Philosophiae Doctor - PhD / Background: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Individuals diagnosed with stroke particularly in rural communities have a poor return to work rate. Vocational rehabilitation has been used as an intervention strategy with various types of clients with disability or injury in order to improve their work skills. The aim of the proposed study is to describe the experiences and perceptions of individuals diagnosed with stroke about the usefulness of the Model of Occupational Self Efficacy in assisting them in returning to their worker role particularly in a rural setting. Eight participants were purposively selected from the data base of a local hospital and semi structured interviews were conducted with the participants until saturation occurred. Furthermore, two focus groups were conducted with eight participants. A key informant was also interviewed to assist the researcher with a different perspective and to avoid bias. The data was analysed by means of thematic analysis into codes, categories and themes. Trustworthiness was ensured by means of credibility, applicability, transferability and conformability. Informed consent and confidentiality was ensured. Permission was obtained from the UWC research committee and from the Department of Health. Four themes were merged from the findings: Theme one: Obstacles which affects the return to work of CVA Participants in a rural community. Theme two: Establishing a strong belief in functional ability through occupation. Theme three: Adaptation strategies that enhances the work participation of stroke survivors in a rural community. Finally Theme four: The MOOSE enables transition to the worker role in a rural context. The findings revealed that the participants experienced a loss of their former self thus affecting their worker identity as they were no longer able to experience the gratification of fulfilling their worker role. This was due to the participants not being aware of the return to work options that they had. After the stroke the participants battled with not only overcoming their condition but also the stigma which the community and their employers had of stroke. Overcoming the stroke event and returning to work required that potential barriers and facilitators be identified by the participants and the researcher. The study also identified adaptation strategies that the participants utilised in order to overcome the barriers and assist the participants to have a smoother transition into the workplace. In conclusion the findings of the study revealed that the participants suffer a loss of their former abilities and undergo a loss of their self-esteem. As a result of the loss, participants struggled to return to work not only due to their loss of abilities but also their lack of knowledge regarding return to work and stroke. The findings indicated that there should be more education regarding the stroke that needs to be conducted in communities via media such as local newspapers, local radio stations, clinics and hospitals. The findings of the study may assist Occupational Therapy practitioners to improve services in a rural community for stroke survivors and improve the facilitation of the return to work process after stroke. The MOOSE facilitates motivation for participants to regain their self-esteem and thus move forward to resume a worker role. / 2020-08-31

A total of 188 patients completed data at twelve months (attrition rate: 29% over 12 months). The path coefficients show low functional ability (beta=0.51), more depressive symptoms (beta=-0.27), low state self-esteem (beta3=0.20), female gender (beta=0.13), older age (beta=-0.11) and living in a residential care facility (beta=-0.12) have a direct effect on participation restriction, and these variables accounted for 71% of the variance in explaining participation restrictions at 12 months. Repeated measures revealed significant decreases in overall levels of participation restriction and depressive symptoms from baseline to one year. However, no significant early changes in the levels of state self-esteem and depressive symptoms (from baseline to six months) and no significant late changes in both depressive symptoms and LHS scores were found (between six months and 12 months). / A total of 210 stroke survivors completed data at six months. Functional ability, state self-esteem, and number of strokes significantly accounted for 57% of the variance in participation restriction. Lower levels of functional ability, state self-esteem and social support satisfaction were associated with an increased likelihood of having depressive symptoms (z = 5.30, 34.12, and 5.51). / Aims. To gain understanding about the social, psychological and physical outcomes following inpatient stroke rehabilitation; to determine the variables predicting the level of participation and depressive symptoms of stroke survivors at baseline, six and 12 months following discharge from a rehabilitation hospital; to test a theoretical model of predictors of participation restriction at 12 months; and to determine the level over time for each of the outcomes. / Conclusion and implications. The findings in this study indicate that identification of stroke survivors at risk of high levels of participation restriction and low self-esteem will assist health professionals to devise appropriate interventions that target improving the psychological well being amongst person with stroke. Rehabilitation services need to continue to focus on restoring functional independence but also need to diagnose and treat depressive symptoms in order to minimise the restriction to participation in society. Assisting stroke survivors in redefining their identity after stroke could be an important aspect in stroke rehabilitation. (Abstract shortened by UMI.) / Chau, Pak Chun Janita. / Adviser: Shelia Twinn. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3426. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 237-276). / 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.

