Dissertationen: „Stroke“

1

Jaigobin, Cheryl S. „Survival, stroke recurrence and functional outcome after lacunar stroke“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ58705.pdf.

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2

Karlsson, Sara, und Amaal Yasin. „Livet efter stroke: Patienters upplevelser av livskvalitet efter stroke“. Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-67818.

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3

Madubuko, Adaku Ngozika. „Stroke Risk Factor Knowledge, Attitude, Prevention Practices, and Stroke“. ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4973.

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Regardless of the advances that have been made in stroke research and treatment and the overall decrease in stroke mortality, the stroke mortality rate for African Americans is still high at 45.2/100,000 and is still the leading cause of adult disability. Knowledge of the risk factors of stroke is paramount to reducing the morbidity and mortality of stroke, but knowledge of stroke risk factors has been found to be suboptimal in the African American population. The purpose of this study was to examine if there is a relationship between the knowledge, perception, and sources of stroke information of risk factors for stroke. The theoretical framework for this study was knowledge, attitude, and practice model and the health belief model. A cross-sectional quantitative approach was used for this study, and data was obtained through in-person administration of a questionnaire to willing participants in two South District Cook County, Illinois, health centers, two churches, a barber shop, and a beauty shop. A total of 273 respondents that consisted of 42% men (n = 113) and 58% women (n = 160) provided valid responses. Chi-Square test of association showed a statistical significance between source of stroke information and previous stroke/transient ischemic attack at Ï?2 (1) = 29.133, p = 0.001. Multiple regression analysis model showed a statistically significant result of perception and stroke, F (14, 259) = 22.692, p < 0.0005. This study found that stroke education should go beyond traditional medical risk factors to also explore people's perception of preventive practices. This study will contribute to social change by providing support for targeted stroke education not only on knowledge but also perception of preventive practices in the African American population.

4

Upshaw, Kris. „The effects of stroke rate and stroke length on upper quadrant stroke patterns in competitive swimming“. Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/958784.

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The purpose of this study was to describe women collegiate swimmers' armstroke sequence at selected velocities. In addition, this study was designed to determine the timing angle during the course of a stroke cycle. Seven members of the Ball State University Women's Swim Team were asked to participate in this study. The test consisted of the subject swimming approximately fifteen meters freestyle (front crawl) at stroke rates of 24, 30, 40, 48, 60 strokes per minute. The subjects attempted three trials at each stroke rate, on a continuum from slow to fast. The following parameters were determined from video analysis: stroke length (SL), velocity (m/s), time of one complete stroke cycle (SCT), timing between the arm cycles (RAE), recovery arm entry as a percentage of SCT (RAE%) and the timing angle. A correlation between the timing angle and V of r = 0.48 was found to be significant at the 0.05 level. A correlation between the SCT and the timing angle of r = -0.62 was found to be significant at the 0.05 level. A correlation of r = -0.43 between SL and the timing angle of less than 90 degrees is believed to benefit theangle was found to be significant at the 0.05 level. This indicates that as the swimmers' SCT decreased, the timing angle increased. And, as the swimmers' SL decreased the timing angle increased. It appears that timing angles increase with increasing V. The mean timing angle for ninety trials was 66.03 degrees with a SD of 17.68. This study indicates that women collegiate swimmers use a timing angle of less than 90 degrees. A timing swimmers' body position, balance and SL.
School of Physical Education

5

Ford, Catherine Elaine Longworth. „The relationship between beliefs about stroke and post-stroke depression“. Thesis, University of East Anglia, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442541.

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6

Mohan, Keerthi Michelle. „The natural history of stroke recurrence after first-ever stroke“. Thesis, King's College London (University of London), 2016. http://kclpure.kcl.ac.uk/portal/en/theses/the-natural-history-of-stroke-recurrence-after-firstever-stroke(530e5d24-437f-43a0-9555-eb45f374e278).html.

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Background - The natural history, predictors and outcomes of stroke recurrence after first-ever stroke have been insufficiently investigated. The available evidence shows great variation and does not provide a consensus of key predictors of stroke recurrence or a critical time-period for stroke recurrence occurring after initial stroke. This thesis uses data collected from the population-based South London Stroke Register to estimate the natural history of stroke recurrence after first-ever stroke. Methods - Data were collected over 12 years from all individuals known to have had an initial and first recurrent stroke from the South London Stroke Register. The cumulative risk and predictors of stroke recurrence up to 12 years after first stroke were identified using survival analyses, taking into account the effect of temporal changes in stroke management. The effect of stroke recurrence on risk of death after first stroke was estimated up to 15 years after initial stroke. A systematic review and meta-analysis of studies of the risk and cumulative risk of stroke recurrence after first stroke was also conducted. Results - The risk of stroke recurrence was estimated to be up to 25% at 12 years after first stroke. Cardiovascular risk factors were found to be important predictors of stroke recurrence, however differences in risk of recurrence were noted between the aetiological subtypes. Stroke recurrence was demonstrated to increase risk of death at all time-points up to 15 years after first stroke. Conclusions – The risk of stroke recurrence is considerable and is associated with increased risk of death up to 15 years after first stroke. Further research is needed to examine the effect of secondary prevention on risk of recurrence. Recurrence in the first year after stroke may also be associated with the biggest increase in risk of death identifying a potentially important time-period for stroke management to be targeted.

7

Persson, Lisbeth, und Annika Svensson. „Upplevelser av stroke“. Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-4943.

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Problemställning: Stroke är en världsomspännande, allvarlig och kostnadskrävande sjukdom. Sjuksköterskans omvårdnadsinsatser av patienter med stroke bör anpassas individuellt och syfta till att främja återhämtning och förhindra komplikationer. Det är därför av vikt för sjuksköterskan att ha kunskap om hur strokedrabbade patienter upplever sin sjukdom. Syftet var att belysa patienters upplevelse av att drabbas av och leva med stroke. Metod: En litteraturstudie där 11 kvalitativa och 1 kvantitativ artikel som svarade mot studiens syfte ingick. Resultat och konklusion: Att drabbas av stroke påverkar personens hela liv med förlorad kontroll över både kropp och personlighet. Oro för att drabbas av en ny stroke leder till ett liv i osäkerhet men också till förändrade levnadsvanor. Stroken påverkar den drabbades roll i familjen och förhållandet, ilska och frustration över situationen går ut över de närmaste. Den sociala relationen med familj och vänner försämras, eftersom kvarstående fysiska eller kognitiva funktionsnedsättningar gör det svårt att delta i sociala sammanhang på samma sätt som innan sjukdomen. Överdrivna känslomässiga yttranden och extrem trötthet försvårar ytterligare social samvaro. Implikation: Det är viktigt att sjuksköterskan får ökad medvetenhet om strokepatienternas upplevelser för att kunna ge en individuellt utformad omvårdnad. Det finns behov av vidare forskning kring copingstrategier samt strokepatienternas upplevelser av sjuksköterskans omvårdnad.

