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Lewinter, M., and S. Mikkelsen. "Patients' experience of rehabilitation after stroke." Disability and Rehabilitation 17, no. 1 (January 1995): 3–9. http://dx.doi.org/10.3109/09638289509166621.
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Tyagi, Shilpa, Daniel Lim, Wilbert Ho, Yun Qing Koh, Vincent Cai, Angela Cheong, Helena Legido-Quigley, and Gerald Choon-Huat Koh. "Stroke Patient-Caregiver Dyads’ Experience and Acceptance of Tele-Rehabilitation." Archives of Physical Medicine and Rehabilitation 100, no. 10 (October 2019): e124. http://dx.doi.org/10.1016/j.apmr.2019.08.370.
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Koroleva, E. S., V. M. Alifirova, A. V. Latypova, S. V. Cheban, V. A. Ott, K. S. Brazovskiy, I. V. Tolmachev, N. G. Brazovskaya, A. A. Semkina, and N. G. Kataeva. "Principles and global experience of applying robotic rehabilitation technologies in patients after stroke." Bulletin of Siberian Medicine 18, no. 2 (August 11, 2019): 223–33. http://dx.doi.org/10.20538/1682-0363-2019-2-223-233.
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This literature review is devoted to the study of recent advances in the field of neurorehabilitation using robotic technologies. Objective: to study best practices of applying robotic rehabilitation technologies in stroke patients, its clinical efficacy and influence on the molecular mechanisms of neuroplasticity. Keywords were searched in the Web of Science, Core Collection, Scopus and PubMed databases.Results.Robotic neurorehabilitation occupies a certain place in the comprehensive rehabilitation of patients with motor deficiency after stroke. An interdisciplinary patient-oriented approach and consistency at all stages of medical rehabilitation are especially important when using rehabilitation methods that implement advances in robotics and information technologies in patients after stroke. Rehabilitation with the use of high-tech computerized rehabilitation systems operating in the biofeedback mode is one of the promising areas and requires further neurophysiological and laboratory studies to create scientifically based methodological approaches. It will have great social significance and tangible economic effects from improving the quality of neurorehabilitation and reducing its duration.
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Palmcrantz, Susanne, and Disa K. Sommerfeld. "Development and validation of the Swedish national stroke register Riksstroke’s questionnaires in patients at 3 and 12 months after stroke: a qualitative study." BMJ Open 8, no. 2 (February 2018): e018702. http://dx.doi.org/10.1136/bmjopen-2017-018702.
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ObjectivesBecause healthcare and community organisations and treatment methods are always changing, continuous changes might also be needed in questionnaires that register patient-reported outcomes (PRO) and patient-reported experiences (PRE) of healthcare interventions and community support. Thus, the aim of this study was to test the content and face validity, including the readability, of two questionnaires used by the Swedish national stroke register Riksstroke to register PRO and PRE at 3 and 12 months poststroke.DesignClinicians’ and patients’ knowledge and experiences of current care, rehabilitation, community support and functioning after stroke as well as comments noted regarding the content and layout of the questionnaires were retrieved in focus-groups with expert clinicians and in patient interviews analysed with content analysis. A workgroup of experts with experience in stroke care, rehabilitation and research repeatedly revised the questionnaires regarding content, layout and consistency throughout the validation process.ParticipantsThe participants included allied healthcare professionals, nurses and physicians with extensive experience of working with stroke care and rehabilitation (expert clinicians) as well as patients who had suffered a stroke 3 or 12 months earlier and who were purposefully selected among those who had completed and returned the 3-month questionnaire.SettingExpert clinicians met at their work place in focus-groups. Patients were interviewed where they resided, that is, in their home or nursing home, including rural, town and city areas in Sweden.ResultsBased on clinical expertise and comments from the patients (n=47), the questionnaires were revised and then found to be valid in terms of content validity and face validity, including readability.ConclusionsThe present evaluation emphasises the need for testing aspects of validity, including readability, of questionnaires addressing PRO and PRE and for the recurrent revision of such questionnaires in order to maintain their validity in a society undergoing constant change.
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Dreyer, Greea, and Matty van Niekerk. "Vocational rehabilitation for young stroke survivors in Gauteng public healthcare: Occupational therapists’ perceptions1." Work 69, no. 1 (May 26, 2021): 91–107. http://dx.doi.org/10.3233/wor-213460.
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BACKGROUND: The prevalence of working-aged stroke survivors is increasing yearly. Stroke is an expensive disease, causing financial burden to the government, the family and caregivers of the patient, thus making it imperative for working-aged stroke survivors to work to remain financially independent. Survivors’ need to work necessitates occupational therapists to shift their focus from basic activities of daily living, to rehabilitating work. OBJECTIVES: This study aimed to determine the perceptions of occupational therapists working with younger stroke survivors in public hospitals and clinics in Gauteng South Africa, about rehabilitating working-aged stroke survivors’ work ability. METHODS: Ethical clearance was obtained. A qualitative research design was used to obtain narrative, descriptive data from six focus groups. Therapists from public healthcare settings, who had more than six months’ experience and had worked in neurological rehabilitation within the six months preceding the focus group, were invited to participate. Focus groups were audio recorded and transcribed. Inductive content analysis was used to identify themes and categories. RESULTS: Few participants are involved in rehabilitating younger stroke survivors’ work ability or facilitating return to work (RTW). The study identified perceived barriers and enablers to rendering OT services that meet working-aged stroke survivors’ needs. CONCLUSIONS: Despite enabling employment equity laws in South Africa, OTs working in the public sector appear to experience a sense of futility when trying to rehabilitate young stoke survivors to RTW. Fragmentation of the public sector and limited resources impede successful RTW for working-aged stroke survivors. Survivors’ employment status and motivation to RTW facilitated rehabilitating work ability.
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Lawrence, Maggie, and Sue Kinn. "Determining the Needs, Priorities, and Desired Rehabilitation Outcomes of Young Adults Who Have Had a Stroke." Rehabilitation Research and Practice 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/963978.
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Background. Guidelines state that young adults' (aged 18–55 years) rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities.Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes.Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction.Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes.Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory.
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LaPiana, Nina, Alvin Duong, Alex Lee, Leon Alschitz, Rafael M. L. Silva, Jody Early, Aaron Bunnell, and Pierre Mourad. "Acceptability of a Mobile Phone–Based Augmented Reality Game for Rehabilitation of Patients With Upper Limb Deficits from Stroke: Case Study." JMIR Rehabilitation and Assistive Technologies 7, no. 2 (September 2, 2020): e17822. http://dx.doi.org/10.2196/17822.
