Stroke is a preventable disease. Minor stroke and transient ischaemic attack (TIA) are important warning signs of the possibility of a major stroke. Worldwide, stroke is the third most common killer and the largest cause of disability. The incidence of stroke is predicted to increase with the predominance of unhealthy lifestyles and the aging population. The adoption of a healthy lifestyle can reduce many of the risk factors. This descriptive study was designed to explore patients’ understanding of modifiable risk factors of cerebrovascular disease. It investigated lifestyle changes actually made, as well as the factors affecting patients’ decisions about whether to make lifestyle changes. The two major factors considered were patients’ sources and level of knowledge and their attitudes and beliefs around making changes. A convenience sample of patients who had suffered a minor stroke or TIA was recruited through a major metropolitan hospital. Thirty-five subjects responded to a postal questionnaire. The mean age was 68 years and 37% of the subjects had sustained some disability as a result of the TIA or minor stroke. The results demonstrated that many subjects had a poor understanding of risk factors of stroke. While smoking was well recognised as a risk factor, subjects showed less awareness of other risk factors, such as excessive alcohol consumption and obesity. Subjects also reported significant confusion regarding diet. Sixty-six percent of subjects depended on doctors as their main source of health information. This may be problematic as the current shortages of General Practitioners has put pressure on doctors to keep appointment times short and reduce the time available for health education. The main barriers to lifestyle change, were lack of motivation, and inadequate, knowledge, guidance, and support and the inability to access good information. Although 83% of subjects suffered from hypertension, medication was the accepted method of control, few subjects realised the significance of lifestyle factors. Nine percent of subjects were only diagnosed with hypertension after their stroke or TIA and few monitor their own blood pressure, despite the wide availability of home monitoring devices. From the findings of this study it is concluded that health promotion and education are very important strategies in the prevention of stroke and it is recommended that this kind of education begins in childhood with tailored, age-specific programs delivered to the public over the lifespan. The role of health screening cannot be underestimated in the detection of risk factors such as hypertension and obesity. Early detection makes effective treatment possible and helps prevent the occurrence of strokes, thus reducing the cost to the community. Long-term health strategies such as improving health resource distribution and enhancing health education are needed where patients and their families participate together in comprehensive education programs. It is hoped that this may lead to a shared understanding, which may translate to patients being more supported, and therefore more able, to make the necessary lifestyle changes. Dysphagia is a common complication following stroke, which can result in significant morbidity and mortality. Multidisciplinary collaboration facilitates management strategies, decision-making and the efficiency of rehabilitation. Nurses are responsible for coordination of management and in particular for continuous monitoring, assessment of swallowing and nutritional state, maintaining safety and preventing complications. An understanding of the issues and strategies relating to management may provide valuable information to enhance the safety, cost-effectiveness and quality of care. A retrospective review of patients’ medical records was used to collect data. A sample of ninety-five adults who were admitted to an Australian public hospital between January 2003 and April 2006, with a diagnosis of dysphagic stroke were recruited. Statistical Package for Social Sciences (SPSS) was used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. All subjects were assessed by a speech pathologist, the mean age was 75 years and 50.5% were male. Except for critically ill subjects, almost all were assessed within three days. Ninety-six percent of subjects had communication problems and 81% had upper limb motor impairment. During hospitalisation almost 60% of subjects had an improvement in their oral intake including 8% resuming their premorbid diet. Eighteen percent were on enteral tube feeding upon discharge, 4% deteriorated and 16% died. It appears that oral intake of most subjects was unsatisfactory. When recorded the mean body weight lost was 2.3kg. At least 22% had malnutrition or dehydration. Forty-five percent aspirated and 22% had respiratory infection. Almost half of the subjects (48%) were discharged to aged care facilities. Eighty percent had no documented follow-up scheduled for management of their dysphagia. Early identification of dysphagia, prudent supervising of appropriate oral intake and mouth care may help to maintain safe swallowing, preventing aspiration and chest infection. Regular checks of body weight, serum albumin level, oral intake and early enteral feeding are essential to guide nutritional support, minimise malnutrition and problematic medication administration. Encouraging oral intake and providing families with support could promote recovery of swallowing skills and help patients to regain the ability to eat independently. Providing helpful information on the care options available may allay patient and family anxiety. A qualified nurse practitioner could assess patients and ensure that a tailored care plan was designed to meet patients’ needs and this may improve the outcomes considerably. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320650 / Thesis (D.Nurs.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Thesis (MHSc--Health Science) -- AUT University, 2009. / Includes bibliographical references. Also held in print (xi, 121 leaves : ill. ; 30 cm.) in the Archive at the City Campus (T 362.19681 MOL)

Thesis (M.N.)--Memorial University of Newfoundland, 2003. / Typescript. Bibliography: leaves 64-71. Also available online.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs’ assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel ®. Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants’ suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants’ health status and ultimate quality of life. / South Africa

This research project focuses on age as a predictor in the emotional adjustment of a spouse following his/her partner's stroke. The medical records of 80 stroke cases were reviewed at Kaiser Permanente Medical Center, Fontana, California. Patients and spouses were examined in two age groupings, age 55 and below, and ages 56 and above. Study of these two age groups afforded the most meaningful division to study spouse adjustment.

