Background. Stroke affects over 80 million individuals worldwide. Elevated arterial stiffness has emerged as a novel independent risk marker for stroke. While arterial stiffness is improved after chronic aerobic training, a single bout of aerobic exercise leads to transient increases that typically resolve within 5 minutes of recovery. Elevated arterial stiffness may persist for up to 30 minutes following exercise in populations with cardiovascular disease. However, no study has examined the effect of acute aerobic exercise on arterial stiffness and central hemodynamics in individuals with stroke. Moreover, no study has explored the clinical significance of these responses. Objectives. The primary objective of this thesis was to characterize the response and recovery of arterial stiffness and central hemodynamics to peak aerobic exercise in individuals ≥ 6 months post-stroke. The secondary objective was to explore the relationships between the exercise response and recovery of arterial stiffness and central hemodynamics, with cardiorespiratory fitness and walking ability. Results. This cross-sectional study recruited 10 adults with stroke (mean ± SD age=56.9 ± 11.8; median [IQR]= 2.9 [1.9] years post-stroke; n=4 females). After peak aerobic exercise, cfPWV increased from rest and remained elevated for 20 minutes (p<0.05). Heart rate increased and remained elevated for 10 minutes post-exercise (p<0.05), while systolic blood pressure decreased and remained reduced for 15 minutes (p<0.05). Positive associations were found between cardiorespiratory fitness and heart rate reserve (r=0.74, p=0.02), and with each phase of heart rate recovery (HR60s r=0.80, p=0.005, HR120s r=0.79, p=0.006; HR300s r=0.72, p=0.02; and HR600s r=0.75, p=0.01). There were no relationships between response and recovery of hemodynamic variables with walking ability. Conclusion. Individuals with chronic stroke may have impaired arterial stiffness and heart rate recovery following peak aerobic exercise. Moreover, heart rate reserve and all phases of heart rate recovery were related to cardiorespiratory fitness, but not walking ability. / Thesis / Master of Science Rehabilitation Science (MSc) / Arterial stiffness has been recently identified as an important risk marker for stroke. Aerobic exercise reduces the risk of stroke by lowering arterial stiffness. But during exercise, there is an increase in arterial stiffness that usually subsides by 5 minutes. Lengthy exposure to arterial stiffness can cause damage to organs like the kidneys and liver. The purpose of this thesis was to measure the arterial stiffness and cardiovascular response to exercise in people with stroke. We also studied the relationship between the responses, fitness and walking ability. Ten people with stroke participated in this study. After aerobic exercise, arterial stiffness stayed high above resting levels and did not recover after 20 minutes. Also, heart rate recovery was related to fitness but not walking ability. This study tells us that people with stroke have an weakened ability to recover from aerobic exercise and that higher fitness levels can improve exercise recovery.

Participation in daily activities in people with strokeDelaktighet i dagliga aktiviteter hos personer med strokeMagisterexamensarbete 15hp, Luleå tekniska universitet, institutionen för hälsovetenskap,2015.AbstractParticipation in people with stroke is highlighted in this study based on people's experiences of participation in their daily activities. Occupational therapists play an important role in the rehabilitation of people with stroke, this by assessing and participate in the treatment of people who have difficulties to participate and perform activities. A better understanding of people's experiences of part-icipation in their lives, can contribute to the design of rehabilitation and actions that are relevant to these persons participation. The purpose of this study was to describe the experience of partici-pation in daily activities in people with stroke who received outpatient rehabilitation. The author used a qualitative approach and interviewed people with stroke from three municipalities in northern Sweden, an interview guide with semi structured questions were used during data collection. Data were analyzed by content analysis and gave five categories: “The importance of engagement to experience participation”, The importance of participation in their own training and rehabi-litation”, “Opportunities for participation and performance of daily activities”, “Adapting to new conditions needed to experience participation”, “Barriers and support in the environment is of importance for participation”. The results indicate many aspects of the participants' experiences of participation in their daily activities. The study shows that knowledge is needed regarding participation in daily activities in people with stroke. This knowledge will be of value in the context of medical care and rehabilitation, as well as for other actors and contexts that are relevant for these persons. / <p>Validerat; 20150625 (global_studentproject_submitter)</p>