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Background Upper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, spatial neglect, and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy but have not yet demonstrated whether or not those games are acceptable, that is, motivational, comfortable, and engaging, which are all necessary for potential adoption and use by patients. Objective The goal of the study was to assess the acceptability of a smartphone-based augmented reality game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss. Methods Patients aged 50 to 70 years, all of whom experienced motor deficits after acute ischemic stroke, participated in 3 optional therapy sessions using augmented reality therapeutic gaming over the course of 1 week, targeting deficits in upper extremity strength and range of motion. After completion of the game, we administered a 16-item questionnaire to the patients to assess the game’s acceptability; 8 questions were answered by rating on a scale from 1 (very negative experience) to 5 (very positive experience); 8 questions were qualitative. Results Patients (n=5) completed a total of 23 out of 45 scheduled augmented reality game sessions, with patient fatigue as the primary factor for uncompleted sessions. Each patient consented to 9 potential game sessions and completed a mean of 4.6 (SE 1.3) games. Of the 5 patients, 4 (80%) completed the questionnaire at the end of their final gaming session. Of note, patients were motivated to continue to the end of a given gaming session (mean 4.25, 95% CI 3.31-5.19), to try other game-based therapies (mean 3.75, 95% CI 2.81-4.69), to do another session (mean 3.50, 95% CI 2.93-4.07), and to perform other daily rehabilitation exercises (mean 3.25, 95% CI 2.76-3.74). In addition, participants gave mean scores of 4.00 (95% CI 2.87-5.13) for overall experience; 4.25 (95% CI 3.31-5.19) for comfort; 3.25 (95% CI 2.31-4.19) for finding the study fun, enjoyable, and engaging; and 3.50 (95% CI 2.52-4.48) for believing the technology could help them reach their rehabilitation goals. For each of the 4 patients, their reported scores were statistically significantly higher than those generated by a random sampling of values (patient 1: P=.04; patient 2: P=.04; patient 4: P=.004; patient 5: P=.04). Conclusions Based on the questionnaire scores, the patients with upper limb motor deficits following stroke who participated in our case study found our augmented reality game motivating, comfortable, engaging, and tolerable. Improvements in augmented reality technology motivated by this case study may one day allow patients to work with improved versions of this therapy independently in their own home. We therefore anticipate that smartphone-based augmented reality gaming systems may eventually provide useful postdischarge self-treatment as a supplement to professional therapy for patients with upper limb deficiencies from stroke.
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Tanlaka, Eric, Kathryn King-Shier, Theresa Green, Cydnee Seneviratne, and Sean Dukelow. "Sex Differences in Stroke Rehabilitation Care in Alberta." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 47, no. 4 (March 12, 2020): 494–503. http://dx.doi.org/10.1017/cjn.2020.53.
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ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.
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Lee, Minyoung, Sung-Bom Pyun, Jinjoo Chung, Jungjin Kim, Seon-Deok Eun, and BumChul Yoon. "A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality–Based Rehabilitation in Patients With Acute Stroke." Physical Therapy 96, no. 10 (October 1, 2016): 1554–64. http://dx.doi.org/10.2522/ptj.20150271.
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AbstractBackgroundVirtual reality (VR)–based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training.ObjectiveThe purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences.DesignAn exploratory mixed-method design was used in this study.MethodsEight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences.ResultsLevels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness.ConclusionsLevels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.
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Arbel, Ifah, Bing Ye, and Alex Mihailidis. "Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit." HERD: Health Environments Research & Design Journal 13, no. 2 (October 21, 2019): 170–85. http://dx.doi.org/10.1177/1937586719879060.
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Objectives: This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). Background: Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit. Methods: The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. Results: The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. Conclusion: The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.
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Holroyd, Sharon. "Urinary incontience after stroke." British Journal of Community Nursing 24, no. 12 (December 2, 2019): 590–94. http://dx.doi.org/10.12968/bjcn.2019.24.12.590.
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Normal bladder function is achieved by most in childhood. Stroke affects 15 million people worldwide every year, with incontinence affecting over half these individuals in the initial post-stroke phase. Statistically it has been shown that incontinence can increase the morbidity risk of stroke victims. The social taboo surrounding continence issues has been a challenge for many years with individuals experiencing shame and isolation. This article looks at the normal physiology associated with continence and stroke. It suggests possible treatment options during the post-stroke rehabilitation phase to encourage improved patient experience and professionals' confidence and knowledge base when treating this group of patients.
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Hendriks, Jeroen, Christina Andreae, Susanna Ågren, Helène Eriksson, Carina Hjelm, Ulla Walfridsson, Chantal F. Ski, Ingela Thylén, and Tiny Jaarsma. "Cardiac disease and stroke: Practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied Professions." European Journal of Cardiovascular Nursing 19, no. 6 (January 30, 2020): 495–504. http://dx.doi.org/10.1177/1474515119895734.
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Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.
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Trammell, Molly, Priyanka Kapoor, Chad Swank, and Simon Driver. "Improving practice with integration of patient directed activity during inpatient rehabilitation." Clinical Rehabilitation 31, no. 1 (July 10, 2016): 3–10. http://dx.doi.org/10.1177/0269215515625100.
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Background: Early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed onset, emphasizing the importance of inpatient therapy. However, literature indicates that following stroke individuals in inpatient rehabilitation spend the majority of their day in their bedroom and inactive. Consequently, since amount of functional activity is posited to relate to outcomes, the current rehabilitation model needs to be challenged with innovative solutions to maximize recovery. Rationale: In an attempt to promote greater activity and higher doses of therapy during inpatient rehabilitation, we implemented the “Patient Directed Activity Program” to facilitate specific movement and improve outcomes for patients post stroke. Our interdisciplinary activity program was conceptualized on a theoretical model for stroke recovery and principles of experience-dependent neural plasticity. Main features: The “Patient Directed Activity Program” includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.
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Wangsa Saputera, Maria Manuk, Yohanes Kurniawan, Ariawan. "DUKUNGAN SOSIAL KELUARGA DAN PROSES REHABILITASI MOTORIK PASIEN STROKE." Adi Husada Nursing Journal 1, no. 2 (December 14, 2015): 6. http://dx.doi.org/10.37036/ahnj.v1i2.12.
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ABSTRAKPenderita stroke dapat mengalami gangguan motorik. Setelah melewati masa akut, penderita stroke yang mengalami gangguan motorik diharapkan menjalani program rehabilitasi motorik. Proses rehabilitasi motorik penderita stroke membutuhkan dukungan keluarga karena dapat memotivasi dan meningkatkan kepatuhan pasien dalam menjalani program rehabilitasi. Penelitian ini bertujuan untuk menganalisa dukungan keluarga pada pasien stroke dalam menjalani rehabilitasi motorik. Sampel penelitian adalah pasien yang berkunjung ke Puskesmas Sidotopo Wetan yang menderita stroke dan sedang melakukan program rehabilitasi sebanyak 27 orang. Teknik pengambilan sampel menggunakan consecutive sampling. Pengumpulan data menggunakan kuesioner. Analisis data dalam penelitian ini menggunakan uji korelasi Pearson. Hasil uji korelasi Pearson menunjukkan nilai p = 0.496 (α<0.05) dan nilai r = - 0.137, dan dari hasil uji tersebut dapat disimpulkan bahwa tidak ada hubungan antara dukungan emosional, penghargaan, informatif, dan instrumental keluarga terhadap proses rehabilitasi motorik penderita stroke. Hal ini dikarenakan sebagian besar penderita tidak tinggal serumah dengan keluarga, sehingga hal ini membuat penderita tidak mendapatkan dukungan keluarga yang optimal. Bila penderita mendapatkan dukungan yang cukup dari keluarga, diharapkan penderita dapat termotivasi untuk merubah gaya hidup sehat secara optimal.
