Older adults constitute a growing population in the United States. A disproportionate percentage of this population experience chronic illnesses and need to recall information important to prevent complications of illness and to self-manage their condition. One example of the need to retain information is to recall the risk factors for ischemic stroke to prevent the damaging effects of stroke.Factors that could influence the recall of health information include age-related changes in cognition, specifically working memory capacity. Research supports that older adults have working memory capacity limitations. Older adults may also experience low health literacy that in combination with declines in working memory could further influence recall of health information.The purpose of this study was to describe the predictive relationships of working memory capacity and health literacy on the recall of the warning signs of stroke in a sample of older community dwelling elders.Fifty-six participants, ranging in age from 68-99 years of age (M= 80 years of age) were recruited from two sites, a Senior Center and Retirement Residence. A brochure published by the American Heart and Stroke Association, "Let's Talk About Stroke" was the tool used to deliver the health information regarding the five warning signs of stroke. Personal factors including demographic and medical variables were collected in this study. Working Memory was assessed using the Wechsler Adult Intelligence Scale III, Working Memory Index (WMI). Health literacy was determined using the Short Test of Functional Health Literacy in Adults (STOFHLA). Participants were asked to recall the health information they were asked to read regarding the five warning signs of stroke at the conclusion of the study visit.Findings indicated that the key variables working memory and health literacy were independently and positively correlated to recall (p < .01); however, regression analysis did not demonstrate an interaction between the two key variables and recall.The findings from this study explore the associations between working memory, health literacy and personal factors and support that these key predictors may be related to the older adults ability to successfully recall health information.

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This study investigated the hypothesis that severity of depressive symptoms following acute ischemic stroke is associated with degree of tissue infarction and severity of white matter changes (WMCs). It employed a novel quantitative region-based approach considering both infarction and WMCs. Of 54 ischemic stroke patients recruited, 50 (72.3 ± 12.8 years, 52.0% male) had useable CT scans. The typical patient was recruited within 3 weeks of their stroke (19.7 ± 31.0 days), exhibited minor cognitive impairment (MMSE score 25.8 ± 4.6), and had mild to moderate stroke severity (NIHSS score 6.5 ± 5.4). 28.0% of patients screened positive for clinical depression with a CES-D score ≥16. While neither degree of infarction nor severity of WMCs (ARWMC score) in the 12 brain regions correlated with depressive symptoms (CES-D score), stroke severity was a significant predictor of depressive symptoms. This stressor, related to physical disability, was a predominant predictor over lesion characteristics.

This study investigated the hypothesis that severity of depressive symptoms following acute ischemic stroke is associated with degree of tissue infarction and severity of white matter changes (WMCs). It employed a novel quantitative region-based approach considering both infarction and WMCs. Of 54 ischemic stroke patients recruited, 50 (72.3 ± 12.8 years, 52.0% male) had useable CT scans. The typical patient was recruited within 3 weeks of their stroke (19.7 ± 31.0 days), exhibited minor cognitive impairment (MMSE score 25.8 ± 4.6), and had mild to moderate stroke severity (NIHSS score 6.5 ± 5.4). 28.0% of patients screened positive for clinical depression with a CES-D score ≥16. While neither degree of infarction nor severity of WMCs (ARWMC score) in the 12 brain regions correlated with depressive symptoms (CES-D score), stroke severity was a significant predictor of depressive symptoms. This stressor, related to physical disability, was a predominant predictor over lesion characteristics.

The ability to walk and negotiate stairs is an important predictor of independent ambulation. The superposition of mobility impairments to the effects of natural aging in persons with stroke render the completion of many daily activities unsafe, thus limiting individuals’ independence within their communities. Currently however, no means exist for the monitoring of mobility levels during daily living in survivors after the completion of rehabilitation programs. The application of inertial sensors for stroke survivors could provide a basis for the study of gait outside of traditional laboratory settings. The main objective of this thesis was to evaluate the performance of inertial sensors in measuring gait of hemiparetic stroke survivors through the completion of three studies. The first study explored the use of inertial measurement units (IMUs) for the measurement of lower limb joint kinematics during stair ascent and descent in both stroke survivors and healthy older adults. Results suggested that IMUs were suitable for the measurement of lower limb range of motion in both healthy and post-stroke subjects during stair ambulation. The second study evaluated the measurement of step length and spatial symmetry during overground walking using IMUs. A systematic error resulting in the underestimation of step lengths calculated using IMUs compared with those measured using video analysis was found, however results suggested that IMUs were suitable for the assessment of spatial symmetry between affected and less-affected limbs in stroke survivors. The final study evaluated the automatic classification of gait activities using inertial sensor data. Findings revealed that the use of a classifier composed of frequency-features extracted from IMU accelerometer and gyroscope data from both the affected and less-affected limbs most accurately identified gait activities from post stroke gait data. This thesis provides a first attempt at applying IMUs to the study of gait post-stroke. Future work may extend the findings of these studies to provide a better understanding to rehabilitation professionals of the demands of everyday life for stroke survivors. / Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2013-08-29 12:42:05.505