Glossary

As defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.

Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis.

Patients less than a month post-stroke are identified as in acute stage of recovery.

Anomic aphasia is the inability to name objects or to recognize written or spoken names of objects. It is also known as: nominal aphasia or amnesic (or amnestic) aphasia.

Found in vegetables and fruits with vitamins A (e.g. lemons, sweet potatoes, spinach and mangos), C (e.g. papaya, oranges and berries) and E (hazelnuts, olive oil, asparagus and tomatoes) that reduce oxidative stress associated with the development of atherosclerotic plaques (which can block vessels if accumulated) and many other diseases.

Aphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada)

Assistive devices are any piece of equipment that you use to make your daily activities easier to perform.

Blocked practice involves practicing one specific type of movement over and over again until you get it right.

 

As defined by the International Classification of Functioning, Disability and Health, body functions are the physiological or psychological functions of body systems (nervous, musculoskeletal, digestive or respiratory and circulatory systems). Impairments are problems in body function or structure as a significant deviation or loss.

Broca’s aphasia is characterised as a disturbance of speech production caused by damage to or developmental issues in anterior regions of the brain, including (but not limited to) the left inferior frontal region known as Broca’s area. In this type of aphasia language comprehension remains largely intact. Also known as expressive aphasia or agrammatic aphasia.

A form of intervention that involves placing either cold or warm water in the external ear canal. For persons with USN, caloric stimulation is used to encourage scanning of the neglected side. Cold water encourages scanning of the field on the same side as the stimulated ear. Warm water encourages scanning of the field opposite to the stimulated ear.

Care pathways are structured, multidisplinary plans of care designed to support the implementation of clinical guidelines and protocols. They are designed to support clinical management, clinical and non-clinical resource management. They provide detailed guidance for each stage in the management of a patient (treatments, interventions etc.) with a specific condition over a given time period, and include progress and outcomes details.

Build-up of plaque in the carotid arteries, the main blood vessels to the brain. Can lead to stroke in severe cases.

A ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement.

Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.”

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.

Systematically developed descriptive tools or standardized specifications for care to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Practice guidelines are typically developed through a formal process and are based on authoritative sources, including clinical literature and expert consensus.

Clinically Important Difference (CID) is the smallest change in a measure’s score that is perceived significant by a patient or healthcare professional.

To validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”

A form of intervention that involves restraining the unaffected upper or lower extremity in order to encourage movement of the affected limbs. For persons with USN, constraint-induced therapy involves restraining the unaffected arm or hand using a sling or padded mitt, in order to promote visual scanning and movement in the neglected hemispace.

Reflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.

Refers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.

A type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.

The extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.

Examines the extent to which a measure provides results that are consistent with a gold standard . It is typically divided into concurrent validity and predictive validity .

Cronbach’s alpha is a coefficient (a number between 0 and 1) that is used to rate the internal consistency (homogeneity) or the correlation of the items in a test. A good test is one that assesses different aspects of the trait (e.g. depression) being studied. If a test has a strong internal consistency most measurement experts agree that it should show only moderate correlation among items (.70 to 0.90). If correlations between items are too low, it is likely that they are measuring different traits (e.g. both depression and quality of life items are mixed together) and therefore should not all be included in a test that is supposed to measure one trait. If item correlation are too high, it is likely that some items are redundant and should be removed from the test.

Administration of two or more experimental therapies one after the other in a specified or random order to the same group of patients.

Illness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

These professionals provide a myriad of services: assessment of nutritional status and requirements; collaborative assessments and management of swallowing disorders, implementation of appropriate diet plans; risk factor modification; patient and family education. (Suggested by Philips et al, 2002)

Measures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.

“The allocation of attentional resources across more than one task” (Ponsford, 2008, p. 514)

Turning an appendage in an upward direction, for example turning the foot so that the angle between the foot and the leg decreases.

Difficulty, discomfort or pain in swallowing due to problems in nerve or muscle control. It is common in patients who have had a stroke. Dysphagia ranges from slight discomfort to complete inability to swallow. Dysphagia may compromise nutrition and hydration and may lead to aspiration pneumonia and dehydration.

Impaired speech with difficulty or inability to put words in their proper order. This disorder affects the power of expression (speech, writing or signs) or loss of the power of comprehension (spoken or written language). More severe forms of dysphasia are called aphasia.

Refers to the extent to which a measure captures behaviours that are reflective of those that would occur in a natural setting

Effect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.