Kata kunci: dukungan keluarga, pasien stroke, rehabilitasi motorik
ABSTRACTStroke patients may experience physical motor impaired. After passing through the acute period, stroke patients with physical motor impaired must took a physical motor rehabilitation program. The process of physical motor rehabilitation program needed social family support because family could motivated and increased patient’s obedience. The aim of this study was to analyzed relationship between family social support with physical motor rehabilitation program of stroke patients. Samples were patient came to Sidotopo Wetan public health care who suffered a stroke and was conducting a physical motor rehabilitation program as many as 27 people. This study used consecutive sampling. Data was collected using questionnaire and analyzed using Pearson correlation test. Result of this study showed p = 0.496 (α<0.05) dan nilai r = - 0.137 so there was not a relationship between emotional, appreciation, informative, and instrumental family support with the patient physical motor rehabilitation process. This was because most patients did not stay together with their family, so this made patients did not get full family support. When patients get enough support from the family, the patient could be motivated to change healthy lifestyle optimally.
Keywords: family support, stroke patient, physical motor rehabilitation
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Bussmann, Marie-Luise, Hans-Peter Neunzig, Joachim Gerber, Jochen Steinmetz, Svenja Jung, and Ruth Deck. "Effects and Quality of Stroke Rehabilitation of BAR Phase D." Neurology International Open 02, no. 01 (January 2018): E16—E24. http://dx.doi.org/10.1055/s-0043-122193.
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Abstract Background Stroke is a major public health problem of enormous epidemiological significance. Each year, approximately 200.000 people in Germany suffer a stroke. Stroke is the third leading cause of death and the most common cause of acquired disabilities in adults. About one fourth of stroke survivors report severe limitations in activities of daily living three months after acute stroke. The most common post-stroke conditions are motor and cognitive dysfunctions as well as affective problems. Stroke rehabilitation plays a crucial role in coping with stroke sequelae. The large number of strokes and the often debilitating consequences raise the question to what extent participation can be increased by medical rehabilitation. Methods A prospective, multicenter survey study was conducted in six neurological inpatient rehabilitation centers. Recruitment focused on patients with recent acute stroke and disease severity corresponding to BAR phase D. Patients completed questionnaires at three points of measurement: at the beginning and at the end of the inpatient rehabilitation and after four months. Primary outcome was participation, secondary outcomes included several parameters of subjective well-being. Furthermore, utilization of aftercare and satisfaction with the rehabilitation program were measured. Results At the beginning of the rehabilitation, patients experienced severe limitations in participation and reduced subjective well-being. At the end of inpatient rehabilitation, significant improvements of small effect sizes for subjective well-being and medium effect sizes for participation were achieved. After four months, effects had decreased, yet improvements compared to baseline were still noticeable. Patient ratings of the rehabilitation program and the outcomes achieved were consistently positive. Two thirds of the patients were advised to make use of aftercare offerings and most patients (83%) participated in an aftercare program of any kind. Conclusions The results of this study support the notion that stroke rehabilitation has significant and sustainable effects. Participation in particular seems to improve through medical rehabilitation. Partly decreased effects after four months raise the question of adequate aftercare.
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Lipson-Smith, Ruby, Leonid Churilov, Clare Newton, Heidi Zeeman, and Julie Bernhardt. "A Framework for Designing Inpatient Stroke Rehabilitation Facilities: A New Approach Using Interdisciplinary Value-Focused Thinking." HERD: Health Environments Research & Design Journal 12, no. 4 (February 25, 2019): 142–58. http://dx.doi.org/10.1177/1937586719831450.
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Aim: To use Value-Focused Thinking to investigate what is important in the design of inpatient stroke rehabilitation facility buildings. Background: Many stroke patients require inpatient rehabilitation in a dedicated facility. Rehabilitation facilities are healthcare spaces, but they are also learning spaces where patients practice targeted tasks to acquire new skills and to reacquire skills and abilities that were compromised as a result of their stroke. There is currently no consensus regarding how the design of inpatient rehabilitation facilities could be optimized for patients’ learning. Method: We used Value-Focused Thinking to develop a framework of what interdisciplinary experts consider important for inpatient stroke rehabilitation facility design. Two workshops were conducted. The following experts were invited to participate: past patients with experience of stroke rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation academics; healthcare environments academics; learning environments academics; architects, designers, and wayfinders with experience designing healthcare or learning environments; and healthcare design policy makers. Results: Thirty experts participated. The experts’ final framework included 16 criteria that were considered fundamentally important for inpatient stroke rehabilitation facility design, and 14 criteria that were considered instrumentally important. Inpatient stroke rehabilitation facility design should maximize efficiency, maximize effectiveness (i.e., patients’ clinical and functional outcomes), foster emotional well-being, and maximize safety. Opportunities to practice physical, cognitive, and social activity were considered important for patients’ outcomes. Conclusions: Value-Focused Thinking was an effective and equitable means of engaging experts from multiple disciplines. Designers, planners, and developers of inpatient stroke rehabilitation facilities should consider the rehabilitation-specific framework developed in this study alongside evidence from other healthcare settings.
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Soundy, Andy, Clive Liles, Brendon Stubbs, and Carolyn Roskell. "Identifying a Framework for Hope in Order to Establish the Importance of Generalised Hopes for Individuals Who Have Suffered a Stroke." Advances in Medicine 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/471874.
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Hope and hopelessness are important psychological constructs that physiotherapists should consider when working with patients who have experienced a stroke. The view of hope in rehabilitation is often focused around the concept of goals and how hope works within this framework. However, the current paper proposes a broader framework for hope and the importance of a more generalised view of understanding why a certain hope exists or is identified by a patient. A narrative review using an a priori thematic analysis was undertaken to consider how more generalised hopes are expressed by individuals who have suffered a stroke. An electronic search of 4 databases from inception until April 2014 was undertaken. Qualitative articles were included if they considered the concept of hope for patients who had suffered a stroke. The results identified three themes which included (1) consideration of the patient’s identity/identities, (2) meaningful activities, experiences, and interactions, and (3) the experience of suffering and need for relief. An awareness of patients’ generalised hopes should be a priority for HCPs. Detailed implications for HCPs are identified within the discussion.
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Gupta, Hitesh, and Alakananda Banerjee. "Recovery of Dysphagia in Lateral Medullary Stroke." Case Reports in Neurological Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/404871.
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Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.
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Proot, Ireen M., Huda Huijer Abu-Saad, Wilma P. de Esch-Janssen, Harry F. J. M. Crebolder, and Ruud H. J. ter Meulen. "Patient autonomy during rehabilitation: the experiences of stroke patients in nursing homes." International Journal of Nursing Studies 37, no. 3 (June 2000): 267–76. http://dx.doi.org/10.1016/s0020-7489(00)00008-0.
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Jones, Fiona, Karolina Gombert-Waldron, Stephanie Honey, Geoffrey Cloud, Ruth Harris, Alastair Macdonald, Chris McKevitt, Glenn Robert, and David Clarke. "Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study." Health Services and Delivery Research 8, no. 35 (August 2020): 1–136. http://dx.doi.org/10.3310/hsdr08350.
