The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

Master of Applied Science / Research into rehabilitation outcomes shows that people recovering from stroke experience serious role loss. Despite this, many occupational therapists working in the area of stroke rehabilitation do not allocate time to therapy designed to achieve specific meaningful role resumption or development for their clients, instead focussing most of their therapy upon the restoration of function at the performance component level (Brodie, Holm, & Tomlin, 1994). Occupational role performance is an area of knowledge that has been neglected within the profession. Little is known about the use of the concept by the role performer. A naturalistic study was undertaken to provide descriptive information about the self-perceived occupational role performance of men over 65 who have had a stroke, and to investigate the possibility that occupational role was a construct used by the participants to organise their occupational performance (Chapparo and Ranka, 1997). Thirteen participants were interviewed in their own homes. Inductive analysis of the data produced the following findings. There was evidence that participants did use role as a construct to organise role performance in terms of meaning, personal abilities and time. This organisation incorporated a large degree of choice about how roles were performed. Choices were made in relation to perceptions of environmental demands and informed by previous experience and personal standards for role performance. A preliminary model of self-perceived occupational role performance was developed from the themes identified in the data. The constructs of the model represent the factors identified as contributing to the meaning, motivation, planning and performance of occupational roles by the participants in the study. Each major construct has a number of sub-constructs, and construct definitions were produced. The relationship between the constructs is thought to be complex, and were considered beyond the scope of this descriptive study. The three major constructs of this model are Active Engagement, Personal Meaning and Perceived Control. The three constructs relate to doing, knowing and being as described in the Occupational Performance Model (Australia) (Chapparo and Ranka, 1997). Active Engagement describes the nature of occupational role performance and is principally related to doing. The construct of Personal Meaning strongly influences Active Engagement and is principally related to being. The last construct of Perceived Control relates to the reasoning of the participant about his role performance, and is principally related to knowing. Perceived Control informs Personal Meaning in terms of the perceived outcomes of Active Engagement. The major outcome of this study has been the detailed identification and description of a number of constructs that relate to both the internal and external aspects of self-perceived occupational role performance for the study participants. These constructs extend the Occupational Performance Model (Australia) (Chapparo and Ranka, 1997) at the role level, and can form the basis of further research to develop a model of occupational role performance that would provide a valuable tool for research and for clinical practice.

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

Thesis (MHSc--Health Science) -- AUT University, 2007. / Includes bibliographical references. Also held in print (160 leaves : ill. ; 30 cm.) in North Shore Campus Theses Collection (T 616.81 STA)

<p>Stroke är en av våra vanligaste folksjukdomar. Många strokedrabbade med fysiska och/eller psykiska funktionsnedsättningar vårdas i hemmet av anhörigvårdare. <strong>Syftet </strong>med denna litteraturstudie var att belysa anhörigas erfarenheter av att vårda strokedrabbade med fysiska och psykiska funktionsnedsättningar i hemmet. <strong>Metoden </strong>som användes var systematisk litteraturstudie. Studien grundades på 16 artiklar som hämtades från databaserna Cinahl, Pubmed och ELIN. <strong>Resultatet </strong>visade att många anhörigvårdare kände sig oförberedda på rollen som vårdare på grund av att insjuknandet i stroke ofta sker akut. Livssituationen förändrades drastiskt och detta innebär en stor påfrestning på det dagliga livet. Förändringarna i livssituationen medförde ett stort behov av olika former av stöd. Socialt/emotionellt och informativt stöd var avgörande för den fortsatta vården i hemmet, och var viktigt för att förebygga ohälsa hos anhörigvårdare. Bristande stöd kunde påverka livssituationen och därmed hälsan på ett negativt sätt. Anhörigvårdare var trots upplevda svårigheter tacksamma för att den strokedrabbade levde och kunde bo hemma. <strong>Slutsats: </strong>forskning om anhörigas erfarenheter av att vårda är viktiga för sjuksköterskors samarbete med anhörigvårdare till strokedrabbade.</p><p> </p>

Purpose: The systematic review summarised the literature on the impact of patient illness perceptions on health outcomes and coping after an acute neurological event, guided by Leventhal’s Self-Regulatory Model (SRM). The empirical study investigated individuals’ lived experiences of emotionalism, a sudden onset neurological disorder characterised by involuntary laughter and crying. A further aim was to develop a questionnaire measuring beliefs about emotionalism based on patients’ perspectives. Method: The review identified seventeen articles through database searches using predefined inclusion criteria. In the empirical paper, eighteen individuals took part in a qualitative study to explore their experiences of emotionalism. Results: Findings provided support for the SRM in acute neurological populations. Negative illness perceptions were associated with a range of poor health outcomes and unhelpful coping behaviours. The empirical paper provided rich individual accounts of the social and personal impact of emotionalism. Four themes were identified and used to develop a questionnaire measuring beliefs about emotionalism. Conclusions: Both chapters emphasise the value of eliciting patient beliefs about their neurological condition and of providing support at the early stages of recovery. The clinical implications and directions for future research were discussed as was the need for further validation of the questionnaire.

Research has shown that skeletal muscle, despite showing a high degree of specialisation, has a remarkable ability to modif,' its properties. Understanding these changes is important for optimal response to therapeutic intervention. These studies investigated alterations in neuromuscular performance of quadriceps femoris muscle in normal subjects, before investigating changes in muscle and neural mechanisms in the first six months following stroke. Muscle ftinction studies were conducted to monitor the effects of selected patterns of long term electrical stimulation (P1 - uniform 8 Hz, P2 - mixed frequency, and P3 random high and low frequency) on quadriceps femoris of2l healthy subjects. Stimulated muscles showed significant increases in strength, fatigue resistance and relaxation times after 3 weeks and in force-frequency output after 6 weeks. Significant changes were observed in the stimulated muscles in Groups P2 and P3 indicating that a mixed or random pattern of activation induced greater changes than a uniform 8 Hz pattern. These studies together with soleus H reflexes were used to study concurrent changes in quadriceps femoris and Ta spinal reflex pathways of stroke patients and age-matched controls (n=1O). One month following stroke, both paretic and non-paretic muscles were more fatiguable and weaker than the muscles of controls and disynaptic and presynaptic inhibition were reduced in the paretic limbs. In subsequent months, the paretic muscles regained strength and inhibitory effects were restored. Subjective analysis suggested that different patterns of recovery related to walking ability at six months. In patients taking less than 15s to walk lOm (Group 1 n=5), the paretic muscles became significantly stronger and less fatiguable over time whereas the muscles of patients who took longer to walk lOm (Group 2 n=5) remained weaker and more fatiguable. Reciprocal inhibition was regained by 1 month in Group 1 and by 6 months in Group 2. These findings provide insight into long-term recovery and rationale for therapeutic intervention following stroke.

Thesis (M.S.)--Boston University