Dissertations / Theses on the topic 'Stroke rehabilitation'
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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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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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Colucci, Elisabetta. "Dose in stroke rehabilitation trials." Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/62989/.
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Background: the dose and the length of rehabilitative interventions for optimal motor recovery after stroke are unknown. Dose optimization studies are required as precursors to efficacy trials, but are rarely conducted in stroke rehabilitation research. Objective: to overcome the knowledge gap on appropriate dose and length of rehabilitative interventions guiding the implementation of novel effective approaches to dose optimization in stroke rehabilitation research. Method: two systematic reviews on dose optimization in exercise-based training and pharmaceutical clinical research guided the development of a new approach to dose-finding suitable for physical interventions. The feasibility of a novel phase I 3+3 rule-based, outcome-adaptive dose-finding design was assessed with stroke survivors with moderate upper limb paresis. Moreover, the feasibility of a repetitive assessment procedure to identify the appropriate length of motor interventions was explored in stroke rehabilitation research. Results: the first literature review showed a lack of reliable approaches to dose optimization in exercise-based training. The review of pharmaceutical research highlighted dose optimization “gold” standard approaches, and helped in devising the dose-finding study for physical intervention. The dose-finding study was feasible using the applied model-task intervention. Preliminary explorations on the dose-response relationship were possible indicating a maximum tolerable dose and a potential recommended dose of 209 and 162 repetitions respectively of the applied intervention-task. The repetitive assessment procedure was found feasible in a clinical efficacy stroke rehabilitative trial. The repetitive assessment procedure provided relevant data on the therapy effect over-time showing that more than six weeks of the applied upper limb intervention may be necessary to reach maximal therapy effects. Whereas, five weeks of intervention appeared enough to exploit therapy effects for the lower limb. Conclusions: results are promising on identifying relevant dose and protocol endpoints implementing dose-finding and repetitive assessments approaches in stroke rehabilitation. Further confirmative data are needed to validate these findings.
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Palade, Nicolae. "Autonomous Stroke Rehabilitation with Microsoft Kinect." Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-153659.
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The aim of the work is to design and prototype an autonomous stroke rehabilitation system using the Microsoft Kinect camera that allows patients to undergo their rehab therapy from home without the constant need of specialized staff involvement in the rehab process. The rehab system tracks and computes a set of measurable indicators that reflect the rehab progress. Today, patients that have suffered a stroke usually have to visit specialized centers to perform the rehabilitation program. This proves to be hard for the patients with motion disorders, especially in the northern parts of Sweden with large distances to the closest specialized center. A prototype rehabilitation system for stroke patients has been designed and built. The system is autonomous and does not need constant staff involvement in the rehab process. The system tracks a set of rehabilitation indicators that reflect the patient rehabilitation progress (joint range of motion, reaction time, precision of motion, energy expenditure and training time). The system is constantly monitoring the patient to make sure the exercises are done correctly. Attention has been paid at making the system more engaging and fun by adding some gamification features like providing real time feedback while exercising and by computing the training statistics with personal best indicators and progress meant to increase patient engagement and motivation. At last but not at least, the system has a multimodal interface including audio feedback that makes usage much more intuitive and simple. The system was designed and implemented and tested on regular users. The results prove that the system is able to achieve good results in automating the rehabilitation process and providing
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Burke, James. "Games for upper limb stroke rehabilitation." Thesis, University of Ulster, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.554247.
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Stroke is a major cause of disability worldwide. For rehabilitation to be effective, it must be early, intensive and repetitive. Stroke rehabilitation starts in hospital, where a structured plan of exercise for the stroke survivor is designed and facilitated by a physiotherapist. Once the patient is discharged, however, supervised therapy sessions can be very infrequent and often people with stroke find it difficult to remain motivated and engaged in rehabilitation programmes when in the home environment. New technology, exploiting natural user interfaces, may offer opportunities for people with stroke to engage in home-based, unsupervised rehabilitation. The problems of poor motivation and low levels of engagement may be addressed by embedding design principles of video games, which are often associated with high levels of user engagement, into the solution. The hypothesis of this thesis is through the incorporation of novel input technology and game design theory, game- based rehabilitation solutions can be designed that are usable, playable and engaging for people with stroke. Reviews of the key areas of conventional stroke therapy, natural user interface technology and game design theory have been conducted and, following analysis, consolidated into a novel 'Games for Rehabilitation' (GAMER) framework. The framework is intended to inform the design of usable, playable and engaging games for stroke rehabilitation and has been evaluated through the development of two implementations which support user interaction through two different interface technologies: video capture (2D) and augmented reality (3D). Evaluation of these implementations with able-bodied and stroke participants using a novel user-centred protocol suggest that the GAMER framework can inform the design of usable, playable, engaging games for upper limb stroke rehabilitation in the home.
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Chau, Cheuk-man, and 周卓敏. "Effectiveness of acupuncture in stroke rehabilitation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44525412.
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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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Burton, Christopher Richard. "Therapeutic nursing practice in stroke rehabilitation : the development and evaluation of a therapeutic nursing intervention in stroke rehabilitation." Thesis, University of York, 2002. http://etheses.whiterose.ac.uk/9871/.
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Langan, Jeanne Marie. "Handedness and cortical plasticity in stroke rehabilitation /." view abstract or download file of text, 2006. http://proquest.umi.com/pqdweb?did=1188874021&sid=1&Fmt=2&clientId=11238&RQT=309&VName=PQD.
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Thesis (Ph. D.)--University of Oregon, 2006.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 124-134). Also available for download via the World Wide Web; free to University of Oregon users.
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Sabe, Emelie. "A Haptic Guidance System for Stroke Rehabilitation." Thesis, Linköpings universitet, Institutionen för teknik och naturvetenskap, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-67182.
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Stroke is the third largest cause of death in Sweden. In 2005, 30.000 people in Sweden suffered from a stroke. The consequences of a stroke varies, but the most common disability among stroke survivors is abnormal reaching movements, which is the primer reason for limitations in activities of everyday living. Rehabilitation is essential in order to get back to everyday life. Physical assistance (or guidance) is used in rehabilitation by physiotherapists and occupational therapists to help a patient through a dicult movement for example. Today, this guidance is limited to be performed by medical personnel. With the technology of virtual environments (VE) and haptics – force feedback from a computer – there is a possibility to create guidance which does not need medical personnel. This should be used as a complement to the traditional therapy. The intention of this work is to create an invisible guidance eld, which should guide a patient's hand to a desired movement pattern, i.e. aid the patient to perform a task in a virtual environment with haptics. This guidance is added to an already existing assessment tool, which is a part of the Curictus AB rehabilitation system. The guiding system is implemented using SenseGraphics AB's H3D API. To create the feeling of guidance and a guidance eld, the Volume Haptics Toolkit, developed by Dr. Karljohan Lundin Palmerius at Linköping University, was used. The basic idea of the algorithm is to calculate an orientation vector, for every position, in which direction the guidance should guide the patient. The guidance, which is generated via a haptic device, is adaptive to the patient's movements and always guides the patient towards the target in a smooth trajectory.Stroke är den tredje största dödsorsaken i Sverige. Under år 2005 ck 30.000 svenskar en stroke. Följderna av en stroke kan variera, men vanligast är försämrad rörlighet i en sida av kroppen, vilket också är den främsta orsaken till begränsningar i dagliga aktiviteter för strokepatienter. Rehabilitering är nödvändig för att kunna återkomma till sitt vanliga liv. Fysisk guidning är något som sjukgymnaster och arbetsterapeuter använder sig av i rehabiliteringen för att hjälpa en patient t.ex. genom en svår rörelse. Denna hjälp är något som idag är begränsad till medicinsk personal. Med teknologi som virtuella miljöer och haptik – kraftåterkoppling från en dator – finns det möjligheter att skapa guidning som inte kräver medicinsk personal. Detta ska fungera som ett komplement till den traditionella rehabiliteringen. Avsikten med det här arbetet är att skapa ett osynligt guidningsfält som ska guida en patients hand till ett önskat rörelsemönster, d.v.s. hjälpa patienten att utföra en övning i en virtuell miljö med haptik. Denna guidning ska läggas in i ett redan existerande utvärderingsverktyg, som nns i Curictus ABs rehabiliteringssystem. Guidningssystemet är implementerat i SenseGraphics ABs H3D API. För att skapa känslan av guidning och guidningsfältet användes the Volume Haptics Toolkit, utvecklat av dr. Karljohan Lundin Palmerius vid Linköpings Universitet. Algoritmen är byggd på att för varje position, beräkna en riktningsvektor dit guidningen ska guida patienten via en haptikenhet. Guidningen, som anpassas efter patientens rörelser, guidar hela tiden mot målet i en mjuk rörelsebana.