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Background Stroke is the most common neurological disability in the UK. Any activity contributes to recovery, but stroke patients can be inactive for > 60% of their waking hours. This problem remains, despite organisational changes and targeted interventions. A new approach to addressing post-stroke inactivity is needed. Experience-based co-design has successfully initiated improvements for patients and staff in other acute settings. Experience-based co-design uses observational fieldwork and filmed narratives with patients to trigger different conversations and interactions between patients and staff to improve health-care services. Objectives To complete a rapid evidence synthesis of the efficacy and effectiveness of co-production as an approach to quality improvement in acute health-care settings; to evaluate the feasibility and impact of patients, carers and staff co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units; and to understand the experience of participating in experience-based co-design and whether or not interventions developed and implemented in two units could transfer to two additional units using an accelerated experience-based co-design cycle. Design A mixed-methods case comparison using interviews, observations, behavioural mapping and self-report surveys (patient-reported outcome measure/patient-reported experience measure) pre and post implementation of experience-based co-design cycles, and a process evaluation informed by normalisation process theory. Setting The setting was two stroke units (acute and rehabilitation) in London and two in Yorkshire. Participants In total, 130 staff, 76 stroke patients and 47 carers took part. Findings The rapid evidence synthesis showed a lack of rigorous evaluation of co-produced interventions in acute health care, and the need for a robust critique of co-production approaches. Interviews and observations (365 hours) identified that it was feasible to co-produce and implement interventions to increase activity in priority areas including ‘space’ (environment), ‘activity’ and, to a lesser extent, ‘communication’. Patients and families reported benefits from participating in co-design and perceived that they were equal and valued members. Staff perceived that experience-based co-design provided a positive experience, was a valuable improvement approach and led to increased activity opportunities. Observations and interviews confirmed the use of new social spaces and increased activity opportunities. However, staff interactions remained largely task focused, with limited focus on enabling patient activity. Behavioural mapping indicated a mixed pattern of activity pre and post implementation of co-designed changes. Patient-reported outcome measure/patient-reported experience measure response rates were low, at 12–38%; pre- and post-experience-based co-design cohorts reported dependency, emotional and social limitations consistent with national statistics. Post-experience-based co-design patient-reported experience measure data indicated that more respondents reported that they had ‘enough things to do in their free time’. The use of experience-based co-design – full and accelerated – legitimised and supported co-production activity. Staff, patients and families played a pivotal role in intervention co-design. All participants recognised that increased activity should be embedded in everyday routines and in work on stroke units. Limitations Communication by staff that enabled patient activity was challenging to initiate and sustain. Conclusions It was feasible to implement experience-based co-design in stroke units. This resulted in some positive changes in unit environments and increased activity opportunities for patients. There was no discernible difference in experiences or outcomes between full and accelerated experience-based co-design. Future work should consider multiple ways to embed increased patient activity into everyday routines in stroke units. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 35. See the NIHR Journals Library website for further project information.
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Bowers, David, Klemens Fheodoroff, Patricia Khan, Julian P. Harriss, Khashayar Dashtipour, Laxman Bahroo, Michael Lee, Denis Zakharov, Jovita Balcaitiene, and Virgilio Evidente. "Spastic Paresis and Rehabilitation – The Patient Journey." European Neurological Review 11, no. 2 (2016): 87. http://dx.doi.org/10.17925/enr.2016.11.02.87.
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Spastic paresis is a complex condition associated with damage to the upper motor neurons, typically caused by cerebral palsy, multiple sclerosis, stroke or trauma. Despite substantial impact on patients’ independence and burden on caregivers, there is a lack of consensus on optimal management of this condition and the patient journey remains unclear. A group of physicians, experienced in spasticity management, recently convened with the objective of analysing the patient journey from a care pathway perspective in different geographical regions and under different conditions from acute phase to long-term/chronic disease status. The experts reviewed results from recent patient and healthcare practitioner surveys on the subject and assessed how current patient pathways could be improved, using their own experiences to highlight the issues related to management deficiencies in their individual countries. The group divided the patient journey into steps, considering the evidence from the point of view of healthcare practitioners, patients, caregivers and funders/payors. This paper is a response to the lack of consensus on the optimal management of spastic paresis, and acts as a call to action to develop a consistent care pathway that could be applied across a broad range of illnesses, using an interdisciplinary approach.
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Fanina, Olga Borisovna. "Experience in performance of graduate qualification work on PM 04. Work of an employee «Junior medical nurse for patient care»." Medsestra (Nurse), no. 2 (February 1, 2021): 56–62. http://dx.doi.org/10.33920/med-05-2102-06.
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The article presents the pedagogical experience of supervising the writing of coursework and final qualifying work, united by the issues of organizing nursing care and medical rehabilitation of patients with stroke.
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Harte, Gillian, Ailish Claffey, and Desmond O’Neill. "224 Dance Artist and Physiotherapist Collaboration in Stroke Rehabilitation." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.51.
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Abstract Background Many studies have measured the benefits of dance for patients, in particular those with Parkinson's disease, with positive effects demonstrated in functional measures, wellbeing and patient experience. However, neither the value of dance when used as an adjunct to stroke rehabilitation nor the act of collaboration between dance artist and physiotherapist has previously been studied. Aim: To explore the experience and process of collaboration between the physiotherapist and dance artist when dance is used as an adjunct to conventional physiotherapy post-stroke in a geriatric medicine and stroke service in a university teaching hospital. Methods The study used a descriptive qualitative design and a convenience sample of 8 participants were recruited from the stroke rehabilitation ward. The physiotherapist advised the dance artist on specific movement goals for each session. The physiotherapist and dance artist kept individual diaries which included subjective and professional assessment of sessions. Exploratory analysis was used to discover emerging themes. Results Themes identified fell into the categories of physiotherapist learning, dance artist learning, collaborative process, language, and the therapeutic relationship. While benefits such as greater liberation of patients’ movements and higher endurance rates were recorded, what was particularly of note was the communication between the physiotherapist and the dance artist. The language used was key: physiotherapy discourse tends to be more specific to particular movements whereas the dance artist relates more to the overall movement of the individual, identifying movement patterns and habits. The dance artist uses the lens of choreological studies (the science of movement) when working with patients and this way of working was particularly beneficial. In particular the use of motif writing became an invaluable resource in terms of communication. Conclusion Within this study we questioned: what is required to create successful collaboration within a medical context? We hope that describing how this particular collaboration was successful will benefit those interested in similar collaborations.
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RAMLEE, MUHAMMAD HANIF, and KOK BENG GAN. "FUNCTION AND BIOMECHANICS OF UPPER LIMB IN POST-STROKE PATIENTS — A SYSTEMATIC REVIEW." Journal of Mechanics in Medicine and Biology 17, no. 06 (September 2017): 1750099. http://dx.doi.org/10.1142/s0219519417500993.
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Current clinical services are struggling to provide the most favorable rehabilitation treatment for patients with stroke, which inspired researchers to investigate and explore the use of rehabilitation devices suitable for the patients and rehabilitation therapy. This review paper addresses the importance of biomechanical features in patients who experienced stroke to the upper limb. First and foremost, a review was done on general biomechanical description associated with motor control, shoulder, elbow, wrist and fingers joint. This included the ability of the patients to move their affected arm and the affect on peak joint torque, range of motion, joint forces, grip strength and muscle activities during the activities of daily living. In addition, we also reviewed the material properties and geometrical condition of tissue in stroke patient. The repercussions of post-stroke patient regarding the bone density, stiffness of muscle as well as the thickness of cartilage are described in this review. Based on the findings, the movement of affected stroke hand is associated with the motor control and material properties of tissue. To strengthen the motor control and maintaining tissue properties, early physical training on patients should be conducted in two to four weeks after stroke. In conclusion, this report suggests a new approach for future biomechanical studies in order to enhance the quality of physiotherapy rehabilitation peculiarly for post-stroke patients.
