The purpose of this study was to operationalize the coronary care patient's concept of hope. Analysis of 25 subjects' responses to an open interview format suggested that the sample's definition of hope revolved around five categories. These categories were: 1) theistic beliefs: 2) knowledge that they would not die, require surgery, or experience pain; 3) a wish not to die; 4) a wish to get better; and, 5) confidence that they would get better. Furthermore, significant differences in: 1) the sample's definition of hope: 2) the feelings associated with admission to the coronary care unit: and, 3) the factors that positively influenced the sample's level of hope were directly related to the subject's age.

The literature on stroke reveals an increasing interest in the role played by social and emotional factors in rehabilitation after stroke. A comprehensive literature survey shows profiles of spontaneous recovery, the significance of a team approach to rehabilitation, patterns of prognostic significance for long-term recovery and adaptation and formulations of rehabilitation models for the Western world. The importance of depression as a major factor in demotivation to participate in rehabilitation and achieve long-term quality of life post-stroke emerges. From the literature survey a research design was formulated for the ecological study of a sample of 51 stroke patients at Ga-Rankuwa Hospital near Pretoria. The questionnaire was structured according to the Synchronous Systems Model, and data gathered from the biological, personal and environmental spheres of patients. Data was collected by a multidisciplinary team at three assessment times, three days, two weeks and three months post-stroke. These corresponded to the acute physical phase of stroke, the end of the hospitalisation period, and an assessment of patients once they had been discharged back into the community. Descriptive statistics were obtained on all variables and principle axis factor analysis was performed to verify the factorial structure of the tests. In order to establish whether group scores changed between assessments, t-tests for dependent measures were applied. Pearson Product Moment correlations were computed for the purpose of establishing relationships between variables. The results revealed dramatically differing biographical characteristics of the sample of stroke patients both premorbidly and at three months after the stroke. Significant recovery profiles emerged in both the physical and neuropsychological spheres at both the 14 day and 3 month assessments. Depression and the functioning at home and at work social sphere of role emerged as profiles of deterioration. At 14 days, depression was related to physical and cerebral functioning. This changed at three months, with depression also being significantly related to aspects of social functioning. On the basis of these results, depression after stroke was conceptualised as a severance of relational connectedness in the social ecological functioning of stroke patients. An ecological approach to rehabilitation is proposed that would seek to reframe the identity of stroke patients and establish relational connectedness post-stroke. / Psychology / D. Litt. et Phil. (Psychology)

Memory impairment is an outcome of Traumatic Brain Injury (TBI), and associated with lower levels of post-morbid adjustment. This research isolated the memory impairment of retrieval deficit, and examined the efficacy of cues and mnemonics in remediating the impairment. Thirty-three male and female TBI survivors, 18 to 71 years old, were pre-tested for attention (COPY), short-term memory (SD), long-term memory (LD) and recognition memory (RS) employing the Rey Osterrieth Complex Figure Test (CFT), and Subtest. Sixteen subjects demonstrating a retrieval deficit were administered the post-test, with even random assignment into four treatment conditions: a control group (CONTROL), a group administered cues (CUES), a group administered mnemonics {MNEM), and a group administered mnemonics and cues (BOTH) (n = 4). A MANOVA revealed a significant effect of TRIAL (p5.05), no significant effect of TREATMENT, and no interaction. A power analysis indicated the lack of TREATMENT effect could be the result of sample size. Post-hoc t tests revealed a difference across TRIAL for SD and LO in the two experimental conditions which utilized mnemonics. The sample was divided into two groups according to subjects' level of functioning (HIGH and LOW). A MANOVA showed main effects for LEVEL for SD and RS, for TRIAL for SD, LO, and RS, and a LEVEL by TRIAL interaction for COPY (R

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy

A descriptive design was utilized to identify the relationship between perceived cardiac rehabilitation at the time of discharge and perceived self-care three months later. Perceived cardiac rehabilitation was indicated by perceived quality of the cardiac rehabilitation program, perceived understanding of self-care, and satisfaction with hospital care. Perceived self-care was indicated by self-reported self-care related exercise, stress management, and medication. Fifty-three patients from a community hospital voluntarily participated in the study by responding to four questionnaires. A low positive relationship was found between (a) perceived quality of the cardiac rehabilitation program and self-reported stress management, (b) perceived understanding of self-care and self-reported exercise and stress management, and (c) satisfaction with hospital care and self-reported exercise and medication administration. These findings of post-hospital care are useful in the evaluation of the effectiveness of one nurse-coordinated cardiac rehabilitation program.

No description available.

The current project applied a new theoretically-driven training paradigm shown to be effective at improving memory performance in a group of aging adults (Jennings & Jacoby, 2003) to a group of 10 individuals with Acquired Brain Injury (ABI). Training effects were assessed on the paradigm itself and other measures of memory and attention. Performance on cognitive measures was compared to a group of 9 healthy, young adults to control for practice effects. Results showed a replication of previous findings in terms of both frequency and magnitude of improvement in this new population. Some proximal effects of training were found on a similarly-structured task (false fame) but no distal effects of training were seen on other cognitive measures. Limitations of the current project included small sample sizes. Recommendations are provided for future research. Implications for a dual-process model of memory and clinical practice are discussed.

No description available.

The capacity of the adult human nervous system to alter the strength of connections between neurons and between networks of neurons is an exciting area of research providing novel insights into the mechanisms involved in learning, memory and recovery following brain damage. In recent years, it has become clear that both afferent input into the motor cortex and the learning of a new motor task can drive cortical reorganisation. This thesis is concerned with the functional significance of this plasticity, in both normal subjects and stroke patients, and with the question of whether stimulation - induced plasticity can lead to improved fine motor performance. My initial experiments were conducted to determine the optimal method of analysing responses to transcranial magnetic stimulation ( TMS ), and to investigate aspects of motor performance as the hand performs a precision task to grasp and lift an object. Studies on normal subjects showed that there is little difference between the dominant and non - dominant hands performing this task, but the type of grip used influences grip - force control. An investigation of stroke patients performing this task demonstrated that certain parameters were sensitive to differences between the affected and unaffected hands and these parameters were highly correlated with stroke - specific functional outcome measures. The induction of plastic change in the human motor cortex can be induced by repetition of movements, performing a complex motor task or stimulation of the peripheral afferents and / or the motor cortex itself. I observed that the application of so - called " associative stimulation " to two hand muscles in normal subjects increased the excitability of the corticospinal projection to those muscles, and improved performance times on a subsequent motor task to a greater extent than subjects receiving a control intervention. I then applied associative stimulation to the affected hand of stroke patients in conjunction with rehabilitation, which improved their ability to perform the dextrous grip - lift task. This is the first study to show that this method of inducing motor cortical plasticity can also lead to functional improvements in stroke patients. These studies confirm that using afferent stimulation to drive cortical reorganisation is associated with improved function and fine motor performance in both normal subjects and stroke patients. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2006.