No description available.

No description available.

No description available.

Background: Evidence indicates that post-stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information technology (IT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. In the near future these systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-management. Aim: To explore the utilisation of extrinsic feedback from computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home. Method: Using the principles of realistic evaluation, this study explored the context of utilising computer feedback for upper limb stroke rehabilitation in the home setting; the underpinning theory-driven mechanisms of the intervention and how these impacted on theoretical outcomes. Focus groups with Community Stroke Teams were followed by initial testing and multi-method case studies before, during and after the use of computer-based equipment. Data were analysed in relation to the hypotheses case by case. This was followed by a synthesis of the findings to answer the question, 'what works for whom and in what circumstances and respects?' Findings: Data analysis reveals that in order to achieve desired outcomes through the use of computer technology, key elements of computer-feedback such as; accurate, measurable, rewarding, adaptable, and knowledge of results feedback are required to trigger the mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts such as; previous experiences of service delivery, personal goals, trust in technology, social circumstances and practicalities may also enable or constrain the underpinning theory-driven mechanisms. Discussion: This research has explored the implications of the paradigm shift from therapist led rehabilitation where feedback is provided face-to-face to a more patient led model of rehabilitation where feedback is provided by a computer in the absence of a therapist. Findings suggest that the delivery of feedback in clinical practice is led by their empirical knowledge and understanding of the therapists. However, this model of delivery may not be conducive to motor learning and self-management and may also influence the personal context of users. The theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The discovery of these elements may therefore result in the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery. Further work is required to; develop the technology so that it incorporates the elements of feedback highlighted by this research; ensure the technology is robust, reliable and accurate; investigate the clinical utility of technology for home-based stroke rehabilitation, and the extent to which it might encourage utilisation by the end user.

No description available.

Background: Atherosclerosis is the leading cause of death in the UK and is the most common cause of stroke, TIA and heart attack. Most of the risk factors for atherosclerosis are shared by both stroke and cardiac patients and are linked to lifestyle factors such as diet, exercise and smoking. Addressing lifestyle factors plays an important role in secondary prevention, and patients with heart disease who undertake cardiac rehabilitation programs involving exercise and education sessions, can reduce the risk of cardiac mortality by 26% (Joliffe 2001). The widespread availability of cardiac rehabilitation programs contrasts with the limited lifestyle support available for stroke patients, with only 37% of patients receiving verbal advice from their doctor (Rudd 2004). Aims: To investigate the feasibity of conducting a randomised controlled trial requiring TIA and minor stroke patients to participate in a standard NHS cardiac rehabilitation programme. The trial will also evaluate the suitability of outcome measures for assessing if the intervention will significantly reduce the risk of secondary cardiovsacular events more effectively than standard care. Methods: A single blinded randomized controlled feasibility trial was conducted with patients randomised to standard care or standard care and cardiac rehabilitation. Baseline measurements were taken one month post event with end point data collection six months post event. Results: Twenty four patients (18 TIA, 6 minor stroke) completed the trial and provide evidence that it is feasible for stroke patients to undertake a programme of cardiac rehabilitation the effect of which can be assessed with a battery of risk factor and quality of life measures. Group analysis showed a significantly greater reduction in the primary outcome measure of Cardiovascular Disease (CVD) risk score for subjects in the intervention group in relation to standard care(intervention 25.7 ± 22.8 to 23.15 ± 18.3, control 25.03 ±15.4 to 27.12 ± 16.1, t=-1.81, P<0.05). There were also significant improvements for the intervention group in activity levels and aspects of health related quality of life. Conclusion: Current secondary prevention strategies for stroke patients are reliant upon pharmacological therapies for managing a lifestyle related disease. This is the first trial to suggest that existing NHS lifestyle modification programmes are an effective and feasible means of reducing the risk of future cardiovascular events.

The present research used van Manen's application of hermeneutic phenomenology as philosophy and method to explore stroke rehabilitation experience across two different settings, i.e. (i) a conventional setting (National Health Service or NHS stroke unit) and (ii) an unconventional setting (Conductive Education or CE). Interviews, observations and reflective diaries were used to collect data on 24 volunteering stroke patients' experiences. High levels of dis empowerment and negative images of self as well as the nature of motivation were indicated to be thematic of stroke rehabilitation experience in the stroke unit. In the CE setting stroke rehabilitation experience was characterised by increased selfconfidence, unconditional positive regard from conductors, challenging activities and body-half integration. A juxtaposition of stroke rehabilitation experience in the CE setting with stroke rehabilitation experience in the NHS stroke unit brought to light an important difference between the physical body-split caused by stroke, and a much wider and deeper disintegration of being. The juxtaposition further indicated that (i) the approach used in the NHS stroke unit is biomedical in spite of the presence of a multi-disciplinary team, and (ii) that the one adopted by CE is a person-centred approach characterised by holistic principles, with an overall focus on mobility. A reflective evaluation of this hermeneutic phenomenological study ensues, including a discussion on the difference between person-centredness and holism. The better understanding gained regarding stroke rehabilitation experience across the two settings was then used to make recommendations regarding what could constitute a holistic approach to stroke rehabilitation. Finally, the researcher's experience of 'being-immersed' in others' lived experiences was discussed in order to illustrate the holistic effect the research process had on the researcher's well-being, and the development of a tool which addresses researcher emotions holistically is also presented.

Psychology / M.A. (Clinical Psychology)

Psychology / M.A. (Clinical Psychology)