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Ewan, Louise Michelle. "An observation-based intervention for stroke rehabilitation." Thesis, Manchester Metropolitan University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493101.
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Cognitive-based techniques have been proposed as instruments for use within stroke rehabilitation as a means of promoting recovery from hemiparesis. This thesis explores the theory and practice of using imagery and observation as rehabilitation therapies for individuals affected by stroke and explores the use of an observation-based intervention for stroke rehabilitation. The first study aimed to develop an appropriate tool with which to explore the processes of observation and, in particular, preferred observation perspective.
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Schuster, Corina. "Motor imagery techniques applied in stroke rehabilitation." Thesis, Oxford Brookes University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.579510.
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Background: Motor imagery (MI) has been shown to be beneficial if added to physical practice. It remained unclear, whether M I is effective in patients after stroke, whether MI techniques differ across disciplines, and whether MI can be applied to complex motor tasks (MTs) in patients after stroke. Methods and results: Two systematic reviews were conducted: firstly, to evaluate evidence of MI interventions. Four randomised controlled trials (RCTs) confirmed MI efficacy in patients after stroke if added to therapy. Secondly, characteristics of successful MI training sessions in different disciplines were reviewed. Totally 141 MI interventions were identified in education, medicine, music, psychology, and sports. Information describing 17 MI training elements and 7 temporal parameters were identified and compared. Prior to conducting a pilot RCT, two questionnaires to assess MI ability (KVIQ, Imaprax) were translated with associated validity and reliability testing. The single blinded pilot RCT compared two MI approaches: embedded (n=13) vs. added (N=13) MI vs. a control group (N=14) in patients after stroke. Primary outcome measure was time to perform a complex MT. Results revealed a significant change for all three groups from pre- to post-intervention but no group differences. A qualitative study evaluated MI experiences in patients from experimental groups using semi-structured interviews. Results showed that answers matched to MI framework questions where, when, what, why, and how to use imagery. Conclusions and contributions: MI is still under-researched in stroke rehabilitation. Conducted research showed that MI was beneficial if added to therapy and MI techniques varied across disciplines. Embedded and added MI supported patients similarly and could be applied to a complex MT. MI appeared spontaneously in patients after stroke and was used to practice simple movements. Furthermore, this thesis proposed steps towards consistent term usage and detailed MI intervention reporting, which is lacking in current Ml literature.
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馮美玲 and Mei-ling Fung. "Stroke rehabilitation: predicting LOS and discharge placement." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31970515.
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Koohi, N. "Hearing evaluation and auditory rehabilitation after stroke." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1541214/.
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Stroke can affect all levels of the auditory system (from the inner ear to the central tracts), and may result in various types of auditory dysfunctions, such as peripheral hearing loss (cochlea to auditory nerve), disordered auditory processing (brainstem to cortex), and cortical deafness. Hearing-impaired stroke survivors have an increased risk of physical decline after discharge to the community. This may be attributed to restricted participation in post-acute rehabilitation programs due to the hearing impairment. Furthermore, hearing impairment may have a significant impact on listening, linguistic skills and the overall communication of the affected stroke patient. To date, no studies have sought to systematically characterise the auditory function of stroke patients in detail in order to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful for understanding and addressing the hearing needs of stroke survivors so that appropriate management could be given to these patients in order to improve their quality of life. One of the main aims of this research was to characterise and classify the hearing impairments of stroke patients using a detailed audiological assessment test battery in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. We found that the most common type of hearing impairment in stroke subjects was the combination type, ‘peripheral hearing loss and central auditory processing disorders’, in the older subgroup (in 55%), and auditory processing deficits in the younger subgroup (in 40%). Both types of impairment were significantly higher in these groups than in controls. Offering a comprehensive audiological assessment to all stroke patients would be a costly and time-consuming process. Therefore, a preliminary screening program for such patients needs to be identified, e.g. by means of a questionnaire, so that the full audiological assessment could be reserved for those who fail the initial screening. We aimed to determine whether a handheld hearing screener together with two validated hearing questionnaires could be used as a hearing screening tool to facilitate early identification and appropriate referral of hearing impaired stroke patients in the subacute stage. The highest test accuracy was achieved when results of the handheld hearing screener and hearing questionnaires were combined. Nehzat Koohi PhD Thesis vi Auditory disability due to impaired auditory processing (AP), despite normal puretone thresholds, is common after stroke. However, there are currently no proven remedial interventions for AP deficits in stroke patients. Our study is first to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. Our results demonstrated that FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. We also evaluated the long term benefits for speech reception in noise, after daily ten-week use of personal FMs, in non-aphasic stroke patients with auditory processing deficits. We found that ten weeks of using FM systems by adult stroke patients may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes.
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Vanhook, Patricia M. "Reintegration and Rehabilitation of Women Stroke Survivors." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/7443.
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Fung, Mei-ling. "Stroke rehabilitation : predicting LOS and discharge placement /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25101298.
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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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Daud, Omar Andres. "Haptic Systems for Post-Stroke Rehabilitation: from Virtual Reality to Remote Rehabilitation." Doctoral thesis, Università degli studi di Trento, 2011. https://hdl.handle.net/11572/368278.
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Haptic devices are becoming a common and significant tool in the perspective of robotic neurorehabilitation for motor learning, particularly in post-stroke patients. As a standard approach, this kind of devices are used in a local environment, where the patient interacts with a virtual environment recreated in the computer's screen. In this sense, a general framework for virtual reality based rehabilitation was developed. All the features of the framework, such as the control loop and the external communication, as well as the haptic and graphic rendering, were implemented inside Matlab/Simulink using Handshake proSENSE toolbox, guaranteeing a real-time system. As an example, a five-bar linkage haptic device with two active degrees-of-freedom (DOF) was designed and integrated within the proposed framework, as well as a device for grasping operations.
An extension of this standard approach is verified when the therapist is allowed to feel and interact remotely and in real time with the patient. We applied the proposed concept to a single degree-of-freedom master/slave system.
One hand orthosis was used as a master device at the therapist's side, while the other was applied to the patient's hand, and used as a slave device.
In order to achieve this issue, we proposed two bilateral control systems in order to guarantee an stable interaction between the master and the slave, even in case of variable network conditions (i.e. Internet). By using the master device, the therapist can remotely move the patient's hand and, at the same time, perceive the patient's resistance to the motion, allowing the assessment of important parameters, such as the residual level of spasticity. In this way, it can be remotely assessed the conditions of the patient and consequently can be proposed a proper rehabilitation program.
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Daud, Omar Andres. "Haptic Systems for Post-Stroke Rehabilitation: from Virtual Reality to Remote Rehabilitation." Doctoral thesis, University of Trento, 2011. http://eprints-phd.biblio.unitn.it/488/1/Daud_-_University_of_Trento_-_PhD_Thesis_XXIII_Cycle.pdf.
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Haptic devices are becoming a common and significant tool in the perspective of robotic neurorehabilitation for motor learning, particularly in post-stroke patients. As a standard approach, this kind of devices are used in a local environment, where the patient interacts with a virtual environment recreated in the computer's screen. In this sense, a general framework for virtual reality based rehabilitation was developed. All the features of the framework, such as the control loop and the external communication, as well as the haptic and graphic rendering, were implemented inside Matlab/Simulink using Handshake proSENSE toolbox, guaranteeing a real-time system. As an example, a five-bar linkage haptic device with two active degrees-of-freedom (DOF) was designed and integrated within the proposed framework, as well as a device for grasping operations.
An extension of this standard approach is verified when the therapist is allowed to feel and interact remotely and in real time with the patient. We applied the proposed concept to a single degree-of-freedom master/slave system.
One hand orthosis was used as a master device at the therapist's side, while the other was applied to the patient's hand, and used as a slave device.
In order to achieve this issue, we proposed two bilateral control systems in order to guarantee an stable interaction between the master and the slave, even in case of variable network conditions (i.e. Internet). By using the master device, the therapist can remotely move the patient's hand and, at the same time, perceive the patient's resistance to the motion, allowing the assessment of important parameters, such as the residual level of spasticity. In this way, it can be remotely assessed the conditions of the patient and consequently can be proposed a proper rehabilitation program.
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Vass, Catherine D. "Recovery of arm function after stroke." Thesis, University of Nottingham, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342501.
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Bråndal, Anna. "Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue." Doctoral thesis, Umeå universitet, Medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-120127.
