DW. An article discussing the Islamic view on starting, stopping, and refusing life-sustaining treatments. Interesting because it offers no easy answers, the situation that applies to all people of any faith and none. link.springer.com/article/10.1...

DW. This page expands on two Clinical Rehabilitation articles: doi.org/10.1177/0269... and doi.org/10.1177/0269..., which are on Rehabilitation Thinking and a General Theory of Rehabilitation.

DW. Intermittent hypoxia seems a counterintuitive treatment for incomplete spinal cord injury; some advocate hyperbaric oxygen. Yet a small trial provided data that certainly justifies further research. doi.org/10.1177/0269...

DW. A new editorial argues that Rehabilitation Thinking is the crucial unifying factor seen in all types of rehabilitation and the primary factor responsible for its effectiveness. doi.org/10.1177/0269...

DW. Papers from a large trial of Acceptance and Commitment Therapy in people with Motor Neuron Disease (ALS in the US) are summarised in this paper; the therapy helped and should be targeted (see synopsis). njl-admin.nihr.ac.uk/document/dow... #neurorehabilitation

DW. A trial of a method to increase the use and effectiveness of group physiotherapy education, support, and exercise for people with osteoarthritis of the knee failed to alter outcomes. Implementing rehabilitation approaches remains a challenge. doi.org/10.1001/jama...

DW. Clinical Rehabilitation has made easily accessible collections of published papers on selected topics. The most recent covers health economic studies in rehabilitation. I was surprised how many we had published. journals.sagepub.com/topic/collec... #neurorehbiitation

DW. Healthcare is a competitive environment, and rehabilitation often struggles to compete for resources. An editorial suggests we are now showing health economic benefits, and we should use health economic outcomes much more. doi.org/10.1177/0269...

DW. Rehabilitation is a complex multifactorial process and many people and organisations are involved. Planning and coordination are integral to rehabilitation. A qualitative study asked, “If I do not coordinate it, who else will?”. Surely, you should. doi.org/10.1080/0963... #neurorehabilitation

DW. A recent study found a difference in glutamate-type synaptic transmitter levels between people with long COVID cognitive impairment and healthy controls. This may be causal or a result of altered cognitive function. Not a readily available test! doi.org/10.1093/brai...

DW. Jeanne Hoffman et al undertook a huge randomised trial in 925 people with moderate/severe traumatic brain injury investigating added support for 6 months after discharge. Amazing follow-up success. Disappointing that no effect was detected. www.liebertpub.com/doi/pdf/10.1... #neurorehabilitation

DW. A useful study on predicting which individuals are likely to experience prolonged problems after a mild head injury. Unfortunately, statistically significant but not sufficiently specific to triage patients. bmjopen.bmj.com/content/15/9...

DW. Two vital aspects of rehabilitation are the professional-patient relationship and teaching self-management; a recent study investigated both, highlighting practical challenges. We must train therapists/nurses/doctors how to develop therapeutic relationships. doi.org/10.1177/0269... #neurorehab

DW. Are we too afraid to recommend more activity after stroke (and in most other conditions)? Gert Kwakkel thinks so; I agree. He has commented on a recent trial of increased walking exercise after stroke. A short, easy read: doi.org/10.1016/S147... #neurorehabilitation

DW. Practice improves function; this is a central tenet of rehabilitation. A recent trial demonstrates that a protocol to increase walking practice after stroke is effective. We must help patients practice independently without professional supervision. doi.org/10.1016/S147... #neurorehabilitation

DW. An updated Cochrane systematic review of virtual reality in stroke rehabilitation identified 190 trials; however, the evidence only allowed for weak conclusions. www.cochranelibrary.com/cdsr/doi/10..... Why was this? My editorial discusses reasons www.cochranelibrary.com/cdsr/doi/10.....

DW. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Ten years after publication, this article is 'trending' on Altimetric. Why such a delay? 2 doi.org/10.1177/0269...

DW. A new paper exploring the concept of financial capability in people with cognitive impairment, a significant issue in #neurorehabilitation. There are many ideas about what it is and how to assess it. doi.org/10.1177/0269... A Rehabilitation in Theory paper journals.sagepub.com/topic/collec...

When offered weekend speech therapy, patients valued the different, more social environment. We should pay more attention to a rehabilitation environment that facilitates adaptation and practice rather than direct therapy. pmc.ncbi.nlm.nih.gov/articles/PMC... #neurorehabilitation

DW. Technological aids in rehabilitation need as much research and evaluation for effectiveness and harm as drugs and other interventions. A study has evaluated an iPad programme to aid goal setting; this is the second evaluation, showing improvement from the first. st doi.org/10.1177/0269...

DW. Self-rehabilitation is practising and adapting without a professional present; it typically follows advice from a professional. A systematic review finds individual practice as effective as practising with a therapist. doi.org/10.1177/1545... This is part of adaptation doi.org/10.1177/0269...

DW. We fail to identify most people who are unable to make sound healthcare decisions. Routine screening might be helpful if it is simple and short. The Mental Capacity Screening Assessment Tool (MCScreen) should be considered. doi.org/10.1016/j.cl... #neurorehabilitation

DW. This randomised trial of exoskeletons for people with spinal cord injury is impressive, with two weaknesses: unequal allocation (68v47) despite block allocation, and selective loss from the control arm. However, there was no difference between the groups. doi.org/10.1016/j.ap... #neurorehab

DW. Does 'cognitive retraining' after stroke have an impact on functional activities? Probably not. The evidence is suggestive, not conclusive. doi.org/10.1177/0269... Task-specific training is likely more effective. #neurorehabilitation

DW. Non-pharmacological treatment for depression after stroke would avoid the cognitive side effects of drugs, if it helps. A systematic review identifies many techniques tried, but the evidence base is too small to enable any recommendation. doi.org/10.1177/0269...

