Introduction: The number of stroke survivors living with post-stroke deficits is increasing worldwide. Although stroke rehabilitation can improve these deficits and promote the recovery of function when initiated early post-stroke, many survivors are not able to access rehabilitation because of a lack of resources. Early mobile tablet-based stroke rehabilitation may be a feasible means of improving access to recovery promoting therapies. Objective: To summarize and advance the knowledge of early mobile tablet-based therapies (MTBTs) for stroke survivors with regards to feasibility and barriers to care. Methods: This thesis is comprised of two major studies. (1) A scoping review summarizing the literature for MTBTs following stroke. (2) A cohort study testing the feasibility of a MTBT for post-stroke communication, cognitive, and fine-motor deficits. Results: (1) Twenty-three studies of MTBTs following stroke were identified. Most of these therapies targeted communication or fine-motor deficits, and involved patients in the chronic stages of stroke. Barriers to care were summarized. (2) A 48% recruitment rate was achieved and therapy was administered a median of four days post-stroke. However, therapy adherence was very low because of frequently encountered barriers to care. Conclusions: Stroke survivors are interested in using tablet technology to assist with their post-stroke recovery. However, early MTBT post-stroke may be challenging for some survivors because of encountered barriers to care. Regular patient-therapist communication using a convenient method of interaction appears necessary to minimize barriers and to help patients overcome barriers when they occur.

Abstrakt Bakgrund: Stroke är en sjukdom som drabbar ca 30 000 personer i Sverige årligen. Det ger upphov till både psykiska och fysiska handikapp. Sjukdomen beror på en hjärnblödning eller en hjärninfarkt. Sjukdomens efterdyningar påverkar den drabbade men även deras partner. Syfte: Syftet är att belysa partners upplevelser av förändringar i relationen då närstående drabbats av stroke. Metod: Systematisk litteraturstudie med kvalitativa artiklar. Vid analysen användes en kvalitativ innehållsanalys på sju valda artiklar för att hitta likheter och skillnader i partners upplevelser. Resultat: Studiens resultat visade på två huvudkategorier; ”Omställningar i det egna livet” med subkatekorierna ”känsla att ha förlorat sig själv”, ”Upplevelse av minskad frihet”, ”Finna mening i livet efter stroke” och ”Omställningar i en partnerrelation” med subkategorierna ”Upplevelser av förlorad partnerrelation” samt ”ökad börda upplevdes svår att hantera”. Dessa visade på olika upplevelser utifrån hur partnerrelationen förändrats och hur den anhörigas egen livsvärld påverkats. Känslor av förlust, sorg och saknad var framträdande för många. Andra kunde finna glädje och styrka i de nya förutsättningarna. Slutsats: En strokedrabbad kommer åter till sitt hem och partnern förväntas ta ett ansvar som denne inte alltid är förberedd på. Det finns ett behov av ökat stöd för partnern till den sjuka, för att klara av hemmiljön och hantera förändringen. Vården borde utvecklas till att se på familjer och partners ur ett helhetsperspektiv, där den friska partnern i en relation är i samma behov av att bli sedd som den sjuka.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is a worldwide medical emergency, and the trend in its incidence is rising. Stroke leads to activity limitation and participation restriction among stroke clients. However rehabilitation of stroke disability has been found as lacking emphasis on reintegration issues, resulting into stroke clients facing different barriers to reintegration in the community after discharge. There is limited information about experiences of stroke clients in the communities after discharge from rehabilitation centers in Malawi. The current study was conducted to explore the barriers to reintegration experienced by the clients post discharge from a rehabilitation center in Malawi. A qualitative research was adopted to explore the perceived barriers to reintegration at Malawi Against Physical Disabilities (MAP) Kachere rehabilitation centre in Blantyre. In-depth interviews were utilized to capture data from perspectives of eight stroke clients, eight caregivers and seven service providers. The data was analyzed by means of content analysis. The findings of this study show key barriers that challenge community reintegration at two levels: individual and environmental. At individual level the barriers include impairments mainly depression and anxiety and physical weakness; and personal characteristics such as denial, gender and comorbidity. At the environmental level stroke clients experience attitudinal barriers by people in different settings of the community, poor terrain, long distance to places of interest, inaccessible structures and poverty. From the findings, therefore, stroke client experience wide range of barriers in both the activity and participation domains of community reintegration.Based on the key findings, recommendations have been made along three broad lines. To decrease barriers to reintegration, service providers could use the findings to consider equally addressing the potential negative contextual factors to reintegration when managing stroke clients, a shift from purely medical model approach to management of stroke. To increase rehabilitation services the government of Malawi could address the problem of limited funding to rehabilitation organizations and put measures to increase number of rehabilitation personnel at community, district and national levels. Further research in the area of community reintegration and development of a model of stroke care and rehabilitation in the country has also been recommended with view to improving stroke care and enhanced community reintegration post stroke in the country.

Bakgrund: Stroke är en av de största folksjukdomar. År 2018 drabbades cirka 25 500 individer och närmare 6 200 avled av sjukdomen i Sverige. Kvarstående symtom som förekommer vid stroke, beroende på vilken sidan av hjärnhalvan som blir drabbat inverkar på patienten fysiskt  och psykiskt, vilken i sin tur påverkas patienten socialt. Sjuksköterskan i detta fall har ett stort ansvar att ta hänsyn till patientens tillstånd och omvårdnadsbehov efter en stroke.   Syfte: Syftet med denna litteraturstudie var att beskriva personers upplevelse av livet efter en stroke. Metod: En beskrivande litteraturstudie som inkluderar 15 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Databasen Medline via PubMed tillämpades för att söka fram artiklarna. Huvudresultat: Efter en stroke kan det uppkomma flertal kvarstående symtom, vilket kan påverka personernas fysiska, psykiska, samt sociala liv. Funktionshinder var den vanligaste kvarvarande symtom till personernas förändrade liv. Flera av dem upplevde en känsla av rädsla, oro, skuldkänslor, depression, förändrad självbild och självkänsla. Alla dessa omständigheter ledde till att drabbade personerna självmedvetet isolerade sig, vilket påverkade deras sociala nätverk. Trots dessa faktorer upplevde  de drabbade personerna ett hopp av att återhämtning skulle uppnås så småningom. Slutsats: Personer som drabbats av stroke beskrev upplevelser av olika psykiska, fysiska och sociala hinder till följd av en stroke. Trots dessa faktorer upplevde personerna ett hopp, motivation och positiva känslor. För sjuksköterskan är det viktigt att ha en tillräcklig kunskap om allt som gäller stroke för att kunna tillgodose personers omvårdnadsbehov, vilket hjälper de att kunna förstå, hantera tillståndet samt återhämta sig utan större svårigheter. / Background: Stroke is a widespread disease that affected approximately 25 500 people in 2018 and nearly 6 200 died of the disease in Sweden. Remaining symptoms that occur at stroke, depending on which side of the brain that been affected, effects the patient physically and psychically, which in turn affects the patient socially. The nurse in this case has a great responsibility to take  a deference about patient's condition and nursings needs after the stroke. Aim: The aim with this literature study was to describe person’s experience of the life after a stroke.  Method: A descriptive literature study that includes 15 scientific articles with both qvalitativ and qvantitativ sample. The Medline database via PubMed was used to search for the articles. Results: Persons who affected of stroke described experiences about their physically changes, psychically changes, and sociallity life changes. The functional obstacle created for example fear, depression, anxiety, debt feeling, changes of self-image and self-feeling. All of these circumstances led the affected individuals to self-isolate themselves, which affected their social network. Despite these factors, the affected person’s experienced a hope that recovery would eventually be achieved. Conclusion: The persons who affected of stroke described experiences of various psychically and sociality obstacles as result of a stroke. Despite these factors, persons experienced a hope, motivation and positive emotions. For the nurse it’s important to have sufficient knowledge about everything that concerns stroke, to be able to cater for person’s nursing needs, which help them to understand, manage the condition and recover themselves without any major difficulties.

