Includes bibliographical references and index.

Abstract Depression is a common consequence of stroke and it is known to be associated with deterioration of quality of life. However, only limited information is available on the relationships between depression and communicative and cognitive disorders. Moreover, the present knowledge of the determinants of the domains of quality of life is limited, and little is known of e.g. the changes in sexual behaviour of stroke patients and their spouses. This prospective study was carried out to evaluate the prevalence of post-stroke depression and aphasia and to study their interrelationships and neuropsychological and functional correlates. The particular aim of the study was to investigate the domain-specific quality of life, and to assess its clinical and sociodemographic correlates, and to study the impact of stroke on the sexual functions of stroke patients and their spouses. The study consisted of 156 first-ever stroke patients. Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months post-stroke according to DSM-III-R-criteria. One third of the patients were aphasic, 70% of them at 3 months and 62% at 12 months after stroke suffering from depression. Among the aphasic patients the prevalence of major depression increased from 11% to 33% during the 12 months follow-up. There was an association between post-stroke depression and cognitive impairment, the domains most likely to be defective being memory, non-verbal problem solving, and attention and psychomotor speed. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. The quality of life of the patients was low at 3 months after the stroke, and it did not improve during the follow-up of a year. The test domains most often impaired were Physical functioning, Physical role limitations, Vitality and General health. Depression, although mostly minor, and being married emerged as significant independent contributors to low score value of Vitality and Physical role limitations. All the analyzed aspects of sexuality were commonly decreased as a consequence of stroke both in the patients and their spouses. Nocturnal erections were impaired in 21 (55%) of the male patients. The present results demonstrate that more than half of the patients after stroke suffer from depression and the frequency of major depression seems to increase over time, especially among the aphasic patients. Both depression and aphasia increase the liability of cognitive deficits. Stroke affects various dimensions of quality of life extensively, and the most important determinants entailing low quality of life seem to be depression, and, interestingly, being married. As a part of quality of life, sexual function and satisfaction with sexual life are impaired both in stroke patients and spouses. These findings call for multidimensional evaluation of stroke patients and provide new challenges for stroke rehabilitation.

The purpose of this study was to identify the nature of nursing care given by general staff hospital nurses to a selected group of patients who had experienced a cerebrovascular accident. Six hemiplegic patients who had experienced a cerebrovascular accident one to three weeks before the period of observation were selected for the study. The data were compiled from direct observations and from a nursing history which included an interview with the patient and/or his nearest relative, and data from his chart. The observed behaviour of twenty-nine general staff hospital nurses, six patients, and other members of the rehabilitation team were recorded in the form of anecdotal notes by the non-participating nurse-researcher. Each patient was observed for two days, the mean length of observation time per day was 6 hours and 49.4 minutes. The data were categorized into ten basic nursing care activities. Basic nursing care as defined by Henderson, meant helping the patient with activities related to his basic needs or providing conditions under which he could perform them unaided. The data were further organized into desirable activities, as outlined in the literature, and undesirable activities that were observed. It was demonstrated that many nurses in the study helped patients with most of the ten activities, however, few nurses provided conditions under which they could perform them unaided. Food and fluids were fed to patients who could have fed themselves with a little encouragement. Bowel and bladder training was not seen as an important factor in the care of the patient who had experienced a cerebrovascular accident. Nurses seldom included exercise during the bath and frequently left the patient in the chair for prolonged periods. Nurses demonstrated that they did not understand the importance of communication with patients who had experienced a cerebrovascular accident, nor did they appear to be aware of the concept of a rehabilitation team. The recommendations were: 1. that an orientation to the total picture of rehabilitation of the patient who had experienced a cerebrovascular accident, in the acute hospital, specialized unit and in the home, be provided for graduate general hospital nurses. 2. that existing knowledge in relation to the nurse's role in the rehabilitation of the patient who had experienced a cerebrovascular accident be compiled and made accessible to general staff hospital nurses. It is now primarily in journals that these nurses do not normally see. 3. that general staff hospital nurses learn to communicate more effectively with patients who have experienced a cerebrovascular accident, with their families and with other members of the rehabilitation team. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (Ph. D.)--University of Washington, 1984. / Vita. Bibliography: leaves [124]-128.

