Previous literature has shown that depression is the most common major emotional result following a stroke. Although the prevalence and severity of this issue have been well documented, limited research has been done to identify the evolution of post-stroke depressive symptoms in the acute phase following a stroke. During this period of time, the patient is faced with a number of significant changes from his / her previous level of functioning. These issues can include loss of physical functioning, loss of independence, changes in living arrangements, and an increased reliance on the support and care of others. The purpose of the current study was to examine fluctuations in depressive symptoms as each participant progressed through rehabilitation and discharge, and to gather qualitative information pertaining to the contributing factors that could play a role in this issue. A sample of nine participants between the ages of 50 and 85 was obtained from a regional rehabilitation unit. Data and clinical information were collected using an intensive case study design. Participants were asked to complete the Geriatric Depression Scale (GDS) at three-day intervals while on the rehabilitation unit and following discharge. This information was interpreted in the context of qualitative information gathered through reports from the participant, his or her significant other / family member, nursing and professional staff members on the rehabilitation unit, and patient records. Other analyses performed included an examination of the interactions between performance and motivation during the rehabilitation process and role of discharge site in the development and course of depressive symptoms. When examined as a whole, the information collected across all nine participants would suggest that following discharge there was a statistically significant increase in the level of post-stroke depressive symptoms. While the individuals were on the rehabilitation unit, the depressive symptoms decreased significantly and this trend continued following discharge, but the slope was not as significant as that which was observed on the rehabilitation unit. The results also suggested that there is a significant difference between the progression of depressive symptoms between groups separated based on discharge site.

Introduktion: När någon i en familj drabbas av en stroke är det inte ovanligt att någon annan i familjen blir anhörigvårdare. Det är inte endast individen som drabbas av en stroke som påverkas utan hela familjen berörs av sjukdomen. Syftet var att belysa anhörigvårdares upplevelser av att vårda en nära anhörig efter en stroke. Metod: Allmän litteraturstudie. Baserad på 11 vetenskapliga artiklar som söktes i databaserna, CINAHL och PubMed. Resultatet baserades på sju artiklar med kvalitativ metod och fyra med kvantitativ metod. Artiklarna lästes i sin helhet av författarna var för sig. Tänkbara fynd markerades och diskuterades. Utav fynden bildades kategorier. Huvudresultat: Upplevelser av brist på egentid och önskan om stöd från samhället, familj, vänner och sjuksköterskor. Slutsats: Sjuksköterskor behöver kunskap om anhörigvårdares upplevelser och behov för att kunna ge stöttning och möta anhörigvårdares behov.

Post-stroke depression (PSD) is highly prevalent and has a significant impact on stroke patients’ recovery. The systematic review aimed to build on previous review evidence to investigate the effectiveness of psychosocial interventions on reducing depression levels post-stroke. Multiple electronic databases were searched using a combination of keywords related to depression, stroke and psychosocial interventions. Randomised controlled trials investigating the effect of psychosocial interventions on depression levels for adult stroke patients were included. Methodological quality of included studies was assessed using criteria developed by the authors. Sixteen studies were included, four of which found a significant benefit of psychosocial interventions over control conditions on mood. While the results suggest some psychosocial interventions may be effective in reducing depression post-stroke; confidence in these findings is limited due to methodological limitations within studies. The review identified a number of methodological limitations across all included studies which may explain why previous research has not found any benefit of psychosocial interventions for PSD. Therefore, the evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn regarding the effectiveness of psychosocial interventions for PSD. The empirical study aimed to explore participants’ experiences of an Interpersonal Psychotherapy (IPT) assessment and formulation post-stroke to investigate the acceptability of using this model with patients experiencing PSD and indicate if more detailed quantitative research is justified. Ten participants with post-stroke depression (PSD) received two assessment appointments with a Clinical Psychologist, generating an IPT formulation of their difficulties. Participants subsequently took part in a semi-structured interview about their experience of this process. The results of these interviews were transcribed and analysed using Framework Analysis. Participants were seen to link their difficulties post-stroke to three of the four IPT interpersonal focus areas; interpersonal disputes, role transitions and grief loss. Overall, participants found an IPT assessment and formulation to be acceptable and identified benefits of the sessions including: altering their viewpoint, increasing acceptance of impaired functioning, reducing frustration, increasing positive feelings and leading to improvements in their social support. IPT may therefore be a suitable intervention for PSD and further robust, quantitative research is justifiable. Results suggest acceptance and an altered viewpoint are common following an IPT assessment and formulation; therefore future IPT research should measure changes in these variables alongside mood and behaviour.