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Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue. Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake. Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity. Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
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Olaoye, Olumide Ayoola. "Determinants of return to work and the development of a return to work programme for stroke survivors in Osun state, Nigeria." University of the Western Cape, 2019. http://hdl.handle.net/11394/6914.
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Philosophiae Doctor - PhDBackground: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.
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McGovern, Alison. "An evaluation of stroke rehabilitation within Greater Manchester." Thesis, University of Salford, 2014. http://usir.salford.ac.uk/30967/.
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This study aimed to evaluate stroke rehabilitation services including the quality of services and the opinions of multiple stakeholders involved in stroke rehabilitation. Several methodologies were employed including a literature review, content analysis of national documents, case note audit and questionnaires of patients, staff and commissioners. The content analysis identified 214 separate recommendations from 15 documents. Of these 21 were relevant to every patient receiving stroke rehabilitation; 13 related to the overall service provision and 8 related to specific aspects of patient care. These recommendations were converted to standards and used to audit the 10 stroke rehabilitation services in Greater Manchester using 100 individual patient records. 146 patients completed a satisfaction questionnaire, 46 staff and 6 commissioners completed questionnaires. Results demonstrated variable compliance to national recommendations with primary stroke centres showing greater adherence than district stroke centres, indicating a two-tier service. All services offered a weekly multidisciplinary team meeting, 93% of patients spent most of their time in hospital on a specialist stroke ward and 96% commenced rehabilitation as soon as they were medically stable. However, only 22% of patients received 45 minutes of therapy per day and 4% received a discharge plan when leaving hospital. Staffing levels did not impact on adherence to national recommendations, however the most long-standing and prominent recommendations achieved greatest compliance. Patients felt that they were treated with dignity, with older patients being more satisfied with stroke rehabilitation services than younger patients. However, patients did not feel that they received enough therapy or information relating to their goals within rehabilitation. Staff felt patients should receive more therapy than they currently do; patients should receive more than 3 hours a day despite currently receiving less than 60 minutes a day. The amount of therapy offered varied across disciplines with speech and language therapists providing less therapy than occupational therapists, physiotherapists and nursing staff. Staff felt the primary factor limiting the amount of therapy was staffing levels. Commissioners' primary priority was to improve the outcomes for stroke patients, however different monitoring mechanisms between localities leads to the potential for different priorities and accountability. This study is the first to systematically compile and evaluate national recommendations within stroke rehabilitation services and to include commissioners in the evaluation of stakeholders’ opinions.
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Clark, Michael S. "Psychological determinants of outcome following rehabilitation from stroke /." Title page, contents and abstract only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09phc594.pdf.
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Dixon, Susan. "Understanding sleep problems in rehabilitation inpatients after stroke." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3646/.
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Background and Purpose: Sleep problems are commonly reported by stroke patients. Poor sleep quality can detrimentally impact upon multiple clinical variables, including mood, physical health, cognition and the rehabilitation process itself. However, the relationship between sleep and stroke is complex and not fully understood. Pre-sleep cognitions and pre-sleep arousal have been proposed as contributing factors in sleep disturbance within the general population and this novel study investigates these variables as potential factors associated with sleep post-stroke. Methods: Stroke rehabilitation inpatients (N=21) were classified as good or poor sleepers using the Pittsburgh Sleep Quality Index (PSQI) and compared using measures of pre-sleep cognitions and pre-sleep arousal; relevant factors including daytime sleepiness, fatigue, mood and environmental disturbance were also explored. Results: Poor sleepers reported a significantly higher level of pre-sleep cognitions, pre-sleep cognitive arousal, fatigue and mood disturbance than good sleepers. The level of daytime sleepiness and perceptions of environmental disturbance did not differ significantly between groups. Conclusions: This study revealed a high level of poor sleep within the current sample (48%) based on the PSQI and pre-sleep cognitions and cognitive arousal appear potentially important factors in sleep quality post-stroke. Theoretical and practical implications and future directions for research are discussed.
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Nabiei, Roozbeh. "Action recognition using instrumented objects for stroke rehabilitation." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7763/.
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Assisting patients to perform activities of daily living (ADLs) is a challenging task for both human and machine. Hence, developing a computer-based rehabilitation system to re-train patients to carry out daily activities is an essential step towards facilitating rehabilitation of stroke patients with apraxia and action disorganization syndrome (AADS). This thesis presents a real-time Hidden Markov Model (HMM) based human activity recognizer, and proposes a technique to reduce the time delay occurred during the decoding stage. Results are reported for complete tea-making trials. In this study, the input features are recorded using sensors attached to the objects involved in the tea making task, plus hand coordinate data captured using Kinect sensor. A coaster of sensors, comprising an accelerometer and three force-sensitive resistors, are packaged in a unit which can be easily attached to the base of an object. A parallel asynchronous set of detectors, each responsible for the detection of one sub-goal in the tea-making task, are used to address challenges arising from overlaps between human actions. In this work HMMs are used to exploit temporal dependencies between actions and emission distributions are modelled by two generative and discriminative modelling techniques namely Gaussian Mixture Models (GMMs) and Deep Neural Networks (DNNs). Our experimental results show that HMM-DNN based systems outperform the GMM-HMM based systems by 18%. The proposed activity recognition system with the modified HMM topology provides a practical solution to the action recognition problem and reduces the time delay by 64% with no loss in accuracy.
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Prashun, Prashant. "Virtual reality based upper extremity stroke rehabilitation system." Thesis, Bournemouth University, 2015. http://eprints.bournemouth.ac.uk/31295/.
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Some studies suggest that the use of Virtual Reality technologies as an assistive technology in combination with conventional therapies can achieve improved results in post stroke rehabilitation. Despite the wealth of ongoing research applied to trying to build a virtual reality based system for upper extremity rehabilitation, there still exists a strong need for a training platform that would provide whole arm rehabilitation. In order to be practical such a system should ideally be low cost (affordable or inexpensive for a common individual or household) and involve minimal therapist involvement. This research outlines some of the applications of virtual reality that have undergone clinical trials with patients suffering from upper extremity functional motor deficits. Furthermore, this thesis presents the design, development, implementation and feasibility testing of a Virtual Reality-based Upper Extremity Stroke Rehabilitation System. Motion sensing technology has been used to capture the real time movement data of the upper extremity and a virtual reality glove has been used to track the flexion/extension of the fingers. A virtual room has been designed with an avatar of the human arm to allow a variety of training tasks to be accomplished. An interface has been established to incorporate the real time data from the hardware to a virtual scene running on a PC. Three different training scenes depicting a real world scenario have been designed. These have been used to analyze the motion patterns of the users while executing the tasks in the virtual environment simulation. A usability study with the healthy volunteers performing the training tasks have been undertaken to study the ease of use, ease of learning and improved motivation in the virtual environment. Moreover this system costing approximately 2725 pounds would provide home based rehabilitation of the whole arm augmenting conventional therapy on a positive level. Statistical analysis of the data and the evaluation studies with the self report methodologies suggests the feasibility of the system for post stroke rehabilitation in home environment.
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Stamatakis, Christopher. "The efficacy of peer support in stroke rehabilitation." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/76796/.
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Aims: Peer support has been incorporated into clinical and national stroke guidelines as an important component of community rehabilitation, yet there is a paucity of research in this area. This study aimed to evaluate the efficacy of a community-based stroke peer support intervention for survivors and carers. Design: Stroke survivors and carers (n=47) were randomly assigned to either a five-week peer support group intervention or a waiting-list comparison condition. Mixed multivariate (MANCOVA) and univariate (ANCOVA / ANOVA) analyses were used to compare mean scores over time on a range of self-report measures. Additionally, mediation analysis was used to explore the processes underlying peer support. Method: All participants completed measures of psychological distress (GHQ-30), perceived social support (Multidimensional Scale of Perceived Social Support), quality of life (EQ-5D-3L) and activities of daily living (Barthel Index). Intervention group participants completed a group process questionnaire (TFI-19). Assessments were completed at baseline, post-intervention (five-weeks) and at follow-up (four-weeks). Due to significant differences between the two groups on the Barthel Index at baseline, these scores were added as a covariate in the MANCOVA and follow-up ANCOVAs used in analysis with the outcome variables (i.e. GHQ-30 and EQ-5D-3L). Results: Participants in the peer support intervention group reported decreased psychological distress and increased perceived social support and quality of life over time. These changes were significantly greater when compared to the control group, over the same time period. Perceived social support was found to mediate the relationship between group condition and psychological distress. Conclusions: Peer support can facilitate improvements in psychosocial wellbeing for stroke survivors and carers. Social support was found to be an important mechanism underlying peer support. Theoretical and clinical implications of peer support in stroke are discussed and recommendations for future research are outlined.
