Aims This study aimed to demonstrate reliability and validity of the Stroke Rehabilitation Motivation Scale, a novel instrument designed to assess internal and external contributions to motivation. Many studies recognise motivation, in the everyday sense, as a factor affecting stroke rehabilitation, but there is no standard measure. There is also no agreement as to whether motivation in the post-stroke period is the same as the absence of depression, anxiety or stress; hence the need for an independent measure of motivation. Method The Stroke Rehabilitation Motivation Scale was adapted from the 28-item Sports Motivation Scale, which in turn was developed according to the intrinsic and extrinsic contributions to motivation identified by Self-Determination Theory. The resulting Stroke Rehabilitation Motivation Scale was tested in two stages. In the 28-item reliability stage, in a sample of 18 stroke patients from the stroke ward of Bankstown-Lidcombe Hospital, the scale was tested for Inter-rater reliability, scale reliability, and validity via comparison of high vs. low motivation groups according to a novel ???motivation score???. The scale was shortened from 28-items (four per subscale) to 7 items (one per subscale) by selecting the most reliable items. The three intrinsic and extrinsic subscales were summed and averaged, and the amotivation score was subtracted from this to produce a ???motivation score???, such that a person with a positive score had more motivation, either extrinsic or intrinsic, than they had amotivation. e.g. [ ( E + I )/2 ??? A ] In the 7-item reliability stage, a further 13 patients were recruited from Bankstown-Lidcombe and Liverpool Hospitals. The 7-item scale was tested for scale reliability, and for validity by comparison of high vs. low motivation groups as well as correlations between motivation score, anxiety, depression and stress, and rehabilitation outcomes. Results In both the 28-item and 7-item stages the scale demonstrated adequate to very good reliability. There was a lack of significant mean differences or correlations to demonstrate validity in either stage; this study does not represent a convincing demonstration of validity of the SRMS. However, it would appear that motivation is conceptually distinct from depression, anxiety and stress, and the scale definitely warrants further testing in a larger sample.

Aims This study aimed to demonstrate reliability and validity of the Stroke Rehabilitation Motivation Scale, a novel instrument designed to assess internal and external contributions to motivation. Many studies recognise motivation, in the everyday sense, as a factor affecting stroke rehabilitation, but there is no standard measure. There is also no agreement as to whether motivation in the post-stroke period is the same as the absence of depression, anxiety or stress; hence the need for an independent measure of motivation. Method The Stroke Rehabilitation Motivation Scale was adapted from the 28-item Sports Motivation Scale, which in turn was developed according to the intrinsic and extrinsic contributions to motivation identified by Self-Determination Theory. The resulting Stroke Rehabilitation Motivation Scale was tested in two stages. In the 28-item reliability stage, in a sample of 18 stroke patients from the stroke ward of Bankstown-Lidcombe Hospital, the scale was tested for Inter-rater reliability, scale reliability, and validity via comparison of high vs. low motivation groups according to a novel ???motivation score???. The scale was shortened from 28-items (four per subscale) to 7 items (one per subscale) by selecting the most reliable items. The three intrinsic and extrinsic subscales were summed and averaged, and the amotivation score was subtracted from this to produce a ???motivation score???, such that a person with a positive score had more motivation, either extrinsic or intrinsic, than they had amotivation. e.g. [ ( E + I )/2 ??? A ] In the 7-item reliability stage, a further 13 patients were recruited from Bankstown-Lidcombe and Liverpool Hospitals. The 7-item scale was tested for scale reliability, and for validity by comparison of high vs. low motivation groups as well as correlations between motivation score, anxiety, depression and stress, and rehabilitation outcomes. Results In both the 28-item and 7-item stages the scale demonstrated adequate to very good reliability. There was a lack of significant mean differences or correlations to demonstrate validity in either stage; this study does not represent a convincing demonstration of validity of the SRMS. However, it would appear that motivation is conceptually distinct from depression, anxiety and stress, and the scale definitely warrants further testing in a larger sample.

