Dysarthria describes the impaired speech intelligibility caused by weakness of muscles involved in speech following stroke. This is a common consequence of stroke and can have a detrimental impact on self-confidence leading to social isolation for many. There is limited evidence for dysarthria intervention but we know that research into speech difficulties after stroke is a priority for stroke survivors. An online speech rehabilitation programme was developed, ReaDySpeech, with the potential to offer improved quality of independent practice, increased intensity of practice and the ability to record interaction. The research presented in this thesis aimed to systematically examine the existing evidence base, to carry out some preliminary acceptability work on ReaDySpeech, and implement a feasibility trial. The initial study was a Cochrane systematic review of the effectiveness of interventions for people with non-progressive dysarthria after stroke or other adult-acquired brain injury. This found insufficient evidence to know whether dysarthria intervention is effective or not. This led to a study of early acceptability work for ReaDySpeech and whether there were any technical barriers to use. This found no significant technical barriers other than lack of Wi-Fi and it was acceptable to participants and therapists. This enabled a progression to a feasibility trial following amendments and improvements to the protocol and ReaDySpeech itself. The feasibility trial found recruitment, retention and the intervention were all feasible to carry out during a trial. Further in-depth consideration of the findings indicates more work is needed to widen recruitment and to develop the intervention, comparator and methodology of a future trial for this to be a success with valid clinical implications. This thesis reports this body of work and discusses potential future directions for dysarthria research.

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Introduktion: Afasi är en komplikation av stroke som ger en försämrad förmåga att kommunicera, vilket innebär utmaningar för sjuksköterskan i mötet med patienten. Sjuksköterskan behöver ges förutsättningar för att tillsammans med patienten som drabbats av afasi skapa en vårdrelation. Syfte: Syftet med studien var att beskriva faktorer av betydelse för vårdrelationen med patienter som drabbats av afasi. Metod: Litteraturstudien var utformad enligt Polit och Beck’s (2017) nio steg. Databaserna Cinahl och PubMed användes för litteratursökningen som låg till grund för litteraturstudien.  Tio artiklar valdes ut, varav fem med kvalitativ metod, fyra med kvantitativ metod och en med mixad metod. Artiklarna granskades enligt Polit och Beck’s (2017) granskningsmall. Resultat: En induktiv analys resulterade i huvudkategorin Faktorer av betydelse för vårdrelationen som beskrevs genom underkategorierna Kommunikation och utbildning samt Kontinuitet, avsatt tid och vårdmiljö.  Slutsats: För att skapa en vårdrelation med patienter som drabbats av afasi behöver sjuksköterskan kunskap och utbildning i kommunikation samt i bemötande av patienter med afasi. Strategier och verktyg underlättade kommunikationen precis som kontinuitet i vården. Andra betydande faktorer var en tillfredsställande vårdmiljö samt att det fanns tillräckligt med tid i mötet med patienten.

Introduktion: Stroke är internationellt sett den största orsaken till funktionsnedsättningoch den tredje största orsaken till död. Nästan två av tre personer som överlever stroke lämnar sjukhuset med någon form av nedsättning vilka kan vara fysiska, kognitiva, kommunikativa och/eller känslomässiga. Syfte: Syftet med denna litteraturstudie var att beskriva patienters erfarenheter av vård efter stroke. Metod: Metoden som användes var en litteraturstudie som utgick från Polit och Becks (2017) nio steg. Via databaserna PubMed och Cinahl identifierades elva kvalitativa artiklar med hjälp av relevanta sökord. Artiklarna kvalitetsgranskades och analyserades innan ett resultat sammanställdes. Resultat: I resultatet framkom fyra huvudkategorier vilka var vårdmiljöns inverkan, informationens betydelse, betydelsen av emotionellt stöd samt medverkan och oro i återhämtningsprocessen med sju tillhörande underkategorier. Slutsats: I resultatet framkom flera erfarenheter som gav missnöje och tillfredställelse hos patienterna i vårdmiljön. Erfarenheter framkom också kring behov av information omsjukdomstillståndet vilken bör vara individanpassad. Stöd från omgivningen upplevdessom viktig för patienterna under vårdtiden. Patienterna beskrev erfarenheter av att inte vara delaktiga i planeringen av sin vård. Patienterna beskrev mål av att bli så självständiga som möjligt. Många patienter hade erfarenheter av oro för att återvända hem efter att de drabbats av stroke.