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Shah, Nauman. "Designing motivational games for robot-mediated stroke rehabilitation." Thesis, University of Hertfordshire, 2016. http://hdl.handle.net/2299/17193.
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The repetitive and sometimes mundane nature of conventional rehabilitation therapy provides an ideal opportunity for development of interactive and challenging therapeutic games that have the potential to engage and motivate the players. Different game design techniques can be used to design rehabilitation games that work alongside robotics to provide an augmentative therapy to stroke patients in order to increase their compliance and motivation towards therapy. The strategy we followed to develop such a system was to (i) identify the key design parameters that can influence compliance, prolonged activity, active participation and patient motivation, (ii) use these parameters to design rehabilitation games for robot-mediated stroke-rehabilitation, (iii) investigate the effects of these parameters on motivation and performance of patients undergoing home-based rehabilitation therapy. Three main studies were conducted with healthy subjects and stroke subjects. The first study identified the effects of the design parameters on healthy players' motivation. Using the results from this study, we incorporated the parameters into rehabilitation games, following player-centric iterative design process, which were formatively evaluated during the second study with healthy subjects, stroke patients, and health-care professionals. The final study investigated the research outcomes from use of these games in three patient's homes during a 6 weeks clinical evaluation. In summary, the research undertaken during this PhD successfully identified the design techniques influencing patient motivation and adherence as well as highlighted further important elements that contribute to maintaining therapeutic interaction between patients and the therapy medium, mainly the technological usability and reliability of the system.
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Sonde, Lars. "Rehabilitation after stroke : effects of length of stay and treatments to facilitate motor recovery after stroke /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4730-9/.
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Wade, Tracy Katherine. "Stroke care mapping : a study of the development and application of the dementia care mapping tool in stroke care." Thesis, City University London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340342.
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Cawood, Judy. "Rehabilitation outcomes of uninsured stroke survivors in the Helderberg Basin." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71858.
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Thesis (MPhil)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Introduction: Rehabilitation is recognised as important in helping stroke survivors achieve their highest levels of functional independence and best quality of life. Conversely, a lack of rehabilitation services, and other environmental barriers, can prevent the attainment of optimal levels of functioning and advanced outcomes, such as community integration and employment. Aim of the study: To determine if uninsured stroke survivors living in the Helderberg Basin (Western Cape) reached their optimal rehabilitation outcome levels and if not, what environmental barriers contributed to this. Methods: A descriptive study was conducted. Quantitative data was obtained from 53 participants, who were selected through proportional stratified random sampling. Demographic information and the health status of participants were recorded. Other instruments utilised were the Stroke Impact Scale (SIS3), Modified Barthel Index (MBI), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), language screening test and the ICF Core Set for Stroke (Environmental Factors). Outcome levels were categorised as described by Landrum, Schmidt and McLean, 1995. Data was subjected to statistical analysis. Qualitative data was obtained from five participants, who were chosen by means of purposive sampling. Data were analysed according to predetermined themes. Results: Six (11%) participants were classified as being on rehabilitation level 1; 21 (40%) on level 2; 16 (30%) on level 3; 8 (15%) on level 4; 2 (4%) on level 5. According to the MBI, 65% of participants required assistance with activities of daily living LOTCA scores showed that most difficulty was experienced with tests for visuomotor organization and thinking skills. Participants experienced varying degrees of difficulty with the speech and language test. A mean score of 50.84 for questions related to feelings on the SIS3 is indicative of underlying depression. Stroke survivors received limited physiotherapy and occupational therapy and even less speech therapy and dietary counselling. Occupational therapy had a significant impact on MBI (<0.01) and SIS3.6 (community mobility) (0.02) scores. Six (12%) reported assistance from a social worker. No psychological counselling was reported by any participant. A limited number of assistive devices, focussing mainly on mobility appliances had been issued. Participants regarded the most significant environmental barriers as being lack of assets (89%), transportation (88%) and general social support services, systems and policies (87%). Qualitative data showed a lack of counselling, education and training by health professionals regarding primary and secondary prevention of stroke and rehabilitation. Conclusion: Numerous environmental barriers impacted on the achievement of advanced rehabilitation outcomes. In addition to shortcomings in the primary and secondary prevention of stroke, many of the minimum standards for rehabilitation, as stipulated in the Western Cape Comprehensive Service Plan for the Implementation of Healthcare 2010, were not being met. Recommendations include establishing a designated stroke unit at Helderberg Hospital, ensuring transport, and improving the referral system to existing rehabilitation services. Increased input from core disciplines essential to stroke rehabilitation has the potential to improve outcomes. A concerted effort by health professionals is required in terms of counselling, education and training with regards to primary and secondary prevention of stroke and rehabilitation.
AFRIKAANSE OPSOMMING: Inleiding: Daar word algemeen aanvaar dat rehabilitasie na 'n beroerte uiters belangrik is, want dit kan beroerte oorlewendes help om die hoogste moontlike vlak van onafhanklikheid te bereik. Daarenteen kan‘n gebrek aan rehabilitasiedienste en omgewingsstruikelblokke verhoed dat ‘n oorlewende weer sy volwaardige plek in die samelewing en werksplek inneem. Doel van die projek: Om vas te stel of beroerte oorlewendes, woonagtig in die Helderberg Kom (Weskaap), sonder mediese versekering, wel hulle hoogste vlak van funksionering bereik het, en indien nie, om vas te stel watter omgewingsstruikelblokke bydraende faktore was. Metode: ‘n Beskrywende studie is uitgevoer. Kwantitatiewe data is verkry van 53 deelnemers wat lukraak gekies is deur gestratifiseerde, ewekansige steekproefneming. Demografiese inligting en die gesondheidstatus van deelnemers is aangeteken. Ander toetse wat gebruik is, is die Stroke Impak Skaal (SIS3), Gewysigde Barthel Indeks, Loewenstein Arbeidsterapie Kognitiewe Bepaling (LOTCA), taalsiftingstoets en die ICF kern stel vir beroerte (omgewingsfaktore). Uitkomsvlakke was bepaal, soos beskryf deur Landrum, Schmidt en McClean, 1995. Die data is statisties geanaliseer. Kwalitatiewe data was verkry van vyf deelnemers wat deur middel van doelgerigte steekproeftrekking gekies is. Tydens data analise is voorafbepaalde temas geidentifiseer. Resultate: Ses (11%) deelnemers was geklassifiseer as op rehabilitasie vlak 1; 21 (40%) op vlak 2; 16 (30%) op vlak 3; ag (15%) op vlak 4; twee (4%) op vlak 5. Volgens die MBI het 65% van die deelnemers bystand nodig vir daaglikse aktiwiteite. LOTCA uitslae toon dat die grootste probleme ondervind is met toetse vir visumotoriese organisasie en denkvermoëns. Deelnemers het verskillende grade van probleme ondervind met die spraak en taaltoets. ‘n Gemiddelde telling van 50.84 vir vrae met betrekking tot gevoelens in die SIS3, mag aanduidend wees van onderliggende depressie. Beroerte oorlewendes het min fisioterapie en arbeidsterapie ontvang en nog minder spraakterapie en raad van dieetkundiges. Arbeidsterapie insette het 'n beduidende impak op MBI telling (<0.01) en SIS3.6 (mobiliteit in die gemeenskap) (0.02) gehad. Ses (12%) het aangedui dat hulle hulp van maatskaplike werkers ontvang het. Nie een van die deelnemers het sielkundige berading ontvang nie. Beperkte hoeveelhede en tipes hulpmiddels is uitgereik, en was meesal om mobiliteit te verbeter. Volgens deelnemers was die grootste struikelblokke 'n gebrek aan bates (89%); vervoer (88%) en algemene sosiale ondersteuningsdienste, stelsels en beleid (87%). Kwalitatiewe data het 'n gebrek aan berading, onderrig en opleiding by gesondheidswerkers in terme van primêre en sekondêre voorkoming van beroerte en rehabilitasiedienste getoon.
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Ghazzawi, Andrea E. "Navigating the Stroke Rehabilitation System: A Family Caregiver's Perspective." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23600.
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Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.
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Sampanis, Dimitrios S. "The rehabilitation of motor and cognitive disorders after stroke." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5150/.