Aims This study aimed to demonstrate reliability and validity of the Stroke Rehabilitation Motivation Scale, a novel instrument designed to assess internal and external contributions to motivation. Many studies recognise motivation, in the everyday sense, as a factor affecting stroke rehabilitation, but there is no standard measure. There is also no agreement as to whether motivation in the post-stroke period is the same as the absence of depression, anxiety or stress; hence the need for an independent measure of motivation. Method The Stroke Rehabilitation Motivation Scale was adapted from the 28-item Sports Motivation Scale, which in turn was developed according to the intrinsic and extrinsic contributions to motivation identified by Self-Determination Theory. The resulting Stroke Rehabilitation Motivation Scale was tested in two stages. In the 28-item reliability stage, in a sample of 18 stroke patients from the stroke ward of Bankstown-Lidcombe Hospital, the scale was tested for Inter-rater reliability, scale reliability, and validity via comparison of high vs. low motivation groups according to a novel ???motivation score???. The scale was shortened from 28-items (four per subscale) to 7 items (one per subscale) by selecting the most reliable items. The three intrinsic and extrinsic subscales were summed and averaged, and the amotivation score was subtracted from this to produce a ???motivation score???, such that a person with a positive score had more motivation, either extrinsic or intrinsic, than they had amotivation. e.g. [ ( E + I )/2 ??? A ] In the 7-item reliability stage, a further 13 patients were recruited from Bankstown-Lidcombe and Liverpool Hospitals. The 7-item scale was tested for scale reliability, and for validity by comparison of high vs. low motivation groups as well as correlations between motivation score, anxiety, depression and stress, and rehabilitation outcomes. Results In both the 28-item and 7-item stages the scale demonstrated adequate to very good reliability. There was a lack of significant mean differences or correlations to demonstrate validity in either stage; this study does not represent a convincing demonstration of validity of the SRMS. However, it would appear that motivation is conceptually distinct from depression, anxiety and stress, and the scale definitely warrants further testing in a larger sample.

<p>Syftet med studien var att beskriva hur personer som har drabbats av stroke upplever sin livskvalitet samt vilka faktorer som associeras med livskvalitet. Designen var en beskrivande litteraturstudie och litteratur söktes i databaserna Medline (via PubMed) och Cinahl. Efter urvalet återstod 15 artiklar som inkluderades i studien. Artiklarna granskades och fyra huvudkategorier kunde utrönas: livskvalitet efter stroke, fysiska, psykiska och sociala faktorer som associeras med livskvalitet. Resultatet visade att personer som har drabbats av stroke ofta uppvisar sänkt livskvalitet. Fysiska faktorer av betydelse var försämrade kroppsfunktioner och kognitiv nedsättning. Äldre personer och kvinnor skattade ofta sin livskvalitet lägre jämfört med yngre och män. Den viktigaste psykiska faktorn var depression. En social faktor av betydelse för sänkt livskvalitet var minskat socialt deltagande. Slutsatsen med studien var att kunskap kring hur personer som har drabbats av stroke upplever sin livskvalitet och vilka faktorer som associeras med livskvalitet kan ge vägledning för vilken typ av stöd och rehabilitering som behövs.</p> / <p>The purpose of the study was to describe how persons who have had a stroke experience their quality of life and which factors are associated with quality of life. The design was a descriptive literature study and literature was sought in the databases Medline (via PubMed) and Cinahl. After the selection a sample of 15 articles was included in the study. The articles were reviewed and four main categories were found: quality of life post stroke, physical, psychological or social factors associated with quality of life. The result showed that persons who had a stroke often show decreased quality of life. Physical factors of importance were impaired body functions and decreased cognitive function. Older persons and women often measured their quality of life as lower compared to younger persons and men. The most important psychological factor was depression. A social factor of importance related to reduced quality of life was decreased social participation. The conclusion of the study was that knowledge about how persons who had a stroke experience their quality of life and which factors are associated with quality of life could give guidance for what kind of support and rehabilitation is needed.    </p>

No description available.

Stroke is a leading cause of disability in Canada. Delayed hypothermia improves outcome in patients following cardiac arrest and reduces lesion volume in rodents after transient focal ischemia, but less is known about the effectiveness of delayed hypothermia following permanent focal ischemia. In Chapter 1, the efficacy of 12, 24 or 48 h of delayed hypothermia was evaluated one week following pMCAO. All treatments attenuated neurological deficits and brain water content, but only the 24 and 48 h treatments reduced stepping error rate and lesion volume. Thus, delayed hypothermia attenuates brain injury and functional deficits following permanent middle cerebral artery occlusion (pMCAO). Longer bouts of cooling provide superior protection; an effect that is not explained by lessened edema. Chapter 3 describes a novel method of focal brain hypothermia in rats. A metal coil was implanted between the Temporalis muscle and adjacent skull and flushed with cold water. Focal, ipsilateral cooling was successfully produced without cooling of the opposite hemisphere or the core. One day of focal hypothermia was maintained in awake rats without significant alterations in blood pressure, heart rate or body temperature. The described simple method allows for safe inductions of focal brain hypothermia in anesthetized or conscious rats, and is ideally suited to trauma or stroke studies. In Chapter 4, long-term efficacy of 12 and 48 h of delayed focal or systemic hypothermia was evaluated following pMCAO. Both systemic treatments equally reduced lesion volume and skilled reaching deficits compared to normothermic controls, but only the 48 h treatment reduced neurological deficits. Conversely, 12 h of focal cooling did not significantly improve outcome, whereas 48 h of focal brain cooling attenuated functional deficits and reduced lesion volume. Thus, both delayed focal and systemic hypothermia attenuate long-term brain injury and functional deficits following pMCAO. Duration of cooling is clearly an important factor that may depend upon the method of cooling. Overall, this data indicates that delayed and prolonged hypothermia provides substantial and persistent protection against pMCAO in the rat. Prolonged hypothermia is a promising neuroprotective therapy for acute stroke and further clinical investigation is warranted.

