Thesis (M.Sc.(Physiotherapy)--University of the Witwatersrand, 2015. / Background Despite it being used clinically, there is limited, inconclusive literature available on shoulder strapping techniques for patients with stroke. Of the published techniques, circumferential strapping seems to show the most positive results. However, in South Africa, variations of a longitudinal technique are applied most often. This study aimed to establish if longitudinal or circumferential strapping techniques would have an impact on a patient's upper limb tone, subluxation, motor function or pain, post stroke and how they compared to each other. Participants This study recruited 56 participants within two weeks of having a stroke, presenting with upper limb involvement (hemiplegia). Participants were excluded if they had receptive aphasia and/or were medically unstable. Method The study was a longitudinal randomised controlled trial comprising of three groups: a control, longitudinal strapping and circumferential strapping groups. Patients with stroke who met the inclusion criteria were assessed at baseline, week one, week two and week six post baseline assessments. The participants were assessed for shoulder subluxation (finger width measurement system), shoulder pain (Ritchie Articular Index), upper limb motor function (upper limb subscales six, seven and eight of the Motor Assessment Scale) and muscle tone (Modified Ashworth Scale). The intervention groups were strapped for two weeks. The sample size for the study was originally calculated at 15 participants however we felt that this should be larger and thus using the central limit theorem a minimum of 30 participants per group was calculated. Demographic data were analysed using descriptive statistics and are presented in tables using frequencies and percentages for the following variables: age, gender and side of stroke. The two-sample test of proportions was used to determine differences among the groups over the study period. The overall within group effect was tested using the Cochran's Q test. The generalized estimated equations were was used to determine the overall effects of the intervention overtime adjusting for groups as well as using population levels. Ethical approval was granted by the Human Research Ethics Committee at the University of the Witwatersrand and informed consent was obtained from all participants prior to the study. Results The total number of participants recruited into the study over three years was 56. The number of participants in the control, circumferential and longitudinal groups was 19, 15 and 22 respectively. Data showed that the study participants were generally young with a mean age of 49.4 (± 13.8) years. There were more females (51.8%) than males and the majority ofthe study sample (60.7%) had a right cerebrovascular accident. Longitudinal strapping decreased shoulder subluxation and pain, but not tone, however, across all of the outcome measures the changes did not reach statistical significance. Circumferential strapping had no significant effect on any of the outcomes compared to the control group, however, it prevented the shoulder pain from worsening, but it had no positive effect on shoulder subluxation post stroke. Improvement in upper limb motor function was observed for all three groups with only a significant improvement in upper arm function being observed for the circumferential group. Conclusion and implications Overall, the study showed positive trends in changes in the shoulder post stroke but no significant differences were found between the groups in any of the outcomes, even when both intervention groups were combined and analysed against the control participants. Looking at the trends, however, the longitudinal technique, with its positive effect on shoulder subluxation and pain, would appear to be the preferred method of the two. Although the study produced overall results that did not have statistical significance one cannot discredit the use of the strapping. Even if strapping had purely a placebo effect it would still serve a purpose by creating awareness in the patient, caregivers and medical personal and thus ensure more cautious handling of the affected upper limb. Thus, when rehabilitating the shoulder post stroke, there appears to be enough clinical evidence to suggest that strapping, more precisely longitudinal strapping, of the hemiplegic shoulder may be used.