The generation of human induced pluripotent stem cells (hiPSCs) from human fibroblasts has revolutionized cell therapy by providing a source of autologous cells for transplantation. Several studies have demonstrated that transplantation of hiPSC-derived neural stem cells (hiPSC-NSCs) increases regeneration and recovery following stroke, supporting their therapeutic potential. However, major concerns for translating hiPSC transplantation therapy to the clinic are efficacy and safety. Therefore, there is demand to develop an optimal strategy to enhance the engraftment and regenerative capacity of transplanted hiPSC-NSCs. The recent published work shows that metformin, an FDA approved drug, is an optimal neuroregenerative agent that not only promotes the proliferation of neural stem cells but also enhances their neuronal differentiation. In this regard, we hypothesize that preconditioning of hiPSC-NSCs with metformin before transplantation into the stroke-damaged brain will improve engraftment and regenerative capabilities of hiPSC-NSCs, further enhancing cell-mediated functional recovery. Here we show that treatment of hiPSC-NSCs with metformin enhances the proliferation and differentiation of hiPSC-NSCs in culture even after withdrawal of metformin treatment, showing its promise as a novel preconditioning strategy. Furthermore, transplantation of preconditioned hiPSC-NSCs into a rat endothelin-1 ischemic stroke model showed an improved engraftment capability 1-week post-transplant. In addition, metformin preconditioned grafts survived longer compared to naïve grafts and were detectable at 8 weeks post-stroke. However, cell transplantation did not result in improve functional recovery when compared to sham group in this model. These studies represent a vital step in the optimization of hiPSC-NSC based transplantation to promote post-stroke recovery.

The aim of this study was to assess the acute and post-acute services for ischaemic stroke patients in the Cape Metro Health District in relation to the South African ischaemic stroke guideline. Part A: Protocol - The protocol outlines the purpose of the study and highlights the importance of conducting this study by analysing the literature on stroke care in both high and low and middle-income countries. The literature also highlights the gaps in stroke care in South Africa which justify the need for this study. The protocol also outlines the methods of data collection and analysis as well as the ethical considerations. Part B: Literature Review - This expands on the literature on the different components of both acute and post-acute stroke care in both high and low and middle-income countries. It also elaborates on stroke in South Africa and why it is important to conduct this study. Part C: South African Medical Journal manuscript - The manuscript summarises the whole study and includes the literature on stroke care, justification of the study and how the data was collected and analysed. The manuscript also includes the results obtained and sections on the discussion and conclusions.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, 28 August 2014 / In previous research done, convergent validity was not established for OT-APST with two cognitive-perceptual tests. In this research, the DLOTCA and RPAB were used as reference tools to determine the convergent validity of the OT-APST using Spearman’s correlation. The aim was to ascertain whether the three tests when administered at the same time would yield the same result. This was a quantitative cross-sectional study that was mainly correlative and comparative in nature. Convenience sampling was used (n=32). The tools compared evaluate similar constructs and were expected to have strong correlations. This current research revealed that six subscales of the OT-APST had significant correlations with similar cognitive areas from the DLOTCA and the OT-APST subscales often correlated with an appropriate item from the RPAB. This study provides sufficient evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. The OT-APST proved useful in identifying patients with visual perceptual problems in a population not standardised for.

Cancer is an important risk factor for stroke, but the relationship between cancer and stroke is not well understood. Cancer patients with stroke often do not receive guideline-based treatments due to perceived higher risks, and experience worse outcomes than patients without cancer, including more recurrent strokes. The aim of this thesis is to expand our knowledge of the relationship between cancer and stroke by addressing five major objectives: 1) calculate the pooled one-year incidence of stroke after a new diagnosis of cancer by performing a systematic review and meta-analysis, 2) investigate if the risk for future stroke varies by a history of stroke prior to cancer diagnosis, 3) compare differences in treatment and outcomes between cancer patients with stroke and the general stroke population, 4) identify predictors for recurrent stroke in cancer patients, and 5) evaluate the utility of synthetic data for the purpose of cancer and stroke research.

