Bakgrund: Varje år insjuknar ca 30 000 svenskar i stroke. Stroke är ett tillstånd som ofta leder till allvarliga funktionsnedsättningar. Funktionsnedsättningarna påverkar inte bara den strokedrabbade utan även dess partner. Syfte: Att belysa hur parets liv förändras efter att en av dem har insjuknat i stroke. Frågeställningar: Vilka emotionella förändringar upplever paret? Vilka sociala förändringar upplever paret? Hur påverkas parets sexualliv?  Metod: Metoden vi använde oss av var en systematisk litteraturstudie. Tolv vetenskapliga artiklar med både kvalitativ och kvantitativ ansats inkluderades i studien. Artiklarna analyserades med inspiration från Friberg (2012) Resultat: Resultatet beskrevs utifrån tre frågeställningar och sex kategorier. Kategorierna var känsloyttringar, ökad börda, behov av stöd, nedsatta kroppsfunktioner, dagliga aktiviteter och förändrad intimitet. Resultatet visade att den strokedrabbade och partnern fick förändrade roller i relationen efter en stroke. Det skedde en omfördelning av sysslor, partnern fick ökat ansvar vilket kunde upplevas som övermäktigt och svårhanterat. Parrelationen och sexuallivet påverkades efter stroken och det var viktigt att paret fann en acceptans i den nya livssituationen. Slutsats: Vår studie visar att både den strokedrabbade och partnern upplever emotionella och sociala förändringar samt fick ett förändrat sexualliv efter en stroke. För att motverka att paret får en försämrad relation efter stroken är det viktigt att vården ser paret ur ett helhetsperspektiv och vid behov erbjuder ett fortlöpande stöd.

Since a significantly greater percentage of body weight is supported by the non-paretic limb following stroke, a greater amount of fatigue may be present during daily activities. This may affect the ability of these individuals to maintain a stable upright posture. The presence of falls following a stroke has been attributed in part to this asymmetrical stance post-stroke. Therefore the purpose of this study was to assess the effect of quadriceps muscle fatigue on bi-pedal posture in individuals who had a stroke and an age-matched control group. Although individuals after stroke displayed greater postural sway under the paretic limb than the non-paretic limb or control subjects, results of this study show that sustaining an isometric knee extension of the non-paretic limb induces changes in postural control for individuals after stroke, but that these changes do not markedly differ from those of healthy age-matched controls.

Since electric power is one the most important necessities for today’s life and industry, its service reliability must be maintained in an extremely high level. Thunderstorms often reduce this quality of service. Since cloud-to-ground lightning strokes are among the most frequent yet least understood causes of service interruption, predicting the geographical and temporal distribution of the lightning strokes can help power system planners and designers improve the protection of new and existing transmission lines. Such a prediction needs a model that is based on physical properties of the phenomenon and acquired data. This approach requires several stages including modelling, simulation, and characterization. Characterization provides metrics for comparison between the physical and simulated data. The distributions of the lightning stroke densities (aka lightning stroke maps (LSMs)) have patterns that are highly nonlinear, nonstationary, and stochastic. Ordinary analyzes and metrics are insufficient to characterize such patterns. Multiscale analysis of these patterns indicates their self-affinity over multiple scales, which is an indication of their multifractality. Consequently, multifractal analysis methods such as the Rényi fractal dimension spectrum are appropriate candidates for characterization of these density maps. This work uses the lightning stroke data collected by Canadian lightning detection network for Manitoba from 1998 to 2006, employs a multifractal analysis of the lightning stroke maps, and investigates the consistency of such a characterization over time. The results indicate that the LSMs of Manitoba have multifractal distributions, both locally and globally. The results also indicate a convergence in statistical distribution for the LSMs and strong sensitivity of the Rényi spectra to the data variations. For modelling such data, multifractal approaches such as diffusion limited aggregation, percolation, or cellular automata are appropriate candidates. This work provides diffusion limited aggregate modelling and simulation for the maps and compares the physical and simulated lightning stroke maps through Rényi spectra, where the results indicate a high similarity, both visually and analytically. Since lightning strokes are global phenomena, the same methods and techniques can be used for LSMs anywhere in the world. In addition, the utilized methods and approaches for analysis and modelling can be used for similarly complicated phenomena.

