Indiana University-Purdue University Indianapolis (IUPUI) / Stroke is the leading cause of adult disability with over 5 million American adults experiencing physical, psychological, and/or social limitations related to stroke. Although depressive symptoms and poor quality of life (QOL) are key outcomes for stroke survivors, little is understood about how these outcomes are affected by stroke survivors’ evaluation of their experience. The concept of cognitive appraisal, an evaluation of the meaning of a situation for one’s well-being, may explain some of the factors associated with post-stroke depressive symptoms and QOL. The purpose of this study was to determine factors associated with post-stroke depressive symptoms and QOL using a conceptual model derived from the transactional theory of stress originally proposed by Lazarus and Folkman. Three aims guided this study: to determine whether (a) depressive symptoms at 4 months after stroke are predictive of stroke-specific QOL at 10 months; (b) perceived social support, self-esteem, and optimism at 1 month after stroke predict depressive symptoms among stroke survivors at 4 months; and (c) threat appraisal at 1 month after stroke is a mediating variable between perceived social support, self-esteem, and optimism at 1 month after stroke and depressive symptoms at 4 months. A secondary analysis of data from 392 stroke survivors in the Randomized Trial of Treatment for Post-stroke Depression (AIM study) was conducted. Using a descriptive correlational design and multiple regression analyses, longitudinal associations among perceived social support, self-esteem, optimism, threat appraisal, depressive symptoms and stroke-specific QOL were examined. Perceived social support, self-esteem, and optimism were significantly associated with threat appraisal. Threat appraisal was significantly associated with post-stroke depressive symptoms. Stroke-specific QOL was found to be stable between 4 and 10 months. Partial mediation of the relationship between the explanatory variables and depressive symptoms by threat appraisal at one month post-stroke was demonstrated. In conclusion, threat appraisal is an important factor to consider in future research and intervention development in relation to post-stroke depressive symptoms.

The following work presents a novel, overground robotic gait trainer: the mobile Tethered Pelvic Assist Device, or mTPAD. The mTPAD is a parallel, cable-driven platform that can apply three-dimensional forces and moments to the user’s pelvis as they walk overground. These forces and moments applied to the pelvis can be timed to the user’s gait and motivated through gait deficits to target specific motions or gait adaptations. An overview of both traditional and robotic gait training is given as an introduction in Chapter 1. The state-of-the-art pelvic robotic gait trainers are discussed, and the need for an overground device that can apply timed forces and moments to the pelvis is highlighted. The design of the mTPAD is covered in Chapter 2. The mechanical structure and the novel controller are discussed and validated through experiments with human participants. The mTPAD device is evaluated on its transparency, accuracy of pelvic localization, and ability to apply specific forces. Chapter 3 illustrates a continuous moment that is applied to the pelvis and synchronized with the user’s gait cycle. The controller is evaluated on its accuracy and ability to alter pelvic kinematics and muscle activations in a group of neurotypical adults. Chapters 4 and 5 highlight the mTPAD’s ability to alter gait characteristics and muscle responses of two groups that exhibit gait deficits: stroke survivors and children with Cerebral Palsy. By evaluating the effects of different force and moment profiles on individuals who may benefit from gait training, this work aims to illustrate the mTPAD’s potential as an overground gait training tool.

The purpose of this study was to investigate the strengths/weaknesses of the stroke spouse/stroke caregiver relationship in relation to the cerebral hemisphere affected by the stroke, the gender of the stroke spouse, the functional capacity of the stroke spouse, the length of time since the stroke, and the socioeconomic status of the couple. Forty stroke spouses, who had received medical rehabilitation at four medical facilities (Woodrow Wilson Rehabilitation Center, Waynesboro Community Hospital, Chambersburg Hospital, and Blue Ridge Rehabilitation Hospital), and stroke caregivers were interviewed regarding their pre- and post-stroke marital relationship. This study specifically investigated the the spouse caregivers' perceptions of the impact stroke had upon the marriage. Scales assessing the variables of marital health/dysfunction and functional independence of stroke spouse were selected. These included: the Family Assessment Measure (FAM) - dyadic relationship version and the Barthel Index. All scores on FAM were within the normal range of strength/weakness. Results indicated that a significant proportion of the variance in task accomplishment, role performance, communication, control, and total relationship health were associated with the gender of the stroke spouse and the level of functional independence. Spouse caregivers perceived more post— stroke than pre-stroke difficulties in these relationship areas, when the stroke spouse was male and functional disability was high. High functional disability was associated with increased difficulties in values and norms post-stroke and low SES was related to increased problems in affective expression. The cerebral location of the stroke and the length of time since the stroke were not associated with significant changes in caregivers’ perceptions of pre- and post-stroke marital health/dysfunction. Couples with male stroke spouses and/or stroke spouses with significant physical disability are at risk for marital dysfunction. Marital counseling services during medical rehabilitation may be useful to these couples. / Ph. D.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / The ability to walk has been rated by stroke patients as one of the most important goals of their rehabilitation. Knee control is a key element in normal gait. Currently, treatment options aimed at improving poor knee control in stroke patients are often costly, need specialised equipment and have poor patient compliance. The purpose of the current study was to assess whether medial patellar taping could improve knee control in stroke patients. Gait speed, dynamic standing balance, knee alignment and whether the subjects experienced any subjective stabilising effect on the knee after taping were tested. Twenty subjects diagnosed with hemiplegia after a stroke served as their own controls in a repeated measures experimental study. Results indicated that dynamic standing balance as tested by the Step Test (p=0.063) and the Timed-up-and-go test (p=0.099) (Wilcoxon test) showed marginal improvement after taping. This improvement in dynamic standing balance may indicate that neuro-motor control and/or eccentric knee control had improved. There was no change in walking speed and knee alignment as tested by change in the Q-angle (Wilcoxon test). However, a decrease in the Q-angle correlated with an improvement in dynamic standing balance as tested by the Step Test (p=0.029) (Spearman‟s test). Participants with decreased Q-angles after taping possibly had better knee alignment and were more willing to accept weight on their affected leg indicating a change in quadriceps activation. No change in walking speed (p=0.351) (Wilcoxon test) before and after taping may indicate that there was no change in the magnitude of contraction and/or concentric activity in the quadriceps muscle. Thirty percent of the participants reported a subjective change in knee stability after taping. Subjective change did not, however, significantly correlate with either of the balance tests, walking speed or Q-angle measurements. The possibility that medial patellar taping may be useful in treating poor knee control in stroke patients during dynamic balance activities should be investigated further.

