Bakgrund: Stroke är en av de vanligaste folksjukdomarna som kan drabba unga och äldre och är en av de vanligaste dödsorsakerna i Sverige. Varje år insjuknar ca 30 000 svenskar i stroke varav ungefär 8 000 avlider. Att drabbas av stroke innebär också ofta rollförändringar när det gäller roller i hemmet, på arbetet också vidare. Detta i sin tur ställer höga krav på samhället och närstående. Vård av personer med stroke har stor tonvikt på omvårdnad, som ska grunda sig på vetenskap och beprövad erfarenhet, samt finna omvårdnadsinsatser som är anpassade efter patientens behov. Syfte: Syftet med studien var att beskriva patienters upplevelser av det dagliga livet efter stroke. Metod: Litteraturöversikt är baserad på tio vetenskapliga artiklar varav nio var kvalitativa medan en hade mixad metod. Vid datainsamlingen användes databaserna CINHAL complete, Medline och Pubmed. Sökningen begränsades med Peer reviewed, abstract och full text samt en avgränsning mellan år 2004 till 2016 Resultat: Fem teman och två sub-teman identifierades: 1. Upplevelser av den förändrade kroppen, 2. Upplevelser av hinder i praktiska aktiviteter, 3. Upplevelser av förändringar i det sociala livet med två sub-teman: Social interaktion och Hinder som begränsar deltagandet i sociala aktiviteter, 4. Självuppfattning och emotionella upplevelser samt 5. Upplevelser i nära relationer.  Diskussion: Metodens styrkor och svagheter diskuteras. Resultatet diskuterades utifrån Roys adaptionsmodellens fyra adaptiva funktionsområden: fysiologiska funktioner, självuppfattning, rollfunktioner samt relationer och samhörigheter samt konsensus begreppet människa och andra studier. / Background: Stroke is one of the most common diseases that can affect both young and older people. This disease is one of the most common causes of death in Sweden.  Every year almost 30 000 of the population becomes diagnosed with stroke of which 8000 die as a result. When a person is affected by stroke, different stages in life changes such as the role the individual has or bares at home, at work, at school and many more. This disease can sometimes create a higher demand on the society, family members and even the people in your surroundings. The role of a healthcare professional in caring for people with stroke is to have emphasis on care which must be based on scientific and proven experience and have a nursing intervention that is suitable for the patient’s needs.  Aim: To describe patients’ experiences of everyday life after stroke Method: Literature review was based on ten scientific articles of which nine have qualitative design and one uses mixed method design. Data were collected through the databases CINAHL complete, Medline and Pubmed. The searching of data was limited with peer reviewed, abstract, full text and a limitation between the year of 2004 and 2016. Results: Five main themes and two sub-themes were identified: 1. Experience of changed body, 2. Experiences of barriers in practical activities, 3. Experiences of changes in the social life with two sub- themes: Social interaction and Barriers limiting participation in social activities, 4. self- concept and emotional experiences and 5. Experience in close relationships. Discussion: The methods strength and weakness were discussed. The results were discussed based on Roy adaptations model’s four adaptive modes (physiological needs, self-concept, role function and interdependence) and consensus concept of person and other studies.

Stroke är den vanligast förekommande sjukdomen i Sverige med cirka 30 000 insjuknanden per år. Ur ett svenskt och internationellt perspektiv är stroke den största orsaken till en icke medfödd funktionsnedsättning hos vuxna individer. Motorisk funktionsnedsättning efter stroke påverkar patienters förmåga att utföra aktiviteter i dagliga livet (ADL). Det inverkar på patienters upplevelse av livet och livskvalité. En begränsning av kroppskontroll medför även en förändrad relation till kroppen. År 2012 var cirka 20 procent av patienter beroende av stöd i ADL, tre månader efter insjuknandet i stroke. Studiens syfte är att beskriva upplevelser av påverkan på ADL hos strokepatienter med nedsatt motorisk funktion. Studien är en litteraturöversikt och bygger på kvalitetsgranskade kvalitativa primärkällor. Databaserna Cinahl och PubMed har använts för att identifiera vetenskapliga artiklar publicerade tidigast år 2000. Det resulterade i att nio kvalitativa artiklar med västerländskt ursprung inkluderades till studien. Fem teman framträdde ur artiklarna vilka utgör grunden för resultatet: upplevelse av att plötsligt drabbas av stroke, upplevelse av att vara isolerad, upplevelse av att vara beroende, upplevelse av otrygghet och upplevelse av förändrad identitet. Tidigare forskning bekräftar studiens resultat och beskriver insjuknandet i stroke via upplevelser av utsatthet och av att inte vara samma person. Forskningen lyfter även vikten att vara i ett betydelsefullt sammanhang. De negativa upplevelserna som patienter beskriver kan tänkas begränsas genom insatser från samhället och ett värdigt bemötande från sjuksköterskor med patienters livsvärld i fokus. / Program: Sjuksköterskeutbildning

