Tesis sobre el tema "Cerebrovascular Accident – rehabilitation – Spain"

The "International Classification of Functioning, Disability and Health" (ICF) is a model that classifies health and health-related function. Of the ICF domains, least is known about participation. Although a few measures have been developed in English that tap the construct "Participation", none exist in Spanish. The Reintegration to Normal Living (RNL)-Index is the measure of reference to evaluate participation. The general objective of the present study was to translate, culturally adapt, and assess the psychometric properties the RNL-Index in Spanish for use in Spain. The translation and the cultural adaptation of the RNL-Index consisted of a five-step process, leading to the Spanish version of the RNL-Index (SRNL-Index). Psychometric evaluation consisted of a cross-sectional study design, with a longitudinal design used for test-retest evaluation. Thirty-two subjects with stroke and 36 with total knee arthroplasty completed the SRNL-Index twice, as well as the Six Minute Walk Test (6MWT), the Short-Form 36 Health Survey (SF-36), and for stroke subjects, the Barthel Index (BI). Descriptive statistics, one-way analysis of variance and post-hoc t tests were calculated, as well as Cronbach's alpha, Pearson's, and Intraclass correlation coefficients. The SRNL-Index was found to be internally consistent. Test-retest reliability was quite poor, being moderately low for the TKA sample and moderate for the stroke sample. Discriminant validity was demonstrated by the correlations between the SRNL-Index's Perception of Self and Daily Activity subscales with the Mental and Physical Component Summary scores of the SF-36. The SRNL-Index has convergent validity as shown by the high correlations between of the SRNL-Index and the 6MWT. Known-groups validity was shown in people with stroke grouped by Barthel Index scores, and in both samples when grouped according to gait speed. The SRNL-Index demonstrated acceptable validity and internal reliability for subjects with stroke and total knee arthroplasty. However, further studies are needed to reassess external validity, reliability, and responsiveness in other populations and other Spanish-speaking countries.

The purpose of this study was to determine if the perceived level of ability (self-efficacy) differed from actual performance ability for individuals with cerebral vascular accidents (CVA's). Patients were assessed for perception and actual ability level on Activities of Daily Living (ADL's) and Balance skills at admission and at discharge from an inpatient CVA rehabilitation program. Thirty patients with unilateral brain lesions (15 right and 15 left) constituted the study group. ANOVA and repeated measures were used in this quasi-experimental, quantitative study to examine data. All three research hypotheses were tested at an alpha level of .05 for significance. The first and third research hypotheses were supported: CVA patients' self-efficacy scores on ADL's and Balance Skills were significantly different from actual performance scores at time of admission to a CVA rehabilitation program; and the self-efficacy scores were significantly closer to actual performance scores for ADL skills at discharge. The improved accuracy in perception of Balance Skills was not supported by comparison of scores between admission and discharge measurements. The second hypothesis that right hemisphere CVA lesion patients self-efficacy and actual performance scores would be significantly different compared to the scores of patients with left hemisphere CVA lesions was not supported. A ttest for paired samples was also performed on the ADL scores data to investigate three-way significance for the third hypothesis. The patients studied successfully completed the prescribed therapeutic activities in a CVA rehabilitation program and were able to predict with significantly improved accuracy, performance ability on ADL skills at discharge.
School of Nursing

Virtual reality environments (VEs) are new tools to improve functional recovery in stroke survivors. Elements essential to maximize motor learning, can be optimized in VEs. Study objectives were: (a) to determine whether training in VE with enhanced feedback about movement patterns, leads to greater gains in arm movement quality, motor performance and decreased compensation compared to training in a similarly designed Physical environment (PE); (b) to estimate whether impairments in cognitive functioning affected the changes observed after training. Twelve stroke survivors practiced 72 pointing movements in VE or PE for 10 sessions with enhanced feedback. Kinematic analysis of pointing task, evaluations of arm impairment and function were carried out pre-post training. After training, VE group had increased shoulder flexion (p<0.05), increased shoulder horizontal adduction and decreased compensation, compared to PE group. Use of feedback correlated with fewer deficits in cognitive functioning. Training in VEs may lead to greater gains in movement quality.