Thesis (MScPhysio)--Stellenbosch University, 2012 / ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Stroke is a difficult condition to manage because of the complex nature of its effects. Caregivers are therefore, crucial in providing ongoing care for the stroke patient at home. Caregivers experience considerable strain during caregiving, as their needs are often overlooked because therapeutic management tends to focus mainly on the stroke patient. In third world countries like South Africa, there are currently no research studies found describing an optimum support intervention which addresses the caregivers' needs and reduces their strain levels. Objective To determine the effectiveness of a caregiver support intervention programme (CSIP) that was developed to address the expressed needs identified by the primary caregiver of the stroke patient in the Bishop Lavis community. Method A prospective and descriptive qualitative study design was used to evaluate the effectiveness of the CSIP. A total of 29 caregivers participated in three CSIPs, which were implemented over five sessions each. The Barthel Index was used to measure the functional level of each stroke patient. The needs of stroke caregivers were determined by 15 semi-structured interviews, until data saturation was reached. The Caregiver Strain Index was completed before and after implementation of the CSIP, in order to measure whether the intervention programme had been effective in reducing the caregivers' level of strain. Written or verbal feedback forms was also completed by the caregivers after each of the five intervention sessions. Results were analysed using repeated measures ANOVA and descriptive qualitative analysis. Results The qualitative results of this study suggest that the CSIP was effective in addressing mainly the physical needs, as well as the emotional, educational and socio-economic needs of the primary caregivers. The CSIP was also effective in reducing caregiver strain in 61.5% of the sample (N=13). However, an additional finding of this study was the personal and logistical barriers identified which limited the caregivers' attendance of the sessions. Conclusion The CSIP was effective in addressing the physical, emotional, socio-economic and educational needs of the primary caregiver. In addition, the results also verified that the CSIP was effective in reducing caregiver strain in the majority of the caregivers, despite a small sample size. The barriers identified which affected the caregivers' attendance, need to be taken into consideration when planning future intervention programmes for caregivers in poor socioeconomic communities. Due to the low attendance rate by the caregivers, a larger sample size is recommended to accommodate for the high drop-out rates in such a population.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / Introduction Decreased hip extension in the paretic leg is a common impairment after stroke. Gluteal taping was introduced as a technique that helped in increasing hip extension of the paretic leg, and step length in the unaffected leg. The aim of this study was to further investigate the effect of gluteal taping on other temporal spatial and kinematic parameters using a 3D motion analysis system (Moven System). Methods The study was conducted in two phases. Phase 1 entailed examining the intra trial reliability of the Moven System, where eight subjects were recruited and tested twice at their normal pace of walking, and twice again at their maximum speed. Phase 2 involved studying the effect of gluteal taping on temporal spatial and kinematic parameters. Thirty subjects participated and were tested under three taping conditions (no tape, therapeutic tape, and placebo tape), while walking at their self selected walking speed. Intra-class correlation coefficient ICC determined around 95% confidence intervals was used to examine the intra trial reliability of the Moven System. Repeated measures-ANOVA was used to study the temporal spatial, and kinematic variables during the three taping conditions. Results The Moven showed moderate to excellent reliability in measuring the gait variables including temporal spatial parameters and sagittal kinematic parameters in addition to the lateral pelvic tilt. Taping caused significant increase in hip extension and reduction in knee flexion at terminal stance for the paretic leg. There was a trend toward better hip flexion at terminal stance, and a mild trend toward more planter flexion at terminal stance. Both treatment and placebo tapes caused an increase in the step lengths of either leg, and a significant increase in gait velocity and cadence. Conclusion Gluteal taping may be beneficial in producing important clinical effects post stroke, and can be used as an adjunct strategy during gait rehabilitation. Further research is needed to understand the mechanism of how taping produces effects, and to further explore its effect on kinetic and muscle activation variables.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

Lu, Jinyan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 75-86). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes in Chinese.