Indiana University-Purdue University Indianapolis (IUPUI)

Upper limb (UL) impairments are common after stroke and can lead to loss of independence and long-term disability. Motor learning interventions for individuals with stroke can improve UL function and engagement in daily activities. Self-controlled practice (SCP) involves allowing choice during motor skill practice and has been shown to improve motor learning in healthy adults as well as individuals with Parkinson's disease. Additionally, SCP may impact psychological outcomes, including intrinsic motivation, self-efficacy, and positive affect. Although SCP has been incorporated into complex stroke rehabilitation interventions, little is known about its specific impact on motor learning for individuals with stroke. The purpose of this study is to investigate the effect of SCP on motor learning and psychological outcomes for adults with chronic UL impairment after stroke. Sixteen participants with chronic UL impairment due to stroke were paired and randomized into two groups. All participants practiced a standardized motor task with both their more affected and less affected hands for two consecutive days. During each day of practice, participants completed 50 30-second trials (10 blocks of 5 trials each) with their more affected hand and 20 30-second trials (10 blocks of 2 trials each) with their less affected hand. The experimental group was given control over their practice schedule and chose the order they practiced blocks of trials. Participants in the control group followed a pre-determined practice schedule based on the choices made by the participant they were paired with in the experimental group. Outcome measures were assessed on Day 1 before practice (Pre-Test), Day 2 after practice (Post-Test), and Day 3 (Follow-up). Motor learning outcomes included 24-hour retention of the trained motor task and immediate (10-minute) and delayed (24-hour) transfer of learning to an untrained motor task. Psychological outcomes including intrinsic motivation, self-efficacy, and positive affect were also assessed. Both groups demonstrated significant improvements from baseline on both the trained task and the untrained task at the Day 3 follow-up assessment. There were no significant between-group differences on any motor learning or psychological outcome measures. However, there was a significant association between perceived choice that was assessed on Day 2 following practice and amount of change on the untrained transfer task at Day 3. This suggests that perception of choice may be a relevant factor for motor learning after stroke. However, more research with larger sample sizes is needed to further investigate this finding.

