Bakgrund: I Sverige drabbas varje år cirka 30 000 personer av stroke och en tredjedel av dem får tydliga funktionsnedsättningar. Även livet för familj och andra närstående till den drabbade kan påverkas. Problem: Tidigare forskning visar att sjuksköterskor kan ha svårt att ta del av patienters upplevelser när de drabbats av funktionsnedsättning efter en stroke. Detta är något som kan påverka sjuksköterskans vårdande. Syfte: Att beskriva de drabbades upplevelser av att leva med funktionsnedsättning efter en stroke. Metod: En kvalitativ litteraturstudie av vårdvetenskapliga artiklar med Evans beskrivande syntes som analysmetod. Resultat: Upplevelser som kom fram delades in i tre stora teman och var kopplade till den förändrade kroppen, det förändrade jaget och den förändrade framtiden. Underteman var kopplade till kontroll och avsaknad av kontroll av kroppen, ett nytt jag och en ny roll, förlust av självständighet samt återhämtning och positiva tankar om framtiden. Slutsats: Att leva med funktionsnedsättning efter en stroke är något som påverkar den drabbade både kroppsligt, själsligt och andligt och det blir en omställning till ett nytt liv. Sjuksköterskan bör bli medveten om dessa upplevelser för att göra vården för dessa patienter så bra som möjligt. / Background: In Sweden aproximately 30 000 people suffers a stroke every year and a third of the victims are also affected by disabilty. The life of families and relatives of the victim is also affected. Problem: Previous research shows that nurses may find it difficult to take part of patients’ experiences when they are affected by disabilty after a stroke. This may be something that can affect the nursing care. Aim: To describe the victims’ experiences of living with disabilty after a stroke. Method: A qualitative literature review based on scientific articles with a descriptive synthesis by Evans as the method of analysis. Result: The experiences that came upp were divided into three different themes which were linked to the changed body, the changed self and the changed future. The subthemes were linked to the control and the lack of control of the body, a new self and a new role, loss of independence, recovery and positive thoughts about the future. Conclusion: Living with disabilities after a stroke is something that affects the victim both physically, mentally and spiritually and it will be a life changing event. Nurses should be aware of these experiences to make the nursing care as good as possible.

Bakgrund: Dysfagi innebär avvikelser i den normala sväljningsfunktionen och är en vanlig funktionsnedsättning till följd av stroke. Tidigare studier har påvisat att incidensen av dysfagi i det akuta skedet efter stroke är 41-68 %. Kliniskt sett upplevs incidensen ha minskat de senaste tio åren.  Syfte: Syftet med denna studie var därför att (1) undersöka den nuvarande incidensen av orofaryngeal dysfagi hos nyinsjuknade strokepatienter, (2) undersöka hur många av deltagarna som upplever svårigheter att äta och svälja samt bedöms lida av dysfagi enligt vårdpersonal.  Metod: Sextiotre patienter inkluderades i studien, av dessa fick 42,9 % diagnosen stroke. Samtliga deltagare genomgick en dysfagibedömning inom tre dygn efter inskrivning på vårdavdelning. Denna bestod av testerna the Standardized Swallowing Assessment – Svensk översättning (SSA-S) och sväljkapacitetstest (SCT). Deltagare som inte klarade kriterierna i dessa bedömdes lida av orofaryngeal dysfagi.  Resultat: Totalt bedömdes 24 deltagare lida av orofaryngeal dysfagi. I diagnosgruppen stroke var incidensen 48,1 %. Det fanns noteringar om dysfagi i patientjournal hos 20,8 % av deltagarna som enligt testledare bedömdes lida av orofaryngeal dysfagi. Vidare upplevde 29,2 % av samtliga deltagare med orofaryngeal dysfagi samt 30,8 % i diagnosgruppen stroke svårigheter att äta eller svälja.  Slutsatser: Studien indikerar på att incidensen av orofaryngeal dysfagi hos nyinsjuknade strokepatienter inte har minskat i jämförelse med tidigare studier. Däremot tycks det finnas en låg medvetenhet om befintliga ät- och sväljningssvårigheter hos såväl patienter som vårdpersonal. / Background: Dysphagia involves abnormalities in the normal swallowing function, and is a common impairment following stroke. Previous studies have shown that the incidence of dysphagia in the acute phase after stroke is 41-68 %. Clinically interprets that the incidence has declined over the past decade.  Aim: The purpose of this study was to (1) examine the current incidence of oropharyngeal dysphagia in recent-onset stroke patients, (2) investigate how many of the participants who experience difficulty eating and swallowing, and how many is believed to suffer from dysphagia according to healthcare professionals.  Method: Sixty-three patients were enrolled in the study, of whom 42,9 % were diagnosed with stroke. All participants underwent a bedside assessment of swallowing function within three days after enrollment in the nursing ward. The assessment consisted of the Standardized Swallowing Assessment - Swedish translation (SSA-S) and swallowing capacity test (SCT). Participants who did not pass the criteria of these two tests suffered from oropharyngeal dysphagia.  Results: Totally, 24 participants suffered from oropharyngeal dysphagia. The incidence in the stroke group was 48,1 %. There were notes about dysphagia in medical records in 20,8 % of the participants who were judged to suffer from oropharyngeal dysphagia by the test managers. Furthermore 29,2 % of all participants with oropharyngeal dysphagia and 30,8 % in the stroke group experienced difficulty eating or swallowing.  Conclusions: This study indicates that the incidence of oropharyngeal dysphagia in recent-onset stroke patients has not decreased in comparison with previous studies. In contrast, it appears to be a low awareness of existing eating and swallowing difficulties for both patients and healthcare professionals.

Aim: The overall purpose of this thesis was to increase the understanding of relatives’ changing life situation during the first six months of a person’s onset of stroke, with focus on learning. Furthermore, the purpose was to evaluate theprinted education materials (PEM) targeted at relatives at Swedish stroke units. Method: In paper I, 16 relatives were interviewed about the meaning of becoming a relative of a person affected by stroke. In paper II, 9 relatives were reinterviewed about what it meant to be a relative of a person affected by stroke. The interviews took place six months after the stroke survivors’ onset of stroke. Data from the two studies were analyzed by Lindseth and Norberg’s hermeneutic phenomenological method of analysis, inspired by Ricoeur. In paper III, 16 and 9 relatives were interviewed about what they wanted to know and understand during the first six months after the onset of the survivors’ strokes. Krippendorff’s method of qualitative content analysis was used to analyse data. In paper IV, 42 PEM:s from 21 Swedish stroke units were examined. Data were analysed by use of descriptive statistics and Krippendorff’s method of qualitative content analysis. Results: Becoming the relative of a person affected by stroke means to experience chaos but also to reach a turning point. The turning point is the start of a febrile activity that shows the relatives’ willingness to seek order in the chaotic situation (I). Being the relative of a person affected by stroke also means to be in a struggle for freedom. Relatives do not want to adapt to the stroke or its consequences. Instead, they prefer to choose their own way of life and to write their own history. Therefore, they strive to integrate the stroke and its consequences to their everyday lives (II). The information that the relatives wished to have was about the stroke survivor, the professionals and themselves. Moreover, the results showed that the relatives’ information quest was related to personal involvement, contextual factors, different knowledge needs and different ways to obtain information (III). The PEM:s, offered at Swedish stroke units, were adequate in terms of quality of suitability and readability. The content of the printed education materials offered to relatives varies with the stroke units. Conclusion: To become a relative of a person affected by stroke means to end up in chaos, but also to reach a turning point (I). At this turning point the person is prepared to adjust arrange his/her life to the new conditions. Therefore, nurses need to learn to identify these turning points and include support for relatives in their changing life situation. Being a relative during the first six months of a survivor’s onset of stroke means to fight for freedom (II) without abandoning the stroke survivor. In this process, it is important that the relatives learn to balance freedom with responsibility and life and care for the survivor with relations to other relatives. Relatives are capable as they are active, committed and social persons (I, II, III). This is why alternative pedagogic methods and approached need to be developed and tested. Nurses need training in using such alternative methods. The content of the printed education materials offered to relatives at Swedish stroke units varies with the unit. As a result, it would be useful to establish a national electronic centre.