The BNIP3 family, a group of death-inducing mitochondrial proteins, includes BNIP3, NIX and BNIP3h. These proteins share structural and functional similarities. BNIP3 causes neuronal cell death in a necrosis-like, caspase-independent manner with mitochondrial dysfunction. We reported that BNIP3 plays a role in delayed neuronal death in stroke models. Over-expression of BNIP3 causes up to 70% neuronal death, while knockdown of BNIP3 only protects 23% neurons from hypoxia. Thus, we hypothesize that other members of the BNIP3 subfamily compensate for the loss of BNIP3. BNIP3 and NIX were highly upregulated in the oxygen and glucose deprivation (OGD)/reoxygenation model, and knockdown of BNIP3 or NIX protected about 20% - 44% of neurons. Knockdown of BNIP3 family reduced neuronal death by 48%. Mitochondrial membrane potential loss, mitochondrial permeability transition pore (MPTP) opening and reactive oxygen species (ROS) production were all significantly attenuated by BNIP3 and/or NIX inhibition. AIF and EndoG were reported involving in caspase-independent cell death in ischemic stroke. We found that AIF was released from mitochondria and translocated into nuclei in neurons after OGD/reoxygenation, while inhibition of BNIP3 blocked AIF and EndoG translocation and prevented neuronal death. Over-expression of BNIP3 and NIX caused AIF translocation and subsequent neuronal death. These data reveal the effects of the BNIP3 family in neuronal death and indicate that AIF and EndoG are two downstream factors in the BNIP3-mediated cell death pathway. Meanwhile, necrostatin-1 (Nec-1), an inhibitor for a caspase-independent necrotic cell death, is able to protect neurons from death in stroke, mechanism of which is unclear. Here, we confirmed that Nec-1 significantly increased survival of neurons in models of stroke in vivo and in vitro. It also attenuated hypoxia or BNIP3-induced mitochondrial dysfunction and prevented mitochondrial release of AIF. Nec-1 did not affect the expression levels of BNIP3 but prevented its integration into mitochondria. These results suggest that Nec-1 protects neurons against ischemia by targeting BNIP3. In summary, this research indicates that the BNIP3 family is one of the regulators of caspase-independent neuronal death in stroke and that Nec-1 is an inhibitor for BNIP3 and a potential therapeutic agent for stroke.

Bakgrund: I samband med en pågående studie vid Norrlands universitetssjukhus (NUS) har det framkommit att patienter med dysfagi har varit svåra att rekrytera. Upplevelsen är således att färre patienter har dysfagi eller att sjukdomsförloppet är kort. Få nyare studier gällande naturalförloppet av dysfagi i den akuta fasen hos nyinsjuknade strokepatienter finns att tillgå och den forskning som gjorts visar på varierade resultat med olika metoder som utgångspunkt.   Syfte: Studiens syfte var att belysa naturalförloppet under slutenvårdtiden hos akuta strokepatienter med påvisad dysfagi samt bidra med ny data. Metod: Inneliggande patienter på Strokecenter vid NUS rekryterades och följdes upp måndagar, onsdagar och fredagar under två tidsperioder innefattande totalt 8 veckor. Samtliga patienter testades, men endast de med slutgiltig diagnostiserad stroke och patologiskt värde på ett eller flera av bedömningsmaterialen Standarardized Swallowing Assessment (SSA-S), Lipforce 100 (LF100) och Swallowing Capacity Test (SCT) inkluderades. Resterande testade patienter som inte fick diagnosen stroke analyserades som en grupp (TIA och annan diagnos), vars resultat jämfördes med strokegruppen. Slutgiltig studiegrupp innefattade 20 patienter med stroke och 12 patienter med TIA och annan diagnos. Resultat: Kvarstående dysfagi under slutenvårdtiden identifierades hos 10 av 17 (59 %) strokepatienter. Strokepatienter med påvisad dysfagi skrevs ofta ut, utan att normaliserad sväljförmåga konstaterats. En viss spontanförbättring sågs i läppkraft under de tre första mättillfällena. Självupplevda sväljsvårigheter fanns hos 7 av 17 strokepatienter och endast 6 av 17 strokepatienter med dysfagi hade uppmärksammats i vårdplanen. Naturalförloppet i gruppen med TIA och annan diagnos är svår att uttala sig om då patienterna på grund av bortfall inte kunde följas upp till ett andra mättillfälle. Slutsatser: Föreliggande studie ger en indikation på att det inte finns någon direkt antydan på ett kort sjukdomsförlopp hos strokepatienter med dysfagi och att många inte uppmärksammats i vårdplanen. Denna studie är dock för liten för att uttala sig om naturalförloppet och större deltagargrupp behövs för en mer komplett kartläggning.