Problem: Stroke is a worldwide, serious and costly disease. Nursing interventions of patients with stroke should be individualized and adapted to promote recovery and prevent complications. It is therefore important for nurses to have knowledge of how the stroke affected patients experience their illness. The purpose was to illustrate patients’ experience of suffering from and living with a stroke. Method: A literature study, where 11 qualitative and one quantitative article that met the study’s purpose, were used. Results and conclusion: To suffer a stroke, affects the patient’s whole life with loss of control over both body and personality. Worries concerning the possibility to suffer a new stroke often results in a life of uncertainty but also in changing of lifestyles. The stroke affects the patient’s role in the family and in the relationship with the spouse; anger and frustration over the situation affect the immediate family negatively. The social relationships with family and friends deteriorate, because the residual physical or cognitive disabilities make it difficult to participate in social contexts in the same way as before the illness. Exaggerated emotional expressions and extreme fatigue makes social interaction even more difficult. Implication: It is important that nurses are more aware of stroke patients' experiences in order to provide individualized care. There is a need for further research on coping strategies and the stroke patients' experiences of nursing.

8

Beranova, Eva. „Post stroke depression“. Thesis, City University London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.503387.

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9

Åström, Monica. „Depression after stroke“. Doctoral thesis, Umeå universitet, Psykiatri, 1993. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96912.

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Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population. Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke. The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation. Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

Härtill 5 uppsatser

digitalisering@umu

10

Pound, Pandora. „Lives with stroke“. Thesis, Royal Holloway, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387609.

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11

Jönsson, Petra, und Stephanie Olsson. „Livet efter stroke“. Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25037.

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Syftet med litteraturstudien var att undersöka hur det dagliga livet upplevdes av personer som genomgått en stroke. Årligen insjuknar 25 000 personer i stroke och det är en av de vanligaste sjukdomarna som kräver rikligt med resurser av vården samt samhället. Stroke är även en vanlig orsak till funktionsnedsättning och död. Designen för arbetet är en litteraturstudie som grundades på kvalitativa artiklar. Databaser som användes var PubMed, CINAHL och PsycInfo. De funna artiklarna kvalitetsgranskades vilket slutligen resulterade i tio artiklar. En tematisk analys och sammanställning genomfördes. Artiklar bearbetades till ett resultat som sammanlagt innefattade 137 deltagare. De framkomna teman i resultaten var: Stroke medförde olika funktionsnedsättningar, vardagslivet påverkades efter stroke och utmanande att återgå till och utföra arbete efter stroke. Det framkom av deltagarna att en stroke innebar fysiska förändringar som upplevdes som hinder i vardagen likväl som den kognitiva påverkan visade sig vara ett vanligt problem. Strategier beskrevs som ett verktyg av en del personer för att hantera de uppkomna komplikationerna. Det sociala nätverket visade sig ha stor betydelse likväl som stödet från även sjukvården och samhället generellt. Det framkom att personernas inställning hade koppling till deras upplevda välmående. Det visade sig även att arbete för många var svårt eller omöjligt att återgå till, men var fortfarande en motiverande och viktig faktor i livet. Slutsatsen visade att primärprevention inom sjukvården kunde vara den insats som sänkte arbetslösheten och bidrog till ökad folkhälsa. Inställningen hos de drabbade var av vikt för att hjälpa individen acceptera sin nya funktionsnivå och för att tänka framgångsrikt vilket kunde bidra till ökad livskvalité. Stödet från sjukvården kunde stärka tryggheten som i sin tur ökade framgång och livskvalité, därav ses kontinuerlig kontakt med sjukvårdspersonal som viktigt.
The aim of this literature study was to investigate how daily life was experienced by people who had suffered a stroke. Every year 25,000 people suffer a stroke and it’s one of the most common illnesses that require plenty of resources from the healthcare and society. Stroke is also a common cause of disability and death. The method was a literature review based on qualitative articles. PubMed, CINAHL and PsycInfo were used for the data collection. The articles found were then assessed for quality which gave ten articles. A thematic analysis and compilation where made. The articles were processed to a result and the papers included together totally 137 participants. Themes that emerged in the results were: Stroke caused a various of disabilities, the everyday life was affected by stroke and a challenge to return to and perform work after stroke. Participants found that stroke involved physical changes that were perceived as obstacles in everyday life and a cognitive impact proved to be a common problem. Strategies were shown to cope with the arise complications. The social network proved to be of great importance, as well as the support of health service and society in general. Attitudes emerged of the participants revealed a connection to their perceived wellbeing. Returning to work for many was difficult or impossible although it was still a motivational factor. The conclusion showed that primary prevention in healthcare could contribute to a lower unemployment and an increased public health. Attitudes of those affected were of an importance to help the individuals accept their new function and think successfully and could contribute to increase a quality of life and a progress to success. The support from the healthcare system could also strengthen the feeling of security, which in turn increased the success and quality of life, hence continuous contact with healthcare professionals is considered an important factor.

12

Larsson, Julia, und Sofia Mattsson. „Post Stroke Fatigue“. Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24401.

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Bakgrund: Stroke är ett samlingsnamn på de symtom som uppstår när hjärnans nervvävnad skadas på grund av hämmad syretillförsel. Stroke kan påverka vilken funktion som helst i hjärnan, vilket leder till fysiska och kognitiva funktionsnedsättningar. En av de vanligaste konsekvenserna efter stroke är fatigue. Syfte: Att undersöka hur fatigue som konsekvens av stroke påverkar individens dagliga liv. Metod: En systematisk litteraturstudie där tio stycken vetenskapliga artiklar med kvalitativ ansats använts och kvalitetsgranskats utifrån SBU´s granskningsmall för kvalitativa studier. Resultat: Att leva med post stroke fatigue innebär en förändring i det dagliga livet. Individerna tvingas avstå helt eller göra större förändringar i aktiviteter som tillhör vardagen. Att vara beroende av andras hjälp och att inte kunna möta de krav som ställs på individerna medför både skuldkänslor och försämrat självförtroende. Slutsats: Det finns starkt vetenskapligt stöd för att post stroke fatigue har inverkan på arbetsliv, det sociala livet, aktiviteter och synen på identitet och självbild.Nyckelord: Dagligt liv, Fatigue, Stroke
Background: Stroke is a disease that affects the arteries leading to and within the brain and occurs when the tissue of the brain doesn´t get oxygen enough. Stroke can have an impact on any of the functions of the brain, leading to both physical and cognitive deficits. One of the most frequent consequences after stroke is fatigue. Aim: To explore how fatigue as a post stroke condition impacts on the daily life of the individual. Method: A systematic literature review where ten qualitative scientific articles have been examined and reviewed according to the template for qualitative research by SBU. Results: Living with post stroke fatigue means making several changes in activities of daily living or completely having to give up on the activity. To be dependent on others causes a negative effect on self-confidence and feelings of guilt. Conclusion: Strong evidence supports that fatigue has impact on daily life in terms of occupational performance, activities of daily living, social life and self-confidence. Keywords: Daily life, Fatigue, Stroke

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Pegert, Anna Carina, und Daniela Toseva. „Återhämtning efter stroke“. Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24580.

