Stroke is the leading cause of disability in the United States. The majority of stroke survivors have persistent arm dysfunction, which impedes their daily task performance. Mirror therapy (MT) as an adjunct to occupational therapy (OT) has been shown to be effective in upper extremity (UE) recovery post-stroke. Two protocols, unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT), have been used in OT practice; however, research specifically comparing these two intervention protocols is absent. The purpose of this study was to compare: (a) home-based UMT and BMT protocols, and (b) both MT protocols to home-based traditional occupational therapy (TOT) regarding upper limb recovery post-stroke. Twenty-two chronic stroke participants were randomized into one of three groups: UMT, BMT, or TOT. The Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), ABILHAND, grip strength, and the Stroke Impact Scale (SIS) were administered pre- and post-intervention. Participants received outpatient OT 2 days/week for 45 minutes, plus a home program 30 minutes a day, 5 days/week for 6 weeks. A repeated measure ANOVA, Kruskal-Wallis Test, and Wilcoxon Ranked-Signed Test were used to compare the three groups, and 95% confidence intervals (CI) and effect sizes were calculated. There was a main effect of time for all groups, except for SIS-strength and activities of daily living (ADL); however, no group differences were noted on any of the measures. When comparing UMT and BMT, the effect size for all measures, except for grip strength, favored UMT. In comparing both mirror groups to TOT, UMT had a moderate to large effect size on the ARAT, FMA, and ABILHAND, as compared to the small effect size for BMT. Furthermore, 95% CI data for the ABILHAND showed clinical significance in favor of UMT compared to TOT, but not for BMT. This study showed that all groups improved over time and UMT may be more beneficial for UE recovery in chronic stroke individuals, compared to either BMT or TOT. However, given the small sample size, future studies comparing the two mirror protocols are necessary for more definitive conclusions to better inform clinicians of the optimal mode of MT treatment.

Bakgrund: För att kunna bli organdonator måste en patient avlida i total hjärninfarkt medan han/hon vårdas i respirator. Det är få personer som avlider på detta sätt.  När döden har fastställts får medicinska åtgärder inte fortsätta mer än 24 timmar. Sjuksköterskan som bör vara med i hela processen, står inför flera utmaningar; är patienten lämplig som organdonator? vad är patientens önskan? vad är anhörigas önskan? m.m. Syfte: Syftet med studien var att belysa sjuksköterskans upplevelse av att vårda en potentiell organdonator med diagnostiserad total hjärninfarkt. Metod: Litteraturstudie baserad på nio vetenskapliga artiklar. Resultat: Resultatet presenteras i kategorierna; att möta anhöriga, behovet av kunskap och sjuksköterskans yrkesroll. Familjeperspektivet involverar etik, lagar och känslomässiga aspekter. Många sjuksköterskor uttryckte att de hade bristande kunskap och att det fanns ett stort behov av utbildning kring hur information och stöd ska ges till anhöriga samt hur en potentiell organdonator identifieras. Vård av en organdonator kräver extra resurser och mer emotionellt engagemang, i jämförelse med att vårda levande IVA patienter. Slutsats: Mer forskning inom organdonation kan öka kunskapen och medvetenheten hos allmänheten och sjukvårdspersonal, vilket kan leda till att öka antalet organdonationer. / Background: In order to become an organ donor, a patient must die of total cerebral infarct while he/she is placed in a ventilator. There are few people who die like that. When death has been established medical interventions may not continue for more than 24 hours. The nurse, who should be involved in the whole donorprocess, faces several challenges: is the patient suitable as an organ donor? what is the patient's wish? what is the family's wish? Etc. Aim: The aim of this study was to illuminate nurses' experience of caring for a potential organ donor diagnosed with total cerebral infarction. Method: Literature review based on nine scientific articles. Results: The results are presented in categories, to meet relatives, the need for knowledge and the nursing profession. Family perspective involves ethics, laws and emotional aspects. Many nurses expressed that they had a lack of knowledge and that there was a great need for education about how information and support should be given to relatives and how a potential organ donor is identified. Caring for an organ donor requires more resources and more emotional involvement, in comparison to caring for a living ICU patient. Conclusion: More research in organ donation can increase knowledge and awareness among the public and health professionals, which may lead to increasing organ donations.

Thesis (Ph. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains x, 121 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 84-118).

The time course of peri-infarct diaschisis following a focal ischemic infarct and the effects of delayed rehabilitation on behavioral and functional recovery were examined. Intracortical microstimulation (ICMS) was used to derive topographical maps of forelimb representations within the rat motor cortex and ischemia was induced via bipolar coagulation of surface vasculature. At one hour there was a dramatic expansion of reprentations in control but not ischemic animals. A significant loss of forelimb representations within peri-infarct dysfunction indicates the need for immediate administration of therapeutic interventions following an ischemic event. These results indicate that the timing of rehabilitation does not effect functional and behavioral recovery but does support the need for rehabilitative interventions of facilitate these types of recovery. / 132 leaves : ill. ; 28 cm.