DW. An observational study in Canada suggests that delays in providing wheelchairs to patients who need them may increase length of stay. The delays were between 1 and 9 days. The UK would have a bigger delay and should replicate this. doi.org/10.1016/j.ap... #neurorehabilitation

DW. The classification of traumatic brain injury severity has been based on the initial Glasgow Coma Scale score for decades. It was simple and applied widely, A new system has been developed. I suspect it is too complex for general use. It focuses only on pathology. doi.org/10.1016/S147...

DW. A significant study on somatic symptoms following concussive head injury. Suggests that psychological factors are a significant contributing factor. doi.org/10.1097/HTR....

DW. People with a prolonged disorder of consciousness have lost extensive networks that underlie consciousness. Surprisingly, repetitive transcranial magnetic stimulation (rTMS) may increase recovery; a randomised trial in 48 people suggests it may. doi.org/10.1016/j.ni... It may simply speed change

DW. Patient education may improve outcomes if (a) education succeeds and (b) the learned knowledge leads to action that helps. A trial of education about osteoarthritis gave information but had no clinical effect. Maybe surgery is needed to reduce pain. doi.org/10.1016/j.pe... #neurorehabilitation

DW. A novel, non-surgical non-pharmacological treatment for chronic pain: EEG entrapment. A well-designed study was conducted on 24 people with fibromyalgia. It is feasible; further trials are essential. doi.org/10.1016/j.jp...

DW. Enablement theory (doi.org/10.1016/j.ap...) underlies the analysis of clinical rehabilitation data within the holistic biopsychosocial model of illness. (doi.org/10.1177/0269...) Treatment theory is sometimes separated, but the two are completely interwoven. Enablement theory is a better term.

DW. Do people with a prolonged disorder of consciousness (PDOC) experience feelings of pain? In 1991, Michael McQillen said, "we do not know that they do not". A new paper suggests they probably do, with evidence and outlining consequences. journals.sagepub.com/doi/10.1177/... #neurorehab

DW. A meta-analysis comparing group and individual therapy for the affected arm after stroke found no difference (currently a weak conclusion). But we should also investigate broader psychological and social effects, and cost-effectiveness. doi.org/10.1177/0269...

DW. We fail to use meals as an active rehabilitation intervention combining many skills with social benefits. This qualitative study of breakfast clubs in a nursing home exposes several avenues for all residential or day units including lunch to explore. doi.org/10.1177/0269... #neurorehabilitation

DW I advocate short, simple measures, especially for audit and research, because they facilitate the collection of data from all participants. The AMPSIMM-4 paper on a simple mobility measure after amputation illustrates how to improve a good measure; I recall the original. doi.org/10.1177/0269...

DW. A large trial of vocational rehabilitation after stroke found no difference compared to standard UK practice. Failure allows learning (see previous tweets). The response must be to develop & evaluate better interventions. It's called evolution & it works. (Ref: Darwin) doi.org/10.1177/1747...

DW. We published some data from the RETAKE vocational rehabilitation trial; it was not cost-effective. doi.org/10.1177/0269... BUT: detailed analysis of some case studies highlights aspects of the intervention worth further study. www.ncbi.nlm.nih.gov/books/NBK613... An opportunity for a new trial?!

DW. Trials on the development and implementation of complex rehabilitation interventions are challenging. This trial concerned psychological therapy for people who had had a stroke. I hope a larger trial is funded because psychological input has great potential. www.mdpi.com/2227-9032/13...

DW. A paper confirming considerable behavioural variability in people with a prolonged disorder of consciousness. It is more common if aroused, and mostly affects the motor function of Coma Recovery Scale - Revised. Consciousness fluctuates. doi.org/10.1016/j.ap...

DW. A complex but valuable investigation comparing healthy and psychiatric control with function neurological disorders on structural MRI scans using machine learning. Consistent differences in different regions were found. Cause, effect, neither? doi.org/10.1136/jnnp... #neurorehabilitation

DW. A systematic study by NICE on identifying rehabilitation needs after trauma found minimal quantitative or qualitative information; all recommendations are by committee consensus. www.ncbi.nlm.nih.gov/books/NBK579...

DW. I recently came across this chapter on rehabilitation assessment in a larger policy document on rehabilitation in Australia. It might interest you clik.dva.gov.au/rehabilitati...

DW. A scoping review on 'Rehabilitation needs screening to identify potential beneficiaries' failed to find any. bmjpublichealth.bmj.com/content/2/1/... A need is the potential to benefit. An editorial in 2022 showed rehabilitation potential to be a flawed concept. 7 doi.org/10.1177/0269...

DW. A useful synopsis of the 2023 US guideline on pulmonary rehabilitation: doi.org/10.1001/jama...

DW. Electronic patient records can alert clinicians to make appropriate referrals automatically. An algorithm increased involvement of palliative care and had beneficial effects. We should develop this for rehabilitation. doi.org/10.1001/jama...

DW. A study in 72 people have lumbar fusion surgery; why do a non-randomised study of "REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions"? The data cannot be interpreted. link.springer.com/article/10.1...

DW. Take Charge is a rigorously developed, effective approach to rehabilitation. A qualitative study highlights being person-centred and helping people learn how to adapt. doi.org/10.1177/0269... It incidentally supports the General Theory of Rehabilitation. doi.org/10.1177/0269...

DW. Amantadine treatment for people with prolonged disorders of consciousness (PDOC) may improve the speed of recovery early on. A trial of brain stimulation found a similar effect; it is a much smaller trial and needs replication. doi.org/10.1177/0269... #neurorehabilitation

DW. Five years after publication, this paper has 155 citations and 33,000 downloads. doi.org/10.1177/0269...