INTRODUÇÃO: A perda óssea acelerada é uma das reconhecidas complicações da hemiplegia pós-acidente vascular encefálico (AVE), mas pouco se sabe sobre o ritmo de perda na fase crônica e seus determinantes. O objetivo deste estudo foi avaliar a evolução tardia da densidade mineral óssea (DMO) em pacientes hemiplégicos crônicos, bem como identificar possíveis fatores associados. MÉTODOS: Foi realizado um estudo longitudinal envolvendo pacientes ambulatoriais com hemiplegia há mais de 12 meses. Pacientes com doenças e outras condições associadas à perda óssea foram excluídos. Avaliações clínica e densitométrica foram realizadas no início e após aproximadamente 16 meses, e foram analisados fatores de risco para perda óssea. RESULTADOS: Cinquenta e sete pacientes foram estudados, sendo 40 do sexo masculino, com média de 59,3 anos e tempo médio de hemiplegia de 33,4 meses. Ao comparar os hemicorpos acometido e não acometido, foi observada perda óssea mais acentuada em antebraço acometido (p=0,001), mas não em fêmur acometido. Foi observada perda óssea significativa em 56% dos pacientes em antebraço e 22,6% em fêmur, no lado acometido. Maior tempo de AVE foi protetor para a perda óssea em antebraço (OR = 0,96, IC 95%: 0,92 0,99; p=0,015), e o uso de anticoagulantes e/ou anticonvulsivantes (OR = 5,83, IC 95%:1,25 27,3; p=0,025) e espasticidade moderada/intensa (OR = 8,29, IC 95%:1,10 62,4; p=0,040) foram determinantes para perda óssea em fêmur. CONCLUSÕES: O presente estudo evidenciou que a perda óssea é comum e frequente em antebraço acometido em pacientes com hemiplegia crônica, com tendência à estabilização da perda com o passar do tempo. Espasticidade mais intensa e uso de anticoagulantes e/ou anticonvulsivantes foram associados à perda óssea em fêmur. Estes achados indicam que pacientes hemiplégicos crônicos devem ser monitorados e tratados para perda óssea, com atenção para os determinantes identificados, e que o membro superior acometido deve ser incluído na avaliação da DMO
INTRODUCTION: Accelerated bone loss is a well-known early complication of hemiplegia. However, less is known about chronicphase bone loss and its determinants. The objective of this study was to evaluate long-term changes in bone mineral density (BMD) in chronic hemiplegic patients, and investigate possible related factors. METHODS: A longitudinal study involving chronic stroke-related hemiplegic patients was conducted. Clinical and densitometric evaluations were performed at baseline and after approximately 16 months, and risk factors for bone loss were analyzed. RESULTS: Fiftyseven patients were studied (40 males) with a mean of 59.3 years and with mean time since hemiplegia of 33.4 months. Decrease in BMD was more pronounced in affected forearms compared to the nonaffected forearms (p=0.001). No difference was found between affected and non-affected femurs. Bone loss was observed in 56% of the affected forearms and 22.6% of the affected femurs. Longer time since stroke was protective for bone loss in the forearm (OR = 0.96, 95% CI: 0.92 0.99; p=0.015), and the use of anticoagulation/antiepileptic drugs (OR = 5.83, 95% CI: 1.25 27.3; p=0.025) and moderate/severe spasticity (OR = 8.29, 95% CI: 1.10 62.4; p=0.040) were associated to bone loss in the femur. CONCLUSIONS: Bone loss is common and more frequent in the affected forearm in chronic hemiplegic patients with tendency to stabilize over time. Greater spasticity and use of anticoagulation and/or antiepileptic drugs were proved to be associated with bone loss at the femur. Our findings indicate that chronic hemiplegic patients should be monitored and treated for bone loss, with attention to the identified determinants, and that the upper paretic limb should be included in BMD evaluation

Previous research has shown that cognitive deficits arising from neurological impairment can impact on driving performance. The diverse nature of cognitive, perceptual and behavioural impairments experienced by drivers with neurological impairment and the resulting impact on driving ability has been the subject of extensive research involving the use of psychometric off-road measures, road safety statistics, actual on-road driving assessments and self-report. This research has shown that some drivers can compensate for limitations in their driving skills but this is dependent upon realistic self-appraisal of driving abilities. Few studies have investigated the role of self-awareness of driving abilities on on-road driving performance in persons with neurological impairment. Aims: To investigate the relationship between self-awareness of driving related abilities in neurologically impaired drivers and on-road driving performance. Participants: Retrospective data were collated on 79 participants who were referred for Occupational Therapy driving assessment, comprising 24 with Closed Head Injury (CHI) (mean age 24.67 + 5.57 yrs), 30 with Cerebrovascular Accident (CVA) (mean age 61.00 + 9.08 yrs) and 25 with 'Other' diagnosis (mean age 50.64 + 21.14 yrs). All participants held a current driver's licence or learner's permit Results: Five predictor variables were significantly associated with the on-road driving assessment outcome including three demographic variables:- diagnosis (2(2)= 7.69, p = 0.021), time since injury/illness onset (2(2)= 6.40, p = 0.041), and mileage (2(2)= 5.84, p = 0.05); and two self-awareness variables:- reaction time (2(2)= 8.04, p = 0.018), and impulse control (2(2)= 13.47, p = 0.001). Logistic regression yielded a final best model containing two predictor variables (2(4) = 20.81, p = 0.000), including diagnosis (p = 0.02) and self-awareness of impulse control (p = 0.01). Discussion and Conclusion: Participants who over-estimated their driving abilities were more likely to fail a driving assessment or require driving rehabilitation than participants who under-estimated or accurately predicted their performance and participants with a diagnosis of CVA were more likely to fail or require driving rehabilitation than those with a CHI or 'Other' diagnosis.