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Following a stroke there can be a large range of different deficits, with poor motor function and cognition being particularly important for outcome. Rehabilitation of these deficits is thus an important priority for clinicians. In this thesis, I present 5 experimental chapters aiming to generate cognitive and motor benefits for the stroke survivor. In Chapter 2, prolonged Mirror Therapy was applied to chronic stroke survivors. In Chapter 3, Mirror Therapy was applied in a home based for chronic stroke survivors. In both these Chapters 2 and 3 benefits in unimanual performance of the affected limb and functional improvements of daily activities are being reported. Chapter 4 considered the application of Mirror Therapy to early subacute stroke participants and tested the neural correlates behind any effect. Changes in brain activation within both the ipsi- and contralesional hemispheres were noted. Functional Electrical Stimulation was applied to chronic stroke patients in Chapter 5. Improvements in motor performance were noted, along with the amelioration of visuomotor neglect. Linked changes in activity in the ipsi- and contralesional hemispheres were again noted. Finally, in Chapter 6, Computer Progressive Attention Training was applied in early subacute stroke patients, comparing performance with patients who received no extra intervention. Importantly, the training not only improved the tested functions but also other cognitive processes not targeted in training (e.g., long-term memory). Taken together, the experimental work provides evidence of strategies that can be followed by clinicians to improve functional ability after stroke. In the final chapter the above findings are being discussed together with clinical implications of motor and cognitive rehabilitation approaches.
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Dirske, van Schalkwyk W. "The essence of stroke rehabilitation experience across two settings." Thesis, Liverpool John Moores University, 2007. http://researchonline.ljmu.ac.uk/5828/.
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The present research used van Manen's application of hermeneutic phenomenology as philosophy and method to explore stroke rehabilitation experience across two different settings, i.e. (i) a conventional setting (National Health Service or NHS stroke unit) and (ii) an unconventional setting (Conductive Education or CE). Interviews, observations and reflective diaries were used to collect data on 24 volunteering stroke patients' experiences. High levels of dis empowerment and negative images of self as well as the nature of motivation were indicated to be thematic of stroke rehabilitation experience in the stroke unit. In the CE setting stroke rehabilitation experience was characterised by increased selfconfidence, unconditional positive regard from conductors, challenging activities and body-half integration. A juxtaposition of stroke rehabilitation experience in the CE setting with stroke rehabilitation experience in the NHS stroke unit brought to light an important difference between the physical body-split caused by stroke, and a much wider and deeper disintegration of being. The juxtaposition further indicated that (i) the approach used in the NHS stroke unit is biomedical in spite of the presence of a multi-disciplinary team, and (ii) that the one adopted by CE is a person-centred approach characterised by holistic principles, with an overall focus on mobility. A reflective evaluation of this hermeneutic phenomenological study ensues, including a discussion on the difference between person-centredness and holism. The better understanding gained regarding stroke rehabilitation experience across the two settings was then used to make recommendations regarding what could constitute a holistic approach to stroke rehabilitation. Finally, the researcher's experience of 'being-immersed' in others' lived experiences was discussed in order to illustrate the holistic effect the research process had on the researcher's well-being, and the development of a tool which addresses researcher emotions holistically is also presented.
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Doyle, Louise A. "The effect of family support systems on stroke rehabilitation /." Staten Island, N.Y. : [s.n.], 1987. http://library.wagner.edu/theses/nursing/1987/thesis_nur_1987_doyle_effec.pdf.
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Staccini, Laura <1982>. "Psychosocial correlates of rehabilitation from stroke: a longitudinal study." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amsdottorato.unibo.it/6897/1/Staccini_Laura_tesi.pdf.
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The general aim of this dissertation was to uncover the association between psychosocial factors and rehabilitation outcome after stroke. METHOD. A sample of patients with stroke (n=40) and their caregivers (n=36) were assessed at admission to and six months after discharge from rehabilitation hospital, using the following instruments: Structured Clinical Interview for DSM-IV, structured interview based on Diagnostic Criteria for Psychosomatic Research, Symptom Questionnaire, Psychosocial Index, Psychological Well-Being Scales, and Family Assessment Device. 40 subjects from the general population underwent the same psychological assessment. In addition, patients' functional status was measured using the Functional Independence Measure. RESULTS. Stroke survivors reported lower education and higher alcohol consumption than controls. No significant differences emerged between the two groups in the prevalence of psychiatric diagnoses or psychosomatic syndromes, however patients reported significantly higher levels of anxiety, depression, somatic symptoms, and lower autonomy than controls. Caregivers reported significantly higher scores in anxiety, depression, and somatic symptoms compared to normative data, while no impairments emerged in psychological well-being and family functioning. At six-month follow-up, in patients a significant decrease in smoking habit and an increase in DSM diagnoses were reported. Both stroke survivors and caregivers showed significant reductions in anxiety, with patients displaying also a decrease in somatic symptoms, an increase in stress and a deterioration in quality of life. Significant deteriorations in several aspects of family functioning was perceived only by patients. An association between patients' functional recovery in the cognitive domain and family behavior control emerged. For caregivers, family functioning significantly predicted hostility and somatic symptoms were associated with family affective involvement. CONCLUSIONS. These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation, in order to development interventions properly targeted to the characteristics of patients and their family members.
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Staccini, Laura <1982>. "Psychosocial correlates of rehabilitation from stroke: a longitudinal study." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amsdottorato.unibo.it/6897/.
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The general aim of this dissertation was to uncover the association between psychosocial factors and rehabilitation outcome after stroke. METHOD. A sample of patients with stroke (n=40) and their caregivers (n=36) were assessed at admission to and six months after discharge from rehabilitation hospital, using the following instruments: Structured Clinical Interview for DSM-IV, structured interview based on Diagnostic Criteria for Psychosomatic Research, Symptom Questionnaire, Psychosocial Index, Psychological Well-Being Scales, and Family Assessment Device. 40 subjects from the general population underwent the same psychological assessment. In addition, patients' functional status was measured using the Functional Independence Measure. RESULTS. Stroke survivors reported lower education and higher alcohol consumption than controls. No significant differences emerged between the two groups in the prevalence of psychiatric diagnoses or psychosomatic syndromes, however patients reported significantly higher levels of anxiety, depression, somatic symptoms, and lower autonomy than controls. Caregivers reported significantly higher scores in anxiety, depression, and somatic symptoms compared to normative data, while no impairments emerged in psychological well-being and family functioning. At six-month follow-up, in patients a significant decrease in smoking habit and an increase in DSM diagnoses were reported. Both stroke survivors and caregivers showed significant reductions in anxiety, with patients displaying also a decrease in somatic symptoms, an increase in stress and a deterioration in quality of life. Significant deteriorations in several aspects of family functioning was perceived only by patients. An association between patients' functional recovery in the cognitive domain and family behavior control emerged. For caregivers, family functioning significantly predicted hostility and somatic symptoms were associated with family affective involvement. CONCLUSIONS. These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation, in order to development interventions properly targeted to the characteristics of patients and their family members.
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Hassan, Soelaylah A. M. "The impact of stroke on the primary caregiver." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/3387.
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MPhil (Rehabilitation)Thesis (MPhil (Interdisciplinary Health Sciences))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: A stroke comes suddenly and has a devastating effect on the lives of the patient and the caregiver. It is disabling and often leaves the patient dependent on care. Providing this care can put tremendous physical, emotional, social and financial demands on the caregiver. The purpose of the study is to determine the impact of caregiving on the primary caregivers of patients who suffered a stroke and were admitted to the Western Cape Rehabilitation Centre (WCRC), for intensive rehabilitation during 2006. This is a descriptive study that utilised both quantitative and qualitative methods of data collection. Quantitative data were collected through two data coding forms, one for caregivers and one for patients, the Bartel Index, the Caregiver Strain Index (CSI) and the Satisfaction With Life Scale (SWLS). Qualitative data were collected through indepth interviews with caregivers. Fifty-seven caregivers participated in the study. According to CSI findings 58% of caregivers were under levels of strain high enough to require support and intervention. The SWLS indicated that the life areas most adversely affected were employment and self and social life. Loss of employment by the caregiver (p = 0.04) and financial difficulties (p = 0.06), cognitive and perceptual problems (p = 0.01), personality changes (p = 0.01), level of physical dependency of patient (0.0012) and nervous strain experienced by the caregiver (0.01) were found to significantly impact on caregiver strain. Caregivers perceived their caregiving duties as overwhelming and a great strain. This was aggravated in some instances by poor health care service delivery at the time of the stroke, no or inadequate explanations on stroke, poor or no training of caregivers, no home visits and a lack of follow-up services in the community. They experienced the period just after discharge as especially challenging and required support, assistance and guidance at that time. Caregivers identified a need for community rehabilitation facilities, adult day care centres, outpatient rehabilitation services, home-based nursing care and caregiver support groups in the community.