I Region Skåne finns tydliga behandlingsriktlinjer gällande prehospitalt omhändertagande av patienter med misstänkt stroke i vårdprogrammet "Rädda hjärnan". Det saknas ett enhetligt bedömningsinstrument som specialistutbildade sjuksköterskor inom ambulans kan använda för att känna sig säkrare och tryggare i sin identifiering av patienter med misstänkt stroke. Syftet med studien var att undersöka specialistutbildade sjuksköterskors uppfattning av att kunna identifiera patienter med misstänkt stroke inom den prehospitala vården. Studien genomfördes med en kvantitativ ansats i form av enkätundersökning som delades ut till 35 specialistutbildade sjuksköterskor. Resultatet av studien visade att en majoritet av respondenterna upplevde att det hade underlättat med ett enhetligt bedömningsinstrument i deras bedömning av patienter med misstänkt stroke. Det framkom även att respondenterna upplevde en större säkerhet med att fastställa debuttiden med hjälp av anhöriga eller vittnen, jämfört med om bedömningen gjordes enbart med hjälp av patienten. Det framkom även att respondenterna kände sig relativt säkra på när vårdprogrammet skulle aktiveras, trots att över hälften upplevde att det inte fanns klara direktiv om hur en neurologisk undersökning skall utföras. Vår rekommendation för vidare utbildning är en gemensam stroke dag för alla medarbetare i vårdkedjan. Om fler patienter kommer under behandling snabbare kan det vara en samhällsekonomisk besparing på grund av mindre restsymtom och kortare vårdtider.

No description available.

Individuals with stroke suffer from impaired balance that increases their risk of falling. Controlling reactive balance is essential to maintaining stability. The objective of the first study was to identify the role of pre-perturbation stance asymmetry on limb preference for reactive stepping in healthy young adults. This study demonstrated that steps taken with a pre-loaded limb are short, directed laterally and have a rapid swing time. The objective of the second study was to investigate the challenges of reactive stepping among individuals with stroke. This study demonstrated that participants primarily execute reactive stepping with their non-paretic limb, although those steps are highlighted by delays in timing and increased incidence of multiple stepping compared to healthy controls, even though all participants had very good clinical balance scores. Outcomes from this thesis present the need for improved clinical assessment of reactive balance control to help reduce the incidence of falling following stroke.

This thesis examined post-stroke gait asymmetry: a prevalent issue and one that has a number of associated negative consequences (e.g. challenged balance control, gait inefficiencies, increased risk of musculoskeletal injury to the non-paretic limb and decreased overall activity levels). This thesis is comprised of three studies that focused on 1) how gait symmetry should be measured, 2) how gait asymmetry may change in the long term post-stroke and 3) whether gait asymmetry is responsive to a rehabilitation intervention. A comparison of the most common expressions of spatiotemporal gait symmetry revealed that the simple symmetry ratio calculation was most appropriate on the basis of ease of interpretation and clinical usefulness. Swing time, stance time and step length were found to be the most useful gait parameters to assess for symmetry. Although related, swing time, stance time and step length ratios exhibit variation in the discrimination of post-stroke individuals, in their inter-relationships and in their relationship velocity. When when used together, swing time, stance time and step length asymmetry ratios may provide a complementary picture of the gait pattern and the quality of gait control. It was also demonstrated that swing time and stance time asymmetry were worse in later stages post-stroke when assessed cross-sectionally. In contrast, gait velocity did not exhibit this pattern. These results indicate that the control of gait (symmetry) may decline over time post-stroke, independent from the capacity for gait which remains constant (velocity). This dissociation in characteristics supports the concept that these two variables (symmetry and velocity) may represent separate features of post-stroke gait. Finally, individuals with sub-acute stroke are capable of altering the temporal symmetry of their gait in response to visual biofeedback. Individuals with sub-acute stroke differ in terms of the strategy they employ in response to biofeedback and the observed improvements in gait symmetry were not always achieved in the desired manner: increased use of the paretic lower extremity. This thesis presents new information regarding the asymmetrical nature of post-stroke gait. Future work may extend these findings to develop a comprehensive approach to gait measurement as well as gait interventions that encourage increased paretic limb use instead of compensatory behaviour.

Individuals with stroke suffer from impaired balance that increases their risk of falling. Controlling reactive balance is essential to maintaining stability. The objective of the first study was to identify the role of pre-perturbation stance asymmetry on limb preference for reactive stepping in healthy young adults. This study demonstrated that steps taken with a pre-loaded limb are short, directed laterally and have a rapid swing time. The objective of the second study was to investigate the challenges of reactive stepping among individuals with stroke. This study demonstrated that participants primarily execute reactive stepping with their non-paretic limb, although those steps are highlighted by delays in timing and increased incidence of multiple stepping compared to healthy controls, even though all participants had very good clinical balance scores. Outcomes from this thesis present the need for improved clinical assessment of reactive balance control to help reduce the incidence of falling following stroke.