Bakgrund: Varje år drabbas cirka 30 000 personer av stroke i Sverige och av dessa är ungefär 20 procent under 65 år. Att drabbas av stroke är en stor omställning i livet. Att då drabbas av stroke i ung ålder kan medföra större problematik eftersom att livssituationen oftast ser annorlunda ut än efter pensionsåldern. Syfte: Syftet med studien var att beskriva upplevelsen av att drabbas av stroke före 65 års ålder. Metod: En litteraturstudie genomfördes med femton vetenskapliga artiklar som analyserades, granskades och sammanställdes till ett gemensamt resultat. Resultat: Det framkom att vardagen förändrades efter insjuknandet av stroke. Relationer inom familjen förändrades. Efter stroke upplevde flertalet strokedrabbade ett förändrat "jag" med bland annat försämrat självförtroende och förlorad identitet. Osynliga handikapp upplevdes som ett stort problem som påverkade bemötandet från både vården och omvärlden. De unga strokedrabbade beskrev en brist på information från vården samt vikten av socialt stöd för att hitta vägen tillbaka till livet. Diskussion: Förståelsen för sjukdomen är en viktig del till att finna begriplighet i de unga strokedrabbades nya situation i livet. Att känna en meningsfullhet i vardagen skulle kunna leda till ökad motivation hos de unga strokedrabbade. Slutsats: Upplevelsen av att vården ej är anpassad för yngre är vanligt bland unga strokedrabbade. Ålders- och personcentrerad vård är därav ett bra förhållningssätt för att de unga strokedrabbade ska få den bästa möjligheten att hitta vägen tillbaka till livet. / <p>Godkännande datum: 2017-03-20</p>

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.

I Sverige drabbas omkring 30 000 människor av stroke varje år. Sjukdomen medför funktionsnedsättningar som begränsar och påverkar livssituationen hos de strokedrab- bade på ett antal sätt.  Tidigare forskning visar att insjukna i stroke påverkar självupp- fattningen och livskvaliten. Syftet är att belysa hur strokedrabbade upplever livssituat- ionen efter stroke. Litteraturstudien är en sammanställning av 10 artiklar med både kva- litativ och kvantitativ ansats.  Resultatet visar att på grund att kroppsliga, kognitiva och emotionella förändringar påverkas strokedrabbades vardag. Det leder till minskad för- måga att utföra aktiviteter som innan ansågs meningsfulla. Frustration av att inte klara sig själv men även livstillförändringar sker. Omställning i livet sker efter stroke, det väcker känslor, hinder uppstår på grund av funktionsnedsättningar, vissa anpassar sig och många blir en annan människa. Sjuksköterska har en viktig roll att stötta stroke- drabbade i den nya livssituationen genom att ge information och kunskap för att minska risken att återinsjukna och bidra till ökad välbefinnande.