Syfte: Att identifiera och beskriva sjuksköterskans kommunikation och bemötande av personer med kognitiv nedsättning, i form av afasi orsakad av stroke. Syftet var även att undersöka vilken betydelse datainsamlingsmetoden har för de inkluderade artiklarna.Metod: Beskrivande litteraturstudie baserad på 14 vetenskapliga artiklar som publicerats år 2000-2012 via databaserna PubMed och Cinahl. En metodologisk granskning av artiklarnas datainsamlingsmetod genomfördes. Resultat: Sjuksköterskans bemötande och kommunikation hade en påverkan på patientens upplevelse av vården. Det framkom både möjligheter och hinder som påverkade kommunikationen i mötet. Brist på kompetens, personalresurser och tid samt stress ansågs vara de faktorer som hindrade kommunikationen. Användning av verbal och icke- verbal kommunikation, bra vårdmiljö, en trygg, lugn och ödmjuk sjuksköterska förbättrade möjligheten till att kunna uppnå ett gott bemötande och en framgångsrik kommunikation. Ostrukturerade intervjuer, djupintervjuer, videoinspelningar och frågeformulär förekom i de valda vetenskapliga artiklarna.Slutsats: En fungerande relation mellan sjuksköterskan och patienten utgör en grund i omvårdnaden och förbättrar omvårdnadskvalitén. Sjuksköterskan behöver ha kompetens, självinsikt och förståelse av mänskligt beteende i mötet med patienter som har en kognitiv nedsättning orsakad av stroke. Sjuksköterskan bör ha ett genomtänkt förhållande till sina egna värderingar och förhållningssätt i mötet och kunna ha förmågan att förutse både eget och patientens beteende. Vald datainsamlingsmetod ger djupare förståelse i det valda omvårdnadsämnet. / Aim: To identify and describe how nursing staff communication and treatment of patients with cognitive impairment such as aphasia caused by stroke and to examine the significance of the included article’s data collection methods.Method: A descriptive literature review based on 14 articles which was published between 2000-2012 in the databases PubMed and Cinahl. A detailed inspection of the articles’ data collection methods was conducted.Result: The nurse communication and treatment had an impact on the patient’s experience of care. It emerged both opportunities and barriers that affected the communication. Lack of staff resources and competence as well as stress were factors that hindered communication. The use of verbal and non-verbal communication, good health environment, a secure, calm and humble nurse improved the possibility to achieve a good treatment and successful communication. Unstructured interviews, in-depth interviews, video recordings and questionnaires occurred in the selected articles.Conclusion: A functional relationship between the nurse and patients is a basis in nursing and improves its quality. Nurses need to have skills, self-awareness and understanding of the human behavior when meeting patients with cognitive impairment caused by stroke. Nurses ought to have a deliberate relation to their own values and attitudes in meetings and be able to anticipate both their own and patient’s behavior. The selected data collection methods give a deeper understanding of the chosen nursing substance.

No description available.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / Introduction Decreased hip extension in the paretic leg is a common impairment after stroke. Gluteal taping was introduced as a technique that helped in increasing hip extension of the paretic leg, and step length in the unaffected leg. The aim of this study was to further investigate the effect of gluteal taping on other temporal spatial and kinematic parameters using a 3D motion analysis system (Moven System). Methods The study was conducted in two phases. Phase 1 entailed examining the intra trial reliability of the Moven System, where eight subjects were recruited and tested twice at their normal pace of walking, and twice again at their maximum speed. Phase 2 involved studying the effect of gluteal taping on temporal spatial and kinematic parameters. Thirty subjects participated and were tested under three taping conditions (no tape, therapeutic tape, and placebo tape), while walking at their self selected walking speed. Intra-class correlation coefficient ICC determined around 95% confidence intervals was used to examine the intra trial reliability of the Moven System. Repeated measures-ANOVA was used to study the temporal spatial, and kinematic variables during the three taping conditions. Results The Moven showed moderate to excellent reliability in measuring the gait variables including temporal spatial parameters and sagittal kinematic parameters in addition to the lateral pelvic tilt. Taping caused significant increase in hip extension and reduction in knee flexion at terminal stance for the paretic leg. There was a trend toward better hip flexion at terminal stance, and a mild trend toward more planter flexion at terminal stance. Both treatment and placebo tapes caused an increase in the step lengths of either leg, and a significant increase in gait velocity and cadence. Conclusion Gluteal taping may be beneficial in producing important clinical effects post stroke, and can be used as an adjunct strategy during gait rehabilitation. Further research is needed to understand the mechanism of how taping produces effects, and to further explore its effect on kinetic and muscle activation variables.

Thesis (MPhil)--Stellenbosch University, 2009. / A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University / ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector. / AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.