A short report submitted to the Faculty of Medicine, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Medicine in Nuclear Medicine / 19 patients were selected, from the patients screened, for investigation within 48 hours of the onset of an ischaemic cerebrovascular accident. Clinical neurulogical scoring, computerized tomography lCT) scans and single photon emission computed tomography (SPECT) scans were performed on day 1, day 10 and day 30. SPECT scan data was analysed by 5 semi-quantitative methods, and findings were compared with neuroloyical clinical scores on each respective day. It was found that day 1 SPECT scans are of value for early localization of the acute ischaemic infarction. A multiple regression model was developed using both the day 30 Defect Volume index and segmental analysis score which related to the day 30 clinical scores. The day 1 model was unsatisfactory and no such model was found relating day 10 SPECT semi-quantitative methods to day 10 clinical scoring. Changes in semi-quantitative scores from day 1 to day 30 did not correlate with clinical changes. Longer follow up may be required for there to be value in performing SPECT scans in stroke trials. A prognostic equation was derived by multiple regression analysis of day 1 SPECT scan scores and day 30 clinical scores. / Andrew Chakane 2019

Research interest in cerebral small vessel disease, which is manifested as lacunar infarct and white matter changes, has surged in the last decade. Small vessel disease has been increasingly recognized via neuroimaging to be highly prevalent among the elderly and more importantly; it is associated with cognitive impairment. Since the population worldwide is ageing, the cognitive burden associated with small vessel disease is foreseen to rise. This burden will be particularly great in China where the population is vast. However, data of cognitive impairment related to small vessel disease among Chinese is scarce. / The methods and results of these studies will be presented in the thesis. In brief, the author concluded that (1) among Chinese stroke patients with relevant subcortical lacunar infarct, underlying intracranial large artery disease should be looked for before attributing that the lacunar infarct is due to small vessel disease because of its not uncommon association with lacunar infarcts among Chinese; (2) half of the patients with stroke associated with small vessel disease complain of varying severity levels of cognitive impairment 3 months poststroke and executive dysfunction also affects functional activities; (3) thalamic lacunar infarct and left frontal lobe atrophy have small yet significant influences on cognitive performances; (4) cerebral atrophy predicts prestroke cognitive impairment; and (5) Chinese frontal assessment battery is a moderately valid, while executive clock drawing test is not a valid test in the evaluation of executive dysfunction among Chinese with small vessel disease. / This thesis aimed to present studies that were conducted by the author among Chinese stroke patients on this particular field. The aims of the studies were to evaluate the (1) frequency of relevant intracranial large artery disease among Chinese stroke patients having subcortical lacunar infarcts; (2) frequency and impact of cognitive impairment after stroke associated with small vessel disease; (3) neuroimaging determinants of cognitive performances after stroke associated with small vessel disease; (4) determinants of prestroke cognitive impairment in stroke associated with small vessel disease; and the (5) validity of frontal assessment battery and executive clock drawing test in assessing executive dysfunction among Chinese patients with small vessel disease. / Mok Chung Tong Vincent. / "April 2005." / Adviser: Lawrence Ka Sing Wong. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3695. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 180-197). / 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. / School code: 1307.

<p>Stroke is the world&rsquo / s third highest cause of death and a major cause of disability. In order to define optimal management for stroke, reliable data are needed. Although Ruhengeri Hospital in Rwanda receives many stroke patients, no in-depth study has been carried out on stroke patients admitted at the hospital. This study, therefore, identified the profile of stroke patients admitted at Ruhengeri Hospital in Rwanda and explored the challenges that they experienced. A concurrent mixed model design was used to collect data. With a data gathering instrument which was developed by the researcher, a quantitative retrospective approach was used to review existing patients&rsquo / records to collect information related to demographic characteristics, documented clinical features and risk factors for stroke, stroke onset-admission interval, length of hospital stay and the process of hysiotherapy for stroke patients. In-depth face-toface interviews were also used to collect data regarding the challenges experienced by stroke patients. The sample for the quantitative phase consisted of medical records of stroke patients admitted at Ruhengeri Hospital from January 1st, 2005 up to December 31st, 2008. In the qualitative phase, a purposive sample of 10 participants was selected.</p>