Damage to motor areas of the brain, caused by stroke, can produce devastating motor deficits, including aberrant control of force. After stroke, reorganization of the brain’s motor system has been identified as one of the fundamental mechanisms involved in recovery of motor control after stroke. Yet, few studies have investigated how force production and modulation are encoded in the brain after stroke and how this relates to motor outcome. Thus, the purpose of this study was to (1) understand how past neuroimaging literature has contributed to establishing common patterns of brain reorganization during both relative and absolute force production after stroke, (2) examine how brain function is reorganized during force production and modulation in individuals with stroke, and (3) relate this task-related reorganization of brain function to the amount of paretic arm use after stroke. In the second chapter, we systematically reviewed all relevant literature examining brain activation during force production after stroke. The following chapters (chapters 3 and 4) applied functional magnetic resonance imaging (fMRI) to examine the neural correlates of force production and modulation after stroke. Chapter 2 supports differences in task-related brain activation dependent on features of stroke, such as severity and chronicity, as well as influence of rehabilitation. In addition, results suggest that activation of common motor areas of the brain during force production can be identified in relation to functional outcome after stroke. Results from the subsequent two chapters (3 and 4), demonstrate that brain function reorganizes in terms of absolute, and not relative force production after stroke. Specifically, stroke participants exhibit greater activation of motor areas than healthy controls when matched for absolute force production. Moreover, there is a relationship between paretic arm usage and brain activation, where stroke participants having less paretic arm use, as measured using wrist accelerometers, exhibit higher brain activation. Results of this thesis suggest that during absolute force production, brain activation may approach near maximal levels in stroke participants at lower forces than healthy controls. Furthermore, this effect may be amplified even further in subjects with less paretic arm usage, as increased activation in motor areas occurs in participants with less arm use after stroke. Ultimately, the results from this thesis will contribute to research relevant to brain reorganization in individuals with stroke and may lead to the development of new, beneficial therapeutic interventions that optimize brain reorganization and improve functional recovery after stroke. / Medicine, Faculty of / Graduate

Background: Stroke is the disease that leads to most days of care in hospitals and which leads to the most disabilities in adults. With these disabilities, the patient often end up in a dependence to both relatives and healthcare professionals to cope with their daily lives. Previous research on family experience shows that they feel regret, stress and do not find time for relaxation. Describing how people experience their quality of life and their everyday life after stroke is important in order to give the nurse a better insight and understanding of the care of these patients.   Aim: To describe how people perceive their quality of life and their daily lives after a stroke and describe the study groups in the selected articles.   Method: A descriptive literature study. 13 scientific articles were used, with both quantitative and qualitative approaches.   Results: When the authors compiled the thirteen articles of this literature study, a continuous theme was seen on how stroke affected the quality of life of the participants and their everyday life. Stroke led to a changed life, both physically and mentally. Many suffered from speech disorders and disabilities, which meant isolating themselves from society. Quality of life was considered to be done by itself, having goals in life and having good social relations. To not have to rely on others and to be independent was a goal that the stroke sufferers constantly sought after.   Conclusion: Both physical and psychological problems arise that affected everyday life after a stroke. Finding new meaningful activities, establish goals, managing oneself and having good social relationships were important for a good quality of life after a stroke.

Background: Stroke is a major cause of disability in the world and its long term effects require good adherence to treatment protocols of physiotherapy. This will ensure optimal rehabilitation and reduce the burden of care in the society and the health service. Superficial analysis of existing data from the Physiotherapy Department of Mthatha General Hospital (MGH) revealed that there was poor attendance of outpatient physiotherapy by patients discharged from MGH with stroke and this had negative effects on outcomes and health care costs. Aim: To identify factors that influence poor attendance for outpatient physiotherapy by patients discharged from MGH with a stroke. Methods: Following approval from the Research Ethics Committee to conduct the study, an observational descriptive study design was used. The study population was 139 patients with stroke who attended for physiotherapy in MGH from January 2007 to December 2007. From a sample size of 103 randomly selected patients, 85 patients participated in the study with a response rate of 82%. Data collection was done using structured interviews and SPSS was used for data analysis. Results: The majority (86%) of patients did not attend physiotherapy until discharge from physiotherapy department. The major factors that influenced poor attendance were movement of patients to other areas (36%) and long distance from MGH (29%). Conclusion: The majority of stroke patients who attended for rehabilitation in MGH Physiotherapy Department lived in rural areas which were distant from Mthatha and could not attend physiotherapy at MGH as required by the physiotherapists. Recommendation: Development of a Provincial Rehabilitation Policy to address the unavailability of physiotherapy services at clinics and health care centers and ensure creation and filling of vacant physiotherapy positions at these levels of care.