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2008. / Includes bibliographical references.

Stroke is a major health problem in all developed countries. These studies, performed in a stroke unit at a medical department, were designed to characterize essential clinical features of the different cerebrovascular disorders on admission to hospital, to evaluate the efficacy of admitting unselected stroke patients to a stroke unit and, to evaluate hemodilution as a therapeutical regime in patients with cerebral infarction. A prospective registry included 409 patients admitted to the stroke unit over a five-year period. Modern diagnostic equipment (CT scan and CSF analyses) and strict diagnostic criteria revealed a diagnostic distribution of 11% hemorrhagic, 76% ischemic cerebrovascular lesions and 13% TIAs. Mean age varied between 65.8 and 77.5 years in the various diagnostic groups with the highest in patients with embolic cerebral infarctions. Concomitant disorders affecting the cardiovascular system were highly prevalent and only 14% was free of such diseases prior to the stroke. In a comparative prospective study, over 16 months, no differences were found between patients treated in the stroke unit (n = 110) and the general medical wards (n = 183) regarding prognostic indicators on admission such as age, concomitant disorders and neurological symptoms. The stroke patients treated in the stroke unit had a statistically significant better prognosis regarding functional outcome and the need for long-term hospitalization was reduced up to one year after the stroke when compared to patients treated in general medical wards. All stroke patients seemed to benefit with the possible exception of patients in coma on admission. These results were achieved within the same or shorter length of initial hospital stay for patients in the stroke unit. Neither overall mortality, nor mortality in subgroups of prognostic importance was significantly affected by the stroke unit regime. Rapid hemodilution in the early phase of cerebral infarction by the combination of venesection and administration of dextran 40 was evaluated in a prospective controlled trial. After randomization 52 hemodi- luted and 50 control patients were comparable in prognostic variables. Signs of blood-brain-barrier breakdown and hemorrhagic admixture to the cerebrospinal fluid in the acute phase were less frequent in hemodiluted subjects. The hemodi luted patients showed a significantly higher degree of early improvement and fewer progressions. Neurological and functional disability in survivors and need for long-term hospitalization was significantly reduced at 3 months and at one year after the stroke compared to controls. Mortality was not affected. / digitalisering@umu

Abstract The aim of this study was to analyze angiographic findings and the presence and topography of cerebral ischemic and/or hemorrhagic lesions in cerebral CT or MRI, and to assess the long-term clinical outcome of a series of 136 consecutive cervicocephalic artery dissection (CCAD) patients. Pulsatile tinnitus was evaluated as a symptom of CCAD. Medical records and films were reviewed retrospectively. Irregular stenosis was found in angiography in 50% and occlusion in 33% of the dissected cervicocephalic arteries. Irregular stenosis normalized in 81% and occlusion recanalized in 34%. Other findings, such as pseudoaneurysms, intimal flaps, double lumens, and irregular dilatations were rare and often remained unchanged in follow-up. Pulsatile tinnitus was a presenting symptom in 12% of the CCAD patients, but the majority of patients had concomitant head or neck pain, ischemic brain symptoms, Horner's syndrome, or cranial neuropathies. Of the 131 patients who underwent brain imaging, 73 (56%) had signs of infarction in cerebral CT or MRI. Occlusion of the dissected vessel was accompanied by infarction in 76%, irregular stenosis in 40%, and other findings only rarely. Of the anterior circulation infarctions, 95% (39/41) were territorial, subcortical, or territorial infarctions with fragmentation and could thus be considered embolic. Subarachnoid hemorrhage was found in CT in 5 of the 22 patients (23%) with intracranial dissection. The patient's long-term clinical outcome was assessed using two methods: a classification into categories based on neurological symptoms and defects and the modified Rankin Scale (mRS). Of the 136 CCAD patients, 60% recovered with no or mild disability and 79% scored 0–2 on mRS. In the case of dissection of one or more cervicocephalic arteries without occlusion, the figures were 75% and 89%. In the case of occlusive dissection of one or more arteries, only about 35% of the patients recovered well, having no or mild disability, and 61% scored 0–2 on mRS. No significant differences were seen in recovery after intra- and extracranial dissections. In conclusion: irregular stenosis, which is the most common angiographic finding in CCAD, is associated with brain infarction less frequently than occlusion, and the long-term clinical outcome is good in most cases. Occlusion of the dissected vessel causes more brain infarctions, and only about 35% of the patients recover well, having no or mild disability. More than 10% of CCAD patients have pulsatile tinnitus as a presenting, and sometimes the only symptom.