Der Schlaganfall ist eine Krankheit mit großer Bedeutung, sowohl für die Betroffenen wie auch unter volkswirtschaftlichen Gesichtspunkten. In der Erforschung neuer und besserer Therapiemethoden für den ischämischen Schlaganfall ist ein gutes in-vitro-Modell der Blut-Hirn-Schranke unerlässlich, da ein Teil der Schädigung des ZNS durch einen Zusammenbruch dieser Barriere verursacht wird. Die hCMEC/D3-Zelllinie stellt ein solches Modell dar; mit steigender Dauer der ischämischen Stoffwechsellage zeigt sich eine Erhöhung der LDH-Konzentration als Marker für das Absterben der Zellen sowie ein Rückgang der Zellvitalität. Zudem lässt sich eine Entzündungsreaktion mit Anstieg der Marker TNF-Alpha und VEGF, sowie tendenziell auch von Interleukin 6 und Interleukin 8 beobachten, welche auch auf eine Barriereschwächung hindeutet. Aus vorherigen Versuchen bekannte Tight junctions-Proteine wie Claudin 1 und Occludin waren in D3-Zellen unter ischämischen Bedingungen nicht verändert, Claudin 5 war in der PCR vermindert exprimiert. Die für die Barriereschwächung verantwortlichen Strukturproteine müssen durch weitere Versuche identifiziert werden. Eine mögliche Erhöhung der Expression des Transkriptionsfaktors ZO-1 könnte unter diesen Bedingungen einen Mechanismus der Barriereschwächung darstellen. Die Expression des Glukokortikoidrezeptors war in Monokultur-Versuchen mit D3-Zellen nach Ischämie erniedrigt. Dies stellt eine Gemeinsamkeit mit Versuchen mit Zelllinien tierischen Ursprungs dar; in diesen zeigten die Zellen durch Degradation des Glukokortikoidrezeptors ein fehlendes Ansprechen auf eine Glukokortikoid-Behandlung. In der Cokultur der D3-Zellen mit Gliomzellen der C6-Zelllinie zeigte sich jedoch eine Erhöhung der GR-Expression. Eine Cokultur kann den komplexen Aufbau der Blut-Hirn-Schranke, mit Beteiligung mehrerer Zelltypen, besser darstellen als Versuche mit nur einer Zelllinie. Die Erhöhung der GR-Expression in diesem humanen in-vitro-Modell der Blut-Hirn-Schranke steht im Gegensatz zu den in-vitro-Versuchen mit anderen Zelllinien. Dies könnte eine mögliche Erklärung liefern, warum die Erkenntnisse aus diesen Versuchen bisher nicht zu einer Verbesserung der Evidenz der Glukokortikoid-Therapie beim ischämischen Schlaganfall beigetragen haben. Zudem zeigt die Fluoreszenzfärbung von D3-Zellen, dass diese auch unter Ischämie auf Glukokortikoide reagieren. / The hCMEC/D3 cell line as human in-vitro-model of the blood brain barrier in ischemic stroke

Die Schlaganfallnachsorge in Deutschland wird von verschiedenen Leistungserbringern geprägt, die teilweise komplementäre und komplexe Dienstleistungen erbringen und sektorenübergreifend arbeiten. In Bad Neustadt wurde in Kooperation mit der Universität Würzburg und dem Zentrum für Telemedizin Bad Kissingen das Stroke Manager Programm entwickelt und evaluiert. Das strukturierte Nachsorgeprogramm Stroke Manager basiert auf einer standardisierten Informations- und Software Unterstützung von der Akutversorgung bis drei Monate nach Entlassung aus der stationären Versorgung. Anhand der Ergebnisse des Stroke Manager Programms konnte eine vergleichsweise hohe Persistenz bzgl. der stationär verordneten medikamentösen Sekundärprävention über einen Zeitraum von drei Monaten festgestellt werden, ebenso konnten wir nachweisen, dass sich das Programm positiv auf die Versorgungsqualität sowie die Patientenzufriedenheit nach Schlaganfall auswirken kann. Die im Stroke Manager-Programm betreuten Schlaganfallpatienten wiesen im Vergleich signifikante Unterschiede bei den Faktoren Rauchverhalten, Schlaganfallschweregrad und subjektive, globale Lebensqualität auf. / Stroke aftercare in Germany is shaped by different service providers, some of whom provide complementary and complex services and work across sectors. In Bad Neustadt, the Stroke Manager Program was developed and evaluated in cooperation with the University of Würzburg and the Centre for Telemedicine Bad Kissingen. The structured aftercare program Stroke Manager is based on standardized information and software support from acute care up to three months after discharge from inpatient care. Based on the results of the Stroke Manager program, a comparatively high persistence of inpatient secondary drug prevention was observed over a period of three months, and we were able to demonstrate that the program can have a positive impact on the quality of care and patient satisfaction after stroke. The stroke patients treated in the Stroke Manager program showed significant differences in smoking behaviour, stroke severity and subjective, global quality of life.