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Prior, Sarah, Nicole Reeves, Gregory Peterson, Linda Jaffray, and Steven Campbell. "Addressing the Gaps in Post-Stroke Sexual Activity Rehabilitation: Patient Perspectives." Healthcare 7, no. 1 (February 5, 2019): 25. http://dx.doi.org/10.3390/healthcare7010025.
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Sexual dysfunction is common but often under-recognised or neglected after stroke. This study sought to identify the existing methods for providing information and discussion on post-stroke sexual activity, and perceived gaps from the patient perspective. A sample of 1265 participants who had been admitted to any of the four major public hospitals in Tasmania, Australia, with stroke (International Classification of Diseases (ICD-10) group B70) were mailed a survey assessing their experiences with, and opinions about, receipt of post-stroke sexual activity education. One hundred and eighty-three participants (14.5%) responded; of these, 65% were male and the mean age was 69.1 years. The results indicated that, whilst over 30% or participants wanted to receive information related to post-stroke sexual activity, only a small proportion of participants (8.2%) had received this. In terms of the method of receiving this information, participants preferred to receive this from a doctor in a private discussion with or without their partner present. The delivery of post-stroke sexual activity information and education is inconsistent and fails to meet patient needs within major Tasmanian hospitals, highlighting the importance of developing sound, routine, post-stroke education and information processes.
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Lamontagne, Marie-Eve, Carol Richards, Leila Azzaria, Mélany Rosa-Goulet, Louise Clément, and France Pelletier. "Perspective of patients and caregivers about stroke rehabilitation: the Quebec experience." Topics in Stroke Rehabilitation 26, no. 1 (October 15, 2018): 39–48. http://dx.doi.org/10.1080/10749357.2018.1534453.
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Saramago, Ines, Suzanne Timmons, Paul Gallagher, and Siobhán Fox. "Stress in nurses’ caring for stroke patients and families: a mixed-method study." HRB Open Research 3 (August 5, 2020): 51. http://dx.doi.org/10.12688/hrbopenres.13078.1.
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Background: Within nursing, caring for stroke patients and helping them with the recovery of their abilities can be strenuous; even more so when considering the nurse’s scope of practice includes the patient and predicts a supportive role to the caregivers. This type of rehabilitative nursing care can be demanding, and nurses may experience increased levels of stress. Despite the extensive literature about the nursing workload and its connection to occupational stress, very little research has been conducted particularly about stress levels experienced by nurses working with stroke patients, who may experience particularly high stress. The rationale for this research emerged from the scarcity of studies worldwide and especially in Irish stroke units. Methods: Nurses from stroke and medical wards (n=100) were distributed the Perceived Stress Scale and requested to complete it from the perspective of their workplace. A convenience sample of these nurses were interviewed about their experience of stress. Results: Of 48 survey respondents, 68% reported ‘moderate’ levels of stress, with higher mean levels in nurses working in medical wards (M=20.10, SD=5.42) than nurses in stroke units (M=16.17, SD=4.41; t(46)=2.757, p<0.01). In interviews with nurses on stroke units (n=11), sources of stress included work performance anxiety (e.g. fear of errors), workload burden/conflicting demands, and family/physician interactions. Coping mechanisms included brief “time outs”, direct problem-solving, and peer support. Conclusions: The participants’ experiences of stress may help other nurses working with stroke patients to cope better with work-related stress, and provide guidance to managers in improving the organization of stroke networks.
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Samėnienė, Jūratė, Aleksandras Kriščiūnas, and Erika Endzelytė. "The evaluation of the rehabilitation effects on cognitive dysfunction and changes in psychomotor reactions in stroke patients." Medicina 44, no. 11 (November 9, 2008): 860. http://dx.doi.org/10.3390/medicina44110109.
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Stroke patients often experience cognitive dysfunctions. One of the parameters assessing cognitive function is the reaction time as it reflects the speed of information processing. The aim of the study was to assess cognitive and psychomotor dysfunctions and the effectiveness of rehabilitation in stroke patients. The subjects of the study were 30 stroke patients who underwent rehabilitation at the Department of Neurorehabilitation. The mean age of patients was 65.33±13.2 years. During the study, the patients’ cognitive functions, the handgrip strength, reaction time, and frequency of movements were assessed. There was a substantial improvement in patients’ cognitive function after rehabilitation. Assessing the results obtained by Mini Mental State Examination, the change was 6.4±2.3 points, and assessing by Neurobehavioral Cognitive Status Examination (Cognistat), the change was 13.3±10 points (P<0.05). Before the early stage of rehabilitation, Cognistat results showed that the majority of the patients experienced memory loss, diminished constructive abilities, and disorientation. After occupational therapy, there was a statistically significant improvement in all cognitive function domains. At the end of the inpatient rehabilitation period, there was a significant change in patients’ reaction time and movement frequency. At the end of early rehabilitation stage, the estimated reaction time in patients with stroke was compared with reaction time in healthy elderly people of the same age. There was no significant difference between these groups; consequently, we concluded that after rehabilitation, improvement of function was achieved. The results of this study showed that at the beginning of early rehabilitation period and after rehabilitation applied, there was a significant moderate correlation between mental state and reaction time in stroke patients.
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Shaw, Lisa, Nawaraj Bhattarai, Robin Cant, Avril Drummond, Gary A. Ford, Anne Forster, Richard Francis, et al. "An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT." Health Technology Assessment 24, no. 24 (May 2020): 1–202. http://dx.doi.org/10.3310/hta24240.
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Background There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. Objective To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). Design A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. Setting Nineteen NHS study centres. Participants Patients with a new stroke who received early supported discharge and their informal carers. Interventions Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. Main outcome measures The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers’ strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. Results A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval –0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: –£311 (95% confidence interval –£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. Conclusions EXTRAS did not improve stroke survivors’ performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. Future work Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. Trial registration Current Controlled Trials ISRCTN45203373. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.
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Raffin, Estelle, and Friedhelm C. Hummel. "Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities." Neuroscientist 24, no. 4 (November 7, 2017): 400–416. http://dx.doi.org/10.1177/1073858417737486.
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More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on NIBS and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.
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Wu, Yung-Tsan, Shin-Tsu Chang, Liang-Cheng Chen, and Tsung-Ying Li. "Concurrence of Crossed Cerebellar Diaschisis and Parakinesia Brachialis Oscitans in a Patient with Hemorrhagic Stroke." Case Reports in Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/519808.
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Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to the supratentorial focal lesion. The phenomenon termed parakinesia brachialis oscitans (PBO) in which stroke patients experience involuntary stretching of the hemiplegic arm during yawning is rarely reported. The concurrence of CCD and PBO has never been described. A 52-year-old man had putaminal hemorrhage and demonstrated no significant recovery in his left hemiplegia after intensive rehabilitation, but his gait improved gradually. Two months after the stroke, the single photon emission computed tomography (SPECT) showed CCD. Four months after the stroke, the patient noticed PBO. The follow-up SPECT showed persistent CCD and the patient’s arm was still plegic. The frequency and intensity of PBO have increased with time since the stroke. We speculate that the two phenomena CCD and PBO might share similar neuroanatomical pathways and be valuable for predicting clinical recovery after stroke.