Purpose: The systematic review summarised the literature on the impact of patient illness perceptions on health outcomes and coping after an acute neurological event, guided by Leventhal’s Self-Regulatory Model (SRM). The empirical study investigated individuals’ lived experiences of emotionalism, a sudden onset neurological disorder characterised by involuntary laughter and crying. A further aim was to develop a questionnaire measuring beliefs about emotionalism based on patients’ perspectives. Method: The review identified seventeen articles through database searches using predefined inclusion criteria. In the empirical paper, eighteen individuals took part in a qualitative study to explore their experiences of emotionalism. Results: Findings provided support for the SRM in acute neurological populations. Negative illness perceptions were associated with a range of poor health outcomes and unhelpful coping behaviours. The empirical paper provided rich individual accounts of the social and personal impact of emotionalism. Four themes were identified and used to develop a questionnaire measuring beliefs about emotionalism. Conclusions: Both chapters emphasise the value of eliciting patient beliefs about their neurological condition and of providing support at the early stages of recovery. The clinical implications and directions for future research were discussed as was the need for further validation of the questionnaire.

Post-stroke hemiparesis usually leads to slow and asymmetric gait. Improving walking ability, specifically walking speed, is a common goal post-stroke. To develop effective post-stroke rehabilitation interventions, the underlying mechanisms that lead to changes in walking ability need to be fully understood. The overall goal of this research was to investigate the deficits that limit hemiparetic walking ability and understand the influence of post-stroke rehabilitation on walking ability in persons with post-stroke hemiparesis. Forward dynamics walking simulations of hemiparetic subjects (and speed-matched controls) with different levels of functional walking status were developed to investigate the relationships between individual muscle contributions to pre-swing forward propulsion, swing initiation and power generation subtasks and functional walking status. The analyses showed that muscle contributions to the walking subtasks are indeed related to functional walking status in the hemiparetic subjects. Increased contributions from the paretic leg muscles (i.e., plantarflexors and hip flexors) and reduced contributions from the non-paretic leg muscles (i.e., knee and hip extensors) to the walking subtasks were critical in obtaining higher functional walking status. Changes in individual muscle contributions to propulsion during rehabilitation were investigated by developing a large number of subject-specific forward dynamics simulations of hemiparetic subjects (with different levels of pre-training propulsion symmetry) walking pre- and post-locomotor training. Subjects with low paretic leg propulsion pre-training increased contributions to propulsion from both paretic leg (i.e., gastrocnemius) and non-paretic leg muscles (i.e., hamstrings) to improve walking speed during rehabilitation. Subjects with high paretic leg propulsion pre-training improved walking speed by increasing contributions to propulsion from the paretic leg ankle plantarflexors (i.e., soleus and gastrocnemius). This study revealed two primary strategies that hemiparetic subjects use to increase walking speed during rehabilitation. Experimental analyses were used to determine post-training biomechanical predictors of successful post-stroke rehabilitation, defined as performance over a 6-month follow-up period following rehabilitation. The strongest predictor of success was step length symmetry. Other potential predictors of success were identified including increased paretic leg hip flexor output in late paretic leg single-limb stance, increased paretic leg knee extensor output from mid to late paretic leg stance and increased paretic leg propulsion during pre-swing. / text

The assessment of rehabilitation effectiveness in the post-stroke hemiparetic population has primarily focused on walking speed. Walking speed, however, may be improved through a number of mechanisms; increased speed can be achieved through a combination of increased propulsion (propelling the center of mass forward) and swing initiation (resulting in longer and faster steps) in either the paretic or nonparetic leg. Therefore the objective of this study was to use a detailed musculoskeletal model and forward dynamics simulations to identify the individual muscle contributions to forward propulsion and swing initiation following locomotor training in two post-stroke hemiparetic patients who had similar speed increases following training, one utilizing an “ankle strategy” (increases in ankle power generation to accelerate the trunk forward) and one a “hip strategy” (increases in hip flexor generation of the swing leg to accelerate the leg forward) to increase speed. Each subject participated in locomotor therapy training using a body weight supported treadmill modality. Strategy classification was based on inverse dynamics analysis pre- and post-training. The simulation analyses revealed that forward propulsion was achieved primarily through the uniarticular plantarflexors and the contralateral knee extensors in both subjects. The main difference between the two strategies occurred primarily in the hip muscle contributions to swing initiation. The “hip strategy” subject, in addition to using the hip flexors to accelerate the leg forward, had higher contributions from the contralateral non-sagittal plane hip muscles to generate energy to the leg to initiate swing. These results suggest that using either the “ankle strategy” or the “hip strategy” to increase speed post-training results in similar muscle function post-training walking with differences primarily occurring in the hip muscle contributions to swing initiation. Future studies analyzing both pre- and post-training may reveal changes in muscle function that correspond more with the strategy classifications. / text