<p>Stroke innebär ofta fysiska, kognitiva och beteendemässiga funktionsnedsättningar som påverkar både den drabbade och dennes familj. Tonåringar, speciellt flickor, anses ha störst risk att utveckla emotionella problem när föräldern blivit sjuk. Förälderns stöd till barnet är väsentligt men även sjukvårdspersonalens. I denna studie undersöktes hur barn uppmärksammas till strokedrabbade föräldrar samt vilket stöd som erbjuds. Fem överläkare och fem sjuksköterskor på en neurologisk rehabiliteringsklinik i Mellansverige intervjuades. Materialet analyserades induktivt genom meningskoncentrering. Det framkom att stödet som ges är situationsberoende, inget strukturerat stöd för barn finns och generellt ses anhöriga som resurser. Ett bra anhörigbemötande ska erbjudas men barnomhändertagandet borde bli bättre. Ökade kunskaper efterfrågades för att kunna stödja barn i kris. En mer familjecentrerad sjukvård behövs för att man ska kunna uppmärksamma barns behov vid förälderns sjukdom.</p>

Post-stroke hemiparesis usually leads to slow and asymmetric gait. Improving walking ability, specifically walking speed, is a common goal post-stroke. To develop effective post-stroke rehabilitation interventions, the underlying mechanisms that lead to changes in walking ability need to be fully understood. The overall goal of this research was to investigate the deficits that limit hemiparetic walking ability and understand the influence of post-stroke rehabilitation on walking ability in persons with post-stroke hemiparesis. Forward dynamics walking simulations of hemiparetic subjects (and speed-matched controls) with different levels of functional walking status were developed to investigate the relationships between individual muscle contributions to pre-swing forward propulsion, swing initiation and power generation subtasks and functional walking status. The analyses showed that muscle contributions to the walking subtasks are indeed related to functional walking status in the hemiparetic subjects. Increased contributions from the paretic leg muscles (i.e., plantarflexors and hip flexors) and reduced contributions from the non-paretic leg muscles (i.e., knee and hip extensors) to the walking subtasks were critical in obtaining higher functional walking status. Changes in individual muscle contributions to propulsion during rehabilitation were investigated by developing a large number of subject-specific forward dynamics simulations of hemiparetic subjects (with different levels of pre-training propulsion symmetry) walking pre- and post-locomotor training. Subjects with low paretic leg propulsion pre-training increased contributions to propulsion from both paretic leg (i.e., gastrocnemius) and non-paretic leg muscles (i.e., hamstrings) to improve walking speed during rehabilitation. Subjects with high paretic leg propulsion pre-training improved walking speed by increasing contributions to propulsion from the paretic leg ankle plantarflexors (i.e., soleus and gastrocnemius). This study revealed two primary strategies that hemiparetic subjects use to increase walking speed during rehabilitation. Experimental analyses were used to determine post-training biomechanical predictors of successful post-stroke rehabilitation, defined as performance over a 6-month follow-up period following rehabilitation. The strongest predictor of success was step length symmetry. Other potential predictors of success were identified including increased paretic leg hip flexor output in late paretic leg single-limb stance, increased paretic leg knee extensor output from mid to late paretic leg stance and increased paretic leg propulsion during pre-swing. / text

Stroke innebär ofta fysiska, kognitiva och beteendemässiga funktionsnedsättningar som påverkar både den drabbade och dennes familj. Tonåringar, speciellt flickor, anses ha störst risk att utveckla emotionella problem när föräldern blivit sjuk. Förälderns stöd till barnet är väsentligt men även sjukvårdspersonalens. I denna studie undersöktes hur barn uppmärksammas till strokedrabbade föräldrar samt vilket stöd som erbjuds. Fem överläkare och fem sjuksköterskor på en neurologisk rehabiliteringsklinik i Mellansverige intervjuades. Materialet analyserades induktivt genom meningskoncentrering. Det framkom att stödet som ges är situationsberoende, inget strukturerat stöd för barn finns och generellt ses anhöriga som resurser. Ett bra anhörigbemötande ska erbjudas men barnomhändertagandet borde bli bättre. Ökade kunskaper efterfrågades för att kunna stödja barn i kris. En mer familjecentrerad sjukvård behövs för att man ska kunna uppmärksamma barns behov vid förälderns sjukdom.

