The purpose of this study was to assess the effect of BWSTT on paretic limb function using the outcome measures of overground walking velocity, paretic leg propulsion, and the mechanical work produced by the hip, knee, and ankle of the paretic limb. Thirteen participants with chronic stroke, ranging in age from 40 to 80 years, completed 24 sessions of BWSTT over eight weeks. Overground walking velocity and bilateral kinematics and kinetics were collected prior to and following completion of the BWSTT intervention. All participants exhibited statistically significant increases in overground walking velocity post BWSTT. Neither the propulsive impulse of the paretic limb, relative to total propulsive impulse, nor the relative contribution of the paretic hip, knee, and ankle to total positive work significantly changed post BWSTT. The results suggest that paretic limb function remains unchanged following BWSTT, despite improvements in overground walking velocity. / School of Physical Education, Sport, and Exercise Science

The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha. / School of Nursing

Belief constructs appear to govern many aspects of life and may have an influence on coping with severe disability. This study investigated the extent to which coping with a stroke is identified by the belief constructs of just world, locus of control, attribution, and reformulated learned helplessness. The data were collected at a comprehensive rehabilitation center from thirty consenting stroke victims. The sample included 17 women and 12 men with a mean age of 64. The median number of days from the stroke to rehabilitation was 16. Twenty subjects had left hemiparesis and ten subjects had right hemiparesis.In addition to the belief-construct predictor variables, nature-of-stroke and demographic variables were collected during an initial evaluation. Demographic variables included sex, age, marital status, occupation, education, and recreation. Nature-of-stroke variables included period of time since stroke, diagnosis, severity, location, and aphasia as measured by the 'Aphasia Language Performance Scales' (Keenan & Brassell, 1975). The belief constructs were measured by the 'Just World Scale' (Rubin & Peplau, 1975), the 'Internal-External Locus of Control Scale" (Collins, 1974), and an adapted version of the 'Attribution Style Questionnaire' (Seligman, 1984). A coping measure was introduced as the criterion variable. It was administered 21 days following the initial evaluation and is based upon the ratings of the stroke victims' therapists. It includes a scale to more clearly define coping.The results of the study did not produce a clear definition of coping, although cognitive, emotional, and physical factors were evident. In addition, there was preliminary evidence of reliability and validity for measures of this construct. The linear composite of five variables was statistically significant (p < .01) and identified 56% of the variance in the coping measure. The significance of these variables suggests that successful coping is associated with older subjects who had passive premorbid recreation, were admitted relatively soon after their stroke, were rated as having a mild stroke, and made stable attributions about rehabilitation. The fact that one of the belief-construct variables (stability of attribution about rehabilitation) was significant, despite the small sample size, is encouraging and justifies further research in this area.

Educational programs covering the technical, treatment and emotional aspects of a cancer diagnosis have been shown to reduce anxiety levels, boost compliance with treatment regimens and improve survival rates. This study was designed to evaluate whether newly diagnosed cancer patients, after reviewing an educational intervention, felt they experienced decreased stress levels and more informed decision making ability. A descriptive, evaluative study was designed. Seventy-five newly diagnosed cancer patient's evaluation forms were examined. Responses were reviewed to see if these patients placed an important versus unimportant value on the individual components of an educational packet. Their responses were tallied and the results showed that an overwhelming majority of the patients felt that the packet components were important in helping them feel decreased stress levels and more informed in their decision making regarding their diagnosis of cancer. It was also determined that the majority of patients felt that the packet components were easy to understand. / Department of Physiology and Health Science

The purpose of this descriptive correlational study was to examine the relationship between admission disability and length of stay obtained from the records of neurological and orthopedic acute rehabilitation adult inpatients. The research question was, "Is there a relationship between the admission disability and length of stay?" Orem's self-care theory was used as the framework of the study. The sample consisted of 118 records of patients dismissed from a freestanding midwestern rehabilitation hospital during July 1, 1996 to November 30, 1996. Admission disability was measured with the Functional Independence Measure (FIM'''*1) instrument that was available in the patient's record. Length of stay was the number of days in the rehabilitation facility. Motor disability was significantly and negatively correlated with length of stay (r= -0.249, p=.006). Implications for practice were discussed. / School of Nursing