Bakgrund: Stroke är den näst dödligaste dödsorsaken globalt sett, efter kardiovaskulära sjukdomar, och orsakas av en propp eller blödning i hjärnan, vilket leder till syrebrist och vävnadsdöd. Riskfaktorer för stroke inkluderar rökning, övervikt och bristande fysisk aktivitet. Rehabilitering efter en stroke är avgörande för att hantera motoriska, sensoriska och psykiatriska komplikationer. Träning kan minska risken för stroke och förbättra fysiska förhinder efter en stroke.  Syfte: Syftet är att beskriva vuxna personers upplevelser av träning efter en stroke. Metod: Arbetet är en litteraturöversikt med en kvalitativ ansats. Tio originalartiklar har analyserats i enlighet med Braun och Clarkes tematiska analysmetod.  Resultat: Resultatet påvisade tre teman: resultatet av träning, vikten av ett tryggt socialt nätverk och begränsningarna efter en stroke vid träning. Vidare framställdes sex subteman.  Slutsats:  Arbetet visar att träning efter en stroke kan ha positiva fysiska och mentala effekter, inklusive ökat välbefinnande och socialt sammanhang. Utmaningar som fysiska, psykiska begränsningar och bristande motivation betonar vikten av individanpassade interventioner och professionellt stöd.

With medical advancements, more Canadians are surviving a stroke. However, many live with residual impairments that can affect their everyday function. Regaining the ability to drive is often a priority among patients after stroke. Current evidence indicates there is a critical need for evidence-based interventions that support their return to this occupation. In the first study, OTs identified assessments and interventions they used to address driving post-stroke. From the breadth of interventions, the use of mobile applications was identified as a major and significant knowledge gap by clinicians, as to how their patients perceived and used this technology when deployed. Following this study, community-dwelling patients with stroke and their caregivers were provided with DriveFocus®; a new mobile application for driving rehabilitation. Their use of DriveFocus® was tracked for four weeks from which distinct patterns with using this technology emerged. Follow-up interviews with participants explored these patterns. Guided by a technology acceptance model, this mixed-methods analysis showed how the presence and absence of certain factors (e.g., having a ‘tech-savvy’ caregiver) can support technology adoption. Participants also described how OTs play a key role with introducing and monitoring their use of this technology during stroke rehabilitation. In the final study, clinicians from the first study as well as additional OTs were recruited. Their interviews identified factors that influenced how they selected and deployed mobile applications, like DriveFocus®, to address a patient’s goal of returning to driving. These factors included clinician awareness of emerging technology and mobile applications, workplace policies that support the upkeep and integration of technology as well as the patients’ level of impairment and comfort with using mobile technology. Having caregivers to facilitate uptake of this technology was also raised during these interviews. This thesis opened by exploring the process by which the occupation of driving is addressed by OTs in stroke rehabilitation where subsequent studies identified factors specific to the uptake of mobile application by individuals with stroke, their caregivers, as well as clinicians to address this occupation. In the closing chapter, these factors are described using an OT model that highlighted opportunities and challenges for implementing mobile technology for driving within stroke rehabilitation. / Thesis / Doctor of Philosophy (PhD) / Returning to driving is often a goal for individuals after their stroke. This thesis examined how driving is addressed during stroke rehabilitation. The first study investigated assessments and interventions used by occupational therapists (OTs) where mobile applications were identified as a promising approach to address this goal. In the next study, individuals with stroke and their caregivers trialled a mobile application called DriveFocus®. While some reported difficulty learning to use this application, family and friends who were comfortable with technology helped participants navigate these difficulties. The final study identified factors that can influence the uptake of mobile applications by OTs working in stroke rehabilitation. Factors included selecting suitable applications, having workplace policies that support the integration of technology, and how a patients’ level of stroke impairment alongside caregiver support can affect technology adoption. Overall, this thesis identified areas of priority to facilitate the adoption of mobile applications for driving in stroke rehabilitation.