25 years after the first sodium images of the human brain were created, sodium MRI remains on the periphery of MR research, despite intimate sodium involvement in cellular metabolism and implicated abnormal concentrations in numerous disorders. The difficulties of sodium MRI include not only tissue concentration, ~1750x less than proton, but also rapid biexponential signal decay. The purpose of this work was to optimize human brain sodium MRI and facilitate a study of sodium increase following onset of acute human stroke, with potential timing application for those patients who present with unknown time-of-onset, as effective treatment is currently bound by a 4.5 hour time-window. Optimization begins with radial center-out k-space acquisition, which minimizes echo time (TE) and signal loss, and in particular concerns the twisted projection imaging (TPI) technique, which has not found wide use. This thesis first considers a new application of TPI, i.e. k-space filtering by sampling density design to minimize detrimental ringing artifact associated with cerebral spinal fluid. Image noise correlation is addressed next, and a method for measuring volumes of statistical noise independence presented, as this correlation together with signal-to-noise ratio (SNR) defines the confidence of signal-averaging measurements. Radial acquisition is then considered with respect to a new imaging metric, i.e. the minimum object volume that can be precisely (with respect to noise) and accurately (with respect to image intensity modulation with object volume) quantified. It is suggested that TPI is a highly beneficial radial acquisition technique when implemented with long readout duration (countering common thought), reduced SNR (i.e. small voxel volumes), and in particular small TPI parameter p. Sequence optimization for bulk-tissue sodium analysis demonstrates a large SNR/voxel-volume advantage for TPI implementation in a steady-state approach, even though excitation pulse length and TE must be increased to mitigate power deposition. Finally, an inversion-recovery based fluid-nulling method that facilitates sodium environment separation based on rapid relaxation during soft inversion pulses is presented, with possible application for intracellular weighted imaging. On high quality sodium images a clear trend of lesion intensity increase with time-after-onset is demonstrated for the first time in acute stroke patients, as expected from animal models.

There are two types of stroke: ischemic and hemorrhagic. Intracerebral hemorrhage (ICH) accounts for about 15% of all strokes and is often severe. Currently no treatments are available to reduce injury, but rehabilitation may improve recovery. Most studies focus on ischemia, putting little emphasis on understanding recovery after hemorrhage. In chapter 2, we evaluated exercise prior to and/or following ICH. Similar protocols improve recovery after ischemic stroke, and we hypothesized that the treatment would also reduce deficits after hemorrhagic injury. However, exercise was not beneficial for ICH and increased intensity of treatment worsened functional outcome. In chapter 3 we assessed amphetamine and/or rehabilitation after ICH, an intervention also shown to improve recovery after ischemia. The rehabilitation consisted of environmental enrichment (EE) with modest amounts of training on beam and skilled reaching. Rehabilitation but not amphetamine partially improved recovery. Skilled reaching was not improved by rehabilitation so we decided to combine EE with more reach training. In chapter 4, we found that two weeks of rehabilitation (EE and skilled reaching), started one week after ICH significantly reduced lesion volume, and improved recovery on walking and skilled reaching tests. We were particularly interested in the mechanisms contributing to the reduction in lesion volume after ICH, and attempted to identify these. In chapter 5, we used the same rehabilitation intervention as in chapter 4 to determine if treatment alters dendritic complexity, spine density, or cell proliferation. Unfortunately, the reduction in lesion volume from chapter 4 was not replicated. But we were able to identify several plastic changes. Dendritic complexity was increased in neurons of the forelimb motor cortex ipsilateral to injury. Dendritic complexity of neurons in the peri-hematoma region and corresponding area in the uninjured hemisphere were also increased. In contrast, rehabilitation did not alter spine density or cell proliferation. In summary, we found that treatments that work for ischemic stroke do not necessarily work for hemorrhagic injury. Some methods of rehabilitation are able to reduce functional deficits and in some cases lesion volume after ICH. These rehabilitation effects are likely due to enhanced plasticity and not cell genesis.