Serious gaps between best and actual stroke rehabilitation practices continue to exist, even with the plethora of evidence and guidelines for stroke best practice management. To address this knowledge gap with an effective knowledge translation (KT) intervention, six steps of the Knowledge to Action (KTA) Model were applied to these specific research objectives: 1) to conduct a systematic review to examine evidence on the effectiveness of single/multi-component KT interventions for improving knowledge, attitudes, and rehabilitation practice behaviors of occupational therapists (OTs) and physical therapists (PTs), in order to inform the design of a KT intervention; 2) to conduct usability testing to explore factors that facilitate or hinder OTs' and PTs' use of an evidence-based, stroke rehabilitation-specific e-learning resource (Stroke Engine; www.strokengine.ca), as a preliminary step in its potential use as a KT intervention; and, 3) to conduct a KT intervention study to determine the extent of knowledge acquired regarding stroke rehabilitation best practices by OTs and PTs while using Stroke Engine as an e-learning KT intervention for three months. A sub-objective was to identify the association between knowledge acquired and factors related to the clinician, their work environment, and adherence to the KT intervention. Main findings from this research agenda suggested that use of active, multi-component KT interventions resulted in some knowledge gains among physical therapists, but additional research was needed to understand impact of these strategies on occupational therapists. During Stroke Engine testing, factors hindering its use were identified and the website was modified to maximize its usability as an e-learning KT intervention. Clinicians were satisfied with Stroke Engine as it provided them with the latest stroke evidence in a quick, user-friendly format. Finally, significant improvements in clinicians' proportion of 'evidence-based' responses on the Stroke Rehabilitation Knowledge Questionnaire were observed between baseline and following Stroke Engine use as a KT intervention. Intensity of Stroke Engine use was the most significant predictor for clinicians' improved 'evidence-based' knowledge on the Questionnaire. It was concluded that Stroke Engine has promise as an effective e-learning KT intervention for enhancing rehabilitation clinicians' knowledge of stroke best practices.

Serious gaps between best and actual stroke rehabilitation practices continue to exist, even with the plethora of evidence and guidelines for stroke best practice management. To address this knowledge gap with an effective knowledge translation (KT) intervention, six steps of the Knowledge to Action (KTA) Model were applied to these specific research objectives: 1) to conduct a systematic review to examine evidence on the effectiveness of single/multi-component KT interventions for improving knowledge, attitudes, and rehabilitation practice behaviors of occupational therapists (OTs) and physical therapists (PTs), in order to inform the design of a KT intervention; 2) to conduct usability testing to explore factors that facilitate or hinder OTs' and PTs' use of an evidence-based, stroke rehabilitation-specific e-learning resource (Stroke Engine; www.strokengine.ca), as a preliminary step in its potential use as a KT intervention; and, 3) to conduct a KT intervention study to determine the extent of knowledge acquired regarding stroke rehabilitation best practices by OTs and PTs while using Stroke Engine as an e-learning KT intervention for three months. A sub-objective was to identify the association between knowledge acquired and factors related to the clinician, their work environment, and adherence to the KT intervention. Main findings from this research agenda suggested that use of active, multi-component KT interventions resulted in some knowledge gains among physical therapists, but additional research was needed to understand impact of these strategies on occupational therapists. During Stroke Engine testing, factors hindering its use were identified and the website was modified to maximize its usability as an e-learning KT intervention. Clinicians were satisfied with Stroke Engine as it provided them with the latest stroke evidence in a quick, user-friendly format. Finally, significant improvements in clinicians' proportion of 'evidence-based' responses on the Stroke Rehabilitation Knowledge Questionnaire were observed between baseline and following Stroke Engine use as a KT intervention. Intensity of Stroke Engine use was the most significant predictor for clinicians' improved 'evidence-based' knowledge on the Questionnaire. It was concluded that Stroke Engine has promise as an effective e-learning KT intervention for enhancing rehabilitation clinicians' knowledge of stroke best practices.

No description available.

Upper limb deficits post stroke affect up to 60% of stroke survivors. The assessment of motor deficits post stroke is important for identifying rehabilitation goals and assessing treatment efficacy. Current clinical tools used to assess motor impairment utilize clinical observation to describe the performance of diagnostic motor tasks. However there are some concerns regarding the ability of these scales to fully describe the quality of performance, and detect small but important changes which reflect motor recovery. Kinematic analysis has been increasingly suggested to augment clinical assessment; however, current kinematic tools are not well suited to the time and financial constraints of a clinical environment. The objective of this thesis was to investigate the feasibility of utilizing low-cost, depth sensing technology (Kinect sensor) to augment the current upper limb stroke assessment. Study one characterizes the accuracy of the Kinect sensor, and defines optimal markers and conditions for data collection. Results revealed sufficient ability to quantify metrics for the hand, and the trunk. Study two explored the feasibility of clinical use for the Kinect sensor, specifically its ability to distinguish kinematic performance between the affected and less-affected limbs within an individual, and differences in the affected limb between individuals. Results from study 2 indicated that the Kinect is able to identify interlimb differences and correlations with upper limb impairment scores for some kinematic metrics. Findings from this thesis suggest a potential use for the Kinect in a clinical environment for the purposes of upper limb stroke assessment; however, there are many factors and limitations which need to be considered prior to its use.