This diploma thesis is a part of the GAJU project entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 128/2016/S)". At the time when the thesis was elaborated, only the patients who suffered the cerebrovascular accident were engaged in the project, since in the hospital, no suitable patient after brain injury who would need a multidisciplinary team in home care had ever been sought. The selection of the patients was based on the communicative skills criteria e.g. if the skills to participate in the directed conversation based on the Functional Independence Measure Questionnaire (FIM), WHO Disability Assessment Schedule 2.0 and the follow-up questions concerning social issues, physiotherapeutic methods and techniques were preserved. Within the framework of the project, the research has not been finished yet. Given the above mentioned reasons, this thesis is therefore mainly focused on the identification of patients' needs after the cerebrovascular accident (CVA), on the period starting from its first incidence during the first three months period after the discharge from the hospital to home care. The complex results will be presented as a part of the publication activity of the project. The thesis comprises a theoretical and a practical part. The theoretical part presents a comprehensive view on the care for the patients who suffered the cerebrovascular accident. I addressed both the basic characteristics of the cerebrovascular accident and the organisation of the care for the patients in the Czech Republic; furthermore, the coordinated rehabilitation team, the role of a social worker, possibilities of social help provided by the welfare system to patients and their families, and the psychical condition of the patient. In the last chapter, I outline the general concept of human needs according to A. Maslow and describe important needs of the sick people. As far as the research part is concerned, my goal is to identify the needs of patients in home care after the brain injury. In connection with the aim of the thesis, two research questions were defined. The first question is: "What are the needs of the patients after brain injury?". The second question is: "What is the role of a social worker in meeting the needs of a patient with brain injury?" The qualitative research strategy was used; the instructional dialogue technique with patients after brain injury in the South Bohemia Region within the project. When analyzing the data collected from the patients during the first three months after the discharge from the hospital to the home care, seven major patient needs emerged need of help, need of psychical equilibrium, need of self-reliance, need of being without paint, need of recovering to the condition before CVA incidence, and need of establishing a new system of activities. Two of these needs, the need of recovering to the condition before CVA incidence and the need of establishing a new system of activities could be considered as principal, because the other needs are in general heading towards them. Furthermore, the analysis of the results showed the role of a social worker by means of which these needs can be saturated The results of the present thesis are used as a partial part from which the complex results of coordinated rehabilitation of patients after brain injury of the GAJU project are complied. The needs analysis of patients brought the proposals of dealing with/saturation of these needs and therefore had a direct impact on the lives of the respondents. The results of the research will become a part of the publication outputs of the above-mentioned projects.

OF MASTER THESIS Author: Bc. Tereza Sádlová Supervisor: Mgr. Barbora Vaculíková, MBA Expert guarantor: plk. MUDr. Michal Říha, PhD., MBA Title of master thesis: Quality management of rehabilitation in patients with cerebrovascular accident This master thesis deals with quality management of rehabilitation in patients with cerebrovascular accident and we can also seen her as a basic summary of everything what is connected with quality rehabilitation understood as a service provided in medical devices. The main goal of this master thesis was determined as a presentation of possible form for monitoring and evaluating quality of rehabilitation using Indicator of quality stroke rehabilitation in patients with cerebrovascular accident. For the complex assessment of functional status of patient before and after stroke rehabilitation was reflected all items which are trained during physiotherapy, occupational theray, speech therapy etc. This master thesis is divided into two parts - theoretical and empirical. Theoretical part provides basic information of cerebrovascular accident, system of stroke rehabilitation and quality management of health care, which si relative to stroke rehabilitation. Empirical part describes a process of creating of Indicator of quality management of rehabilitation in patients...

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Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.