This study investigated the differences between right and left hemisphere brain damaged (BD) patients and controls in response to verbal and spatial-affective stimuli. The three null hypotheses explored in this study were: (a) Right hemisphere BD patients would not display significantly different arousal levels from controls in response to verbal and spatial-affective stimuli, (b) left hemisphere BD patients would not display significantly different arousal levels from controls in response to verbal and spatial-affective stimuli, and (c) left hemisphere BD patients would not display significantly different arousal levels from right hemisphere BD patients in response to verbal and spatial-affective stimuli. A One-Way Analysis of Variance was used to determine if differences in arousal existed between right and left hemisphere BD patients and controls. Planned comparisons (t-tests) were used in analyzing the hypotheses.A total of 48 subjects was used in this study. Experimental subjects were composed of 16 left and 16 right hemisphere BD patients from Community Hospital, Indianapolis, Indiana. Sixteen control subjects were obtained from the community of Muncie, Indiana. All subjects were volunteers. No significant differences were found between right and left hemisphere BD patients and controls with respect to age, education, and post injury.The instruments used in this study were a J & J electrodermal unit, the Affective Behavior Test, and the Comprehension subtest of the Wechsler Adult Intelligence Scale-Revised. All tests were individually administered while GSR recordings were obtained. Administration, scoring, computer analyses, and interpretation was completed between May 1982 and February 1984.All three null hypotheses were rejected. Right and left hemisphere BD patients' arousal levels in response to affective stimuli were significantly different from those of controls (p <.001). These results suggested that arousal levels in right and left hemisphere BD patients were lower than non-brain damaged individuals. Additionally, right hemisphere BD patients were found to have significantly lower arousal levels than left hemisphere BD patients (p<.01). In light of these findings, it was recommended that future research explore the value of increasing arousal levels for cerebrovascular accident patients in the rehabilitative process.

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

Purpose: The principal aim of this project was to investigate the influence of clinical indices of injury severity and polymorphism of the apolipoprotein E gene upon the long-term physical, cognitive and emotional sequelae of traumatic brain injury and spontaneous subarachnoid haemorrhage. It was also intended to determine the extent to which changes occur in these sequelae beyond the initial six months post injury. Method: Sixty-two brain injury patients who had previously taken part in a neuropsychological assessment at six months post injury were traced and participated in a follow-up assessmens some 6-9 years subsequent to their injury. Separately, a group of 70 subarachnoid patients drawn from a consecutive series of neurosurgical admissions participated in a neuropsychological assessment at 14 months subsequent to their haemorrhage. In both studies, the assessment comprised a semi-structured interview and a battery of cognitive measures focusing principally upon memory and executive function tasks. A questionnaire including a range of standardised measures of anxiety, depression and quality of life was left with patients to be returned by post. Results: The ApoE e4 allele did not appear to influence recovery amongst these brain injury survivors, though there are suggestions that it may have an influence upon subgroups of patients. Amongst traumatic brain injury survivors, post-traumatic amnesia was a better predictor of functional or emotional outcome than consciousness based measures. However, consciousness based measures were more predictive of cognitive sequelae and low admission Glasgow Coma Scale was associated with continued improvement on information processing tasks. Other than on these tasks, there was little evidence of change between 6 months and 6-9 years post injury. Amongst the subarachnoid haemorrhage patients, Fisher Grade was found to be more predictive of subsequent Glasgow Outcome Scale and cognitive function than WFNS Grade or other clinical indices. Surviving aneurysmal patients had comparable levels of recovery to patients who had a negative angiogram. In both studies emotional sequelae, in particular anxiety-related difficulties, were found to be a principal factor in the functional outcome of some 40% of patients. Conclusions: Greater emphasis should be placed upon measures of post-traumatic amnesia as predictors of functional recovery in surviving patients. The use of an amnesia measure may also be warranted in studies of outcome following subarachnoid haemorrhage or other stroke. The ApoE e4 allele does not appear to have a strong influence upon functional recovery after brain injury across all patients, though it is possible that it interacts with other factors to influence recovery in subgroups. Greater emphasis should be placed upon the prevention and/or detection and treatment of mood disorders following brain injury. In the absence of intensive rehabilitative interventions, survivors of serious brain injury are more likely to deteriorate than to continue to recover beyond six months post injury.

Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 152-158). / Also available by subscription via World Wide Web / xii, 158 leaves, bound ill. 29 cm

Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.