Electronic paging systems consist of reminders sent to standard pagers to assist with memory and planning. The person receives electronic prompts to carry out tasks such as taking medication or remembering appointments (Evans et al., 1998; Fish et al., 2008a,b)

EMG-triggered stimulation is a technology to detect the extremely small electrical ElectroMyoGraphic (EMG) signals still measurable in paralyzed muscles after stroke and use these signals to initiate electrical stimulation impulses to the same muscles resulting in actual muscle movement.

As defined by the International Classification of Functioning, Disability and Health, environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

 

A form of intervention that involves placing one right monocular patch or two right half-field patches on a pair of standard eyeglass frames. For persons with USN, eye patching conceals the visual field of the non-affected side in order to encourage visual scanning of the neglected hemispace.

A form of content validity, face validity is assessed by having ‘experts’ (this could be clinicians, clients, or researchers) review the contents of the test to see if the items seem appropriate. Because this method has inherent subjectivity, it is typically only used during the initial phases of test construction.

A decrease or absence of emotional expression

The ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008)

The floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also “ceiling effect.”

A form of intervention that involves placing prisms over regular eyeglass frames, which result in a shift of the visual field so that visual targets appear deviated from their original position. When wearing the eye glasses patients initially reach toward the virtual position of the target due to their deviated vision. After repeated treatments with Fresnel prisms, patients can correct their visual positioning and will reach the actual target. For persons with USN, prisms may be used to encourage visual scanning of the neglected hemispace.

The ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.

The pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.

Global aphasia is characterized by the complete loss of the ability to comprehend spoken or written language, as well as express language verbally or orthographically. Verbal expression is limited to words or short automatic phrases such as explicatives. Meaning can sometimes appear to be present because of the emotional content of the explicatives. Also, comprehension is totally absent even though facial expression and fleeting looks might appear that the patient comprehends. Repetition and naming are also disturbed.

A measurement that is widely accepted as being the best available to measure a construct.

Blindness in one half of the visual field of one or both eyes.

Complete paralysis of the arm, leg, and trunk on one side of the body that results from damage to the parts of the brain that control muscle movements. Hemiplegia is not a progressive condition, nor is it a disease.

The ability to suppress automatic actions that are inappropriate in a given context that interfere with a certain behavior (Grieve & Gnanasekaran, 2008)

The ability to spontaneously start a task or activity (Grieve & Gnanasekaran, 2008)

Complex tasks that involve social or societal issues (shopping, bill paying, cooking, housework, etc.) that are done on a regular basis.

A method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.

A method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.

Classification system setup by the World Health Organisation, portrays how people live with their condition in relation to the body functions and structures, activities and participation in daily life. ICF website

This is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.

Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance.

Exercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.

Exercise involving muscle contraction against resistance.

The assessment and ‘ordering of various competing actions and goals’ (Barnes & Thagard, 1996)

A measure of the degree of nonrandom agreement between observers or measurements of the same categorical variable (Last JM, A Dictionary of Epidemiology, 2nd Ed, Oxford University Press, 1988).

Known groups method is a typical method to support construct validity and is provided when a test can discriminate between a group of individuals known to have a particular trait and a group who do not have the trait. Similarly, known groups may be studied using groups of individuals with differing levels/severities of a trait. Again the known groups methods will evaluate the test’s ability to discriminate between the groups based on the groups demonstrating different mean scores on the test. For example, a group of individuals known to be not depressed should have lower scores on a depression scale then the group known to be depressed. Foundations of Clinical Research: applications to practice, Portney LG, Watkins M, 3rd ed. Prentice-Hall, 2008

Known groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.

1a (Strong) :
Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings

1b(Moderate):
1 RCT of high quality (PEDro ≥ 6)

2a (Limited):
At least 1 fair quality RCT (PEDro = 4-5)

2b (Limited):
At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)

3 (Consensus):
Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results

4 (Conflicting):
Conflicting evidence of 2 or more equally well-designed studies

5 (No evidence):
No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

Likert scaling is one type of response to items in a questionnaire or tool. For example, Likert scaling would have you rate an item such as “I am satisfied with the care I received” on a scale using a 1-to-5 response scale where:

• 1 = strongly disagree
• 2 = disagree
• 3 = undecided
• 4 = agree
• 5 = strongly agree

You will find various options and scaling methods for the number of response choices (1-to-7, 1-to-9, 0-to-4). Odd-numbered scales usually have a middle value that is labelled Neutral or Undecided. Some tools used forced-choice Likert scaling with an even number of responses and no middle neutral or undecided choice.