People with stroke may experience losses of muscle strength and physical function. The two are related, whereby a threshold of strength is often needed to execute activities of daily living. Strength training (ST) is a potent stimulus to elicit gains in muscle mass, strength, and function. However, it is underutilized in clinical practice due to ambiguity around how to prescribe it. It is also unclear to which extent people with stroke are currently engaging in these activities. The purpose of this thesis was to advance the understanding and application of ST in stroke rehabilitation. Study 1 was a systematic review and meta-analysis of 39 trials (n=1,928), which found that ST improved both muscle strength, as well as outcomes rated as important by a community advisory group of adults with stroke, such as balance, walking capacity and speed. We also found that traditional ST programs using free weights and machines, power-focused intensities (i.e., exercises performed at lower external resistance and high speeds), and more frequent ST were more beneficial for some aspects of stroke recovery. Study 2 examined the feasibility and effects of a 10-week power-focused ST program on muscle strength, power, physical function, and health-related quality of life in 15 people living with mild to moderate chronic stroke. We found that the study was feasible with respect to participant recruitment, sex and gender distribution, attendance, attrition, safety, exercise tolerance, and satisfaction with the program. Moreover, the program showed potential for clinically important improvements in physical function and health-related quality of life. Finally, Study 3, was a cross-sectional study (n=2,094) using data from the Canadian Longitudinal Study on Aging which found that fewer than a quarter of Canadians with stroke engage in muscle strengthening activities and are not likely to meet moderate to vigorous physical activity (MVPA) guidelines. Moreover, people with lower intrinsic capacity, functional mobility, and negative environments had lower physical activity levels. These findings suggest that ST is effective and may be feasibly optimized through power-focused intensities. However, very few people with stroke reported engaging in ST, indicating that health promotion should be a key focus for future research and practice. / Thesis / Doctor of Philosophy (PhD) / After a stroke, people often lose muscle mass and strength, which can impact their physical abilities. Strength training can help improve muscle strength and function, but rehabilitation experts are often unclear how to prescribe it. We also do not know whether people with stroke participate in this form of exercise. This thesis contains 3 studies that explored the role of strength training for impacting stroke recovery and the extent of strength training participation in Canadians with stroke. In the first study, we reviewed 39 studies and found that strength training improved muscle strength, balance, and walking abilities for stroke survivors. Performing strength training more frequently, using free-weights and machines, and power-focused strength training (exercises designed to improve speed and strength together) was especially beneficial. In the second study, we tested a 10-week power-focused strength training program for 15 people living with stroke. We showed that our program was safe and showed potential for improving strength, power, physical function, and quality of life. Our third study looked at data from over 2,000 Canadians with stroke. We found that less than 25% were doing ST, and 94% were not meeting physical activity guidelines. In summary, strength training, especially power-focused strength training, can enhance stroke recovery, but not enough stroke survivors are doing it. We need more research on promoting strength training for better recovery.

Aims: Life satisfaction and self-efficacy are psychosocial experiences that appear to profoundly influence the rehabilitation of a stroke patient. However, relevant studies have been mostly carried out on Western stroke survivors, with limited reports on stroke experience in the Middle East. Reviewed literature suggests a positive correlation between religious faith and health outcome, however studies investigating relationships among religious faith, self-efficacy and other psychosocial variables in stroke patients are limited. The aims of this study were therefore to (1) explore stroke experience and factors associated with life satisfaction post-stroke in Kuwait, (2) to investigate the relationships between self-efficacy, life satisfaction and religious faith in female stroke patients living in Kuwait, and (3) to identify cultural influences on stroke survivors in Kuwait from the health professionals‘ point of view. Method: The study was carried out in these four phases. 1) Phase 1:- Exploring stroke experience in patients in Kuwait with semi-structured interviews 2) Phase 2:- Client-Centred Adaptation of a Self-Efficacy measure for stroke patients living in Kuwait 3) Phase 3:- Assessing quantitative relationships between the three variables (self-efficacy, life satisfaction and religious faith) with questionnaires 4) Phase 4:- Exploring perceptions of health professionals regarding the world of the stroke patient and effects of culture on recovery and rehabilitation with semi-structured interviews Qualitative data were analysed with thematic analysis. Results: Significant correlations were found between general self-efficacy, and psychosocial adaptation self-efficacy. Self-efficacy (both general and psychosocial adaptation) showed significant correlations with life satisfaction post-stroke. Religious faith was not related to either life satisfaction or self-efficacy. Health professionals‘ interviews identified cultural characteristics specific to stroke patients living in Kuwait. These included family involvement, prevailing attitude towards stroke, dependency and access to maids, religious beliefs, and social stigma. Conclusion: Psychosocial self-efficacy was identified as having the strongest relationship to life satisfaction compared with the other variables tested. This study failed to show any significant relationship between religious faith and self-efficacy or life satisfaction in female stroke patients living in Kuwait. However, results from patient and health professional interviews identified religious beliefs as playing an important role in recovery, behaviour during rehabilitation and in interaction with the health professions. The qualitative aspects of this study, in particular, highlight the importance of taking into consideration religious and cultural influences during the rehabilitation of stroke patients in Kuwait.