AFRIKAANSE OPSOMMING: ’n Beroerte gebeur skielik en sonder enige waarskuwing met ’n vernietigende uitwerking op die lewens van die pasiënt asook die versorger. Dit veroorsaak gestremdheid en laat dikwels die pasiënt afhanklik van sorg. Die voorsiening van hierdie sorg kan erge fisiese, emosionele, sosiale en finansiele eise aan die versorger stel. Die doel van die navorsing is om die impak van versorging op die primêre versorger van beroerte pasiënte, wat gedurende 2006 intensiewe rehabilitasie by WKRS ontvang het, te ondersoek. Dit is ’n beskrywende studie wat gebruik gemaak het van beide kwantitatiewe en kwalitatiewe metodes om data in te samel. Kwantitatiewe data was verkry deur twee datakoderingsvorms, een vir pasiente en een vir versorgers, die Bartel Index, die Caregiver Strain Index (CSI) en die Satisfaction With Life Scale (SWLS). In diepte onderhoude was gevoer met versorgers om kwalitatiewe data te verkry. Sewe en vygtig versorgers het aan die studie deelgeneem. Bevindinge van die CSI dui daarop dat 58% van versorgers hoë vlakke van spanning ervaar en ondersteuning sowel as intervensie benodig. Volgens die SWLS was die areas wat die ernstigste be-invloed was werk en eie en sosiale lewe. Die volgende areas het volgens resulate ’n statisties beduidende impak op die spanning wat versorgers ervaar het gehad: finansiële spanning en verlies van werk (p = 0.04), in gevalle waar pasiente persoonlikheids veranderinge ondergaan het (p = 0.01) of kognitiewe en perseptuale skade oorgehou het (p = 0.01) na die beroerte en die emosionele impak van versorging (p = 0.01). Versorgers het hulle versorgings take as oorweldigend en as ’n bron van groot spanning gesien. Dit is in sommige gevalle vererger deur swak ondersteuning van gesondheidssorgdienste direk na die beroerte, geen of swak verduidelikings oor wat ’n beroerte is, geen of swak opleiding aan versorgers, geen tuisbesoeke en ’n tekort aan opvolg dienste in die gemeenskap. Die tydperk direk na ontslag uit die rehabilitasie sentrum was besonder uitdagend en hulle het ondersteuning, hulp en leiding nodig in daardie tyd. Swak ondersteuning en ’n tekort aan of afwesigheid van hulpbronne in die gemeenskap het die situasie vererger. Versorgers het ’n behoefte aan gemeensskapsrehabilitasie fasiliteite, volwasse dagsorg sentrums, buite patiënte rehabilitasie dienste, tuis verpleegsorg en ondersteuningsgroepe uitgespreek.
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Dennis, Diane. "Exploring different models of stroke unit care and outcome : the Stroke Rehabilitation Outcome (SRO) study." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/2093.
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Introduction: Stroke is a significant cardiovascular event requiring sub-acute rehabilitation, best provided in a stroke unit (SU). These units include dedicated neurological SUs usually catering only for patients with stroke and more generic SUs existing within geriatric rehabilitation units (GRUs). There exists a "grey" group of survivors of stroke whose allocation to one type of rehabilitation facility over another is arbitrary, in that the referring physician had no evidence to suggest advantages of SU versus GRU rehabilitation.Objectives: The aim of this inception cohort study was to provide a direct comparison of quality of life and functional outcome between two commonly applied models of organised multidisciplinary SU rehabilitation for the "grey" group of stroke survivors. Further, it evaluated differences in the intensity of treatment and the environment in which rehabilitation was implemented.Method:All patients presenting to Royal Perth Hospital-Wellington Street Campus acute stroke unit (RPH-WSC ASU) with a diagnosis of recent stroke requiring hospitalisation and subacute rehabilitation were considered for inclusion into the study. Patients were selected based on their age, absence of dementia and their acceptance by incumbent medical staff for rehabilitation transfer at either Royal Perth Hospital-Shenton Park Campus stroke unit (SPC SU) or at a GRU geographically closest to their home (located at either Mercy hospital, Bentley hospital or Swan health campus).Baseline data was collected in order to establish the underlying level of disability and compare groups for comparability, and also to be used as covariates in data analysis.All treatments received were those considered standard for the individual facility, administered as usual by registered health professionals. During the study, periodic behaviour mapping at each of the study facilities was undertaken by a research assistant in order to quantify differences in the rehabilitation environment. In addition, attending therapists at each facility recorded the frequency and duration of their intervention with individual patients involved in the study in a patient diary designed for that purpose. Six and twelve months following their transfer from RPH-WSC ASU, patients attended follow-up outpatient appointments at neutral rooms where objective and subjective assessments were undertaken by an independent assessor (a physiotherapist) who was blinded as to which rehabilitation facility the patient had attended. The primary outcome measure was the MOS 36-Item Short Form Health Survey (SF-36) and secondary outcome measures included the Functional Independence Measure (FIM) and other functional measures.Results: Between July 2004 and June 2007, 354 patients with stroke were age appropriate (60 years of age or older) for recruitment into the study and of these, 94 consented to participate (SPC SU n=22; GRUs n=72). Patients referred to SPC SU were younger, more likely to be male, and have speech abnormality, peripheral vascular disease and diabetes than those referred to GRUs. Otherwise there were no significant differences between groups in any of the characteristics measured at baseline. Rehabilitation data demonstrated a significant difference in both the total allied health professional (AHP) therapy time (p<0.001) and the indirect support time such as telephone calls and meetings with family (p=0.022), with SPC SU therapists utilising more time compared with GRU therapists. There was no significant difference in time spent undertaking administration including writing notes and reports (p=0.957). Data showed significant difference in length of stay (LOS), whereby patients spent a longer time at SPC SU (p=0.036), however there was no significant difference in discharge destination between facilities (p=0.312). Of the 10 unadjusted patient measures in this study, there were significant differences between groups in only two, the Berg balance score and the Chedoke McMaster posture inventory. The differences in both of these secondary outcomes favoured the SPC SU group. In addition there were differences in the SF36 Mental component summary (MCS) and Physical component summary (PCS) scores that approached significance. The difference in the PCS scores also favoured the SPC SU group but for the MCS score it was the GRU group that had more favourable scores.As the study was not randomized, age and gender, which differed between groups at baseline, and Barthel Index score, known to be associated with length of stay in stroke patients, were added to the models as covariates. As data from 6 and 12 month follow-ups was included in the dependent variable, "visit" was added to the models. After these adjustments there were no significant differences between facilities in any quality of life or functional outcomes.Discussion:Overall there was relatively high quality of life, and low anxiety and depression reported and results were not influenced by where rehabilitation took place. Selection criteria excluding dementia and young age may in part explain this, as both have been found to predict worse quality of life outcome in stroke. Significant differences in both where patients were, and what they were doing throughout the day reflected different ethos between facilities in the way rehabilitation was delivered. However, there was no difference in functional outcome despite these environmental differences and the fact that patients experienced more intensive treatment over a more prolonged hospital stay at SPC SU.Conclusion:In most cases, rehabilitation of this "grey" subgroup of the wider population of stroke may be more cost-effective if carried out at GRUs (with higher patient/ staff ratios, less intensive treatment and shorter LOS) rather than the neurological SUs.