Thesis (MSportSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: There are a growing number of men and women world-wide who are suffering strokes due to poor lifestyle-related habits. While there is evidence of the differences in cerebral haemodynamics between stroke patients and both elderly and young healthy individuals, limited evidence has examined the effect of rehabilitation on cerebral haemodynamics. Furthermore, most studies have examined changes in cerebral haemodynamics during cognitive and functional tasks in isolation, with no literature published on them simultaneously. The primary aim of this study was to examine whether differences in cerebral haemodynamics exist between stroke patients and healthy elderly individuals while performing a simple and complex cognitive task. Thirty two men and women (age 75 ± 8 years) volunteered to participate in the study and were split into an experimental (n = 14) group consisting of stroke patients and a control (n = 18) group consisting of healthy individuals. Each participant was required to attend one testing session where measurements of oxyhaemoglobin (O2Hb), deoxy-haemoglobin (HHb), tissue oxygenation index (TOI) and total haemoglobin index (THI) were obtained. Measurements were obtained with the participants at rest, while performing the Mini Mental State Exam (MMSE) and the modified Stroop Task as cognitive tests, and the Timed Up-and-Go (TuG) and six minute walk test (6MWT) or Toe Taps (TT) as the functional tests. Furthermore, the outcome scores of the various tests were also recorded. Change in O2Hb levels were lower in the experimental group than in the control group, especially in the left prefrontal cortex (LPFC) while HHb values were higher in the right prefrontal cortex (RPFC) (p > 0.05). There were almost no differences in TOI between the two groups in either the LPFC or RPFC, however, statistically significant differences were seen in THI in the RPFC during the MMSE (p = 0.03), rest period 2 (p = 0.03), the first modified Stroop Task (p = 0.04), as well as the TuG (p = 0.02). Furthermore, significant differences were seen between the two groups with respect to the time taken to complete the TuG, with the experimental group completing it much faster (p = 0.04). The experimental group participants who had received regular rehabilitation performed consistently better across most of the testing phases, with a number of practically significant findings. The results show that definite differences exist between stroke patients and healthy elderly individuals when performing a simple and complex task. The positive effect of low intensity exercise on task performance was clearly seen in both groups, and holds a great deal of practical significance for the development of exercise programmes for healthy individuals, as well as stroke patients. Furthermore, rehabilitation following a stroke has obvious benefits as shown by the positive results of the current study, however, limited research exists to validate these findings, highlighting the need for further research in this area. / AFRIKAANSE OPSOMMING: Daar is ʼn wêreld wye toename in die aantal mans en dames wat beroertes ondervind as gevolg van swak lewenstyl-verwante gewoontes. Alhoewel baie navorsing beskikbaar is oor die verskille in serebrale hemodinamika tussen beroerte pasiënte en bejaardes, asook jong gesonde individue, is daar ʼn beperkte aantal studies oor die effek van rehabilitasie op serebrale hemodinamika. Meeste van hierdie studies het die veranderinge in serebrale hemodinamika tydens kognitiewe of funksionele take in isolasie ondersoek, met geen literatuur waar die effek van albei gesamentlik gemeet word nie. Die hoofdoel van hierdie studie was om die verskille in serebrale hemodinamika tussen beroerte pasiënte en gesonde bejaardes, tydens die uitvoering van ʼn eenvoudige en komplekse kognitiewe taak, te ondersoek. Twee-en-dertig mans en vroue (ouderdom 75 ± 8 jaar) het aan die studie deelgeneem. Die eksperimentele groep (n = 14) het bestaan uit die beroerte pasïente en die kontrole groep (n = 18) was gesonde bejaardes. Elke deelnemer het een toets sessie bygewoon waartydens oksihemoglobien (O2Hb), deoksihemoglobien (HHb), weefsel oksigenasie indeks (TOI) en totale hemoglobien indeks (THI) gemeet is. Metings is tydens rus geneem, asook tydens die kognitiewe toetse, die “Mini Mental State Exam” (MMSE) en die gewysigde Stroop taak gemeet, en die funksionele toetse, naamlik die “Timed Up-and-Go” (TuG) en die ses minute loop toets (6MWT) of “Toe Taps” (TT). Die eksperimentele groep se O2Hb was laer as die kontrole groep, veral in die linker voor frontale korteks (LPFC), en die eksperimentele groep se HHb waardes was hoër in die regter voor frontale korteks (RPFC) (p > 0.05). Daar was geen statisties betekenisvolle verskille in TOI tussen die twee groepe nie, maar wel in die THI in die RPFC tydens die MMSE (p = 0.03), rusperiode twee (p = 0.03), die eerste gewysigde Stroop Taak (p = 0.04) en die TuG toets (p = 0.02). Die kontrole groep was statisties betekenisvol vinniger as die eksperimentele groep in die TuG toets (p = 0.04). Deelnemers in die eksperimentele groep wat gereelde rehabilitasie ontvang het, het konsekwent beter gevaar tydens die toets sessie, en ʼn aantal prakties betekenisvolle verskille is in sekere veranderlikes gevind. Die resultate dui aan dat daar wel ʼn verskil in serebrale hemodinamika bestaan tussen beroerte pasiënte en gesonde bejaardes terwyl hulle eenvoudige en komplekse take verrig. Die positiewe effek van lae intensiteit oefening op prestasie was duidelike sigbaar van beide groepe. Hierdie resultate is prakties betekenisvol as dit kom by die ontwikkeling van oefenprogramme vir gesonde individue asook beroerte pasiënte. Rehabilitasie na ʼn beroerte hou ooglopende voordele in soos aangedui deur die positiewe bevindinge van die huidige studie, hoewel daar beperkte navorsing beskikbaar is om hierdie bevindinge te staaf. Daar is dus ʼn behoefte vir verdere navorsing in hierdie gebied.

While dyspraxia has been studied from the neuro-anatomical aspects, few studies have explored the experience of adults with dyspraxia in the course of their everyday activities. This study reveals the unique and complex experiences of five adults as they struggle to live with dyspraxia.The research is underpinned by the phenomenological perspective. Participants were filmed performing everyday activities of their choice and were interviewed on their experiences of dyspraxia with everyday activities.The stories and videos reveal the struggle participants have with their unknowing and unwilling bodies, puzzled thinking, unfamiliar surroundings, and unhandy tools. Despite the enormity of their struggles, participants persevere, using individual strategies to overcome obstacles. The findings show that the lived-experience of dyspraxia tends to remain hidden from the person, as well as the clinician. Much of what is taken for granted during everyday activities is shattered in the lives of people with dyspraxia. The automatic, smooth, unconscious way activities are done, tools are handled and the world is experienced is altered. The path to recovery remains unclear as dyspraxia makes itself known one day and not the next. Sheer determination and a hope for the future helps participants carry on with trying to reclaim the person they lost as a result of the dyspraxia.The importance for understanding, by clinicians of the impact of dyspraxia on people's everyday lives cannot be underestimated. Implications for practice are discussed, as these relate to formal definitions of dyspraxia, client-centred practice, as well as diagnosis, assessment, intervention, and education.

Stroke outcome is highly variable. Experiments in this thesis test the hypothesis that experience prior to a stroke is an important variable in the manifestation of stroke. Optokinetic tracking was used to evaluate the effects of visual cortex stroke and MCA occlusion in rats. Normal laboratory rats showed a small, but significant decrease in tracking thresholds following visual cortex stroke. Animals with developmental visuomotor experience or reach training experience in adulthood, however, had tracking thresholds which were substantially increased, and the effects of visual cortex strokes were greater. MCA occlusions did not affect tracking behaviour. These data indicate that specific experiences engage neural plasticity that can alter brain function. These changes can, in turn, affect the behavioural manifestation of a stroke. Understanding the effect that environmental experience has on stroke outcome promises to enable better characterization of strokes, and set appropriate behavioural baselines for the measurement of recovery of function. / vi, 135 p. : ill. ; 29 cm