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Schmidt, John G., Jessie Drew-Cates, and Mary L. Dombovy. "Severe Disability After Stroke: Outcome After Inpatient Rehabilitation." Neurorehabilitation and Neural Repair 13, no. 3 (September 1999): 199–203. http://dx.doi.org/10.1177/154596839901300310.
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Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.
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Boakye, Ndidi T., Richard Scott, Aisling Parsons, Shai Betteridge, Melody A. Smith, and Gill Cluckie. "All change: a stroke inpatient service’s experience of a new clinical neuropsychology delivery model." BMJ Open Quality 8, no. 1 (January 2019): e000184. http://dx.doi.org/10.1136/bmjoq-2017-000184.
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Adults presenting to stroke services are frequently faced with the challenge of adjusting to a different life following a stroke. Difficulties often include cognitive impairments, such as memory deficits, attention and language difficulties, and mood disturbances such as anxiety and depression. It has been highlighted that psychological care for this group is just as important as physical rehabilitation. Psychological expertise may therefore be required for the multitude of problems that occur after a stroke. UK National guidelines recommend routine assessment and management of mood and cognition after stroke. The aim of this study was to evaluate a new stroke clinical neuropsychology service developed by the Department of Neuropsychology and Clinical Health Psychology, in order to meet the needs of stroke survivors and their families referred into a large acute hospital. This involved using a different skill mix of staff across one post delivering a service in an acute inpatient stroke unit. This model was evaluated and results revealed that the model delivered increased patient access to neuropsychological support, an expansion in provision of clinical work, along with positive multidisciplinary team feedback. This finding is key as where resources are limited, clinical services may benefit from adopting a ‘skill mix’ model to meet the varying needs of their patients in a timely manner. This model serves to raise the value of psychology to medical services.
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Meesters, J. J. L., D. P. H. W. van de Ven, E. Kruijver, J. Bender, W. G. Volker, T. P. M. Vliet Vlieland, and P. H. Goossens. "Counselled Patients with Stroke Still Experience Sexual and Relational Problems 1–5 Years After Stroke Rehabilitation." Sexuality and Disability 38, no. 3 (April 28, 2020): 533–45. http://dx.doi.org/10.1007/s11195-020-09632-5.
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van Balen, Romke, Adam L. Gordon, Jos M. G. A. Schols, Yvonne M. Drewes, and Wilco P. Achterberg. "What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus." European Geriatric Medicine 10, no. 6 (October 8, 2019): 977–87. http://dx.doi.org/10.1007/s41999-019-00244-7.
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Abstract Purpose Many European countries have developed services to rehabilitate the increasing number of older people who experience an acute or subacute decrease in function after a medical event such as a hip fracture or stroke. However, there are important differences between countries regarding patient selection, organization of services, length of stay, and content of the rehabilitation process. The lack of consensus around, and quality criteria for, geriatric rehabilitation limits opportunities for exchange of best practice and scientific research. Methods 33 experts, mostly geriatricians with experience in geriatric rehabilitation, from 18 European countries were invited to participate in a modified Delphi study. They were asked to react to 68 statements using a five-point Likert scale. The statements were formulated on the basis of literature review and practice experience, and were initially piloted among Dutch elderly care physicians. Consensus was defined beforehand as an Interquartile Range (IQR) of </= 1 for each statement. Results Consensus was reached on 61 (90%) statements after two rounds. The resulting consensus covers: the need for a multidisciplinary approach to Geriatric Rehabilitation after CGA; inclusion of patients with temporary confusion or cognitive decline; use of structured goal-oriented rehabilitation plans; the necessity of an early start of rehabilitation; preference for ambulatory rehabilitation or Geriatric Rehabilitation at home; the advantage of protocolled treatment programs; the need for consensus on patient outcome assessment instruments; and education and training in Geriatric Rehabilitation for healthcare professionals. Conclusion These consensus statements provide a first step towards more coherent organization and delivery of geriatric rehabilitation across Europe.
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De Paula Carvalho, Helio. "Impact of Race on Patient Outcomes After Stroke Thrombectomy: Single Center Experience." Journal of Stroke and Cerebrovascular Diseases 29, no. 5 (May 2020): 104726. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104726.
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Nelson, Michelle L. A., Rachel Thombs, and Juliana Yi. "Volunteers as members of the stroke rehabilitation team: a qualitative case study." BMJ Open 10, no. 4 (April 2020): e032473. http://dx.doi.org/10.1136/bmjopen-2019-032473.
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ObjectivesClinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers’ place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement.DesignA qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada.Participants28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed.ResultsWhile there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments.ConclusionsAn interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.
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Xu, Guozheng, Xiang Gao, Lizheng Pan, Sheng Chen, Qiang Wang, Bo Zhu, and Jinfei Li. "Anxiety detection and training task adaptation in robot-assisted active stroke rehabilitation." International Journal of Advanced Robotic Systems 15, no. 6 (November 1, 2018): 172988141880643. http://dx.doi.org/10.1177/1729881418806433.
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In the therapist-centered rehabilitation program, the experienced therapists can observe emotional changes of stroke patients and make corresponding decisions on their intervention strategies. Likewise, robotic-assisted stroke rehabilitation systems will be more appreciated if they can also perceive emotional states of the stroke patients and enhance their engagements by exploring emotion-based dynamic difficulty adjustments. Nevertheless, few research have addressed this issue. A two-phase pilot study with anxiety as the target emotion state was conducted in this article. In phase I, the motor performances and the physiological responses to the stroke subject’s anxiety with high, medium, and low intensities were statistically analyzed, and anxiety models with three intensities were offline developed using support vector machine–based classifiers. In phase II, anxiety-based closed-loop robot-aided training task adaptation and its impacts on patient–robot interaction engagements were explored. As a comparison, a performance-based robotic behavior adaptation was also implemented. Experimental results with 12 recruited stroke patients conducted on the Barrett WAMTM manipulator verified that the rehabilitation robot can implicitly recognize the anxiety intensities of the stroke survivors and the anxiety-based real-time robotic behavior adaptation shows more engagements in the human–robot interactions.
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Hall, Ruth E., Diana Sondergaard, Walter P. Wodchis, Jiming Fang, Prosanta Mondal, and Mark T. Bayley. "Trajectories of Stroke Care in Ontario: Which Path to Best Care?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 3 (February 3, 2017): 261–66. http://dx.doi.org/10.1017/cjn.2016.440.
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AbstractBackground:Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care.Methods:A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories.Results:Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures.Conclusions:There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.
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Martin, B. J., B. Yip, M. Hearty, S. Marietta, and R. Hill. "Outcome, Functional Recovery and Unmet Needs following Acute Stroke. Experience of Patient follow up at 6 to 9 Months in a Newly Established Stroke Service." Scottish Medical Journal 47, no. 6 (December 2002): 136–37. http://dx.doi.org/10.1177/003693300204700605.
