Twenty-five patients with a mean age of 59.7 ± 11.8 (SD) years who were hemiparetic due to a cerebrovascular lesion of the cortex were assessed to determine the degree of neuromuscular dysfunction produced in the affected lower limb. Dysfunction was postulated to be the result of a secondary lower motoneuron lesion precipitated by the primary upper motoneuron lesion. The effects of cerebrovascular disease on skeletal muscle were assessed through an evaluation of the motor unit which involved assessment of excitable muscle mass (M-wave amplitudes), motor unit counts, peripheral nerve conduction velocities, evoked contractile properties of the dorsiflexor muscles (tibialis anterior) of the lower limb and degree of motor dysfunction expressed as a function of motor unit activation and maximum voluntary contraction (twitch interpolation method). Results showed preservation of the skeletal muscle with normal contraction times (108 ± 33 ms and 106 ± 35 ms, affected limb versus unaffected limb) and half relaxation times (119.3 ± 41 ms and 114 ± 32 ms respectively). Twitch torque was maintained and did not show significant differences between limbs (2.3 ± 1.6 N.m and 2.4 + 1.5 N.m., paretic vs. non-paretic limb). Voluntary force production of the affected limb, (10 ± 12.1 N.m) however, was 38% of that produced by the unaffected limb (26 + 1.4 N.m.) and measures of mean percent motor unit activation of the paretic limb were 58% of that produced by the unaffected limb. Interpolated twitch results showed that mean percent motor unit activation was significantly different in the affected limb (46 ± 36%) than the unaffected limb (79 + 19.6%). These results indicate that some motoneurone in hemiplegic patients were healthy but not readily activated. No effect was seen for age, sex of the subject and time post stroke. No significant difference in the pattern of results was observed between initial and final test results for subjects examined more than once. Conclusions were that skeletal muscle integrity was preserved probably due to spinal reflex activity and force production was depressed due, in part, to an inability to fully activate motor units. The inability to activate motoneurone may occur because some motoneurone are in a dysfunctional state. The following data from the present experimental work revealed several trends suggesting the possibility of a sick motoneuron hypothesis due to transynaptic motoneuron degeneration and the existence of a secondary lower motoneuron lesion in stroke syndrome. These trends are: 1) decreased motor unit counts of a sub-group of the total sample consisting of subjects under 60 years of age approached conventional levels of significance. Mean values for the affected limb were 73.8 ± 52 and 130.0 ± 61 for the unaffected limb (P < 0.05, F =5.05, critical F =5.59) In addition, M-wave amplitudes showed significant differences between limbs in the sub-group (4.0 + 2.3 mV and 5.7 ± 2.2 mV affected vs unaffected limb p<0.05), indicating that transynaptic motoneuron loss may have occurred; 2) decreased nerve conduction velocities and prolonged terminal latencies in the motor nerves of the paretic limbs also suggest sick motoneurone and the possibility of a dying back phenomenon of the terminal nerve endings; 4) normal M-wave amplitudes and twitch torque values of the tibialis anterior muscle coupled with the prolonged terminal latencies may be indicative of collateral sprouting of terminal axons which have taken over previously denervated muscle fibres. Future studies are needed to confirm or refute these observations. / Thesis / Master of Science (MS)

Thesis (Ph. D.)--University of Oregon, 2002. / Includes bibliographical references (leaves 178-188). Also available online.

Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2012.

Diskettes comprise Appendix N andO. / System requirements: IBM compatible, requires Word for windows 6 or higher. / Bibliography: leaves 400-428. / xix, 428 leaves ; 30 cm. + 2 diskettes (3 1/2 in.) / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 1997?

Thesis (M.S.W.)--University of Hong Kong, 1996. / Includes bibliographical references.

Thesis (M.S.W.)--University of Hong Kong, 1993.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2003. / Includes bibliographical references.

Thesis (Ph. D.)--University of Oregon, 2002. / Includes bibliographical references (leaves 178-188).

This investigation explored the relationship of demographic, social network, social support, and stroke-related factors to depressive symptomatology and well-being in 50 elderly individuals who had recently suffered a first, completed stroke and their partners. Data were gathered at two points in time, with interviews scheduled six months apart. Outcome measures included the CES-D depression scale and the Index of Psychological Well-Being. Data were analyzed using descriptive statistics, correlational procedures, multiple regression, and change-focused regression analyses. For the caregivers, lower depression levels at Time 1 were associated with better subjective health, less concern about being able to care for the patient in the future, higher levels of patient ADL functioning, greater perceived pre-stroke instrumental support, and greater patient optimism. At Time 2, lower caregiver depression scores were associated with lower levels of perceived burden, fewer health problems or negative changes in health status, fewer negative network interactions, greater network density, greater frequency of network contacts, and fewer perceived personality and behavior changes in the patient. Best predictors of depression score for the caregivers at Time 1 were subjective health rating, the patient's level of ADL functioning, degree of concern about ability to care for the patient in the future, the proportion of the network providing instrumental support, and the percent of reciprocal confiding relationships reported. At Time 2, best predictors of depression were level of perceived caregiver burden, objective health score, and network density. The best predictor of caregiver depression level over time was Time 1 depression level. Perceived caregiver burden was also a strong predictor of depression score. For the patients, higher depression scores at Time 1 were associated with whether they felt they could have done anything to prevent the stroke, higher levels of concern about their partner's ability to care for them in the future, and greater reported frequency of pre-stroke disagreement with their partners. At Time 2, higher levels of depressive symptomatology were associated with decreased satisfaction with amount of social contact, a greater proportion of friends in the post-stroke network, a greater degree of perceived negative health change, and change in employment status.

The literature on stroke reveals an increasing interest in the role played by social and emotional factors in rehabilitation after stroke. A comprehensive literature survey shows profiles of spontaneous recovery, the significance of a team approach to rehabilitation, patterns of prognostic significance for long-term recovery and adaptation and formulations of rehabilitation models for the Western world. The importance of depression as a major factor in demotivation to participate in rehabilitation and achieve long-term quality of life post-stroke emerges. From the literature survey a research design was formulated for the ecological study of a sample of 51 stroke patients at Ga-Rankuwa Hospital near Pretoria. The questionnaire was structured according to the Synchronous Systems Model, and data gathered from the biological, personal and environmental spheres of patients. Data was collected by a multidisciplinary team at three assessment times, three days, two weeks and three months post-stroke. These corresponded to the acute physical phase of stroke, the end of the hospitalisation period, and an assessment of patients once they had been discharged back into the community. Descriptive statistics were obtained on all variables and principle axis factor analysis was performed to verify the factorial structure of the tests. In order to establish whether group scores changed between assessments, t-tests for dependent measures were applied. Pearson Product Moment correlations were computed for the purpose of establishing relationships between variables. The results revealed dramatically differing biographical characteristics of the sample of stroke patients both premorbidly and at three months after the stroke. Significant recovery profiles emerged in both the physical and neuropsychological spheres at both the 14 day and 3 month assessments. Depression and the functioning at home and at work social sphere of role emerged as profiles of deterioration. At 14 days, depression was related to physical and cerebral functioning. This changed at three months, with depression also being significantly related to aspects of social functioning. On the basis of these results, depression after stroke was conceptualised as a severance of relational connectedness in the social ecological functioning of stroke patients. An ecological approach to rehabilitation is proposed that would seek to reframe the identity of stroke patients and establish relational connectedness post-stroke. / Psychology / D. Litt. et Phil. (Psychology)