Stroke is the third leading cause of death and the most common cause of disability in the world. To relieve the heavy burden of stroke, we need to understand the mechanisms that will form the basis of improved prevention and treatment. Epidemiological studies have found evidence for a genetic influence on the common form of stroke. However the genetic of stroke is still in its infancy. Subclinical intracranial atherosclerosis is sometime a predisposing factor for ischemic stroke (IS). This study was carried out to elucidate genetic factors influencing the complex phenotype of IS and subclinical intracranial atherosclerosis. In the Belgium Stroke Study (BSS), we collected 237 middle-aged (45-60 yrs) patients with small vessel occlusion (SVO) or large vessel atherosclerosis (LVA) IS, according to the Acute Stroke Treatment (TOAST) criteria, 326 ethnicity and gender matched subjects were used as controls. We tested variants in cholesterol-related candidate genes (sterol regulatory element binding protein, SREBP, SREBP-cleavage activating protein, SCAP, Apolipoprotein E, APOE, and Proprotein convertase subtilisin/kexin type 9, PCSKA) for association with IS. Significant gene-IS associations were further tested in a Finnish autopsy collection of 1004 cases with a quantitative assessment of atherosclerosis in the circle of Willis. While we could not detect any significant association between polymorphisms in the SREBP and SCAP genes and IS, we found evidence for association at the APOE and PCSK9 loci. The APOE ε4+ genotype was related to a more severe intracranial atherosclerosis score in men, and within the most common APOE ε3/ε3 genotype group a higher risk of IS was associated with the G-allele at the -219G/T promoter polymorphisms. At PCSK9, the minor allele (G) of the tagging E670G polymorphism appeared as a significant predictor of LVA (OR = 3.52, 95% CI 1.25-9.85; p = 0.017). Accordingly, in the Finnish autopsy series, G-allele carriers tended to have more severe allele copy number-dependent (p=0.095) atherosclerosis in the circle of Willis and in its branches. Our findings in this unique combination of clinical and autopsy data suggest a multifaceted role of apoE on the risk of cerebrovascular diseases. The APOE ε4+ genotype did not predict the risk of IS, but was associated with severity of subclinical intracranial atherosclerosis in men. In contrast, the promoter variants affecting apoE expression were significant predictors of IS, suggesting that quantitative rather than qualitative variation of apoE is related to IS independently of subclinical intracranial atherosclerosis. Furthermore, we demonstrated that PCSK9 associates with the risk of LVA stroke subtype, and suggest that the risk is related to the severity of the underlying intracranial atherosclerosis. Atherogenesis is considered as an active, inflammatory process, interleukin (IL)-18 a proinflammatory cytokine, is thought to play a central role in the development of atherosclerosis and more specifically in plaque rupture. We genotyped four haplotype tagging polymorphisms at the IL18 gene in the BSS and the Finnish autopsy series. The minor alleles of the IL18 -607 and +127 polymorphisms, as well as the haplotype carrying both minor alleles, associated with IS after adjustment for all cardiovascular risk factors. No association was seen with the development of subclinical intracranial atherosclerosis. Our findings suggest that variation in the IL18 gene influences the acute atherosclerotic IS event, but not the previous development of subclinical intracranial atherosclerosis, suggesting a causal role of IL18 in the vulnerability of cerebral arterial atherosclerotic plaques to acute rupture and subsequent thrombosis.

Bakgrund: I Sverige insjuknar årligen cirka 30 000 människor i stroke. Medelåldern för män är cirka 74 år och för kvinnor cirka 78 år. Ätsvårigheter är vanligt efter stroke och det har visat sig att incidensen ökar med stigande ålder. Nära hälften av alla som drabbas kan besväras av: ätsvårigheter, tuggsvårigheter, ansamling av mat i kind, läckage av mat från munhålan, svårigheter med att förstå att maten skall tuggas och sväljas ner. Syfte: Belysa och sammanställa forskning som beskriver patienters upplevelser av ätsvårigheter efter insjuknande i stroke.  Metod: En litteraturöversikt har genomförts för att besvara studiens syfte, där sammanlagt sex vetenskapliga artiklar inom området har analyserats. Resultat: Fem teman framkom vid analysen och dessa var: känslor och upplevelser under ätandet, hantering av mat, sociala relationer, förlust av ätfunktioner och att vara beroende. Denna kunskap kan öka sjuksköterskans förståelse för hur patienter upplever sin matsituation och därmed finna individanpassade lösningar i det kliniska arbetet.