising from disease also have increasing problems managing the disabilities of their patients, with recovery and discha...

Registration of randomized controlled trials is essential to reduce the risk of biased data being used when judging the effectiveness of an intervention. This journal will in future require that all randomized trials submitted are registered on a recognized register. This editorial explains why.

Determining fitness to drive is a major concern affecting aging and disabled populations, particularly concerning reduced cognitive functioning, functional limitations and reduced vision.1 ,2 The Royal Society for Prevention of Accidents encourages aging drivers to maintain their license (for independence, mobility and quality of life), emphasising...

Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness. M...

People with neurological disability present healthcare systems with a large range of complex problems covering many different domains and often lasting a long-time. Consequently, they need a large range of different professional staff, often from different organizations. These people will be considering different, small parts of the overall set of...

Neurorehabilitation is an expanding field with an increasing clinical impact because of an ageing population. During the last 20 years it has developed from a discipline with little scientific background, separated from other medical centres, to a medical entity largely based on the principles of evidenced based medicine (EBM), with strong ties to...

Multidisciplinary rehabilitation is recommended for Parkinson’s disease, but evidence suggests that benefit is not sustained. Objectives (1) Implement a specialist domiciliary rehabilitation service for people with Parkinson’s and carers. (2) Provide continuing support from trained care assistants to half receiving the rehabilitation. (3) Evaluate...

The authors sought to review the efficacy of interventions for fatigue in Parkinson's disease. A search was conducted of PubMed, Cinahl, Psychinfo, EMBASE, and Web of Knowledge up to November 2013. Methodological quality was assessed using the PEDro scale. For meta-analyses, studies were weighted on variance. Effect sizes were calculated with 95% c...

Objective: To investigate attainment of important life goals and to examine whether self-efficacy, tenacity in goal pursuit and flexibility in goal adjustment contribute to adaptation by affecting levels of emotional distress and quality of life in patients with newly acquired brain injury. Methods: Data were collected from a prospective clinica...

Objectives: To investigate the relations linking self-efficacy and coping to quality of life (QOL) and social participation and what effect self-efficacy, changes in self-efficacy, and coping style have on long-term QOL and social participation. Design: Prospective clinical cohort study. Setting: General hospitals, rehabilitation centers. Par...

Objectives: To investigate coping flexibility in patients with newly acquired brain injury and to investigate the influence of problem type, self-efficacy, self-awareness and self-reported executive functions on coping flexibility. Methods: Data were collected from a prospective clinical cohort study of 136 patients assessed after discharge home...

Patients who remain unconscious and unaware after a brain insult challenge healthcare. Clinicians are faced with a clinical situation often outside their usual experience. Organisations are faced with practical issues concerning resource use. And people, especially family and friends, are faced with moral, legal and philosophical questions that hav...

In the UK, the National Institute for Health and Care Excellence (NICE) is responsible for producing clinical guidance based on sound evidence. In 2013 they produced guidance on Stroke Rehabilitation and this editorial outlines why this is not a useful guide for clinicians or commissioners. Primarily this is because NICE used inappropriate methods;...

Information on the psychometric properties of the Coping Inventory for Stressful Situations (CISS) in acquired brain injury (ABI) is currently unavailable. Therefore, we investigated the construct and discriminant, convergent, and divergent validity of the CISS in a Dutch adult sample with newly ABI (N = 139). Patients were recruited at the start o...

After acute severe brain damage, many people are rendered unconscious or comatose for more than 24 hours. Although a significant number can still recover fully, some will not and a substantial minority remain unconscious for days, weeks or longer. These patients have a prolonged disorder of consciousness. A specialist multidisciplinary team should...

A cardiac arrest can lead to hypoxic-ischaemic brain injury which can result in cognitive and emotional impairments and may negatively affect daily functioning, participation in society and quality of life. Furthermore, the impact on the family of the patient can be high. We designed an intervention called 'Stand still..., and move on', which is a...

Objective: To investigate validity and reliability of a new measure of case complexity, the Oxford Case Complexity Assessment Measure (OCCAM). Design: Data collection on inpatients and outpatients attending for rehabilitation. In subsets, repeat assessments were undertaken two weeks apart, by clinicians unaware of initial data, and on admission...

Rivermead Assessment of Somatosensory Performance. This manual has been made available as a PDF. Unfortunately the test is not longer available for purchase. If you email me at Charlie.winward@ouh.nhs.uk I can send you links to equipment that matches the RASP>

Many stroke patients and their partners report long-term negative consequences of stroke on their health-related quality of life. Adequate self-management abilities may help manage the consequences of the stroke, but it is unknown what specific intervention might be effective to enhance self-management abilities of stroke patients and their partner...

. Fatigue is a chronic symptom for people with multiple sclerosis (PwMS). . Symptoms of fatigue were investigated during and following a single exercise session. In all, 58 PwMS and 15 healthy, low-active controls performed a cycle ergometer incremental exercise test to voluntary exhaustion. Physiological intensity (expired air and heart rate), per...

Objective: To investigate the beneficial and adverse effects of a mental practice intervention on activities, cognition, and emotion in patients after stroke, patients with Parkinson's disease or multiple sclerosis. Methods: Electronic databases PubMed/Medline, PEDro, Science Direct, Cochrane Library, PsycINFO, Rehadat, Embase, and Picarta were sea...

Background: Guidelines for optimal exercise doses in people with multiple sclerosis (MS) have to be established. We need to ascertain the basic physiological and perceptual response and adaptation to different exercise doses in this clinical population. Aim: The aim of this paper was to explore the response during maximal and sub-maximal exercis...

Spasticity is commonly experienced by people with multiple sclerosis (MS), and it contributes to overall disability in this population. A wide range of non pharmacological interventions are used in isolation or with pharmacological agents to treat spasticity in MS. Evidence for their effectiveness is yet to be determined. To assess the effectivene...

Background: The extent to which motor symptom severity impacts on Quality of Life (QoL) in people with Parkinson’s Disease (PD) is equivocal in the literature. However, problems with walking mobility are often the primary concern of people with neurological conditions. Therefore it is reasonable to propose that motor symptoms affecting walking mobi...