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Bakgrund: Att uppleva en stroke är en dramatisk händelse. Många drabbade får fysiska funktionsnedsättningar som kvarstår i lång tid efter insjuknandet. Återhämtningen präglas av hårt arbete vilket kräver resurser både hos individen och i omgivningen. Syfte: Att beskriva strokedrabbades upplevelser av återhämtningen av fysisk funktion i vardagen. Metod: En litteraturstudie.Resultat: Ett övergripande tema identifierades; önskan om att återställas som individ. Resultatet omfattar fyra teman; emotionellt, motivation, miljö och socialt. Emotionellt präglades upplevelserna av negativa känslor kring den egna kroppen och en känslomässig anpassning till den nya situationen. Motivationen var hos de strokedrabbade stark och det var viktigt att ha ett mål att arbeta mot. Miljön påverkande återhämtningen genom att den upplevdes olikt på rehabiliteringsavdelning och hemma. Det sociala livet hade ändrats på grund av den fysiska funktionsnedsättningen och att inte kunna göra som förr. Konklusion: Strokedrabbades återhämtning kännetecknas av en stark motivation efter att känna helhet i sina liv. Det framkom att många var oförberedda på utmaningarna när de kom hem, och de efterfrågade mer information från vårdpersonalen om detta. Mer forskning kan behövas för att identifiera åtgärder som underlättar inför hemgång.
Background: Surviving a stroke is a dramatic experience. Physical disabilities are common among stroke survivors, and they can be long lasting. The recovery process is hard work and requires resources within the individual as well as from the surroundings. Aim: To describe stroke survivors experiences of physical recovery in everyday life. Method: A literature review. Results: One major theme emerged; wishing to recover as an individual. The results are represented by four themes; emotionally, motivational, environmental and social. Emotional experiences were characterized by negative feelings towards their own bodies, and by emotionally adapting to the new situation. Stroke survivors had a strong motivation in working towards their goals. Physical recovery was influenced in different ways by the environment at the rehabilitation ward and at home. Stroke survivors´ social lives had changed because of the physical disabilities and not being able to participate in activities important to them. Conclusion: Recovering from stroke is a process driven by a strong motivation to feel complete. Many stroke survivors felt unprepared when returning home, and experienced a lack of information before discharge. Further research on this subject should identify measures and arrangements to help stroke survivors when returning to their own homes.

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Lilly, Flavius R. W. „Severe Mental Illness among Stroke Survivors| Post-Stroke Non-Psychiatric Hospitalizations, Recurrent Stroke and Mortality Over Five Years“. Thesis, University of Maryland, Baltimore County, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3707293.

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BACKGROUND AND PURPOSE: This study sought to examine the association of severe mental illness (SMI) among stroke survivors treated in Veteran Administration (VA) hospitals with medical (non-psychiatric) hospitalizations, recurrent stroke hospitalization and mortality risk over a five year period after the initial stroke. Additionally, this study used administrative data to explored inpatient stroke treatment differences between patients with and without SMI.

METHODS: This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VA medical center during fiscal year 2003. This cohort of stroke survivors was followed from discharge in 2003 through 2008 using administrative data documenting patient demographics, disease co-morbidities, subsequent VA hospital admissions, recurrent stroke admissions, and death. Multivariate Poisson regression with log link functions was used to examine the relationship between SMI status and non-psychiatric hospitalizations after stroke. Cox proportional hazards regression was used to examine the relationship between SMI status and recurrent stroke and post-stroke mortality. The differences in compliance with inpatient stroke treatment guidelines between patients with and without SMI was assessed using logistic regression.

RESULTS: The study cohort of 523 veterans included 100 with SMI comorbidity and 423 without SMI comorbidity. It was found that stroke survivors with SMI do not have significantly increased risk for non-psychiatric hospitalizations, recurrent stroke or mortality at any time period post-stroke after adjustment for covariates. It was also found that there was no significant difference in the delivery of guideline concordant inpatient stroke care between patients with and without SMI.

CONCLUSIONS: The finding that SMI had little impact on the post-stroke outcomes of hospitalization, recurrent stroke and mortality among veterans who receive their care at VA hospitals was surprising. It was hypothesized that SMI would continue to disadvantage individuals even after having survived a stroke. These findings may be partially explained by the highly integrated nature of care for the mentally ill in the VA system, which may equalize disparities associated with SMI post-stroke. This study offers preliminary evidence of this in VA hospital inpatient settings where acute stroke treatment did not significantly vary between patients with and without SMI.

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Söderlund, Matilda, und Hanna Niemelä. „Livet med följder efter stroke : Patienters upplevelser av hälsa efter stroke“. Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-38679.

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Bakgrund: Stroke kan medföra kvarstående problem som kan orsaka konsekvenser för patienters hälsa ur ett helhetsperspektiv. Sjuksköterskor har till uppgift att vägleda patienter att hantera förändringarna som en stroke kan föra med sig. Problem: Forskning visar att vården till stor del fokuserar på den kroppsliga återhämtningen trots medvetenheten om att se människan som en enhet. Syfte: Att beskriva patienters upplevelser av hälsa efter stroke. Metod: En systematisk litteraturstudie med deskriptiv syntes valdes där 16 vårdvetenskapliga artiklar analyserades i resultatet. Resultat: Två teman kunde urskiljas, förändrad identitet och relationernas betydelse. Utifrån dessa skapades fyra subteman; Osäkerhet inför möten med andra, anpassning till ett nytt jag, behov av stöd från sjuksköterskor samt att vara beroende av anhöriga. Patienter upplevde sig som förändrade vilket bidrog till att de kunde urskilja både positiva och negativa delar av livet. Då stroke bidrog till en stor förändring i livet behövde patienter en trygg tillvaro med stöd från omgivningen. Slutsats: Sjukvårdspersonal kan stötta patienter i upplevelsen av hälsa genom att samtala och informera om vilka hinder de kan tänkas möta i samspelet med andra.

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Ramasubbu, Rajamannar. „Serotonergic fuctioning in depressed stroke, nondepressed stroke, and in healthy elderly“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ34063.pdf.

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17

Burn, John Philip Southerden. „The outcome of a first stroke : the Oxfordshire Community Stroke Project“. Thesis, University of Oxford, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316813.

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18

McKenna, Suzanne. „Bridges stroke self-management programme for stroke survivors in the community“. Thesis, University of Ulster, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.629077.

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The research presented within this thesis utilised a mixed methods research design to explore self-management practices specific to stroke within four studies: 1) a systematic literature review of trials on stroke self-management; 2) a feasibility randomised controlled trial (RCT) exploring the Bridges stroke self-management programme (SSMP) in addition to community rehabilitation versus usual rehabilitation; 3) a qualitative study conducted with participants from the feasibility RCT to explore their experiences of the Bridges SSMP and, 4) a comparative study exploring the Bridges SSMP with an alternative self-management programme currently offered within Northern Ireland. Study 1 identified relatively few published studies on stroke self-management programmes. The types of programmes explored in these studies varied and results were mixed but findings suggest some effect on functional recovery, quality of life and confidence in recovery post stroke. Study 2 established that the Bridges SSMP appeared feasible to implement within the clinical rehabilitation setting, however, further exploration of the reasons behind relatively low recruitment needs further evaluation. Study 3 found that the Bridges SSMP was acceptable to all stakeholders and helped illuminate key mechanisms of change involved in the Bridges SSMP such as the personalised nature of goal setting which resulted in the perception by participants that they were better able to manage their progress. Study 4 suggested that the Bridges SSMP was equally as acceptable and feasible to deliver as the Taking Control self-management programme currently offered by Northern Ireland Chest Heart and Stroke but highlighted key issues related to the delivery of both programmes that need further exploration. The findings of this research suggest that self-management programmes may offer potential benefit to stroke participants and indicate that it may be feasible to deliver the Bridges SSMP in both the clinical rehabilitation and voluntary sector. Further research is needed to improve the understanding of the mechanisms and context of delivery.

19

Ross, Susan Clare. „Finding meaning after stroke : an analysis of older people's stroke narratives“. Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/6309.

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Little is understood about the process by which individuals maintain or lose a positive sense of wellbeing in the face of a chronic disabling condition such as stroke (Clarke, 2003). It appears that the impact of residual impairments and disabilities can pose significant problems for wellbeing in older adults, but the presence of such sequelae is not necessarily correlated with subjective wellbeing – some adapt well while others are devastated by minor sequelae (Clarke, 2003). Additionally, little is known about recovery in stroke survivors in relation to normal ageing processes (Green & King, 2007). Through narrative we bring a sense of order to the disorder in our lives, and gain a sense of temporal continuity as we define ourselves in the context of our experiences (Murray 2008). A qualitative study examined the narratives of a sample of six older people with stroke in the East of Scotland. Participants took part in an episodic interview exploring their experience of stroke and the impact it has had on them and their lives. Narrative analysis was used to explore these stories. A story analytic approach was used to examine the content and structure of stroke narratives. A performative analysis revealed that narrative anchors relating to health, relationships, activity and ageing were used by participants to make sense of stroke, while stroke itself was an anchor point in participants‟ ongoing life stories. These findings were interpreted in relation to theories of ageing, suggesting that a developmental approach may be helpful in understanding the experiences of stroke survivors entering frailty, rather than focussing on the active ageing strategies which benefit those in the younger-old age groups. An approach similar to that used in working with grief is proposed as a framework to help health and social care staff and service users understand the process of adjustment following stroke.

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Chong, Boon Hor, und 鍾文一. „Risk of ischemic stroke and recurrent hemorrhagic stroke in Chinese population“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47323450.

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Stroke is a devastating, neurological dysfunction due to brain blood supply disturbance. It is responsible for increasingly high rate of mortality and disability worldwide. This thesis comprises two original studies involving 868 patients at risk of ischemic stroke and/or hemorrhagic stroke. The first study investigated aspirin’s effect among patients with intracranial hemorrhage. Unlike Caucasians which hemorrhagic strokes account for 10-15% of all strokes; in Chinese, intracranial hemorrhages strike up to 35%. After such, anti-platelet agent like aspirin is often avoided for fear of recurrent intracranial hemorrhages, despite compelling indications. However, clinical data is limited. In this single-centered observational study, we included 440 consecutive Chinese patients with a first spontaneous intracranial hemorrhage surviving the first month performed during 1996-2010. 56 patients (12.7%) of these 440 patients were prescribed aspirin after intracranial hemorrhage (312 patient-aspirin years). After a mean follow-up of 62.2 ± 1.8 months, 47 patients had recurrent intracranial hemorrhage(10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have higher risk of recurrent intracranial hemorrhage compared with those without (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years and hypertension as independent predictors for recurrent intracranial hemorrhage. In a subgroup analysis: the incidence of combined vascular events including recurrent intracranial hemorrhage, ischemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than without (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). Implications of the results: despite having a substantial risk for recurrent intracranial hemorrhage, post-intracranial hemorrhage ones are at risk for thrombotic vascular events and management goal should thus focus on ameliorating overall cardiovascular risk instead of preventing recurrent intracranial hemorrhage. Hence, thrombo-prophylaxis should still be considered. The second study investigated the relation between premature atrial complexes and new-onset atrial fibrillation together with other cardiovascular events. Premature atrial complexes though taken as benign phenomenon, are common in patients with underlying conditions such as coronary heart disease, chronic rheumatic heart disease. While prompt management of atrial fibrillation may prevent ischemic stroke, atrial fibrillation is often unfound until ischemic stroke occurs. In this study, 428 patients without atrial fibrillation but complained of palpitations, dizziness or syncope were recruited. 107 patients with >100 premature atrial complexes/day were defined to have frequent premature atrial complexes. After a mean follow-up of 6.1 ±1.3 years, 31 patients (29%) with frequent premature atrial complexes developed atrial fibrillation compared with 29 patients (9%) with premature atrial complexes?100/day (p<0.01). Cox regression analysis revealed: frequent premature atrial complexes, age>75 years and coronary artery disease were independent predictors. In secondary endpoint (ischemic stroke, congestive heart failure, and death), patients with frequent premature atrial complexes were more at risk than those without (34.5% vs. 19.3%) (Hazard ratio: 1.95, 95% confidence interval: 1.37-3.50, p=0.001). Cox regression analysis showed: age> 75 years, coronary artery disease and frequent premature atrial complexes were independent predictors. These permit early identification of high risks patients of new atrial fibrillation and other events, thus promoting appropriate preventive treatment.
published_or_final_version
Medicine
Master
Master of Philosophy

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Kalra, Lalit. „Standardised measures in stroke rehabilitation and their application to stroke research“. Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/standardised-measures-in-stroke-rehabilitation-and-their-application-to-stroke-research(d0d96c8d-bb08-42bc-954b-4886e9402a04).html.

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22

Bailey, Emma Louise. „Pathophysiology of lacunar stroke : ischaemic stroke or blood brain barrier dysfunction?“ Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/6529.

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Lacunar strokes account for approximately a quarter of all ischaemic strokes and traditionally are thought to result from occlusion of a small deep perforating arteriole in the brain. Lacunar infarcts can be up to 2cm in diameter and are found in deep brain structures such as the thalamus and internal capsule. Despite their prevalence and specific accompanying clinical syndromes, the cause of lacunar stroke and its associated vascular pathology remain unclear. Many hypotheses as to the cause exist, which fall broadly into two categories; firstly, a direct occlusion via emboli or thrombus usually from a cardiac or large artery source, microatheroma (intrinsic lenticulostriate occlusion) or macroatheroma (parent artery occlusion) all operating primarily via ischaemia. Secondly, there could be an indirect occlusion resulting from vasospasm, endothelial dysfunction or other forms of endovascular damage (e.g. inflammation). Therefore the question of whether the resulting lesions are truly “ischaemic” or actually arise secondary to an alternative process is still under debate. To clarify the chain of pathological events ultimately resulting in lacunar stroke, in this thesis I firstly undertook a systematic assessment of human lacunar stroke pathology literature to determine the information currently available and the quality of these studies (including terminology). The majority of these studies were performed in patients who had died long after their stroke making it difficult to determine the early changes, and there were few patients with a clinically verified lacunar syndrome. Therefore I adopted alternative approaches. In this thesis, I systematically looked for all potential experimental models of lacunar stroke and identified what appears at present to be the most pertinent - the spontaneous pathology of the stroke-prone spontaneously hypertensive rat (SHRSP). However, the cerebral pathology described in this model to date is biased towards end stage pathology, with little information concerning the microvasculature (as opposed to the brain parenchyma) and confounding by use of salt to exacerbate pathology. Therefore, the aim of the experimental work in this thesis was to assess pathological changes within the cerebral vasculature and brain parenchyma of the SHRSP across a variety of ages (particularly young pre-hypertensive animals) and to look at the effects of salt loading on both the SHRSP and its parent strain (the Wistar Kyoto rat - WKY). Three related studies (qualitative and quantitative histology, immunohistochemistry and a microarray study of gene expression confirmed by quantitative PCR), revealed that the presence of inflammation (via significant changes in gene expression in the acute phase response pathway and increased immunostaining of activated microglia and astrocytes) plus alterations in vascular tone regulation, (via genetic alteration of the nitric oxide signaling pathway probably secondary to abnormal oxidative state), impaired structural integrity of the blood brain barrier (histological evidence of endothelial dysfunction and significantly decreased Claudin-5 staining) and reduced plasma oncotic potential (reduced albumin gene expression) are all present in the native SHRSP at 5 weeks of age, i.e. well before the onset of hypertension and without exposure to high levels of salt. We also confirmed previous findings of vessel remodelling at older ages likely as a secondary response to hypertension (thickened arteriolar smooth muscle, increased smooth muscle actin immunostaining). Furthermore, we found not only that salt exacerbated the changes see in the SHRSP at 21 weeks, but also that the control animals (WKY) exposed to a high salt intake developed features of cerebral microvascular pathology independently of hypertension (e.g. white matter vacuolation and significant changes in myelin basic protein expression). In conclusion, via the assessment of the most pertinent experimental model of lacunar stroke currently available, this thesis has provided two very important pieces of evidence: firstly that cerebral small vessel disease is primarily caused by a non-ischaemic mechanism and that any thrombotic vessel lesions occur as secondary end stage pathology; secondly that these features are not simply the consequence of exposure to raised blood pressure but occur secondary to abnormal endothelial integrity, inflammation, abnormal oxidative pathways influencing regulation of vascular tone and low plasma oncotic pressure. Patients with an innate susceptibility to increased blood brain barrier permeability and/or chronic inflammation could therefore have a higher risk of developing small vessel disease pathology and ultimately lacunar stroke and other features of small vessel disease. Research, addressing whether lacunar stroke patients should be treated differently to those with atherothromboembolic stroke is urgently needed.

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Runeson, Sofia, und Lise Ulldahl. „Livet efter stroke : En litteraturöversikt om depression till följd av stroke“. Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-47433.

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Bakgrund: Stroke är något som sker akut och ofta får förödande konsekvenser. Den drabbade förlorar inte sällan sin självständighet och känner sig som en börda för sina närstående. En fjärdedel av alla som drabbas av stroke blir också drabbade av depression. De depressiva symtomen har en negativ inverkan på livskvalitet och rehabilitering. Den förlängda vårdtiden som depression kan leda till innebär ökat lidande för den drabbade samt ökade kostnader för samhället. Syfte: Att beskriva personers upplevelser av depression till följd av stroke. Metod: En litteraturöversikt av nio kvalitativa studier som analyserades utifrån en induktiv ansats. Resultat: Huvudfynden som framkom var i två huvudteman: djup nedstämdhet och emotionella förändringar. Båda temana hade flera underteman. I temat djup nedstämdhet framkom upplevelser av förlust och beroende. I temat emotionella förändringar framkom upplevelser av rädsla, humörsvängningar och sorg. Slutsats: Det är svårt att bedöma om nedstämdheten är konsekvenser av stroke eller om det handlar om depression. Det är viktigt att vårdpersonal har förståelse för detta och arbetar personcentrerat för att på bästa sätt kunna bemöta personen och dennes behov. Mer forskning behövs för att öka kunskapen om depression till följd av stroke och därmed förbättra förutsättningarna för den drabbade personen. Nyckelord: Stroke, depression, omvårdnad, upplevelse, personcentrerad omvårdnad

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Kapral, Moira Kassia. „Sex differences in surgical risk, an analysis of strokes after stroke prevention surgery“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ40713.pdf.

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25

Persson, Rebecka. „Upplevelser av en stroke : En litteraturstudie om personer som drabbats av stroke“. Thesis, Mittuniversitetet, Institutionen för hälsovetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-14670.

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Bakgrund: Ungefär 30 000 människor drabbas varje år av stroke i Sverige och många människor lever i dag med någon form av komplikation. Stroke förändrar livet och många upplever att det är svårt att finna sig tillrätta i sin nya livssituation. Syftet: Syftet med litteraturstudien var att belysa personers upplevelser av att drabbas av stroke samt deras behov av stöd. Metod: Litteraturstudien omfattade 14 vetenskapliga artiklar som har granskas och kvalitetsbedömts. I analysen skapades huvudkategorier; upplevelser och hantering med tillhörande underkategorier. Resultat: Stroke är en omtumlande händelse där många i samband med komplikationer som nedsatt rörlighet och depression upplever en förändrad självbild samt minskad självständighet. Diskussion: För många som drabbas av stroke var det betydelsefullt att känna delaktighet. Delaktighet kan uppnås genom att låta personen själv vara delaktig i sin egen vård. Viktigt är därför att sjukvårdspersonal har kunskap och förståelse för personernas upplevelser. Slutsats: Talsvårigheter skapade för många personer frustration och att samtidigt uppleva att sjukvårdspersonal inte tar en på allvar bevisar att mer forskning inom området krävs för att förbättra personernas upplevelse av att drabbas av stroke.

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Malm, Matilda, und Cajsa Öhrbom. „ATT DRABBAS AV EN STROKE : Patienters upplevelser av vardagen efter en stroke“. Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-26355.

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Bakgrund: Stroke är en cerebrovaskulär sjukdom, en skada i hjärnans blodkärl. Skadan kan förorsakas av antingen en blodpropp eller en blödning. Symtomen när någon drabbats av en stroke är ansiktsförlamning, kroppsförlamning och att språket kan bli otydligt. Tiden är en viktig faktor när någon drabbats av stroke, där en snabbt insatt behandling minskar risken för att få bestående hjärnskador. Att drabbas av en stroke är en högst individuell upplevelse och ett nytt liv med rörelsehinder, talsvårigheter eller förändrad personlighet kan uppstå. Syfte: Syftet med studien var att beskriva vuxna patienters upplevelse av hur vardagen har förändrats efter att ha drabbats av en stroke. Metod: Studien är en litteraturstudie som baseras helt på vetenskapliga och kvalitativa artiklar. De kvalitativa artiklarna tar upp en förståelse för det subjektiva perspektivet vilket svarade an på studiens syfte. En kvalitativ manifest innehållsanalys har använts vid analysarbetet. Resultat: Två huvudteman med underrubriker kom fram ur analysen av de olika artiklarna som studerats. Den nya vardagen och Hantering av den nya vardagen. Utifrån det första huvudtemat växte underkategorier fram, Upplevelsen av minskad fysisk förmåga, Upplevelsen av att vara beroende av andra, Upplevelsen av hur det sociala livet påverkats och Upplevelsen av förändrad identitet. Ur det andra huvudtemat växte underkategorin Strategier för att hantera sin nya situation fram. Slutsats: Den fysiska nedsättningen som stroken medförde förorsakade det största lidandet. Upplevelsen av att vara en börda för familj och vänner var också något som medförde stort lidande. Att ha mål och en strategi var av stor betydelse för livet efter en stroke. Stroke är en individuell upplevelse som medför ett lidande både fysiskt och psykiskt.

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Patel, Mehool Devendrakumar. „Post-stroke impairments : natural history and associations with long-term stroke outcomes“. Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.398047.

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Hendley, Lora L. „Post stroke interpersonal communication| An intimate exploration of stroke survivors' lived experiences“. Thesis, University of Alaska Fairbanks, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10000439.

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This qualitative study explores the personal and intimate lived experiences of stroke survivors who suffer the comorbid emotional sequelae of Post Stroke Depression (PSD) and how it affects their rehabilitation and interpersonal relationships post stroke. By using Uncertainty Reduction Theory (URT), the idea of Social Construction of Identity, the epistemology of Narrative Inquiry (NI), and conversational interviews (CI), with stroke survivors, their spouses/significant others, friends, and other family members, the aim of this body of research has been to take on the difficult task of observing how stroke survivors navigate the difficult and sometimes daunting path that all stroke survivors must travel as they attempt the reconstruction of their self post stroke. They face every new day with the knowledge of who they once were and who they are now. The person that they are now has become their reality.

Many stroke survivors regardless of the hemisphere in which the brain lesion occurs, suffer from some degree of the post stroke emotional sequelae, or a condition following and resulting from a disease, of post stroke depression (PSD). With the comorbid occurrence of PSD comes yet another challenge to their reconstruction process. The findings of this research study have remained consistent with the current research data and literature on stroke, stroke recovery, PSD, and aphasia.

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Ford, Emma Jane. „Quality of life after stroke and aphasia : stroke survivors' and spouses' perspectives“. Thesis, Staffordshire University, 2014. http://eprints.staffs.ac.uk/1997/.

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Having previously worked in research teams investigating the impact of stroke and aphasia upon individuals and spending two years working therapeutically with people with low mood and post-stroke aphasia, a passion for aiding this client group to achieve a good quality of life was developed. Furthermore, completing this work highlighted the paucity of good quality research including this population, despite having learned from personal experience that it was feasible to do so, given that the appropriate adaptations and considerations were made to accommodate communication difficulties. Subsequently, a need for further research regarding quality of life post-stroke and aphasia was acknowledged. An initial review of the existing literature regarding quality of life post-stroke and aphasia was conducted, to determine what was already known, and what remained to be found. The studies identified for review were subjected to evaluation. The outcome of the review suggested that quality of life was a complex, multifaceted concept, impacted by a number of factors, but that it was not possible to determine for certain what factors were important in achieving a good quality of life, primarily due to the methodological limitations of the studies forming the evidence base. Chiefly, the data collection methods used were seemingly inappropriate for people with communication difficulties. Thus it was proposed that the more aphasia friendly, Q methodology approach was utilised to gather the views of people with post-stroke aphasia about what factors were important to achieve a good quality of life. Six aphasic stroke survivors and five spouses completed a Q sort task, in which they were required to rank a number of statements depicting different factors related to quality of life, in terms of personal importance. Spouses did this task from the perspective of the stroke survivor. Ultimately, two factors were identified: ‘returning to the pre-stroke self’ which represented the stroke survivors of working age, and ‘life beyond stroke, what’s important now?’ which reflected the views of the older, retired participants. The two factors were considered in relation to Erikson’s (1968) psychosocial stages of development model and in terms of stroke recovery models (Holbrook, Quality of Life After Stroke and Aphasia 1982; Kirkevold, 2002). Significant, strong and positive pair-wise correlations between the Q sort outcomes of the stroke survivors’ and their respective spouses’ suggested that spouses could reliably report the stroke survivors’ views regarding quality of life. The importance of the findings in relation to the work of a clinical psychologist was subsequently considered.

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Hjelmblink, Finn. „Understanding Life After Stroke“. Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9278.

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Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered.

This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews were analysed through qualitative methods.

Study I was about four survivors who delayed hospital arrival far beyond time limits for trombolytic treatment. The survivors had a strong need for control of body, autonomy and integrity and they demanded to be encountered in consultations as a person by a person. To make them search for emergency evaluation in time might demand an emergency care treating them according to these needs.

In Study II the voice of an aphasic survivor was heard. Because of the damaged language his rehabilitation unilaterally focussed on language training and his need for comprehensive support and planning for the future was not observed. Implementation of a qualitative research method for text analysis adapted to practical use in dialogues with aphasic persons might ensure these survivors an adequate rehabilitation.

Study III showed how time models in narratives helped stroke survivors to overcome uncertainty and recreate narrative coherence in their lives. Professionals can support survivors through revealing and reinforcing the meaning of these models.

Study IV found that the meaning of rehabilitation to stroke survivors was social reintegration. Many probably did not socially reintegrate because their own strategies and subjectively experienced disabilities were unacknowledged in their rehabilitation. Through integrating illness-as-lived perspectives with biomedical perspectives, subjective dysfunctions and rehabilitation strategies of survivors could be acknowledged in stroke rehabilitation.

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Horne, Jane. „Measuring confidence after stroke“. Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/31465/.

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Introduction: Improving confidence following stroke has been cited as a research priority (Pollock et al 2012). It is difficult to measure a change in confidence levels without valid and reliable measures. This research aims to develop and conduct a psychometric evaluation of a self-reported, confidence after stroke measure [CaSM]. Methods: Items were generated from themes highlighted in the literature review, and from a qualitative interview study, exploring the meaning of confidence. The CaSM was piloted with expert groups to establish face and content validity. The CaSM was administered to a sample of stroke and healthy elderly people recruited from the community. Completed postal questionnaires were analysed for reliability (internal consistency and test-retest), construct validity (factor analysis) and convergent validity. A visual analogue scale, to correlate therapists opinion with CaSM scores was used to assess concurrent validity. Sensitivity to change was assessed by comparing change scores at three time points after a confidence intervention. Case vignettes were used with stroke clinical experts to detect a minimal clinically meaningful change score. Results: Stroke (n=101) and healthy elderly participants (n=101) were recruited. Using item reduction techniques, a 53 item scale was reduced to 27 items. Factor Analysis was used to derive a three factor solution, Self-Confidence, Positive Attitude and Social Confidence, which explained 52% of variance. There was good evidence for internal consistency (α=0.94) and good temporal stability (rs=0.85 p=0.001). There was a small positive correlation between the two variables when assessing concurrent validity (rs=0.18, n=31, p<0.34), and did not demonstrate statistical significance. Four points on the CaSM was recommended by clinical experts as being a clinically important change score. Conclusion: The 27 item CaSM [Appendix 1] was shown to be a valid and reliable measure. The CaSM was designed to be used to identify people with low confidence after stroke in order to facilitate appropriate treatment. The CaSM could be used in research, as a patient reported outcome measure to evaluate strategies to improve confidence after a stroke. Assessment of the CaSM’s ability to detect sensitivity to change needs further assessment.