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 Physiotherapy Johannesburg, 2014 / Stroke is a significant contributor to disease worldwide and is the second highest cause of death in both men and women. Importantly, stroke is not only a common cause or mortality but also morbidity. This increased risk of suffering a stroke could lead to an increased number of individuals with functional limitations. The main objective in stroke rehabilitation is seen as aiding the patient to achieve their highest physical and psychological performance, with the ultimate goal of a stroke survivor being one of functional independence allowing them to return to their home and reintegrate into their community. The aim of this study is to describe the differences in functional abilities between patients with stroke who are HIV positive and those who are HIV negative admitted to Witrand rehabilitation unit in the North-West province of South Africa. This is a retrospective longitudinal study utilizing the review of subject records. All subject files dating back to 21 April 2005 to December 2010 were analysed. Functional ability of patients with stroke was scored using the Beta assessment tool.The Beta assessment tool is one of three platform level tools designed by the South African Database for Functional Medicine (SADFM).It is an evidence – based scoring system which can convert a patient’s functional abilities and behaviour into quantifiable data. Scores on admission and discharge were recorded to determine the presence of change in functional ability after having received rehabilitation. Demographic information and clinical characteristics of subjects were captured using a self-designed questionnaire. Data were analysed using both a two sample t-test and descriptive statistical tests. Over the period, 2005 – 2010, 173 stroke survivors were admitted to the Witrand rehabilitation unit.Data from 32 patient files was excluded for not meeting the inclusion criteria; leaving data from 141 files to form our study group (n). The study group included 53.2% male and 46.8% female stroke survivors, with the mean age for stroke at 54.4 years and52.4 years for males and females respectively. Ischaemic strokes were more prevalent than haemorrhagic strokes (74.5% and 25.5% respectively) with hypertension asthe most common (31.9%) stroke risk factor. The mean age of stroke onset for a HIV positive individual was 39.6 years and 54.9 years for an individual without HIV.This study found that HIV positive individuals required on average 7.5 days less to rehabilitate than an individual with HIV. This discrepancy could be a result of the notably younger HIV positive group. After receiving rehabilitation from a multidisciplinary team, the HIV positive group improved with an average of 40 points and the individuals without HIV by 38 points. When performing the various statistical tests there were in fact no significant differences between the two different clinical groups. Despite the statistically insignificant findings when comparing the HIV positive and HIV negative group, when taking a closer look at the study groups demographics and clinical characteristics this study yielded interesting results. It could be argued that a majority of the HIV positive group were generally younger than the HIV negative group and perhaps the advantage of age on recovery could result in this group in gaining, on average, a similar number of points on the beta scale with those individual without HIV.Prior to their commencement of rehabilitation it should be taken into account that neurological recovery requires a degree of brain reorganization and that with age comes a certain degree of neuronal loss. Neuroplasticity is the ability of the central nervous system to respond to internal and external stimuli by reorganizing its structure, function and connections. Normal ageing is associated with a decline in and reduced plasticity. These negative changes can be experienced as reductions in processing speed, working memory and peripheral nervous system functions; all of which can be associated with poorer rehabilitation outcomes. Neural plasticity is crucial for functional recovery and this occurs more effectively and efficiently in younger individuals.However, in general the age for stroke onset was younger than that of developed countries thus stroke should no longer be considered an ‘old-age’ disease in developing countries. Keywords: Stroke; Human Immunodeficiency Virus (HIV); Functional abilities

Stroke remains a serious public health problem in low, middle and high income countries worldwide. In low and middle income countries there has been a greater than 100% increase in stroke incidence. The impact of HIV associated vasculopathy is recognized as contributing to the increased prevalence of stroke in younger patients (Tipping et al., 2007) and is an independent risk factor for stroke (Cole et al., 2004). The impact of this increased stroke incidence has not only resulted in an increase in death rates in the developing world, but has also resulted in increases noted in long term disability as a result of stroke. The available resources for stroke care and rehabilitation are lacking in developing countries including Africa, particularly in rural areas. It has also been noted that 80% of the population live in areas where factors such as limited resources and cultural practices limit access to stroke services (Poungvarin 1998). Currently patients with stroke are discharged from hospitals in the public healthcare sector within six to 14 days of having a stroke, because of the pressure for beds (Mudzi, 2009; Reid et al., 2005; Hale, 2000). As a result patients are not benefitting from rehabilitation services and this leads to suboptimal recovery post stroke and to a large number of persons living with disabilities in under resourced communities. Because the patients with stroke are discharged so acutely after their stroke, carers become a necessity to cope with the burden of care. These conditions result in increased stroke survivor dependence in South Africa compared to the USA or New Zealand. While 80% of stroke survivors who are initially unable to walk achieve independent walking (Jorgensen et al., 1995), at three months post