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Mapulanga, Miriam. "Exploration and determination of the process of care of stroke in Zambia." University of the Western Cape, 2016. http://hdl.handle.net/11394/4976.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Zambia is undergoing epidemiological changes from communicable diseases to NCDs as a result of demographic transition and hence Stroke is an emerging NCD in the country. The process of care of stroke in Zambia as country is unknown. Exploring the process of care of stroke in Zambia, could help understand the gaps in service delivery thereby helping to create interventions to improve stroke service delivery. The purpose of this study was to determine and explore the process of care of stroke in Zambia. As there is no information regarding stroke care in Zambia, the study aimed to explore and determine the process of care and explore the conditions under which diagnosis and management of stroke is done in Zambia and are the factors influencing stroke diagnosis and management in Zambia. The study was conducted in Zambia’s five general hospitals which were selected conveniently. The study consisted of both quantitative and qualitative methods. The quantitative part consisted of stroke patients’ medical records reviews, who were admitted to general hospitals between 1st January to 3oth October 2014. A sample of 80 medical records was selected randomly from each general hospital, making the total of 400 medical records from all the hospitals. Data was collected using a checklist which was specifically design for the study after literature review and contained stroke care processes including diagnosis, medical management, rehabilitation, lifestyle management and community linkage. Analysis of quantitative data was done using Statistical Package for Social Science (SPSS) version 22. The qualitative part consisted of individual in-depth interviews with a purposefully selected sample of three health workers from each hospital making 15 health workers. The in-depth interviews were based on predetermined themes including staffing levels, multidisciplinary team action, treatment guidelines, clinical capacity, planning and budgeting and technical environment. All the interviews were audio-taped, transcribed verbatim and the predetermined themes were analysed using content analysis. Ethical clearance to conduct the study was obtained from the University of the Western Cape Faculty Board Research and Ethics Committees and Senate Research Committee and ERES Converge in Zambia. Permission to conduct the study in Zambia was obtained from the Ministry of Health, Zambia. Informed consent was obtained from the health workers who took part in the study. The study found that the stroke process of care in Zambia ranged from diagnosis through to physical rehabilitation and lifestyle management. The stroke process of care was challenged in the area of diagnosis using biochemistry, haematology, CT scan, MRI and Angiography etc. The process of care in rehabilitation was challenged by lack of gadgets and space to use in rehabilitation. Community linkage, speech therapy and social welfares services were not part of the stroke process of care in Zambia as the study as established. Staff shortages, busy schedules, no treatment guidelines, poor clinical capacity, lack of resources and poor technical environment impacted negatively on the stroke process of care according to this study. Diagnosis and management of stroke was made with no treatment guidelines, poor clinical capacity and poor technical environment. The same were the factors which were influencing diagnosis and management namely staff shortages, no multidisciplinary teams due to busy schedules of health workers, lack of treatment guidelines, poor clinical capacity by health workers, lack of resources for stroke and poor technical environment. Using the Chi-square association of variables, the study showed that CT scan was associated with definitive diagnosis with the p-value of 0.000. Equally, Chi-Square test showed that Diagnosis was not associated with medical management (p value=0.058).
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Pugliese, Michael. "Mobile Tablet-Based Stroke Rehabilitation in the Acute Care Setting." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/37016.
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Introduction: The number of stroke survivors living with post-stroke deficits is increasing worldwide. Although stroke rehabilitation can improve these deficits and promote the recovery of function when initiated early post-stroke, many survivors are not able to access rehabilitation because of a lack of resources. Early mobile tablet-based stroke rehabilitation may be a feasible means of improving access to recovery promoting therapies.
Objective: To summarize and advance the knowledge of early mobile tablet-based therapies (MTBTs) for stroke survivors with regards to feasibility and barriers to care.
Methods: This thesis is comprised of two major studies. (1) A scoping review summarizing the literature for MTBTs following stroke. (2) A cohort study testing the feasibility of a MTBT for post-stroke communication, cognitive, and fine-motor deficits.
Results: (1) Twenty-three studies of MTBTs following stroke were identified. Most of these therapies targeted communication or fine-motor deficits, and involved patients in the chronic stages of stroke. Barriers to care were summarized. (2) A 48% recruitment rate was achieved and therapy was administered a median of four days post-stroke. However, therapy adherence was very low because of frequently encountered barriers to care.
Conclusions: Stroke survivors are interested in using tablet technology to assist with their post-stroke recovery. However, early MTBT post-stroke may be challenging for some survivors because of encountered barriers to care. Regular patient-therapist communication using a convenient method of interaction appears necessary to minimize barriers and to help patients overcome barriers when they occur.
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White, Gregory Nicholas Clinical School South Western Sydney Faculty of Medicine UNSW. "Pilot reliability and validity of the stroke rehabilitation motivation scale." Awarded by:University of New South Wales. Clinical School - South Western Sydney, 2010. http://handle.unsw.edu.au/1959.4/44814.
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Aims This study aimed to demonstrate reliability and validity of the Stroke Rehabilitation Motivation Scale, a novel instrument designed to assess internal and external contributions to motivation. Many studies recognise motivation, in the everyday sense, as a factor affecting stroke rehabilitation, but there is no standard measure. There is also no agreement as to whether motivation in the post-stroke period is the same as the absence of depression, anxiety or stress; hence the need for an independent measure of motivation. Method The Stroke Rehabilitation Motivation Scale was adapted from the 28-item Sports Motivation Scale, which in turn was developed according to the intrinsic and extrinsic contributions to motivation identified by Self-Determination Theory. The resulting Stroke Rehabilitation Motivation Scale was tested in two stages. In the 28-item reliability stage, in a sample of 18 stroke patients from the stroke ward of Bankstown-Lidcombe Hospital, the scale was tested for Inter-rater reliability, scale reliability, and validity via comparison of high vs. low motivation groups according to a novel ???motivation score???. The scale was shortened from 28-items (four per subscale) to 7 items (one per subscale) by selecting the most reliable items. The three intrinsic and extrinsic subscales were summed and averaged, and the amotivation score was subtracted from this to produce a ???motivation score???, such that a person with a positive score had more motivation, either extrinsic or intrinsic, than they had amotivation. e.g. [ ( E + I )/2 ??? A ] In the 7-item reliability stage, a further 13 patients were recruited from Bankstown-Lidcombe and Liverpool Hospitals. The 7-item scale was tested for scale reliability, and for validity by comparison of high vs. low motivation groups as well as correlations between motivation score, anxiety, depression and stress, and rehabilitation outcomes. Results In both the 28-item and 7-item stages the scale demonstrated adequate to very good reliability. There was a lack of significant mean differences or correlations to demonstrate validity in either stage; this study does not represent a convincing demonstration of validity of the SRMS. However, it would appear that motivation is conceptually distinct from depression, anxiety and stress, and the scale definitely warrants further testing in a larger sample.
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Basobas, Brittani A. "Psychometric Properties of the National Institutes of Health Stroke Scale in Post Acute, Minimally Impaired Stroke Survivors." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1460457853.
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Smith, Melissa. "The experiences and perceptions of individuals with stroke about the usefulness of the model of occupational self efficacy in a rural setting." University of the Western Cape, 2019. http://hdl.handle.net/11394/6923.
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Magister Scientiae (Occupational Therapy) - MSc(OT)Individuals diagnosed with stroke particularly in rural communities have a poor return to work rate. Vocational rehabilitation has been used as an intervention strategy with various types of clients with disability or injury in order to improve their work skills. The aim of the proposed study is to describe the experiences and perceptions of individuals diagnosed with stroke about the usefulness of the Model of Occupational Self Efficacy in assisting them in returning to their worker role particularly in a rural setting. Eight participants were purposively selected from the data base of a local hospital and semi structured interviews were conducted with the participants until saturation occurred. Furthermore, two focus groups were conducted with eight participants. A key informant was also interviewed to assist the researcher with a different perspective and to avoid bias. The data was analysed by means of thematic analysis into codes, categories and themes. Trustworthiness was ensured by means of credibility, applicability, transferability and conformability. Informed consent and confidentiality was ensured. Permission was obtained from the UWC research committee and from the Department of Health. Four themes were merged from the findings: Theme one: Obstacles which affects the return to work of CVA Participants in a rural community. Theme two: Establishing a strong belief in functional ability through occupation. Theme three: Adaptation strategies that enhances the work participation of stroke survivors in a rural community. Finally Theme four: The MOOSE enables transition to the worker role in a rural context. The findings revealed that the participants experienced a loss of their former self thus affecting their worker identity as they were no longer able to experience the gratification of fulfilling their worker role. This was due to the participants not being aware of the return to work options that they had. After the stroke the participants battled with not only overcoming their condition but also the stigma which the community and their employers had of stroke. Overcoming the stroke event and returning to work required that potential barriers and facilitators be identified by the participants and the researcher. The study also identified adaptation strategies that the participants utilised in order to overcome the barriers and assist the participants to have a smoother transition into the workplace. In conclusion the findings of the study revealed that the participants suffer a loss of their former abilities and undergo a loss of their self-esteem. As a result of the loss, participants struggled to return to work not only due to their loss of abilities but also their lack of knowledge regarding return to work and stroke. The findings indicated that there should be more education regarding the stroke that needs to be conducted in communities via media such as local newspapers, local radio stations, clinics and hospitals. The findings of the study may assist Occupational Therapy practitioners to improve services in a rural community for stroke survivors and improve the facilitation of the return to work process after stroke. The MOOSE facilitates motivation for participants to regain their self-esteem and thus move forward to resume a worker role.
2020-08-31
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陸慧霞 and Wai-ha Veronica Luk. "Evidence-based DVT prophylactic guideline for stroke and neurosurgicalpatients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251419.
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De, la Cornillere Wendy-Lynne. "Participants’ experience of the Bishop Lavis Rehabilitation Centre stroke group." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/1695.