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Cobley, Christine. „Psychological adjustment after stroke“. Thesis, University of Sheffield, 2016. http://etheses.whiterose.ac.uk/14348/.

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The systematic review critically evaluates and synthesises the available literature on the effectiveness of psychotherapeutic interventions targeted at reducing depressive symptomatology following stroke. Studies were identified through electronic database searches using terms related to ‘stroke’, ‘patient’, ‘depression’, ‘intervention’, and ‘trial.’ Thirteen studies were included in the review. The large amount of heterogeneity between the reviewed studies precluded the use of meta-analysis. Nonetheless, the findings support the use of psychotherapy for treatment of post-stroke depression, with behaviour therapy demonstrating beneficial effects. The methodological limitations of the reviewed studies and recommendations for clinical practice and future research are discussed. The research study investigated relationships between mindfulness, coping and psychological outcomes in a stroke population. Using a cross-sectional design, participants (N = 114) completed The Five Facet Mindfulness Questionnaire, The Brief Ways of Coping Questionnaire, The Mental Adjustment to Stroke Scale, The Patient Health Questionnaire-9 and The General Anxiety Disorder Questionnaire-7. Mindfulness explained significant amounts of variance in psychological adjustment to stroke and post-stroke depression and anxiety. Dysfunctional coping was found to mediate the effect of the mindfulness facet ‘acting with awareness’ on the adjustment subscale ‘helplessness/hopelessness.’ This study provides support for the role of mindfulness and coping in recovery following stroke. The clinical implications of these findings are discussed in addition to future research recommendations.

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Stavric, Verna A. „Muscle power after stroke“. AUT University, 2007. http://hdl.handle.net/10292/131.

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Stroke is the leading cause of disability worldwide. It often leads to mobility limitations resulting from deficits in muscle performance. While reduced muscle strength and rate of force production have been reported, little is known about the power generating capability of people after stroke and its relationship to mobility. Research in other populations has found that measures of muscle power may have a greater association with activity performance than do measures of muscle force alone. Consequently, in an attempt to optimise power, investigators have focused on identifying ideal parameters within which to train for power. One such parameter is the identification of the loading level at which maximal power is generated. Literature reporting optimal loads from both young athletic and healthy older populations has yielded mixed results, making the applicability to a hemiparetic population difficult. The purpose of this study was to investigate muscle power performance at differing loads and to determine at what load muscle power is best elicited in hemiparetic and age and gender matched control groups. A secondary aim was to ascertain whether there is a relationship between the muscle power values obtained and activities such as gait, stair climbing and standing from a chair. Twenty nine hemiparetic volunteers and twenty nine age and gender matched controls were evaluated. Involved and uninvolved legs of the stroke group and a comparison leg of the control group underwent testing. Leg press muscle power was measured using a modified supine leg press machine at 30%, 50% and 70% of a one-repetition maximum (1-RM) load. Participants were positioned on the leg press machine and asked to push, with a single leg, as hard and as fast as they could. Data was collected via a mounted force platform and a linear transducer connected to a platform on which the participants lay. From these, power was able to be calculated. The activities were timed while being performed as fast as possible. The results showed that peak muscle power values differed significantly between the involved, uninvolved and control legs. Peak leg power in all three leg groups was greatest when pushing against a load of 30% of 1-RM. Involved leg peak power tested at 30% of 1-RM (Mean:240; SD:145 W) was significantly lower (p<0.05) than the uninvolved leg (Mean:506; SD:243 W). Both the involved and uninvolved legs generated significantly lower peak power (p<0.05) than the control leg (Mean:757; SD:292 W). Correlations were found between the involved leg peak power and gait speed and involved leg peak power and stair climbing (r=0.6-0.7, p<0.05). No correlation was found between paretic leg peak power and chair stands. The control group leg peak power demonstrated significant associations with the performance of all three activities.In summary, there were significant differences between the involved and the uninvolved leg in power production after stroke. As well, there are significant differences between the uninvolved leg and the leg of those not affected by stroke. Power was related to a number of activities.

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Clarke, Philippa J. „Handicap in stroke survivors“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ51554.pdf.

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Aerden, Leo Adrianus Maria. „Diazepam in acute stroke /“. [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Universiteit Maastricht [host], 2006. http://arno.unimaas.nl/show.cgi?fid=5836.

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Laska, Ann Charlotte. „Aphasia in acute stroke /“. Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-195-1/.

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37

Horn, Johanna. „Calcium antagonists in stroke“. [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2001. http://dare.uva.nl/document/58263.

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Bebb, Katie. „Stroke and executive dysfunction“. Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.510413.

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39

Prangnell, Simon. „Psychological distress following stroke“. Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.531938.

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Dorman, Paul Jocob. „Measuring outcome after stroke“. Thesis, University of Newcastle Upon Tyne, 1998. http://hdl.handle.net/10443/1611.

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Stroke is the second most common cause of death worldwide. However stroke is not invariably fatal and survivors may experience major physical, social and psychological problems. The United Kingdom government identified the improvement of the quality of life of stroke survivors as a key objective in the recent "Health of the Nation" consultative document. The concept of health related quality of life has developed over the past few years. Although there is no one universally agreed definition, there are several instruments which claim to measure at least some aspects of health related quality of life. These instruments have not been extensively tested in stroke patients, so the hypothesis which I shall test in this thesis is as follows: that a simple instrument can prove a feasible, valid, reliable, and clinically useful measure of health related quality of life in stroke survivors. I selected a simple measure of health related quality of life (the EuroQol questionnaire) and evaluated its validity in a sample of patients with stroke. A small, but important proportion of patients were unable to complete EuroQol questionnaires either by themselves or by interview, so I investigated whether a proxy (e. g. a spouse or carer) could assess the patient's health status after stroke accurately and without bias. Previous studies comparing one or more different health status instruments did not involve strictly random allocation, so could not provide reliable information on the "best" measure of quality of life to use in stroke patients. I therefore performed a study in a sample of survivors of stroke which directly compared the EuroQol and SF- 36 by using a strict random allocation of questionnaires. It was not possible to compare quantitatively the reliability and validity of the EuroQol and SF-36; however, a qualitative comparison suggested their reliability was similar and they appeared to be sampling broadly the same areas of health. I finally investigated patients' perception of their own quality of life after stroke. The data suggested that many disabled stroke survivors might not view survival in a dependent state as badly as one might expect. This somewhat surprising finding will inform decisions about whether to accept the high risks associated with certain treatments (e. g. thrombolysis) in order to reduce the chances of survival in a dependent state. Assessments of health related quality of life may therefore provide a more comprehensive and relevant view of the patients' outcome than simple measures of disability or impairment.