stroke 25%-33% still require assistance or supervision when walking (Jorgenson et al., 1995; Duncan et al., 1994; Richards et al., 1993). Unfortunately these independent walkers seldom achieve walking speeds that are sufficient for community ambulation (Schmid et al., 2007; Lord and Rochester, 2005; Lord et al., 2004). Walking competency is a term used to describe a certain level of walking ability allowing an individual to participate in the community safely and efficiently (Salbach et al., 2004). It should also be noted that even those with mild and moderate strokes experience limitations with higher physical functioning which impacts on their quality of life and ability to return to work (Duncan and Lai, 1997). The cerebral cortex has the ability to undergo functional and structural reorganization for several weeks and even months in more severe cases post stroke. Rehabilitation post stroke facilitates this process and can shape the reorganization of the adjacent intact cortex (Green, 2003). Further, it has been concluded that to facilitate the best possible functional outcome for people post stroke, engagement in intensive task oriented therapy is necessary (Kwakkel et al., 2004; Van Peppen et al., 2004). Considering these findings it is extremely concerning that there is little or no rehabilitation provided to stroke survivors in the public healthcare sector in South Africa (Mudzi, 2009; Rhoda and Hendry 2003; Hale and Wallner, 1996; Stewart et al., 1994). With this in mind, the aim of this study was to determine if an out -patient based task oriented group training programme would promote improved walking competency more than the current progressive resistance strength group training programmes that are common practice in persons who have had an acute stroke in the public healthcare system in South Africa. The specific objectives of this study were to establish the effect of a low intensity, namely once a week (for six weeks), out- patient based task programme on: walking competency, walking endurance, gait speed and health status in terms of physical functioning in persons with sub-acute stroke. Due to the high incidence of post stroke survivors with HIV it was important to establish if the training programme produced comparable effects in HIV positive and HIV negative subjects. This study used a stratified blocked randomised controlled trial design. Where group allocation was concealed. In addition assessor blinded evaluations were conducted at baseline, post intervention and at six months after the intervention had ceased. A total of 144 persons who had a stroke were stratified according to their walking speed – mild (able to walk at a gait speed > 0.8m/s), moderate (able to walk at a speed of 0.4-0.8 m/s) or severe (able to walk at a speed < 0.4m/s) – and randomly assiged to one of three training groups. One group received task oriented group circuit training (task group), the second group received progressive resistance strength training (strength group), and the third group participated in one multidisciplinary education group training session (control group). The task and strength interventions included 6 sessions, of 60 minutes each for six to 12 weeks. While the control intervention group participated in one three hour education session, which included advice on the importance of exercise and a 20-minute exercise session. All subjects had been discharged from the public healthcare sector and were less than six months post stroke at inclusion into the study. The primary objective was walking competency, which included the measurement of walking endurance, gait speed, functional balance and mobility (Salbach et al., 2004). The task group showed an improvement that was significantly greater than that achieved by the strength and control groups in walking endurance, gait speed, functional mobility and balance at the follow-up. These findings demonstrate that the provision of as little as six sessions of task training (in a developing country, where persons with sub-acute stroke have had no previous rehabilitation) improves walking competency to a significantly greater extent than either a strength intervention of equal intensity, or a control intervention programme consisting of one three hour education visit in the sub -acute phase post stroke. While the strength group received a more frequent and intensive training compared with the control group, there were no significant differences in terms of walking competency between these two groups over the study period. The task group showed significantly greater improvements in walking endurance, comfortable and maximum gait speed than the strength and control groups immediately post intervention. While post intervention, the task training led to superior gains in functional mobility and balance compared to the control group, it was not superior to the strength group. For subjects, with a moderate gait disability at baseline, the improvements in walking endurance and in comfortable and maximum walking speed in the task group were significantly more than the strength and control groups. For subjects with a severe gait deficit at baseline, the task group improved significantly more than the control group on all measures of walking competency but not significantly more than the strength group. There were no significant differences among the groups for subjects with a mild gait deficit at baseline. All three treatment intervention groups improved their score on the stroke impact scale 16 (SIS 16) over the course of the study period. The task group improved significantly more than the control group’s health status in terms of physical functioning measured by the SIS16. There were no significant differences among the groups in the change scores for the measures of walking competency between the HIV positive and HIV negative subjects throughout the study period. The results of this study demonstrate that an extremely limited number of task training sessions resulted in significantly greater improvements in walking competency than progressive strength training or a multidisciplinary education training approach. However, these results must be interpreted with caution, remembering the context of the sample population who had not received a period of inpatient rehabilitation prior to their inclusion into the study and were 10-15 years younger than subjects in numerous other studies. This appears to be the first study conducted with such a limited rehabilitative intervention post stroke. As a result, further research to evaluate the effectiveness of limited intensity task oriented training interventions for non -ambulant stroke survivors in the developing world where resources are limited, needs to be conducted. It is important to explore the benefits of different group based rehabilitative interventions for stroke survivors to alleviate the burden as a result of disability as much as possible. Key words: Stroke, Task Oriented, Rehabilitation, Walking, Walking Competency

Magister Scientiae (Physiotherapy) - MSc(Physio) / Zambia is undergoing epidemiological changes from communicable diseases to NCDs as a result of demographic transition and hence Stroke is an emerging NCD in the country. The process of care of stroke in Zambia as country is unknown. Exploring the process of care of stroke in Zambia, could help understand the gaps in service delivery thereby helping to create interventions to improve stroke service delivery. The purpose of this study was to determine and explore the process of care of stroke in Zambia. As there is no information regarding stroke care in Zambia, the study aimed to explore and determine the process of care and explore the conditions under which diagnosis and management of stroke is done in Zambia and are the factors influencing stroke diagnosis and management in Zambia. The study was conducted in Zambia’s five general hospitals which were selected conveniently. The study consisted of both quantitative and qualitative methods. The quantitative part consisted of stroke patients’ medical records reviews, who were admitted to general hospitals between 1st January to 3oth October 2014. A sample of 80 medical records was selected randomly from each general hospital, making the total of 400 medical records from all the hospitals. Data was collected using a checklist which was specifically design for the study after literature review and contained stroke care processes including diagnosis, medical management, rehabilitation, lifestyle management and community linkage. Analysis of quantitative data was done using Statistical Package for Social Science (SPSS) version 22. The qualitative part consisted of individual in-depth interviews with a purposefully selected sample of three health workers from each hospital making 15 health workers. The in-depth interviews were based on predetermined themes including staffing levels, multidisciplinary team action, treatment guidelines, clinical capacity, planning and budgeting and technical environment. All the interviews were audio-taped, transcribed verbatim and the predetermined themes were analysed using content analysis. Ethical clearance to conduct the study was obtained from the University of the Western Cape Faculty Board Research and Ethics Committees and Senate Research Committee and ERES Converge in Zambia. Permission to conduct the study in Zambia was obtained from the Ministry of Health, Zambia. Informed consent was obtained from the health workers who took part in the study. The study found that the stroke process of care in Zambia ranged from diagnosis through to physical rehabilitation and lifestyle management. The stroke process of care was challenged in the area of diagnosis using biochemistry, haematology, CT scan, MRI and Angiography etc. The process of care in rehabilitation was challenged by lack of gadgets and space to use in rehabilitation. Community linkage, speech therapy and social welfares services were not part of the stroke process of care in Zambia as the study as established. Staff shortages, busy schedules, no treatment guidelines, poor clinical capacity, lack of resources and poor technical environment impacted negatively on the stroke process of care according to this study. Diagnosis and management of stroke was made with no treatment guidelines, poor clinical capacity and poor technical environment. The same were the factors which were influencing diagnosis and management namely staff shortages, no multidisciplinary teams due to busy schedules of health workers, lack of treatment guidelines, poor clinical capacity by health workers, lack of resources for stroke and poor technical environment. Using the Chi-square association of variables, the study showed that CT scan was associated with definitive diagnosis with the p-value of 0.000. Equally, Chi-Square test showed that Diagnosis was not associated with medical management (p value=0.058).

Thesis (Sc.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Therapy to restore functional movement of stroke patients is based on assumptions about what deficits occur in motor control as a result of stroke. These assumptions are derived from observational studies of movement behavior. The success of therapy to restore voluntary movement has been limited, perhaps as a result of insufficient information concerning the characteristics of movement post stroke. Technology now exists to quantitatively describe the characteristics of movement behavior. In this study WATSMARTtm, a non-contact, optoelectric motion analysis system, was used in combination with surface electromyography to measure voluntary movement in the symptomatic and nonsymptomatic arms of five subjects with left hemiparesis as they attempted to reach to one of three targets placed to require movement inside and outside of extensor synergy. Each subject was tested five times over approximately a nine week period. Results indicated that the symptomatic arms were significantly less able to generate muscular activity and to move in a smooth coordinated way [execute the program] than the nonsymptomatic arms whose scores were essentially within normal limits. Target location made no significant difference to the speed or smoothness of movement, but did significantly affect level of muscle activity because of the biomechanical demands of each location. Over the two month period, there were no significant improvements in the nonaffected arms, as would be expected. In the affected arms, amplitude of peak velocity and sense of limb position significantly improved. Improved amplitude of peak velocity was related more to a decrease in the discontinuity of movement (r=-.49, p<.02), a sign of increased maturity of reach, than to electrical activity of the prime movers (anterior deltoid: r=.l9; biceps: r =.37, p<.05). Since the goals of therapy to restore functional movement are to reverse deficient aspects of movement, the findings suggest that strengthening and relearning of motor programs would be appropriate therapeutic goals for these patients. The effectiveness of therapy to actually reverse these deficits must, of course, be established in future studies. / 2031-01-01