Bakgrund: Stroke är en folksjukdom som drabbar cirka 20 000-25 000 personer i Sverige varje år och leder till syrebrist i hjärnan. De symtom som uppkommer vid en stroke varierar beroende på vilken del av hjärnan som skadas Tiden från första symtom tills att behandling sätts in har en stor inverkan på hur allvarliga skador det blir. De vanligaste symtomen är domning eller förlamning och en lång rehabilitering väntar oftast. Syfte: Syftet med denna litteraturstudie var att beskriva personers upplevelser efter att ha drabbats av en stroke samt att beskriva undersökningsgrupperna i de valda artiklarna. Metod: En beskrivande litteraturstudie som baseras på tolv kvalitativa vetenskapliga artiklar. Databaserna Cinahl och Medline via PubMed användes för att söka artiklarna, via högskolan i Gävle. Huvudresultat: I resultatet presenteras personers upplevelser efter en stroke utifrån deras fysiska och psykiska hälsa, samt det sociala livet. Funktionsnedsättningar var den vanligaste fysiska förändringen i livet som fick dessa personer att uppleva en psykisk påfrestning, bland annat depression, rädsla och förändrad självbild. Det sociala nätverket påverkas genom isolering på grund av den fysiska funktionsnedsättningen och den psykiska påfrestningen. Totala antalet deltagare i studien var 184 personer vars erfarenheter och upplevelser studerades, 53,3% var män och 46,7% var kvinnor. Slutsats: Alla personer som drabbats av en stroke upplevde någon form av förändring i det dagliga livet. Därför krävs det att vårdpersonalen har kunskap om hur olika individer hanterar denna livsförändring. Det kunde vara allt från fysiska, psykiska och sociala förändringar. Stödhjälp ansågs varit en viktig del under rehabiliteringsprocessen för dessa personer. / Background: Stroke is a widespread disease in Sweden and it affects approximately 20 000-25 000 persons every year and it leads to oxygen deprivation in the brain. The symptoms that are caused by a stroke very depending on which part of the brain that is damaged. The time between the first symptoms of a Stroke and the first treatment of the disease is another major reason of how serious the damage becomes. The most common symptoms are numbness or paralysis and a long time of rehabilitation waits for the person that suffers from a stroke. Aim: To describe people´s experience after having suffered a stroke and to describe the included articles study-group.. Method: A descriptive literature study based on twelve qualitative scientific articles. The databases Cihnal and PubMed was used to search the articles, through the University of Gävle. Results: People's experiences after a stroke based on their physical and mental health, their social life are being presented in the results. Movement disabilities was the most common physical change in people’s life and also the reason why people experienced psychological distress such as depression, fear and a different view of themselves. Their social network is affected because of their physical movement disabilities and psychological distress. The total amount of people participating in the study was 184 persons whose experiences were studied, 53, 3% were men and 46, 7 % were women. Conclusion: Every person who suffered from a stroke experienced some kind of change in their daily life. Therefore, it requires that health professionals have the knowledge of how individuals manage this life-changing. It could be anything from physical, psychological to social changes in their lives. Supportive help for the affected people has been an important part of the rehabilitation process.

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.

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

PDFには「高橋 由佳子」と記載 / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21955号 / 医博第4497号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM