Bakgrund: I Sverige utgör patientgruppen som har haft stroke en stor del i den somatiska sjukvården. Stroke anses vara en av de främsta orsakerna till invalidisering ur ett internationellt perspektiv. Patienterna upplever fysiska och psykiska förändringar som oftast blir mer hanterbara genom de anhörigas stöd. Sjuksköterskor har ett stort ansvar över patienternas vård och är en viktig del i vårdteamet. Problem: Sjuksköterskor upplever svårigheter i att göra de anhöriga delaktiga i vården kring patienterna samt att utforma en hållbar vårdplan som kan fortsätta i hemmet. Syfte: Ur ett anhörigperspektiv beskriva upplevelser av att vårda en närstående som har haft stroke. Metod: En litteraturstudie med en beskrivande syntes. Resultat: De anhöriga upplevde en utmaning i att ge vård då ansvaret kom plötsligt och medförde stora livsförändringar. En ständig oro och rädsla var närvarande och familjerelationerna var förändrade. Allteftersom tiden fortlöpte upplevde de anhöriga att de kunde skapa kontroll över den förändrade livssituationen och finna mening. Slutsats: För att skapa en förhöjd delaktighet behöver vårdplanen tidigt utformas tillsammans med de anhöriga och ansvaret över vården behöver tilldelas dem utifrån deras förmåga och i en långsam takt. / Background: In Sweden, the patients who have suffered a stroke account for a significant amount of cases in the somatic care. Seen from an international perspective, stroke is considered to be one of the prime reasons for incapacitation. Patients can experience both physical and psychological changes which generally become more manageable with support from relatives. Nurses have a vital responsibility for the patients’ care and an important role in the healthcare team. Problem: Nurses are experiencing difficulties in making the relatives involved in the patient’s healthcare and to develop a sustainable care plan which can proceed at home. Aim: To describe the care experiences of the stroke patient’s relatives. Method: A literature review with a descriptive analysis. Results: The relatives experienced a challenge in providing care when the responsibility suddenly came and brought great changes. A constant worry and fear were present and family relationships were altered. As time progressed, the relatives felt that they could gain control of the changed life situation and find meaning. Conclusion: To create enhanced participation, the healthcare plan needs to be designed in an early stage together with the relatives. The responsibility of the care needs to be allocated to the relatives on the basis of their ability and in a slow pace.

Background: Every year the number of young and middle-aged persons who receive stroke are increasing. Stroke is often considered as a disease of old people. A stroke often leads to changes in life. The consequences can be cognitive impairments and movement disabilities. These consequences can have a high impact of the person's life. Aim: The aim was to describe experiences of daily life after a stroke from the perspective of adults younger than 65 years old. Method: To analyze data, Friberg's (2012) method aimed to contribute to evidence-based care based on analyzing qualitative research, was used. Ten scientific articles were chosen and analyzed. Results: The result showed that adults younger than 65 who suffered from a stroke experiences a lot of difficulties in life afterwards. The analyze process generated four categories and nine subcategories. The four categories are "an altered work situation", "lack in rehabilitation", "to loose myself", "difficulties in social meetings". Conclusion: The study showed that rehabilitation is very important for adults younger than 65 who suffered from a stroke. Their experiences showed a lack in rehabilitation when it comes to their age category. To go back to work, live family life and participate in other social events is important. It's different to suffer from a stroke at younger age when it comes to their needs. Health staff should be aware of these needs.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Hypertension is a risk factor for both cerebrovascular accidents and cardiovascular diseases, holistic and cost effective measure are called upon to reduce its impact on society. One of the methods advocated for achieving this is health promotion. Therefore, health professionals, including physiotherapists, are called upon to redirect their health care management approaches towards preventative care. Aim: The aim of this study was to determine the knowledge, attitude and practice as well as to explore the perceptions of physiotherapists regarding their role in the management of hypertension in Dar es Salaam, Tanzania.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, 2017 / Introduction: Lycra compression garments have been documented as beneficial in affecting spasticity in children with cerebral palsy but there is little research on the use of Lycra compression garments in adults with neurological conditions. Thus, the purpose of this study was to explore the effectiveness of Lycra compression garments on motor function and functional use of the upper limb, in patients with stroke. Methods: A randomised control design with a control or intervention group was used. Both groups received routine upper limb rehabilitation while the experimental group also received a custom Lycra compression garment worn for a minimum of six hours a day. Results: Change between an initial assessment and assessment at six weeks, was measured on the Fugl-Meyer Assessment of Motor Recovery (FMA) and The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). While both groups had significant improvement in upper limb movement, statistically significant differences for change in total motor function, wrist and hand movement and coordination were found when the experimental group and the control group were compared. Small differences in measurements of pain, passive range of motion, sensation and functional use of the upper limb were found between the two groups. Conclusion: Results indicate that Lycra compression garments may be beneficial in facilitating the return of movement in the upper limb in individuals with stroke. / MT2017