TRUNK BALANCE AS A PREDICTOR OF MOTOR OUTCOME IN PATIENTS WITH STROKE ABSTRACTBackground: The search for predictors of functional stroke outcome has always been matter of research in Physical Medicine and Rehabilitation. Outcome prediction at an early stage enables clinicians not only to inform patients and their families, but also to set realistic therapeutic goals. A lot of prognostic studies have evaluated several factors, which either individually or in combination claim to predict functional outcome in stroke. The Trunk Control Test (TCT) proposed by Collin & Wade administered at 6 weeks post-stroke is a predictor of the walking ability at 18 weeks. The TCT reliability and validity has been demonstrated in stroke patients, as well as its positive correlation with disability at hospital discharge from in-patient rehabilitation measured with the Functional Independence Measure (FIM). In a previous study, a predictive model which only includes the FIM and the TCT measured at admission of patients to a rehabilitation ward, predicts 66.5% of the variability of the functional level at discharge (total FIM). Objective: To develop an early model to predict motor function (disability, walking ability and balance)at 6 months, taking into account the TCT and other valid predictors evaluated in the first and second week after suffering a stroke.Patients and Methods: Seventy-five consecutive patients with first stroke who were admitted to a rehabilitation hospital were studied. Sex, age, the stroke type, urinary incontinence, the National Institutes of Health Stroke Scales (NIHSS) and the TCT scores (assessed at first and second week post-stroke) as independent variables. Motor function outcome at 6 months after stroke is defined by the use the Rankin score, the motor FIM and the Berg Balance Scale (BBS).Results: Older patients, women and those with initial urinary incontinence and lower TCT and NIHSS scores showed significantly worse motor outcomes at first and six months after the stroke (Rankin, motor FIM and BBS). A multiple regression reveals that only age and the TCT (at 14 days after stroke) accounts for the 61.1% of the variance in the motor FIM score at 6 months after stroke. When the TCT is registered at 7 days after stroke, age and the TCT accounts for the 51.7% of the motor FIM variance. A cluster analysis identifies 12 patients with low outcome scores: Rankin 4-5, motor FIM < 59 and BBS < 5. The ROC curves show a better prediction ability for the TCT than the NIHSS at 14 days after stroke. Logistic regression is used to predict the probability of achieving in this group with low motor scores. The TCT &#61603; 50 at 14 days after stroke is a significant predictive factor of poor motor outcome at 6 months after stroke (Sensibility 83.3%, Specificity 85.7%) (OR=30.0, 95% CI 4.7 - 247.3). The TCT &#61603; 24 at 7 days after stroke is a significant, but obviously worse predictive factor of poor motor outcome (Sensibility 66.7%, Specificity 89.3%) (OR=16.7, 95% CI 3.2 - 97.5). Discussion and conclusions: Age, sex, urinary incontinence, TCT and NIHSS scores are related with disability, balance and walking ability six months after the stroke. It is possible to approach to the motor functional outcome at 6 months after stroke by the early use of data easily recorded as age and the TCT. In this study the TCT even overcomes the NIHSS, a comprehensive neurological measure whose ability to predicts outcome has been well documented in stroke patients. The reproducibility of this model must be cross-validated in future studies. The TCT registered at 14 days provides better prediction values compared with those obtained at 7 days after stroke. This study shows that the TCT early administered predicts motor outcome at six months after stroke.EQUILIBRI DE TRONC: PREDICTOR DE LA FUNCIÓ MOTORA EN L'HEMIPLÈGIC VASCULAR RESUMIntroducció: La cerca de factors predictors del resultat funcional després de patir un ictus és objecte constant d'investigació en Medicina Física i Rehabilitació. Un pronòstic funcional en fases inicials permet al clínic informar als pacients i a la seva familia, però també establir objectius terapèutics realistes. Molts estudis han avaluat la capacitat predictora de diferents factors individual i combinadament. El Test de Control de Tronc (TCT) registrat a les 6 setmanes de l'ictus és un predictor de la capacitat de marxa a les 18 setmanes. La fiabilitat i validesa del