The purpose of this study was to determine if the perceived level of ability (self-efficacy) differed from actual performance ability for individuals with cerebral vascular accidents (CVA's). Patients were assessed for perception and actual ability level on Activities of Daily Living (ADL's) and Balance skills at admission and at discharge from an inpatient CVA rehabilitation program. Thirty patients with unilateral brain lesions (15 right and 15 left) constituted the study group. ANOVA and repeated measures were used in this quasi-experimental, quantitative study to examine data. All three research hypotheses were tested at an alpha level of .05 for significance. The first and third research hypotheses were supported: CVA patients' self-efficacy scores on ADL's and Balance Skills were significantly different from actual performance scores at time of admission to a CVA rehabilitation program; and the self-efficacy scores were significantly closer to actual performance scores for ADL skills at discharge. The improved accuracy in perception of Balance Skills was not supported by comparison of scores between admission and discharge measurements. The second hypothesis that right hemisphere CVA lesion patients self-efficacy and actual performance scores would be significantly different compared to the scores of patients with left hemisphere CVA lesions was not supported. A ttest for paired samples was also performed on the ADL scores data to investigate three-way significance for the third hypothesis. The patients studied successfully completed the prescribed therapeutic activities in a CVA rehabilitation program and were able to predict with significantly improved accuracy, performance ability on ADL skills at discharge. / School of Nursing

The purpose of this study was to assess the effect of BWSTT on paretic limb function using the outcome measures of overground walking velocity, paretic leg propulsion, and the mechanical work produced by the hip, knee, and ankle of the paretic limb. Thirteen participants with chronic stroke, ranging in age from 40 to 80 years, completed 24 sessions of BWSTT over eight weeks. Overground walking velocity and bilateral kinematics and kinetics were collected prior to and following completion of the BWSTT intervention. All participants exhibited statistically significant increases in overground walking velocity post BWSTT. Neither the propulsive impulse of the paretic limb, relative to total propulsive impulse, nor the relative contribution of the paretic hip, knee, and ankle to total positive work significantly changed post BWSTT. The results suggest that paretic limb function remains unchanged following BWSTT, despite improvements in overground walking velocity. / School of Physical Education, Sport, and Exercise Science

Belief constructs appear to govern many aspects of life and may have an influence on coping with severe disability. This study investigated the extent to which coping with a stroke is identified by the belief constructs of just world, locus of control, attribution, and reformulated learned helplessness. The data were collected at a comprehensive rehabilitation center from thirty consenting stroke victims. The sample included 17 women and 12 men with a mean age of 64. The median number of days from the stroke to rehabilitation was 16. Twenty subjects had left hemiparesis and ten subjects had right hemiparesis.In addition to the belief-construct predictor variables, nature-of-stroke and demographic variables were collected during an initial evaluation. Demographic variables included sex, age, marital status, occupation, education, and recreation. Nature-of-stroke variables included period of time since stroke, diagnosis, severity, location, and aphasia as measured by the 'Aphasia Language Performance Scales' (Keenan & Brassell, 1975). The belief constructs were measured by the 'Just World Scale' (Rubin & Peplau, 1975), the 'Internal-External Locus of Control Scale" (Collins, 1974), and an adapted version of the 'Attribution Style Questionnaire' (Seligman, 1984). A coping measure was introduced as the criterion variable. It was administered 21 days following the initial evaluation and is based upon the ratings of the stroke victims' therapists. It includes a scale to more clearly define coping.The results of the study did not produce a clear definition of coping, although cognitive, emotional, and physical factors were evident. In addition, there was preliminary evidence of reliability and validity for measures of this construct. The linear composite of five variables was statistically significant (p < .01) and identified 56% of the variance in the coping measure. The significance of these variables suggests that successful coping is associated with older subjects who had passive premorbid recreation, were admitted relatively soon after their stroke, were rated as having a mild stroke, and made stable attributions about rehabilitation. The fact that one of the belief-construct variables (stability of attribution about rehabilitation) was significant, despite the small sample size, is encouraging and justifies further research in this area.

Stroke is a medical event that has serious consequences for the survivor, his family, and society. Stroke is the third leading cause of death in the United States, and two-thirds of stroke survivors are permanently disabled with one-half of these survivors considered severely impaired. The economic burden from stroke is estimated to be $30 billion annually in health care costs and lost productivity.This study described the needs of 35 caregivers of stroke survivors within 24 hours of discharge to home from an acute care "safety net" teaching hospital in Indiana and how well those needs were met. Two subscales, (a) the Need for Information and (b) Patient Care Needs, of the Home Caregiver Need Survey were used. The theoretical framework for this study was the Neuman Systems Model.The stroke survivors were over 50 years old (77.1 %), half were African-American and half were Caucasian, and about a quarter were minimally impaired (25.8%) and less than a quarter were very impaired (22.9%) cognitively and/or physically upon discharge to home. Their caregivers were their children (48.6%) or spouses (28.6%), half of whom worked full-time outside the home. Most (85.7%) caregivers were female, in good health, and with no experience (81.8%) in caring for patients at home. / School of Nursing