Stroke är en vanligt förekommande sjukdom världen över. År 2017 drabbades drygt 25 000 personer i Sverige av stroke, varav cirka 4000 var under 65 år. Stroke kan leda till både fysiska och kognitiva funktionsnedsättningar och är den vanligaste orsaken till permanent funktionsnedsättning hos vuxna. Det är av vikt att sjuksköterskor som vårdar strokepatienter identifierar den enskilde patientens behov för att optimera en individanpassad omvårdnad. Syftet var att belysa patienters upplevelser av livet efter stroke i yrkesverksam ålder. Metoden var en litteraturstudie som utgick från Polit och Beck’s (2017) nio steg. Databassökning genomfördes i CINAHL, PubMed och PsycINFO. Efter kvalitetsgranskning kvarstod totalt 15 artiklar och databearbetningen av dessa  resulterade i 5 teman. Resultatet visade att livet efter stroke blev påverkat av funktionsnedsättningar och att detta i sin tur påverkade utförandet av dagliga sysslor. Det sociala livet blev förändrat både inom familjen, bland vänner och på arbetet. Patienterna upplevde att ett behov av stöd var viktigt i livet efter stroke och de kände sig ensamma i vissa frågor och funderingar. För att hantera livet efter stroke var det viktigt med en positiv attityd som motiverade patienterna att nå nya mål.  Slutsatsen av litteraturstudien var att livet efter stroke innefattade stora förändringar som krävde att patienterna behövde omorientera sig i livet. Genom att belysa patienters upplevelser utifrån livssituation får sjuksköterskan en ökad medvetenhet om vikten av att individanpassa sin vård utifrån patientens behov.

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Bakgrund Stroke tillhör en av våra största folksjukdomar och förblir en av de sjukdomar som kräver de högsta dödsantalen och ger allvarliga följder med omfattande funktionsnedsättningar. Följderna efter en stroke varierar beroende av vart och med vilken omfattning skadan orsakat, vilket ger en varierande symptombild med olika grader av funktionsnedsättningar. Detta gör omvårdnaden av en strokepatient till komplex som ställer höga krav på en individuellt anpassad vårdplan med anpassade professioner som omger patienten.   Syftet med denna litteraturstudie var att undersöka sjuksköterskans erfarenheter av att vårda patienter med en strokediagnos.    Metod En beskrivande litteraturstudie som baserats på resultatet av 10 kvalitativa och 3 kvantitativa artiklar.   Huvudresultat Det framkommer att sjuksköterskan har en viktig uppgift i att arbeta kliniskt och nära patienten men att det på grund av brist på resurser och utbildning är svårt att ge en tillfredställande omvårdnad. Sjuksköterskans position bland andra professioner upplevs inte heller som självklar och behöver vara väldefinierad för att kunna säkerställa att patientens vård är av hög kvalitet. Det framkommer även att sjuksköterskan i sin omvårdnad behöver involvera patienten mer i kommunikationen genom att lära känna personen bakom patienten för att på så vis förbättra återhämtningen efter en stroke.   Slutsats Sjuksköterskan utgör en nyckelroll vid omvårdnaden av strokepatienten. Studier visar dock att det saknas kunskap, utbildning och förståelse från både organisation och sjuksköterskor vilket på flera sätt sänker patientens vårdkvalitet.