Abstract Patent foramen ovale (PFO) is a common finding in the general population and is present in approximately one quarter of adults. The potential role of PFO in the pathogenesis of ischaemic brain infarction of unknown aetiology in young adults has been investigated during the past 15 years, and associations with other diseases have been proposed. The most plausible mechanism of stroke associated with PFO is paradoxical embolism, but there is uncertainty about this because a venous source of emboli is seldom identified. If the theory of venous emboli is relevant, prothrombotic states should be associated with PFO and ischaemic stroke. Relatively little is known about the risk factors of cryptogenic brain infarction, although this subgroup of stroke is relatively common. As the present diagnostic methods for detecting PFO have certain limitations, new non-invasive, simple and reliable methods would be useful. Two new methods examined here, the dye dilution method and ear oximetry, were both found to be feasible and to be highly specific and sensitive in relation to the present gold standard, contrast transoesophageal echocardiography. A case-control study among adult patients with PFO and cryptogenic brain infarction showed the presence of a prothrombotic state, particularly factor V Leiden and prothrombin G2021OA gene mutation, to be associated with an increased risk of stroke, and migraine was also identified as a risk factor. Associations with the classical risk factors for venous thrombosis and Valsalva manoeuvre-like activities at the onset of stroke were also observed. The results lend support to the theory that paradoxical embolism is one of the pathogenic mechanisms behind cryptogenic brain infarction with associated PFO. In another case-control study among adult patients with cryptogenic brain infarction but without associated PFO, prothrombotic states were not identified as risk factors, except that an association was found between elevated factor VIII activity and stroke. The major independent risk factors for such cryptogenic strokes were current cigarette smoking, hypertension and a low level of high density lipoprotein cholesterol.

Plasticity of residual cortical tissue has been identified as an important mediator of functional post-stroke recovery. After neonatal stroke the thickness of residual tissue can change, the tissue can move, and tissue can fill in the stroke core. Nevertheless, the majority of preclinical stroke research utilizes adult rats. Thus, the purpose of the present thesis was to systematically document such gross morphological changes in peri-infarct tissue after stroke in the adult rat. Morphological changes were assessed in pial strip devascularization, photothrombotic occlusion, and middle cerebral artery occlusion models of stroke using histological and magnetic resonance imaging. Decreases in cortical thickness, volume, and neural density were found to extend far beyond the stroke infarct and included the sensorimotor regions of the intact hemisphere. Movement of residual tissue towards the infarct was observed and confirmed using anatomical markers placed in intact cortical tissue at the time of stroke induction. I conclude that the extensive time-dependent morphological changes that occur in residual cortical tissue must be considered when evaluating plasticity-related cortical changes associated with post-stroke recovery of function. / ix, 162 leaves : ill. ; 28 cm

<p>The mortality of thoracic aortic diseases (mainly aneurysms and dissections) is high, even with surgical treatment. Epidemiology and long-term outcomes are incompletely investigated. Stroke is a major complication contributing to mortality, morbidity, and possibly to reduced quality of life. </p><p><i>Study I</i> Increasing incidence of thoracic aortic diseases 1987 – 2002 was demonstrated (n=14229). Annual number of operations increased eight-fold. Overall long-time survival was 92%, 77%, and 57% at 1, 5, and 10 years. Risk of operative and long-term mortality was reduced across time.</p><p><i>Study II</i> 2634 patients operated on the proximal thoracic aorta (Swedish Heart Surgery register) were examined. Aortic valve replacement, coronary revascularization, emergency operation, and age were independently associated with surgical death. Long-term mortality was similar for aneurysms and dissections. Operative mortality was reduced (13.7% vs 7.2%) for aneurysms but remained unchanged (22.3% vs 22.4%) for dissections across time.</p><p><i>Study III</i> 65 patients underwent selective antegrade cerebral perfusion (SACP) uni- or bilaterally. Stroke was significantly more common after unilateral SACP (29% vs 8%, p=0.045), confirmed by propensity score-matched analysis. Subclavian artery cannulation with Seldinger-technique entailed vascular complication in one case (1.5%).</p><p><i>Study IV</i> Near-infrared spectroscopy (NIRS) was used to monitor cerebral tissue saturation (rSO2) during SACP in 46 patients. Lower rSO2 were encountered (1) in patients suffering a stroke (2) with unilateral SACP, and (3) in the affected hemisphere of stroke victims. A decrease of rSO2 by 14 – 21% from baseline increased the risk of stroke significantly.</p><p><i>Study V</i> Quality of life (QoL) in 76 survivors of thoracic aortic surgery was examined with the SF-36 health questionnaire. Except for pain, QoL was reduced in all dimensions. QoL was not affected by acuity of operation. Tendencies of lower QoL after descending aortic operations, after major complications, and with persistent dysfunction were non-significant.</p>