According to the statistics from Department of Health, Executive Yuan, in 2007,brain attack has been listed as the third of the top ten reasons for death. In Taiwan, the occurrence rate of brain attack on population above 35-year-old is 3/1000. And the total amount of population above 35-year-old is nearly 10,000,000. Then the latest number of occurrence of brain attack is approximately 30,000¡COnce the stroke happens, under such a circumstance, not only the expense of acute care increases but also the long-term medical care expense, the family and social cost will become larger. In view of that, the long-term care plan for stroke patient has been in urgent need. This research, ¡¨Long-distance Community Health Care Nursing Service for Stroke Patients¡¨, which is originated from a plan conducted by a medical center in Southern Taiwan. Based on Andersen¡¦s¡]1968¡^health behavior model as the theoretical structure¡Awe studied 102 patients who had a stroke (including high stroke risk patients)within one year in Kaohsiung. In this study, we applied JMP V6.0¡]SAS Institute, Cary, NC, USA¡^to analyzing case characters¡Aconducting univariate analysis by £q2 analysis and ANOVA. Then we applied multivariate logistic regression analyses to significant variables. We hope to find out the predisposition, enabling factors and need factor from those important predictor variables in ¡§Long-distance Community Health Care and Nursing Service¡¨. We research the differences of stroke patients¡¦ behaviors, providing those research results as the reference materials for related business promotional strategy in future, hoping to advance the quality of long-term care and nursing for stroke patients. In this study, total 102 copies of the questionnaire were sent out and returned, with a return rate of 100%, and 100 copies of questionnaire were effective. The research results show that: 1. Predisposition¡GThere are significant differences on these items--¡§Number of Children¡¨(Demography), ¡§Buddhist¡¨(Religion) and ¡§Those who have a health check within nearly one year¡¨(Health Concept). 2.Enabling factors¡GThere are significant differences on these items--¡¨Monthly Family Income¡¨(Economical factor),¡¨Monthly Balance of Payment¡¨(Economical factor) and ¡§Commercial Insurance¡¨(Insurance resource). 3.Need factors¡GPeople (those who think their health state stay at the average level), Health State (¡§High Blood Pressure and Heart Attack¡¨,¡¨Eye Diseases¡¨, ¡¨Cancer¡¨,¡¨Bone and Muscle¡¨,¡¨Asthma¡¨,¡¨Ears Disease¡¨and ¡¨Neural Diseases¡¨are involved. The behavior research includes ¡§Number of Accepting Medical Treatment per month¡¨(1 to 2 times), ¡§Activity in Daily Life ¡¨¡]ADL¡BIADL-Shopping Ability¡^and ¡§Functional Behaviors¡¨. 4. To sum up, the predisposition, enabling and need factors in this research could partially influence using behaviors¡Ain accordance with Andersen¡¦s inference in health behavior model. In conclusion¡G1.¡¨Long-term Community Health Care and Nursing¡¨ can be applied to stroke patients, which can help patients to build up effective self-management and advance life quality; 2. This service combines Medical Service Chain established by Information-Telegraphic Technology. Currently, blood pressure checking and telephone consultation are most popular service among interviewees, and other kinds of service are under development; 3. Stroke patients with different demographical characters show a great difference on using behaviors; 4. To speak briefly, this service can meet the ideal long-term care and nursing standard for local aging population.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21669号 / 医博第4475号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 古川 壽亮, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Stroke is the largest cause of severe adult complex disability, caused when the blood supply to the brain is interrupted, either by a clot or a burst blood vessel. It is characterised by deficiencies in movement and balance, changes in sensation, impaired motor control and muscle tone, and bone deformity. Clinically applied stroke management relies heavily on the observational opinion of healthcare workers. Despite the proven validity of a few clinical outcome measures, they remain subjective and inconsistent, and suffer from a lack of standardisation. Motion capture of the upper limb has also been used in specialised laboratories to obtain accurate and objective information, and monitor progress in rehabilitation. However, it is unsuitable in environments that are accessible to stroke patients (for example at patients’ homes or stroke clubs), due to the high cost, special set-up and calibration requirements. The aim of this research project was to validate and assess the sensitivity of a relatively low cost, wearable, compact and easy-to-use monitoring system, which uses inertial sensors in order to obtain detailed analysis of the forearm during simple functional exercises, typically used in rehabilitation. Forearm linear and rotational motion were characterised for certain movements on four healthy subjects and a stroke patient using a motion capture system. This provided accuracy and sensitivity specifications for the wearable monitoring system. With basic signal pre-processing, the wearable system was found to report reliably on acceleration, angular velocity and orientation, with varying degrees of confidence. Integration drift errors in the estimation of linear velocity were unresolved. These errors were not straightforward to eliminate due to the varying position of the sensor accelerometer relative to gravity over time. The cyclic nature of rehabilitation exercises was exploited to improve the reliability of velocity estimation with model-based Kalman filtering, and least squares optimisation techniques. Both signal processing methods resulted in an encouraging reduction of the integration drift in velocity. Improved sensor information could provide a visual display of the movement, or determine kinematic quantities relevant to the exercise performance. Hence, the system could potentially be used to objectively inform patients and physiotherapists about progress, increasing patient motivation and improving consistency in assessment and reporting of outcomes.

No / Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.