Bakgrund: I Sverige insjuknar varje år ungefär 25000 människor i stroke för första gången. Ungefär 40 procent av de som överlever en stroke får kvarstående funktionedsättningar, vilka påverkar deras vardag och försämrar livskvaliteten. En vanlig komplikation är hjärntrötthet, vilket innebär en förlamande trötthet som plötslig uppstår, där energin tar slut och som det inte går att vila sig ifrån. Hjärntrötthet leder ofta till frustration hos personen inte minst på grund av bristande förståelse från omgivningen. Syfte: Att beskriva patienters erfarenheter av att leva med hjärntrötthet efter stroke Metod: En litteraturöversikt genomfördes där 15 artiklar med kvalitativ ansats analyserade med hjälp av Fribergs femstegsmodell. Resultat: Analysen av materialet resulterade i tre huvudkategorier: Förändring i vardagen, Förändring av jaget och Hantering av den nya vardagen. Hjärntrötthet har en stor inverkan på personens liv, det innebär att hjärntrötthet påverkar vardagen även sociala sammanhang, de upplever frustration för den förlorad identitet och förminskad självbild. De behöver information och stöd för att kunna hantera symtomet, minska lidandet, öka självkänslan och få kontroll av sin sjukdom. Slutsats: Sjuksköterskor bör informera personer om hjärntrötthetens påverkan i persons liv men sjuksköterskor ska även stödja, uppmuntra och ge råd till hjärntrötthetsdrabbade patienter för att de ska utveckla egna strategier som kan underlätta symtomen samt minska komplikationer.

Class of 2015 Abstract / Objectives: Warfarin has historically been the anticoagulant used for the primary prevention of stroke in atrial fibrillation (AF), however three target specific oral anticoagulants, dabigatran, rivaroxaban, and apixaban, have recently been approved for use in this setting. Current literature lacks a comparison of these four drugs in relation to post-stroke outcomes, and this study aims to compare their performance in a natural setting. Methods: This retrospective cohort study identified stroke patients admitted to an academic medical center between January 2013 and December 2014 using the Quintiles, Inc.-American Heart Association Get With The Guidelines-Stroke database; pertinent data was collected from the database and patient electronic medical records. Primary endpoints measured were length of stay, 30-day readmission, and discharge disposition; secondary endpoints included rates of admission to the intensive care unit (ICU) and complications. Results: Of 940 stroke admissions, 53 ischemic stroke patients were identified as receiving an oral anticoagulant for stroke prevention in AF. The warfarin (n=40) and non-warfarin (dabigatran, rivaroxaban, and apixaban; n=13) groups were well matched regarding admission demographics, however patients taking warfarin were more likely to have an elevated INR at hospital admission (P=0.0053) and receive tPA (P=0.047). Patients in the warfarin group were also statistically significantly more likely to receive warfarin on discharge (P=0.004). No endpoints achieved statistical significance. Conclusions: No differences in post-stroke outcomes between warfarin and non-warfarin oral anticoagulants used for stroke prevention in AF were found.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13397号 / 論医博第2221号 / 新制||医||1051(附属図書館) / (主査)教授 伊佐 正, 教授 中本 裕士, 教授 渡邉 大 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: År 2021 insjuknade 24 500 svenskar i stroke. En konsekvens av stroke är post-stroke fatigue (PSF). PSF är ett tillstånd som är förknippat med försvårad rehabilitering och återgång till arbetslivet, ökad dödlighet samt försämrad livskvalitet. Syfte: Syftet var att belysa personers upplevelser av fatigue till följd av stroke. Metod: En allmän litteraturstudie där 11 resultatartiklar granskades för vetenskaplig kvalitet och analyserades med kvalitativ innehållsanalys. Resultat: Innehållsanalysen mynnade ut i fyra kategorier. Kategorin upplevelser av fatigue som en utmaning, vilken belyser hur PSF upplevdes som oförutsägbart och begränsande. Kategorin upplevelser av fatigue och behov av att möta livet på ett nytt sätt belyser hur personerna behövde ändra på sättet de verkade och såg på sina liv. Kategorin upplevelser av fatigue och behov av kunskap belyste hur personerna upplevde informationen de fick av vården. Kategorin upplevelser av fatigue och förståelse från personer i deras närhet belyser upplevelsen av stöd från omgivningen. Konklusion: Personer med PSF och deras anhöriga var överens om att de hade ett gemensamt och omfattande behov av undervisning om PSF. Ett personcentrerat bemötande baserat på kunskap om PSF bör prägla sjuksköterskans arbete gentemot personer med PSF. Mer forskning kring effektiva behandlingar och omvårdnadsåtgärder vid PSF behövs. / Background: In 2021 24 500 persons in Sweden had a stroke. A consequence of stroke is post-stroke fatigue (PSF). PSF can be a hindrance to rehabilitation, return to work and have a negative effect on quality of life and mortality. Aim: The aim was to highlight person’s experiences of fatigue following stroke. Method: A general literature review where 11 articles were examined for scientific quality and analyzed with qualitative content analysis. Results: Four categories: Experiences of fatigue as a challenge, which highlights PSF as unpredictable and limiting. Experiences of fatigue and a need to face life in a new way highlights how the persons had to adapt how they lived their lives and viewed themselves. Experiences of fatigue and the need for knowledge highlights how the persons experienced the information from health care professionals. Experiences of fatigue and understanding from people close to them highlights the importance of a supporting social network. Conclusion: Persons with PSF and their social network has a mutual and extensive need of education about PSF. A person-centered approach based on knowledge should characterize the nurses work with persons with PSF. More research on how to better treat and care for persons with PSF is needed.