Early deterioration and long-term recurrence were common after stroke or transient ischemic attach (TIA), however, it is unclear whether they were correlated with active embolization and the consequent new cerebral infarct in acute phase. By employing TCD and diffusion weighted imaging (DWI), we studied the significance of the progression of MES and infarcts during acute phase on the clinical outcomes. We found that the disappearance of MES was correlated with better improvement on day 7 of recruitment; for the long-term outcome, occurrence of exacerbating infarct tended to predict recurrent stroke. Treatment aiming to reduce MES and prevent infarct exacerbation in acute phase may improve the prognosis after stroke. / Finally, one study was performed to assess the changes of hemodynamic parameters after stenting of severe stenosis in the MCA. We aimed to investigate whether TCD can reflect the lumen changes after revascularization and detect hyperperfusion. The findings showed that the velocity of stented MCA in most patients normalized within 24 hours after procedure, but the role of TCD in detecting restenosis in long run needed to be verified; no one suffered from hyperperfusion during the period of our study. The long-term outcomes of patients with normalized velocity versus those with persistently high velocity needed to be further studied. Apart from the velocity changes, changes of the collateral flow after intervention may also be an important part of hemodynamic changes. (Abstract shortened by UMI.) / It was suggested that anti-platelet therapy can reduce the MES, but little was known about the efficacy of low molecular weight heparin (LMWH) although in theory LMWH can reduce the red fibrin-dependent thromboemboli. As a sub-analysis of Fraxiparine in Ischemic Stroke (FISS)-tris study, our study did not show advantages of LMWH in eliminating MES compared with aspirin. / Previous studies showed the accuracy of TCD in diagnosis of middle cerebral artery (MCA) stenosis was variable and the positive predictive value (PPV) was less than 50% in a recent report. One of the important reasons was that most criteria were based on the velocity-only method, ignoring other non-velocity information. Thus, we tried to establish new diagnostic criteria by means of designing an assessment form which integrated more characteristics apart from the velocity acceleration. A composite score for each MCA was calculated according to following parameters in the form: Velocity Scale (score 0-6 for peak systolic velocities&lt;140 to &ge;300cm/s), Hemodynamic Scale (score 0-5 for focal or diffuse velocity increase; score 0-6 for differences between bilateral MCA; score 17 for damping velocity), Spectrum Scale (score 0-2 for normal spectrum, turbulence and musical murmurs). Our results showed that compared with the previously reported criteria, the score calculated from the assessment form yielded much more balanced accuracy against magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). However, the composition of the assessment form was only based on personal experience and need to be further modified. Multicenter studies with large sample size are also needed to confirm the advantages of this new method. / Second, we performed three studies to investigate the relationship between the progression of MES and the short or long-term outcome and the relationship between MES and different treatments. / Hao, Qing. / Adviser: Ka Sing Wong. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3419. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 155-181). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Background: Recent studies showed that the safety and benefit of early intravenous (IV) thrombolysis on favourable outcomes in acute ischemic stroke are also seen in the elderly. Furthermore, it has shown that age increases times for pre- and in-hospital procedures. We aimed to assess the applicability of these findings to telestroke. Methods: We retrospectively analysed 542 of 1659 screened consecutive stroke patients treated with IV thrombolysis in our telestroke network in East-Saxony, Germany from 2007 to 2012. Outcome data were symptomatic intracranial hemorrhage (sICH) by ECASS-2-criteria, survival at discharge and favourable outcome, defined as a modified Rankin scale (mRS) of 0–2 at discharge. Results: Thirty-three percent of patients were older than 80 years (elderly). Being elderly was associated with higher risk of sICH (p¼0.003), less favourable outcomes (p¼0.02) and higher mortality (p¼0.01). Using logistic regression analysis, earlier onsetto-treatment time was associated with favourable outcomes in not elderly patients (adjusted odds ratio (OR) 1.18; 95% CI 1.03–1.34; p¼0.01), and tended to be associated with favourable outcomes (adjusted OR 1.13; 95% CI 0.92–1.38; p¼0.25) and less sICH (adjusted OR 0.88; 95% CI 0.76–1.03; p¼0.11) in elderly patients. Age caused no significant differences in onset-to-doortime (p¼0.25), door-to-treatment-time (p¼0.06) or onset-to-treatment-time (p¼0.29). Conclusion: Treatment time seems to be critical for favourable outcome after acute ischemic stroke in the elderly. Age is not associated with longer delivery times for thrombolysis in telestroke.

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network. Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality. Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05). Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.

Hung, Sze Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 186-192). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.