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Objective To assess outcome at six months post stroke and the unmet needs and adherence to the secondary prevention advice among survivors living at home. Setting Stroke Rehabilitation Unit (SRU), Hairmyres Hospital and patients homes. Subjects Survivors living at home who had been managed in the SRU. Results Of 572 consecutive patients with confirmed acute stroke, 301 were managed in the SRU and 179 of these were reviewed at home between 6 and 9 months post acute stroke incident. One hundred and thirty seven (76%) survivors at home were living with a carer. Sixty-eight (38%) had had no personal contact with their General Practitioner since discharge from hospital, although 83 (46%) had attended or were attending day hospital. Thirty-two individuals (18%) had resumed smoking. One hundred and forty nine survivors (83%) still required assistance with daily living tasks. One hundred and fifteen patients (64%) required medication advice. One hundred and forty one (79%) had health concerns. Eight subjects had returned to paid employment. Issues raised by survivors included a feeling of being abandoned by the healthcare system, poor access to professional psychological support and a fear of further stroke. Conclusion There is a need for continuing patient education, improved support for stroke survivors and more active involvement of Primary Care Services in the care of stroke patients following hospital discharge.
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Zahl, Melissa, Michelle Miller, and Greg Horneber. "The Experience Of Community Re-Entry Intervention from the Perspective of The Patient With a Stroke." Archives of Physical Medicine and Rehabilitation 99, no. 10 (October 2018): e103. http://dx.doi.org/10.1016/j.apmr.2018.07.369.
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Suchak, Pria, Khalid Ameer, Jane Gaylard, Julie Newman, and Khalid Ali. "Improving patients experience in a neuro-rehabilitation unit using tablet computers." European Journal for Person Centered Healthcare 4, no. 2 (July 26, 2016): 289. http://dx.doi.org/10.5750/ejpch.v4i2.1082.
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Rationale, aims and objectives: Patients in stroke rehabilitation units spend considerable time unengaged in therapeutic or meaningful activity, feeling bored with suboptimal engagement in rehabilitation. Systematic reviews have shown that novel interventions such as interactive video gaming result in improved motor function and cognitive performance. The objective of this study was to evaluate the feasibility of introducing “tablet computers - iPads” in hospital rehabilitation programmes and their impact on patients’ boredom and overall satisfaction. In addition, acceptance and familiarity of the multidisciplinary members of the neuro-rehabilitation team with iPads were explored.Methods: A £10,000 fund was secured from Health Education England, UK to buy 10 iPads. A loan scheme was implemented to regulate iPad use. Information technology and governance issues were agreed with the hospital trust to ensure safety, accountability and confidentiality. Members of the multidisciplinary team offered training and education to patients on iPad use. Questionnaires were used before iPad use to assess patients and staff views on iPads. After iPad use patients and staff completed another questionnaire and were interviewed about which specific applications were used, boredom levels before and after use, and overall satisfaction.Results: Nine patients (7 males) used the iPads (8 strokes and 1 traumatic brain injury), with an average age of 59 (19-79) years. Staff used several applications in physiotherapy and speech therapy and found some applications such as memory games and puzzles particularly helpful. In addition to therapeutic uses, patients used iPads for internet searches, e-mail, Facebook, Skype and games. Eighty-nine percent of patients were satisfied with the iPad experience and 100% reported less boredom or between better and the same boredom compared to baseline.Conclusions: iPad use is feasible and beneficial to patients and welcomed by staff in neuro-rehabilitation units.
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Anderlini, Deanna, Guy Wallis, and Welber Marinovic. "Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation." Neurorehabilitation and Neural Repair 33, no. 3 (February 13, 2019): 167–78. http://dx.doi.org/10.1177/1545968319829454.
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Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca’s aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca’s area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.
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de Graaf, JA, MMT Kuijpers, JMA Visser-Meily, LJ Kappelle, and MWM Post. "Validity of an enhanced EQ-5D-5L measure with an added cognitive dimension in patients with stroke." Clinical Rehabilitation 34, no. 4 (February 19, 2020): 545–50. http://dx.doi.org/10.1177/0269215520907990.
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Objective: The 5-level EuroQoL (EQ-5D-5L) is a patient-reported outcome measure frequently used in stroke research. However, it does not assess the cognitive problems many patients with stroke experience. The aim of this article is to compare the content validity, internal consistency and discriminative ability of the EQ-5D-5L with and without an additional cognitive domain (EQ-5D-5L+C), administered three months post-stroke. Design: Cross-sectional study. Setting: Six general hospitals in the Netherlands. Subjects: In all, 360 individuals with stroke three months after the event. Interventions: Not applicable. Main measures: The modified Rankin Scale and EQ-5D-5L+C were administered in telephone interviews three months post-stroke. Results: A total of 360 patients with stroke were included. Mean age was 68.8 years (standard deviation (SD) = 11.7), 143 (40%) were female, 334 (93%) had had an ischemic stroke, 165 (46%) had a National Institutes of Health Stroke Scale (NIHSS) score ⩽ 4 at presentation and the Barthel Index was 17.2 (SD = 4) four days post-stroke. Cognitive problems were reported by 199 (55%) patients three months post-stroke. Internal consistencies of the EQ-5D-5L and EQ-5D-5L+C were 0.75 and 0.77, respectively. Adding a cognitive domain resulted in a decrease of the ceiling effect from 22% to 14%. Both EQ-5D-5L and EQ-5D-5L+C showed good discriminative ability, but differences between patients with different modified Rankin Scale scores and with/without reported decrease in health and daily activities were slightly larger with the EQ-5D-5L+C compared to the EQ-5D-5L. Conclusions: The EQ-5D-5L+C, which includes a cognitive domain that is highly significant for stroke patients, showed increased content validity and good discriminative ability, without losing internal consistency.
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Sañudo, Borja, Redha Taiar, Trentham Furness, and Mario Bernardo-Filho. "Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision." Rehabilitation Research and Practice 2018 (September 24, 2018): 1–8. http://dx.doi.org/10.1155/2018/8180901.
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Stroke is associated with long-term disability and patients experience numerous physical impairments including muscle weakness, particularly in the paretic limbs, balance, and functional mobility. During acute stroke rehabilitation, when individuals are less likely to be functionally independent and rely on rehabilitative care, the efficacy of low skill interventions that can reduce sedentary behaviour should be established. As such, this narrative revision focused on the use of empirical studies of whole-body vibration exercise (WBVE) on different health outcomes in stroke patients. The effects of WBVE on neuromuscular performance (muscular strength and power), mobility, spasticity, and cardiovascular responses have been highlighted. Although some positive results were reported we can conclude that there is no solid evidence confirming the beneficial effects of WBVE among people with stroke compared with either other types of physical activities or sham WBVE. Therefore, further research should be performed in this area, testing the feasibility and efficacy of using WBVE in a more homogeneous sample of stroke patients or comparing different WBVE parameters.
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Aries, Alison M., Lucy Cooke, and Sue M. Hunter. "Mobilisation And Tactile (Sensory) Stimulation For The Foot Post Stroke: Opinions And Perceptions Of Experienced Therapists." International Journal of Therapy and Rehabilitation 26, no. 6 (June 2, 2019): 15. http://dx.doi.org/10.12968/ijtr.2019.26.6.15.