A form of intervention that involves voluntary movement of the arm and hand. For persons with USN, voluntary movements of the affected upper extremity on the neglected side can encourage visual scanning and exploration of that hemispace.

Longitudinal validity is the extent to which changes on one measure will correlate with changes on another measure.

The Mann Whitney U test is a nonparametric test that compares two uncorrelated groups. This test determines significant differences between the two groups. It can be used as an alternative to the independent group t-test when the scores are not normally distributed.

Method in which the results of two or more studies are statistically combined. Typically used when studies have few subjects, but similar designs. By increasing the available number of subjects, more weight can be given to the findings.

Minimal Detectable Change (MDC) refers to the minimal amount of change outside of error that reflects true change by a patient between two time points (rather than a variation in measurement).

“The process of checking the task over time for ‘quality control’ and the adjustment of behavior” (Stuss, 2009, p. 9-10)

Loss of strength and coordination, decrease in arm or leg movement

A form of intervention for USN that involves the use of trans-cuteneous electrical stimulation (TENS) to produce vibrations on the neck or hand. For persons experiencing USN, when TENS is applied on the neck and hand of their affected side, proprioceptive input from the neck muscles (i.e. the head-on-trunk signal) appear to influence visual scanning of the neglected hemispace.

This team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)

This team member is responsible for the “assessment of changes in cognition, behaviour and emotional status, evaluation of competency, development of intervention programs, including patient and family education, program evaluation, research.”(Suggested by Philips et al, 2002)

In charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)

In charge of the “assessment of personal and domestic care activities; evaluation and treatment of functional impairments related to change in sensorimotor, cognitive and perceptual abilities; prescription of wheelchairs and bathroom appliances; home visits; patient and family education.”(Suggested by Philips et al, 2002)

Polyunsaturated fatty acids, such as α-linolenic acid, which are essential nutrients required for normal body functioning that cannot be synthesized by the body and must be obtained from a dietary source. Some possible sources include salmon or sardines, flax seeds, kiwi fruits and walnuts.

A form of intervention for USN that involves the observation of moving visual targets to encourage visual scanning of the neglected hemispace. A computer screen is typically used to display a leftward moving background of dots or strips in order to produce the illusions of visual stimuli being displaced to the right.

As defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations.

The most commonly used method of computing a correlation coefficient between variables that are linearly related. Pearson’s r is a measure of association which varies from -1 to +1, with 0 indicating no relationship (random pairing of values) and 1 indicating perfect relationship

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

This is a test for spasticity. The patient sits on a table and the examiner holds the patient’s foot with the knee as fully extended as possible. The examiner drops the leg, and a computer records the motion and vibration.

Provides “consultation for matters related to drug therapy; patient and family education.”(Suggested by Philips et al, 2002)

A form of intervention that involves the use of prescription medications. For persons experiencing USN, dopamine-agonist drugs are prescribed to improve visual attention skills and potentially encourage scanning of the neglected hemispace.

In charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)

Planning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint” (Anderson, 2008, p. 17)

The percentage of people with a positive test result who actually have the disease.

A form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.

“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))

Consequences linked to emotion, cognition, personality and behavior.

The value assigned to duration of life as modified by the impairments, functional states, perceptions and opportunities influenced by disease, injury, treatment and policy (Patrick DL, Erickson P, 1988).

A study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups.

An experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.

Random practice involves practicing a variety of different movements, in no particular order, with minimal repetition of a single movement.

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Rasch analysis is a statistical measurement method that allows the measurement of an attribute – such as upper limb function – independently of particular tests or indices.   It creates a linear representation using many individual items, ranked by item difficulty (e.g. picking up a very small item, versus a task requiring a very gross grasp) and person ability.   A well performing Rasch model will have items hierarchically placed from simple to more difficult, and individuals with high abilities should be able to perform all the items below a level of difficulty.  The Rasch model is statistically strong because it enables ordinal measures to be converted into meaningful interval measures. It also allows information from various tests or tools with different scoring systems to be applied using the Rasch model.

A ROC curve is a graph that plots true positive rates against false positive rates for a series of cutoff values, or in other words, graphically displays the trade-off between sensitivity and specificity for each cutoff value. An ideal cutoff might give the test the highest possible sensitivity with the lowest possible false positive rate (i.e., highest specificity). This is the point lying geometrically closest to the top-left corner of the graph (where the ideal cutoff value with 100% sensitivity and specificity would be plotted). Picking the ideal cutoff score is, to some extent, dependent on the clinical context, that is the purpose for which the tool will be used. The area under an ROC curve can be used as an overall estimate of its discriminating ability and sometimes is expressed as accuracy. The area under the ROC curve is equal to the probability that a test correctly classifies patients as true positives or true negatives. Greater areas under the curve indicate higher accuracy. To further clarify, a discriminant test might have an area under the curve of 0.7 while a nondiscriminant test has an area under the curve of 0.5.Rosenberg, L., Joseph, L., & Barkun, A. (2000). Surgical Arithmetic: Epidemiological, Statistical and Outcome-Based Approach to Surgical Practice. Georgetown, Texas: Landes Bioscience.

Reliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .

The ability of an instrument to detect clinically important change over time.

Testing for disease in people without symptoms.

Sensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”

“The coordination and proper ordering of the steps that comprise the task, requiring a proper allotment of attention to each step” (Lezak, 1989; as cited in (Baum, Morrison, Hahn & Edwards, 2007))

Provides services related to “emotional and adjustment counselling for patients and families; assessment of patient, family and community resources required to facilitate discharge planning; referral to appropriate community agencies; patient and family education” (Suggested by Philips et al, 2002)

Involuntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.

A correlation coefficient for ranked, i.e., ordinal, data in which the items on the scale represent higher vs. lower values but are not of equal intervals

Specificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).

In charge of the “diagnosis and treatment of acquired communication disturbances; collaborative assessment and management of swallowing disorders; patient and family education.”(Suggested by Philips et al, 2002)

The standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.

Also called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.

Stroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.)

As defined by the International Classification of Functioning, Disability and Health, body structures are anatomical parts of the body such as organs, limbs and their components. Impairments are problems in body function or structure as a significant deviation or loss.

 

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

Many measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).

A systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.

Responsible for the “organization of patient care rounds, administration meetings and educational sessions; data recording in registry.”(Suggested by Philips et al, 2002)

A way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).

3 bursts of transcranial magnetic stimulation at 50Hz and repeating at 5Hz at 80% of resting motor threshold.

A fixed time interval toileting assistance program determined by the person’s own habits used as an intervention for urinary.

A transcutaneous electrical nerve stimulator, more commonly referred to as a TENS unit, is an electronic device that produces electrical signals used to stimulate nerves through unbroken skin. The unit is usually connected to the outer surface of the skin using two or more electrodes. A typical battery-operated TENS unit consists of a pulse generator, small transformer, frequency and intensity controls, and a number of electrodes.

A form of intervention that involves actively twisting the body’s trunk towards the affected side. This can also be performed passively by means of a shoulder strap or corset. For persons experiencing USN, trunk rotation may be used to improve visual scanning and exploration of the neglected hemispace.

The degree to which an assessment measures what it is supposed to measure.

Volume of carbon dioxide production.

Volume of total expiration.

A form of intervention that involves the use of visual (i.e. red tape or flashing lights), verbal (i.e. the voice of the therapist or a family member) or auditory (i.e. a horn or bell) stimuli/cues. For persons with USN, these types of cues are used to encourage visual scanning and awareness of the neglected hemispace.

A form of intervention where a patient is videotaped while he performs an activity. The therapist and patient then watch the video together in order for the patient to obtain visual and verbal feedback regarding their performance. For persons experiencing USN, the therapist addresses how the patient has neglected their body or hemispace. Once the patient is aware of their inattention, strategies are then discussed to encourage visual scanning of their neglected hemispace/body.

During this intervention the person with USN is encouraged to conduct voluntary eye movements toward the neglected visual field (usually the left side) by performing a task in that hemispace. The treatment often includes a visual target that the patient uses as an anchor to direct voluntary gaze control while scanning.

A form of intervention that involves mentally visualizing the performance of motor tasks. Visuo-motor imagery consists of imagining a body movement or posture and verbally describing this sequence. For persons with USN, visuo-motor imagery may stimulate areas of the brain to activate those actual movements during daily activities in order to improve neglect symptoms.

Blood oxygen level.

Wernicke’s aphasia: is characterized by fluent but meaningless speech and severe impairment of the ability understand spoken or written words. Is often (but not always) caused by neurological damage to Wernicke’s area in the brain. It is also known as receptive aphasia, fluent aphasia, or sensory aphasia.

The Wilcoxon test is a nonparametric test that compares two paired groups. This test calculates and then analyzes the differences between the pairs. The Wilcoxon Rank Sum test is used to determine whether two scores have the same continuous distribution. The Wilcoxon Signed Rank test is suitable to use as an alternative to the paired t-test when the scores are not normally distributed.

Executive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007)