Emphasis has always been given to the physiological aspects of stroke. This thesis explores the often neglected psychological areas of stroke. It includes a review of etiology but stress is given to the psychological management of the patient including motivation, aphasia, sensation and perception.The patient's feelings and attitudes and their effects on his recovery are discussed. The way in which the patient interacts with the medical staff, his friends and family markedly affect his eventual adjustment to his disability. Mention is made of guilt, shame, anxiety, depression, regression and denial as related to sudden and catastrophic illness. Agencies that can assist the patient and his family at home are also included.The proper care of the stroke patient must include the total person and should be based upon a thorough understanding of the psychological side of stroke.

No description available.

No description available.

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Upper limb (UL) impairments are common after stroke and can lead to loss of independence and long-term disability. Motor learning interventions for individuals with stroke can improve UL function and engagement in daily activities. Self-controlled practice (SCP) involves allowing choice during motor skill practice and has been shown to improve motor learning in healthy adults as well as individuals with Parkinson's disease. Additionally, SCP may impact psychological outcomes, including intrinsic motivation, self-efficacy, and positive affect. Although SCP has been incorporated into complex stroke rehabilitation interventions, little is known about its specific impact on motor learning for individuals with stroke. The purpose of this study is to investigate the effect of SCP on motor learning and psychological outcomes for adults with chronic UL impairment after stroke. Sixteen participants with chronic UL impairment due to stroke were paired and randomized into two groups. All participants practiced a standardized motor task with both their more affected and less affected hands for two consecutive days. During each day of practice, participants completed 50 30-second trials (10 blocks of 5 trials each) with their more affected hand and 20 30-second trials (10 blocks of 2 trials each) with their less affected hand. The experimental group was given control over their practice schedule and chose the order they practiced blocks of trials. Participants in the control group followed a pre-determined practice schedule based on the choices made by the participant they were paired with in the experimental group. Outcome measures were assessed on Day 1 before practice (Pre-Test), Day 2 after practice (Post-Test), and Day 3 (Follow-up). Motor learning outcomes included 24-hour retention of the trained motor task and immediate (10-minute) and delayed (24-hour) transfer of learning to an untrained motor task. Psychological outcomes including intrinsic motivation, self-efficacy, and positive affect were also assessed. Both groups demonstrated significant improvements from baseline on both the trained task and the untrained task at the Day 3 follow-up assessment. There were no significant between-group differences on any motor learning or psychological outcome measures. However, there was a significant association between perceived choice that was assessed on Day 2 following practice and amount of change on the untrained transfer task at Day 3. This suggests that perception of choice may be a relevant factor for motor learning after stroke. However, more research with larger sample sizes is needed to further investigate this finding.

published_or_final_version / abstract / Humanities / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Previous studies that have examined functional status in relation to vascular events have focused on the short term after events and have measured functional status a limited number of times. The trajectories of functional status before and after vascular events are not well characterized, and the factors influencing these trajectories are not well known. Methods: A comprehensive, structured, narrative review was performed on the topic of trajectories of disability and cognition surrounding vascular events. Then using 2 large population-based epidemiologic cohorts, the Northern Manhattan Study (NOMAS) and the Cardiovascular Health Study (CHS), trajectories of functional status were examined. In Analysis A, in NOMAS, the effect of inflammatory biomarkers (interleukin-6 [IL6], tumor necrosis factor receptor-1 [TNFR1], C-reactive protein [CRP], and lipoprotein-associated phospholipase-A2 [LpPLA2]) on the intercept and slope of functional status was determined over a median of 13 years, measured with yearly assessments by the Barthel index. In Analysis B, in NOMAS, a similar modeling strategy was used to examine whether subclinical ischemic disease on brain MRIs, measured by subclinical brain infarct (SBI) and white matter hyperintensity volume (WMHV), was associated with functional trajectories. In Analysis C, in CHS, participants had yearly assessments of disability with a combined activities of daily living (ADL) and instrumental ADL scale. The slope of change in disability was compared before and after vascular events (stroke and myocardial infarction [MI]). Results: In Analysis A, CRP (-0.41 BI points per 1 SD increase, 95% CI -0.82 to 0.002) and LpPLA2 (-0.40, 95% CI -0.75 to -0.04) were associated with baseline BI but not change over time. TNFR1 was associated with baseline BI (-0.93, 95% CI -1.59 to -0.26) and change over time (-0.36 BI points per year, 95% CI -0.69 to -0.03). In Analysis B, functional change was -0.85 BI points per year (95%CI -1.01 to -0.69); among those with SBI there were -0.88 additional points annually (-1.44 to -0.32). In WMHV models, annual functional change was -1.04 points (-1.2 to -0.88), with -0.74 additional points annually per SD WMHV increase (-0.99 to -0.49). In Analysis C, stroke (0.88, 95% CI 0.57-1.20, p<0.0001) was associated with a greater acute increase in disability than MI (0.20, 0.06-0.35, p=0.006). The annual increase in disability before stroke (0.06 points per year, 0.002-0.12, p=0.04) more than tripled after stroke (0.15 additional points per year, 0.004-0.30, p=0.04). The annual increase in disability before MI (0.04 points per year, 0.004-0.08, p=0.03) did not change significantly after MI (0.02 additional points per year, -0.07-0.11, p=0.7). Conclusions: In these large population-based studies with repeated measures of functional status and disability over long-term follow-up, several trajectories were found. In Analysis A, TNFR1 predicted worse overall functional status as well as accelerated decline over time. In Analysis B, both SBI and WMHV were associated with accelerated decline. In Analysis C, there was a steeper decline in function after stroke but not MI. These findings help to elucidate the course and potential etiologies of long-term functional decline related to vascular events, and they suggest directions for future research in this area.