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Background/Aims Intensive proprioceptive stimulation applied to the paretic hand post-stroke, using a complex hands-on intervention known as mobilisation and tactile stimulation, has reduced motor impairment and improved hand function in sub-acute and chronic stroke. While, anecdotally, mobilisation and tactile stimulation is also applied to the paretic foot to prepare it for standing, its use in stroke rehabilitation and effects on standing and balance have not been evaluated. Therefore, expert clinicians' experiences, opinions and perceptions of using mobilisation and tactile stimulation in routine clinical practice were explored to inform a subsequent feasibility study of mobilisation and tactile stimulation for the paretic foot post-stroke. Methods Following ethical approval, focus groups were undertaken: using purposive sampling, physiotherapists and occupational therapists with >12 months experience of stroke rehabilitation were recruited from a regional special interest group. A pilot study (n=4) and main study (n=7) explored content and application of hands-on therapy for the paretic foot, and the perceived impact of sensory loss on lower limb function. Data were audio-taped and transcribed verbatim. Thematic analysis was undertaken. Results All 11 therapists had previous experience of using mobilisation and tactile stimulation for the foot post-stroke. Three main themes were identified: (1) therapeutic intervention (sub-themes: therapy content, sensation, adjuncts, the foot as an active base of support and preparation for function); (2) 24-hour care; and (3) analysis (sub-themes: outcome measures, response to treatment). The most common adjuncts to mobilisation and tactile stimulation were orthotics and task-specific training. The importance of mobilisation and tactile stimulation in restoring foot alignment, sensory feedback and progression of the patient towards weight bearing and ambulation in the clinical setting was highlighted. Conclusions Mobilisation and tactile stimulation is a complex intervention used in stroke rehabilitation to enhance weight bearing and ambulation post stroke. Further research into its effects on the foot and lower limb is warranted in order to evaluate it and determine its evidence base for inclusion in routine clinical practice. Alternative methods of applying proprioceptive stimulation should also be considered, for example use of textured insoles, and relative effectiveness of these explored in clinical trials.
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Brand, Gabrielle, Ashlee Osborne, Steve Wise, Collette Isaac, and Christopher Etherton-Beer. "Using MRI art, poetry, photography and patient narratives to bridge clinical and human experiences of stroke recovery." Medical Humanities 46, no. 3 (June 6, 2019): 243–49. http://dx.doi.org/10.1136/medhum-2018-011623.
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Integrating co-produced humanities-based pedagogy into patient and workforce education is of growing interest. The aim of our Depth of Field: Exploring Stroke Recovery project grew from a strong commitment to use patients' lived experiences as a voice to educate new stroke patients and the health professional staff who will care for them. The aim of the initial Quality Improvement project at a West Australian Stroke Rehabilitation Unit (SRU) was to co-produce a reflective learning resource with stroke patients and their families to help navigate the stroke recovery journey. A series of artefacts (documentary-style photographs, audio-narrated vignettes, MRI images and poetry) were collected from four stroke patients and their families at differing stages of recovery over 12 months as they recounted the honest and raw reality of what life is really like following a stroke. These artefacts were used in a pilot qualitative project to explore new stroke patients, their families and SRU health professional staff perceptions towards the artefacts in order to inform the final educational resource. These findings enhance our understandings of how we can use art and patient (healthcare consumers) voice to widen the lens of stroke recovery and provides a valuable template to co-produce peer-to-peer and health professions education reflective learning resources to promote more human- centred approaches to care.
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Venketasubramanian, Narayanaswamy, Craig Anderson, Hakan Ay, Selma Aybek, Waleed Brinjikji, Gabriel R. de Freitas, Oscar H. Del Brutto, et al. "Stroke Care during the COVID-19 Pandemic: International Expert Panel Review." Cerebrovascular Diseases 50, no. 3 (2021): 245–61. http://dx.doi.org/10.1159/000514155.
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<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. <b><i>Summary:</i></b> The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. <b><i>Key Messages:</i></b> Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.
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Frolov, A. A., O. A. Mokienko, E. V. Biryukova, P. D. Bobrov, R. Kh Lukmanov, A. A. Kondur, and I. Z. Dzhalagonya. "CLINICAL EXPERIENCE OF POST-STROKE REHABILITATION WITH THE USE OF HAND EXOSKELETON CONTROLLED BY BRAIN-COMPUTER INTERFACE." Science and Innovations in Medicine 1, no. 3 (September 15, 2016): 56–61. http://dx.doi.org/10.35693/2500-1388-2016-0-3-56-61.
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Aim - to evaluate the efficiency of the motor recovery rehabilitation procedure with the use of hand exoskeleton controlled by the brain-computer interface (BCI). Materials and methods. 60 post-stroke patients participated in the study. 46 patients had ischemic stroke and 14 had hemorrhagic stroke. 42 patients of the main experimental group were trained in kinesthetic motor imagery using hand exoskeleton controlled by BCI, 18 patients of the control group carried out the imitating procedure. Exoskeleton - BCI system consists of encephalograph NVX52 («Medical Computer Systems», Russia), personal computer and hand exoskeleton («Android Technique», Russia). Motor functions were estimated by neurological scales ARAT and Fugl-Meyer. Results were statistically analyzed by Mann-Whitney, Wilcoxon and x2 tests, Spearman's correlation and RM-ANOVA using Statsoft Statistica v. 6.0. Results. It is shown that post-stroke patients are able to control BCI with the same efficiency as healthy subjects, regardless of the duration, severity and localization of the disease. Ten days of BCI training significantly improved patients’ motor functions according to neurological scales ARAT and Fugl-Meyer. Improvement was mainly provided by the small movements of the hand. According to several sections of neurological scales, improvement in the main group is significantly higher than in the control group. However, according to general scores, statistically significant difference between two groups was not observed. Conclusion. It is shown that the rehabilitation procedure using hand exsoskeleton controlled by BCI significantly improves motor functions of the paretic arm regardless of the duration, severity and localization of the disease. Increase of the training duration enhances the rehabilitation efficiency.
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Sidaway, Marta, Julita Głowacka-Popkiewicz, Maciej Krawczyk, and Tomasz Waraksa. "Early upper limb physiotherapy in stroke patients. Questions without answers." Advances in Rehabilitation 31, no. 1 (March 28, 2017): 37–47. http://dx.doi.org/10.1515/rehab-2015-0060.
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Abstract Stroke is still the most common cause of disability in Poland and in western countries. As many as 80% of patients report reduced upper limb function in the acute phase after stroke. It is estimated that only 5% to 20% of patients experience full functional recovery of an upper limb. In clinical practice, paretic upper limb stimulation after stroke is usually treated as of secondary importance. However, it constantly poses a challenge to physical therapists. The existing procedures do not provide detailed guidelines regarding upper limb rehabilitation model particularly in the first four weeks after stroke. It is hard to predict biological limitations and the effectiveness of upper limb rehabilitation. The aim of this work is to make an attempt at reviewing the knowledge of the current state of early upper limb physiotherapy, its intensity and strategy type as well as neurobiological foundations of the improvement process. Ample scientific evidence confirms that early post-stroke rehabilitation is crucial. There are relatively few foreign (and virtually no Polish) reports related to early upper limb rehabilitation that would take into account the type of exercises and their therapeutic dose. There are still no solid foundations for determining optimal intensity and type of upper limb rehabilitation (including physical and occupational therapy). There is a scarcity of extensive and uniform (in terms of research groups and tools) multicentre investigations aimed at defining an optimal model of upper limb rehabilitation at an early stage after stroke. Thus, a number of questions still remain unanswered.