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Thesis (MPhil (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--University of Stellenbosch, 2007.Current emphasis for rehabilitation in South Africa remains on individual intervention within the move towards primary health care. Primary health care is the strategy that has been adopted by the South African department of health to bring access and equity in health care services. Even so, the burden of providing effective rehabilitative services with limited resources requires innovative strategies, such as the use of therapeutic groups, to address certain aspects of rehabilitation. These strategies must be proven effective. There is a paucity of literature detailing the uses of group therapy in physical rehabilitation, and particularly the use of interdisciplinary group work in stroke rehabilitation. Furthermore, evidence shows that stroke survivors feel ill equipped to return to their communities despite rehabilitation. Stroke is a major cause of death and disability in South Africa, and is a condition shown to benefit from rehabilitation. These factors led to the selection of the Bishop Lavis Rehabilitation Centre stroke group as the setting for this study, which aims to describe the range of experiences relating to attendance or non-attendance of those referred to this programme. This descriptive study, employing quantitative means (to describe the demographic details of the participants) and qualitative means (to describe the experiences of participants), was conducted with twenty participants. Data was collected by means of an administered questionnaire. Following that, a focus group discussion involving six participants was used to gather in-depth information. Quantitative data was analysed with the assistance of a statistician, utilising the computer program, Statistica. The Chi-Squared, Kruskal-Wallis and ANOVA tests were used, with p>0.05 showing statistical significance. Qualitative data was thematically analysed, whereby data was categorised by means of an inductive approach. The study population consisted of 20 participants, with an average age of 59 years, of whom 15 were female and five male. The stroke group provided meaning to participants on two levels. On a psychosocial level, the phenomena of universality (identifying with others in a similar position), development of socialising techniques, imparting information and cohesiveness emerged strongly. On the level of meaning related to stroke recovery, improvement in ability to execute activities of daily living, mobility and strength were most frequently mentioned. Transportation issues were most commonly mentioned as factors negatively influencing attendance. Staff attitude and activities of the programme were most often cited as positive factors. Given the positive response of study participants, and the programme’s ability to sustain intervention with limited resources, it was concluded that this programme has a valid place within stroke rehabilitation in Bishop Lavis. Recommendations in terms of the group programme included investigating methods of providing transportation, providing childcare facilities and expanding the content of educational sessions. Further recommendations were to maintain the positive attitude of staff and the current activities of the programme. Frequency of group outings should also be increased and compensatory strategies for inclement weather must be explored.
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Layfield, Claire Alexandra. "Applying Principles of Motor Learning in Dysphagia Rehabilitation." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29907.
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Dysphagia or difficulty swallowing can be the consequence of numerous neurological and medical conditions. In mild forms individuals may be restricted in the types of foods and liquids they are able to consume, in its most severe form individuals are unable to consume any food or liquid orally and depend on direct nutrition to the stomach via a feeding tube. Dysphagia is associated with multiple adverse health outcomes including pulmonary complications, dehydration and malnutrition. Furthermore, the psychosocial impact of dysphagia is devastating. In most cultures, socializing with friends and family frequently involves enjoying a shared meal or drink and celebrations and holidays often have an accompanying feast.
Swallowing is complex movement involving both volitional and reflexive components. Our understanding of the neural underpinnings of swallowing continues to evolve. Alongside this, our understanding of the motor control of swallowing is augmented. A related concept to motor control, is motor learning which refers to the mechanism underlying the ability to develop skilled movements. The role of motor learning has primarily been studied in neurologically intact individuals. Its application to rehabilitation has gained traction across allied health disciplines. In speech pathology, it has been explored most thouroughly in Motor Speech Disorders. Emerging evidence is arising in the clinical practice area of voice. The role of motor control and motor learning for swallowing and dysphagia rehabilitation has been recognised. To date, no research prospectively designing an intervention program grounded in principles of motor learning is available.
The overarching goal of this doctoral research program was to evaluate the potential benefit of applying the Principles of Motor Learning to dysphagia rehabilitation. In achieving this, an important objective was to present a multifaceted perspective on the current status of dysphagia rehabilitation and draw together conceptual, empirical, clinical and patient perspectives. This research program is motivated in clinical practice so translational research findings are paramount to its inception, development, implementation and dissemination.
Review the status of motor control for complex movements like swallowing and the implications of motor learning in neurologically injured populations. (Chapter 1)
Present a clinically oriented evidence-based review of intervention options for severe dysphagia following brainstem stroke. This chapter reports an evidence based response to a case based scenario based on the first participant in this study. (Chapter 2)
Review the literature investigating behavioural intervention for post stroke dysphagia through the lens of motor learning.(Chapter 3)
Develop an intervention protocol grounded in the practice and feedback principles of motor learning. (Chapter 4)
Report on outcomes of the intervention protocol using single case experimental design methodology to evaluate efficacy. (Chapter 5)
Interview and thematically analyse the perspectives of stroke survivors with chronic dysphagia who have completed the research led intervention program. (Chapter 6)
From this multifaceted perspective future directions and clinical implications are recommended.
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Bakken, Annika, and Morine Kalulanga. "Delaktighet vid rehabilitering i hemmet för personer med stroke : - en litteraturstudie." Thesis, Örebro University, School of Health and Medical Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-10787.
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Syfte: Att belysa hur faktorer inom områdena person, miljö och sysselsättning kan påverka delaktigheten hos personer med stroke vid rehabilitering i hemmet.
Metod: Genom en litteraturstudie har tio vetenskapliga artiklar av kvalitativa och kvantitativ art analyserats utifrån Internationell klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) och Person Environment Occupation Model (PEO).
Resultat: Resultatet visade att vårdtagare som rehabiliterats i sin hemmiljö upplever mer delaktig i rehabiliteringen i jämförelse med vårdtagare som har genomgått sin rehabilitering på sjukhus. Betydelsefulla faktorer till den ökade delaktigheten är bland annat att vårdgivare får anpassa sig till vårdtagaren, som därmed får ett ökat medbestämmande. Vårdtagare upplever en trygghet när rehabiliteringen äger rum i hemmet, eftersom det är där de har sina gamla aktivitetsmönster. Vårdgivare får även större möjligheter att identifiera vilka aktiviteter som tidigare varit meningsfulla för vårdtagaren. Minskad delaktighet kopplas i flera studier till informationsbrist hos vårdtagarna angående deras nya livssituation och rehabiliteringsinsatser. The Canadian Occupational Performance Measure (COPM) är en klientcentrerad modell som visat stor användbarhet i att få vårdtagare delaktiga i rehabiliteringsprocessen, och då inte minst när det gäller information till vårdtagaren. Litteraturen visade även att det finns brister i samhällsresurser för att personer som drabbats av stroke ska uppleva delaktighet.
Slutsats: För att kunna göra en person delaktig vid rehabilitering i hemmet krävs det att åtgärderna utformas och genomförs i samråd med vårdtagaren. Vårdtagaren ska också få individuellt anpassad information om rehabiliteringsinsatser och förvärvat hälsotillstånd. Ett sätt att främja för vårdtagares optimala delaktighet är att ta hjälp av bedömningsinstrumentet COPM i rehabiliteringsprocessen. Ett bra stöd från samhället är en förutsättning för att bidra till delaktighet hos personer som drabbats av stroke.
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Bennett, Beverley. "Emotional encounters with stroke : an ethnographic study of nurse-patient interactions in a stroke rehabilitation unit." Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/3285/.
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Stroke is the third most common cause of death in the United Kingdom and the single greatest cause of severe disability. The effects of stroke are complex but the impact on emotional wellbeing is arguably one of the most problematic aspects of stroke rehabilitation to address. Nurses play a key role in stroke rehabilitation and the ways in which they interact with and respond to the emotional experience of stroke, may be crucial to the well-being of the patient and their relatives. Informed by an interactionist theory of emotion, the aims of this interpretive ethnographic study were to explore the emotional experiences of persons affected by a stroke (patients and relatives), nurses’ interpretations of these experiences and how they used them to inform and influence person-to-person interactions during the period of hospital-based rehabilitation. Taking a case study approach, a purposive sample of 10 cases was selected, with each ‘case’ comprising a patient, their closest relative and the nurses who provide their care. Data were constructed through participant observation, interviews and documentary review. Data analysis revealed that through a complex interplay of core beliefs, personal and professional attributes and interpersonal skills, nurses enabled patients and relatives to access and utilise their own personal attributes in order to recover from stroke. An emergent relationship model explains how the relationships built and sustained between nurses, patients and relatives during their encounters with each other on a stroke rehabilitation unit are central to creating a positive culture of caring which promotes emotional wellbeing and aids recovery. The findings have implications for policy, clinical practice, health care education and research.