Ischaemic stroke is a complex disorder with many different aetiologies, but previous studies of stroke often did not differentiate aetiological subtypes of ischaemic stroke. However, different stroke subtypes may have different risk factors, and to target preventive treatments more effectively, we need to understand these associations. I studied the association of established vascular risk factors with different aetiological stroke subtypes in population-based cohorts of stroke patients. I studied Diffusion Weighted Magnetic Resonance Imaging (DWI) in patients with subacute minor stroke and TIA to determine whether DWI may be a useful addition to the management of such patients, and whether it may be a useful tool in future epidemiological studies of stroke. To determine whether carotid anatomy may be a risk factor for large vessel atheroma I studied angiographical data from the European Carotid Surgery Trial. My main findings are that the prevalence of risk factors differs between stroke subtypes. It also differs between hospitalised and non-hospitalised patients, highlighting that risk factor studies should be performed in population-based cohorts. Analysis of family history data suggests that future genetic studies may best be targeted at non-cardioembolic stroke and at younger patients, and that genetic studies of hypertension may help to unravel some of the genetic factors contributing to stroke risk. DWI is sensitive in subacute minor stroke, and inter- and intra-observer reproducibility are high. DWI frequently adds useful information and may influence patient management. More widespread use of DWI in patients with subacute stroke and TIA should be considered, and DWI may also be a useful tool in future epidemiological studies of stroke. Carotid anatomy varies considerably between individuals, is very asymmetrical within individuals, and it differs between men and women. These findings may partly explain differences in plaque development between individuals, asymmetrical plaque formation within individuals, and sex differences in the distribution of carotid plaque and in the prevalence of carotid atheroma in the general population. Carotid anatomy may be a risk factor for local plaque development. Although not amenable to treatment, knowing which anatomical configuration is associated with atheroma formation could help to identify high-risk individuals in whom other risk factors should be treated aggressively.

<strong>Aims:</strong> The purpose of the research presented in this thesis is to elucidate the mechanism of the stimulation of oxidative metabolism and contractile function that occurs in vascular smooth muscle during cerebral vasospasm (CV) after subarachnoid haemorrhage (SAH). The biochemical mechanisms leading to CV were investigated using an in vitro model of CV developed for this research. CSF (cerebrospinal fluid) from SAH patients at risk of vasospasm which stimulated oxygen consumption (CSF S ) was used to model vasospasm. The hypothesis is CSF_S contains a substance which stimulates tension generation over that of CSF_N ,(non-stimulatory cerebrospinal fluid) and also inhibits the myosin light chain phosphatase. <strong>Methods:</strong> The porcine carotid artery was used as a model for the human basilar artery. The rate of oxygen consumption (JO₂) was measured in response to CSF_S and tension generation was also examined. Various agents were used to treat or pretreat the tissue such as magnesium and andalpha;₁-adrenergic receptor agonists. Their effects on the CSF_S-induced stimulation were measured to study the mechanism of vasospasm. A myosin light chain phosphatase (MLCP) assay was developed to study the mechanisms leading to CV. <strong>Results and conclusion:</strong> Addition of CSF_S to the porcine carotid artery is a reliable and reproducible in vitro model of CV. Using this model, it was found that Mg⁺⁺ loading and andalpha;₁-adrenergic receptor agonists attenuated the vasospasm, but a non-specific endothelin antagonist had no effect. Acute addition of 12mM Mg⁺⁺ relaxed the tissue from a CSF_S induced contraction significantly and rendered the contraction rinsible. Okadaic acid (InM), a phosphatase inhibitor, had very similar effects to CSF_S because it stimulated JO₂ and slowed relaxation after a stretch. There was also significant inhibition of phosphatase caused by the CSF_S. Vasospasm appears to be caused by a combination of a contractile stimulus, and inhibition of MLCP activity.

The aim of this study was to examine and compare the contribution of central neuromuscular fatigue and peripheral neuromuscular fatigue to total neuromuscular fatigue in the hemiplegic leg of people with stroke, with that of a matched control group.Study Design: This experimental study utilised a repeated measures block design.Participants: Fifteen people with chronic stroke who had mild to moderate physical disability and fifteen age, height and weight matched controls were compared.Main outcome measures: Participants physical function was evaluated using the 30s Chair Stand Test, Comfortable Paced Walking Speed and Fast Paced Walking Speed. Neuromuscular function was measured using maximal voluntary isometric contraction force and voluntary activation. Total neuromuscular fatigue, central neuromuscular fatigue and peripheral neuromuscular fatigue was measured during a 90 second sustained maximal voluntary isometric contraction of the quadriceps muscle.Results: The fatigue profile of stroke participants differed from that of control participants. Stroke participants demonstrated less total neuromuscular fatigue (U=41.00, p=.026) and less peripheral neuromuscular fatigue (U=14.00, p=.000) than the control participants. While stroke participants did demonstrate greater central neuromuscular fatigue than control participants, this finding was not statistically significant (U=80.00, p=.817).Conclusions: Statistically significant differences were found in the performance of people with mild to moderate physical disability following stroke on measures of neuromuscular fatigue when compared to age, weight and height matched healthy adults.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Dissertation (Ph.D.) -- Worcester Polytechnic Institute. / Keywords: rat brain; osmotic shock; blood brain barrier; manganese-enhanced MRI. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.