The latest evidence indicates that 50,000 Canadians will experience a stroke in 2013. The hospital care, rehabilitation, and long term care associated with a stroke places a significant burden on our health care system. Lost productivity and premature death have an immeasurable impact on communities in our province as well as the rest of the country. Small, less populated regions such as Saskatchewan may be underrepresented in national data utilized in the development of national prevention and treatment strategies across the country. The absence of local research has necessitated the use of national information to guide prevention, treatment education and programming in Saskatchewan. The goals of this study was to provide a descriptive profile of stroke and transient ischemic attack cases admitted to Royal University Hospital over the period of April 1, 2009 to March 31st, 2010 and to assess the acute management of these cases as defined in the Canadian Best Practice Recommendations for Stroke Care (Strategy, 2010). A randomized sample of 200 cases 55 years and older was selected for a retrospective descriptive study involving review of adult stroke case records. Personal demographics and healthcare performance through the use of measures provided in The Canadian Best Practice Recommendations for Stroke Care (Canadian Stroke Network (CSN) and Heart and Stroke Foundation of Canada (HSFC), 2010) were evaluated. The results indicated many similarities to available national information on type of stroke, risk factors, gender, and age. Hospital adherence to national guidelines comparing selected indicators was exceeded in some areas, and met in most. The remaining indicators provide an opportunity for improvement and possibly more research. This regional information supplements the available Canadian information and could be used to guide planning and care strategically targeting Saskatchewan residents and increasing their potential for success.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2003. / Includes bibliographical references.

Diss. (sammanfattning) Umeå : Univ., 2009. / Härtill 4 uppsatser.

Bakgrund: I Sverige drabbades år 2016 cirka 26 500 människor av stroke, varav 6900 avled. Att få en stroke innebär att delar av hjärnan blivit utsatt för syrebrist och till följd sker en vävnadsdöd. Det är vanligt med såväl fysiska och psykiska komplikationer efter en stroke. Sjuksköterskan har ett stort ansvar över omvårdnaden för att kunna tillgodose patientens omvårdnadsbehov efter en stroke. Syfte: Att beskriva personers upplevelse efter att ha drabbats av en stroke samt att beskriva samtliga studiers datainsamlingsmetod. Metod: En litteraturstudie med beskrivande design med ett innehåll av 15 kvalitativa artiklar som sökts fram genom databasen Medline via PubMed. Huvudresultat: Efter att ha drabbats av en stroke upplevde personerna en förlorad identitet, en minskad autonomi och en social isolering till följd av de komplikationer som uppstod. Fysiska funktionsnedsättningar som förekom var till exempel pares och dysfagi medan psykiska funktionsnedsättningar som förekom var till exempel trötthet och nedstämdhet. Trots funktionspåverkan upplevde flera deltagare glädje, hopp och motivation i de framsteg som gjordes. Vanligaste datainsamlingsmetoden som användes i åtta studier var semi-strukturerade intervjuer. Slutsats: Samtliga deltagare beskrev upplevelser av förlust av sin identitet, minskad autonomi samt social isolering till följd av komplikationer som uppstod efter en stroke. Trots dessa omständigheter upplevde flera deltagare glädje, hopp och motivation. För sjuksköterskan är det viktigt att ha kunskap om, och i tidigt skede informera patienten om de kvarstående symtom som kan upplevas för att personerna bättre ska kunna begripa och hantera sin situation. / Background: In Sweden, about 26,500 people suffered from a stroke in 2016 of whom 6,900 died. Stroke means that parts of the brain have been exposed to oxygen deficiency causing necrosis in the brain tissue. It is common that stroke have negative impact on physical and mental abilities. The nurse has a major responsibility to meet the demands of care and patient´s nursing needs after a stroke. Aim: To describe people's experience after having a stroke and to describe the method used in the scientific articles used in this study. Method: A literature study with descriptive design including 15 scientific articles with a qualitative approach that were found at the database Medline PubMed. Results: After suffering a stroke people experience a loss of loss of identity, a reduced autonomy and a social isolation caused by stroke related complications. Physical disabilities that occurred were, for example paresis and dysphagia while mental disabilities were, for example fatique and depression. Despite the complications several participants experienced joy, hope and motivation in the progress made. The most common data collection method, used in eight of the studies, was semi-structured interviews. Conclusion: All participants expressed a loss of identity, a reduced autonomy and a social isolation caused by stroke related complications. Despite these circumstances, several participants experienced joy, hope and motivation. For nurses, it is important to have knowledge and to inform the patient about remaining symptoms in order to help the patient to better understand and manage the situation.