The extent to which sensory impairments in the foot, ankle and lower limb persist into the chronic phase of stroke is unclear. Furthermore, the extent to which these impairments influence walking, balance and falls is not well understood. This thesis investigated the prevalence, functional importance and measurement of lower limb somatosensory impairments in ambulatory people with chronic stroke. Methods This thesis comprised three studies: the first, a qualitative investigation, explored the views and experiences of people with chronic stroke (n=13). This led to the second study: a cross sectional observational study in which the prevalence, distribution and functional relevance of lower limb sensory impairments were investigated in chronic stroke participants (n=180) and healthy controls (n=46). The final study, informed by the findings from the first two studies, a “synthesis” review of current sensory measures and patient and carer involvement, developed and evaluated three novel, functionally oriented measures of lower limb somatosensory discrimination in chronic stroke (n=32) and healthy controls (n=32). Results People with stroke felt problems with foot, ankle and lower limb sensation affected their walking, balance and contributed to falls. Furthermore, sensory impairments in the lower limb are prevalent with up to 59% of chronic stroke survivors having a deficit of one or more somatosensory modality. Despite this, weak associations between traditional measures of tactile and proprioceptive sensation and walking, balance and falls were demonstrated. Novel, functionally oriented measures of tactile and proprioceptive discrimination were developed and evaluated. These measures were reliable and valid, showing greater sensitivity to predicting the presence of sensory impairments and had stronger associations with functional measures than traditional sensory tests. Conclusions This thesis has provided a comprehensive picture of lower limb somatosensory dysfunction in chronic stroke survivors. Sensory impairments persist into the chronic phase of stroke in the majority of stroke survivors. The extent to which such impairments influence functional ability warrants further investigation. The use of functionally oriented measures that assess higher-level somatosensation is encouraged.

Despite years of research, an effective therapy for treatment of ischemic stroke has yet to be found. Survivors of stroke may suffer debilitating and permanent motor dysfunction for the remainder of their lives. Current treatments are limited to physical therapy and tissue plasminogen factor (tPA), a thrombolytic medication with a time- window of efficacy up to only three hours after symptom onset. Clinical studies and animal models have shown that partial recovery of motor function occurs with or without pharmacological interventions due to adaptive plasticity and reorganization in the brain. The precise mechanisms, though unclear, have become a major focus of stroke research. In the following study, we investigated inosine, a naturally occurring purine nucleoside that stimulates axonal growth, as a potential long-term stroke treatment. Following controlled cortical ischemia in the motor cortex of rhesus monkeys, recovery of dominant hand function was monitored through NHP Upper Extremity Motor Dysfunction Scale ratings for two weeks post-operation and through performance on two motor tasks, the Hand Dexterity Task (HDT) and the Digit Coordination Task (DCT). Results of cage- side assessment ratings demonstrated a trend towards greater recovery in the group treated with inosine for functional strength in the dominant hand on 12-14 days after surgery. The suggested trend is enough evidence to pursue research on the use of inosine as a therapeutic agent in post-stroke functional recovery.

Pre-existing dementia is associated with poorer functional outcome after stroke. It is unclear however whether this is due to lack of access to, or inequality in, stroke rehabilitation. This PhD used mixed methods to understand whether pre-existing dementia is a factor considered by clinicians when referring/admitting patients for rehabilitation, when providing rehabilitation interventions, and whether there is a difference in rehabilitation received by patients with and without pre-existing dementia. A background literature review informed the first study, which was a systematic review examining factors influencing clinical decision-making about access to stroke rehabilitation. The systematic review suggested that pre-stroke cognition influenced referrals/admission to rehabilitation, however, no studies examined this specifically. The qualitative study therefore used interviews (n=23) to explore clinicians experiences of decision-making about rehabilitation for patients with pre-existing dementia/cognitive impairments. The findings highlighted that clinicians own knowledge influenced their decision-making, with a common perception that people with pre-existing cognitive impairment lack potential to benefit from rehabilitation. The third study, a prospective cohort study, examined differences in rehabilitation received by patients with and without pre-existing cognitive impairments (n=139). People with pre-existing cognitive impairments received less rehabilitation than those without, particularly physiotherapy and referral to community therapies and more non-patient facing occupational therapy. This PhD identified that people with pre-existing dementia/cognitive impairment receive less rehabilitation when compared to those without. This may be, in part, due to clinicians decision-making about which patients should receive stroke rehabilitation. These findings have multiple clinical implications, particularly around the number of patients in stroke services with undiagnosed pre-existing cognitive impairment. Decisions can become more equitable by ensuring clinicians have access to relevant education, training and skills to work alongside patients with pre-existing dementia/cognitive impairments.