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Tracey, Fergal. „Glycaemia in acute stroke“. Thesis, Queen's University Belfast, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317452.

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Drummond, Avril. „Leisure rehabilitation after stroke“. Thesis, University of Nottingham, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.359853.

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43

Watson, Margaret. „Depression, personality and stroke“. Thesis, University of Glasgow, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395075.

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44

Fonder, Gregory Paul. „The back stroke buddy“. Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/59702.

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Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2005.
Cataloged from PDF version of thesis.
The objective of this thesis was to study and improve one's own physical intelligence. Through studying bodily movements of people trying to accomplish new tasks, I realized one way to enhance physical intelligence was through teaching devices. My area of expertise in training was swim instruction, as I have been teaching swim lessons for over seven years. The initial problems that new swimmers encounter involve getting accustom to the water, submerging their heads, and floating on their backs. As a swim teacher, one can verbally instruct students through the first two problem areas, but in order to float on one's back, there are methods required to facilitate this skill. The most widely used approach is for a swim teacher to support the back of the student's head and neck with his/her hand and guide the student through the water. The goal of this thesis is to eliminate the need for constant support from a swimming teacher by developing a device which will apply the same teaching technique, yet enable students to learn using this device to swim on their backs without assistance. The apparatus created by following the criteria set forth is aptly named The Back Stroke Buddy. This apparatus consists of three parts - a head support, a neck support, and a base. A swimmer's head will lie in the middle of the base while the head and neck support, which are located below the base, cradle the back of the head and provide support. This device is made out of soft foam which allows it to be robust and one size fits all. While it does meet all the necessary requirements set forth, The Back Stroke Buddy does have other added benefits. This device, due to its durable nature, allows the user to swim into an obstacle such as the wall or a lane line while remaining unscathed. Although this device does enable the swimmer to float on his/her back, the strokes which can be performed while using it are limited because of shoulder interference. Future work on this product involves making The Back Stroke Buddy more conducive to all arm movements, obtaining a patent and producing it large scale to be sold in stores.
by Gregory Paul Fonder.
S.B.

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Hasan, Nazeeha. „Biomarkers for ischaemic stroke“. Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/27254.

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Background: Current diagnostic, prognostic and risk stratification tools are inadequate for effective ischaemic stroke management. Hypothesising that -omics approaches can be used to detect novel candidate biomarkers for ischaemic stroke, this thesis aimed to evaluate the current status of biomarkers for ischaemic stroke and develop strategies for biomarker discovery. Methods: Systematic literature review and individual patient data meta-analyses were performed to assess current candidate biomarkers associated with ischaemic stroke. Proteomic SELDI-TOF MS profiling was undertaken to identify novel blood-based protein biomarkers for the diagnosis of acute ischaemic stroke, consisting of a pilot study and a subsequent well-powered discovery study of 104 patients. In an integrative genomics study, transcriptomics data from carotid endarterectomy samples was combined with a genome-wide association study meta-analysis and subjected to functional enrichment analysis to detect differential gene expression or alternative splicing profiles that may be under the control of a genetic variant. Results: Systematic review and meta-analysis concluded that no current candidate biomarkers could be recommended for routine clinical practice, supporting the pursuit of novel biomarkers for ischaemic stroke and informing the design of subsequent experimental studies. SELDI-TOF MS detected two plasma protein ions, m/z 3699 and m/z 6640, which could differentiate between acute cerebral ischaemia and stroke mimics. Protein ion m/z 6640, identified as ApoC 1, highlighted the role of lipid dysregulation and was postulated to be a novel candidate biomarker for acute cerebral ischaemia. Integrative genomics provided evidence for the genetic regulation of cytoskeletal organisation and extracellular matrix remodelling processes in carotid disease. The LTBP4 gene was found to be a candidate risk biomarker for ischaemic stroke by predicting plaque instability and rupture. Conclusions: This work provides workflows for successful biomarker discovery using innovative -omics approaches, highlights key pathogenic pathways and identifies novel candidate biomarkers for ischaemic stroke diagnosis and risk stratification.

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Richards, Alexandra F. „Sexuality within stroke rehabilitation“. Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12811/.

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Post-stroke sexual difficulties are common but sexuality is an area frequently neglected within stroke rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. This was hoped to improve understanding of why current guidelines around addressing post-stroke sexual issues are not followed, and what would support professionals to meet patients’ needs. Ten healthcare professionals working within stroke rehabilitation were interviewed, covering a range of disciplines and settings. The data was analysed using grounded theory methodology. Fourteen major categories were co-constructed from participants’ data and a theoretical model was developed. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with the sexual concerns of their patients. Concerns were usually addressed through the provision of information and supportive conversation with a professional. Professionals’ own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engaging with sexual concerns. These barriers included environmental factors relating to the context of stroke rehabilitation, professionals’ perception of lacking abilities and unhelpful attitudes towards patients and sexuality. Positive and inclusive attitudes towards sexuality and professional roles and building a strong therapeutic relationship facilitated professionals taking action. The findings are considered in relation to existing guidelines and research, and the clinical implications for rehabilitation and staff training are discussed.

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Luís, Ana Isabel Lopes. „Stem cells and Stroke“. Master's thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/50130.

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48

Nandkumar, Subhash. „Two-stroke linear engine“. Morgantown, W. Va. : [West Virginia University Libraries], 1998. http://etd.wvu.edu/templates/showETD.cfm?recnum=153.

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Thesis (M.S.)--West Virginia University, 1998.
Title from document title page. Document formatted into pages; contains x, 82 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 69-70).

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Stobie, Paula Anna. „Community education on stroke“. Thesis, Montana State University, 2009. http://etd.lib.montana.edu/etd/2009/stobie/StobieP1209.pdf.

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50

Carcel, Cheryl. „Sex differences in stroke“. Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/21164.

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An understanding of sex differences in terms of the risk of disease and its influence on therapeutic interventions can lead to improved disease recognition and treatment for women and men. The overall goal of this thesis was to identify gaps in knowledge in the reporting of sex differences in stroke by using a series of systematic approaches to examine the reporting of sex and gender differences more generally and in stroke. First, in order to determine whether funding agencies and peer-reviewed journals in Australia have policies on the collection, analysis and reporting of sex and gender-specific health data, I performed a qualitative survey utilising web-based searches and interviews. Then I narrowed the focus to stroke where I examined the temporal and regional trends in female participation and the reporting of sex differences in randomised controlled trials identified from ClinicalTrials.gov. Finally, three databases were explored to detect where the sex differences were in stroke: (i) a prospective, population-based cohort study, UK Biobank, was used to identify major risk factors in women and men with stroke; (ii) an individual participant data meta-analysis was performed on five large international stroke randomised controlled trials to examine sex differences in outcome and treatment; and (iii) an Australian cohort study on young stroke survivors was examined for sex differences in returning to unpaid work. The statistical methods used for this work were logistic regression, cox regression and multivariable analysis. Analysing results by sex and gender in medical research is important because this may lead to personalised prevention and treatment strategies. In stroke, researchers need to consider enrolling more women in clinical trials and to report results by sex.

Dissertationen zum Thema „Stroke“

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