Training locomotor pattern generating networks (CPGs) with body weight supported treadmill training or through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5-weeks of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1Hz arm cycling. Clinical function tests assessed walking, balance and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion and muscle activation. ‘Normalization’ of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflexes amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. / Graduate

Bakgrund: Stroke är ett samlingsnamn för hjärnskador som orsakas av en blodpropp eller blödning i hjärnan. I Sverige inträffade 28 600 strokeanfall 2016, där ca 6 900 personer dog av sjukdomen. Det är vanligt att patienterna lämnar sjukhuset med någon form av funktionsnedsättning vilket påverkar deras vardag. Åter i hemmet har sjuksköterskan en viktig roll i att stötta och finnas där för patienten. Syfte: Syftet var att belysa strokepatienters upplevelser av sin vardag det första året efter att ha återgått till hemmet. Metod: En kvalitativ litteraturstudie som baserades på fem självbiografier och analyserades genom en kvalitativ innehållsanalys.  Resultat: Författarnas upplevelse av att leva med stroke presenteras genom tre huvudkategorier. De främsta upplevelserna efter sjukdomen var svårigheter att kommunicera med andra, minskad självständighet och påverkad självkänsla.  Slutsats: Uppsatsen belyser att stöd från närstående och sjukvården kan hjälpa strokepatienter att minska lidande och öka välbefinnande åter i hemmet efter sjukdom.

This thesis aims to explore the nature of emotion work within the context of care occurring in adult stroke survivors (18-59) and their carers situated at home in Nakhon Sawan Province, Thailand. It also investigates how their roles were constructed after the stroke event. An ethnomethodological approach facilitated the understanding of the sense-making processes in daily routines. Data collection was comprised of semi-structured interviews and observations which were gathered from a sample of twelve pairs of stroke survivors and carers, 24 participants in all, over a period of three months. Data were analysed by a thematic analysis approach. Stroke survivors’ belief about the cause of stroke and its effects on their attitude towards themselves and carers, and carers’ accounting for their care of stroke survivors emerged as two overarching themes derived from the interview data. The first theme illustrates that stroke survivors described difficult experiences during the first six months post stroke as the turning point of their lives. They searched their life experiences to create their current status within society. A self-evaluation of their health created a positive or negative attitude towards themselves, which affected their emotions in everyday living. In all cases the stroke survivors’ appreciation of carers’ help was significant. For carers, family relationships and expectations influenced their sense of responsibility and expectations. The feeling of gratitude, the morality of Buddhist values and a sense of duty were their underlying reasons for taking the caring role. Carers’ expectations of stroke survivors’ ability to perform routine activities were influential in managing their own feelings and actions in everyday life. The influence of neighbours reinforced carers’ ideas of moral standards of caring for stroke survivors. Emotion management is the third theme. Emotion work is involved in stroke survivors’ and carers’ everyday affairs which helped to keep their current life situations in balance and assist them in continuing to live as normal. Their life experiences and specific feeling rules (the feeling of gratitude and the sense of responsibility) govern the achievement of their emotion work. A differentiation between male and female roles also influenced their emotion work. Stroke survivors and carers presented how emotion work served to maintain their interpersonal relationship and to minimise difficult conditions in ordinary living. A conceptual framework of the process of emotion work is presented to facilitate understanding of how they engage in and accomplish emotion work during caring interactions. Emotion work emerges as a means to show their gratitude to each other and represents one of several ways to fulfil their Buddhist beliefs in the law of karma. They exchange emotion work for the values of caring and gratitude. These findings will be beneficial to stroke survivors and carers for dealing effectively with emotional problems in day-to-day life. Community nurses and other health professionals will gain a deeper knowledge of emotion work in order to assist them in providing holistic care for stroke survivors and carers. The findings will also be of interest to health policy makers to enable them to organise information and home-healthcare activities in future stroke care and health promotion strategies in rural communities in Thailand and elsewhere.