In the acute stages of stroke where the patient experiences dysphagia or reduced levels of consciousness, clinicians make decisions on how a patient's food and fluid needs will be met. These decisions include whether the patient should take oral diet, or whether nutrition should be administered via a Nasogastric (NG) or Percutaneous Endoscopic Gastrostomy (PEG) tube. This qualitative study investigates the process by which clinicians make decisions over the timing and mode of nutrition or hydration interventions available to them. Data were collected from twenty patient participants and twenty-four clinicians from two NHS Trusts. The patient data comprised both clinical case note data and observational data taken from clinical discussions on the ward during their admission. In-depth interviews were undertaken with clinicians to explore their experiences and views on decision making for nutrition and hydration. The data were analysed to generate substantive theory following the principles of grounded theory. The findings suggest that the decision making process follows a normative pathway of 'not to feed' the patient which is based on three key beliefs. These were that; nutrition and hydration were viewed as distinct and different interventions, with nutrition not being considered essential to recovery after stroke; the risk of pulmonary aspiration was perceived to outweigh the benefits of providing nutrition; and, that nutritional interventions could prolong a poor Quality of Life for a patient. Deviation from this normative pathway by clinicians was influenced by four key themes; views about the patient's prognosis; beliefs about the nutrition and hydration interventions available; perceived responsibilities of those involved; and, personal conscience issues. The findings from the study are discussed in the context of clinical practice and the implications for future research

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Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. Lesions to one part of the sensory or motor cortex produces symptoms in the opposite half of the body. Lesions might also impair speech, cognition and movement. Evidence supports the use of robot-mediated therapy to reduce functional upper limb impairment but current technologies only target proximal or distal upper limb segments independently. This study developed and evaluated whole-arm robot-aided rehabilitation, using a purpose designed robotic system for upper limb rehabilitation facilitating selective functional reaching and grasping movements in a reach-grasp-transport-release sequence with a task orientated paradigm incorporating visual, audio, haptic and performance feedback. A clinical trial with a total duration of twelve weeks was conducted with four stroke impaired subjects at the sub-acute phase of recovery and with four unimpaired volunteers. Impaired subjects were exposed to sixteen hours of robotic intervention whereas the unimpaired participants experienced one hour of robotic therapy. Clinical outcome measures were used to assess therapy effectiveness on the recovery of the stroke participants prior to the study, during the study and on study completion. Electromyography techniques were used to quantify functional gains obtained with the clinical outcome measures and features from two muscles on the hand involved in grasp and release movements. The results obtained from the clinical outcome measures showed substantial gains in favour of the robot-aided intervention. The clinical outcome results are consistent with the results reported in the literature, and show higher gains when compared to other sub-acute studies targeting only proximal arm segments. Specific muscle features were indentified with the unimpaired participants reproduced with the stroke subjects at the end of the robot-aided intervention.

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