TCT s'ha demostrat en pacients amb ictus, així com la seva correlació positiva amb la discapacitat a l'alta hospitalaria. Un model predictiu que inclou només el TCT i el Functional Independence Measure (FIM) registrats a l'ingrés en la unitat de rehabilitació d'hospitalització aguda prediu el 66.5% de la variabilitat del FIM a l'alta.Objectius: Conèixer la relació de les variables predictores amb els resultats de funció motora global al mes i als sis mesos de l'ictus. Construir un model de predicció precoç de la funció motora (discapacitat, capacitat de marxa i equilibri) als 6 mesos, tenint en compte el TCT i altres predictors vàlids avaluats en la primera i en la segona setmana després de patir l'ictus.Pacients i Mètode: estudi longitudinal i prospectiu en 75 pacients consecutius ingressats per un primer episodi d'ictus. Les variables independents van ser: edat, sexe, tipus d'ictus, incontinencia urinària, l'escala d'ictus National Institutes of Health Stroke Scales (NIHSS) i el TCT (recollits en la primera i segona setmanes de l'ictus). Els resultats de funció motora al mes i als 6 mesos de l'ictus es van definir amb l'escala de Rankin, la subescala motora del FIM i l'escala d'equilibri Berg Balance Scale (BBS).Resultats: els pacients de més edat, les dones i els que tenen incontinència urinària inicial i puntuacions més baixes de TCT i NIHSS són els que presenten significativament pitjors resultats de funció motora tant en el primer com en el sisè mes de l'ictus (Rankin, FIM motor i BBS). Una anàlisi de regressió múltipla determina que només amb l'edat i el TCT de la segona setmana s'explica el 61.1% de la variabilitat del FIM motor als 6 mesos de l'ictus. Quan el TCT es registra en el setè dia de l'ictus, l'edat i el TCT expliquen el 51.7% de la variabilitat del FIM motor. Una anàlisi de conglomerats identifica 12 pacients amb resultats baixos de funció motora: Rankin 4-5, FIM motor < 59 i BBS < 5. Les corbes ROC mostren que la millor capacitat predictora correspon al TCT de la segona setmana, per sobre del NIHSS. La probabilitat de tenir un mal resultat motor, es a dir, d'estar entre aquests 12 pacients es calcula mitjançant una anàlisi de regressió logística. Un TCT &#61603; 50 en la segona setmana de l'ictus és un factor predictiu de mal resultat motor als 6 mesos (Sensibilitat 83.3%, Especificitat 85.7%) (OR=30.0, IC 95% 4.7 - 247.3). Un TCT &#61603; 24 en la primera setmana també és un factor predictor significatiu, tot i que menys potent, de obtenir un mal resultat motor als 6 mesos (Sensibilitat 66.7%, Especificitat 89.3%) (OR=16.7, IC 95% 3.2 - 97.5).Conclusions: L'edat, el sexe, la incontinència urinària, el TCT i el NIHSS inicials són factors relacionats amb la discapacitat, equilibri i capacitat de marxa 6 mesos després de l'ictus. És possible aproximar-nos al resultat funcional motor als 6 mesos després de patir l'ictus amb la utilització precoç de dades de fácil recollida com l'edat i el TCT. El TCT recollit en fases inicials prediu el resultat motor als 6 mesos de l'ictus.

<p>Stroke is the world&rsquo / s third highest cause of death and a major cause of disability. In order to define optimal management for stroke, reliable data are needed. Although Ruhengeri Hospital in Rwanda receives many stroke patients, no in-depth study has been carried out on stroke patients admitted at the hospital. This study, therefore, identified the profile of stroke patients admitted at Ruhengeri Hospital in Rwanda and explored the challenges that they experienced. A concurrent mixed model design was used to collect data. With a data gathering instrument which was developed by the researcher, a quantitative retrospective approach was used to review existing patients&rsquo / records to collect information related to demographic characteristics, documented clinical features and risk factors for stroke, stroke onset-admission interval, length of hospital stay and the process of hysiotherapy for stroke patients. In-depth face-toface interviews were also used to collect data regarding the challenges experienced by stroke patients. The sample for the quantitative phase consisted of medical records of stroke patients admitted at Ruhengeri Hospital from January 1st, 2005 up to December 31st, 2008. In the qualitative phase, a purposive sample of 10 participants was selected.</p>

Thesis (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Not Embargoed. Vita. Bibliography: 182-204.