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No description available.

Background and Purpose Caregivers of patients with stroke are central in providing for the patient‟s needs, facilitating participation of the patient in their daily functional ability, maintaining functional improvements gained in rehabilitation and the long-term well-being of stroke survivors. The strain and ultimate decrease in quality of life of the caregiver can lead to breakdown in the support they provide to the patient. The well-being and quality of life of the caregiver is therefore of vital importance in the rehabilitation of the patient with stroke. It is therefore necessary to evaluate relevant factors in the South African context that affect the quality of life of the caregiver, so as to foresee and prevent possible breakdown in the support provided by the caregiver to the patient with stroke. The objectives of the study are to establish the functional level of patients six to 36 months post-stroke, the level of strain and quality of life of the caregiver six to 36 months post-stroke, and the influence of demographic factors, caregiver strain and patient‟s functional ability on quality of life of the caregiver. Method A cross-sectional study was performed on 35 patients six to 36 months post-stroke and their primary caregiver, obtained from a sample of convenience from six local clinics/hospitals in the Johannesburg area. Demographic information was gathered from both patient and caregiver by means of a questionnaire. The Barthel Index (BI) was used to assess the patients‟ functional ability at the point of interview. Caregiver strain and caregiver quality of life were measured using the Caregiver Strain Index (CSI) and EQ-5D and EQ-5D VAS respectively. Results Of the 35 patients with stroke, 19 (54.3%) were male, and 16 (45.7%) were female, with the mean age of 55.9 years. Of the 35 primary caregivers, 6 (17.1%) were male, and 29 (82.9%) were female, with the mean age of 50.7 years. Sixty percent of patients ranged from being independent in functional ability to being moderately dependent on the caregiver for their functional ability. Seventy seven percent of caregivers reported severe strain as a result of caring for the patient with stroke. Thirty one percent of caregivers reported midrange (50/100) quality of life using the EQ-5D VAS. No association was established between patient‟s functional ability and caregiver quality of life (Pearson x²=0.59). Negative association was established between caregiver strain and quality of life (Kendall‟s Tau-b=-0.23), however it was of marginal significance (Pearson x²=0.06). Logistic regression showed caregivers under severe strain were 1.6 times of higher odds to experience a decrease in quality of life than caregivers with less strain. Caregiver age showed a negative correlation with caregiver quality of life (Kendall‟s Tau-b=-0.48; Pearson x²=0.009). Logistic regression showed older caregivers were 0.19 times of higher odds to experience a decrease in quality of life than younger caregivers. Conclusion There is no association between the patient‟s functional ability and the quality of life of the caregiver six to 36 months post-stroke. A negative association is shown between caregiver strain and caregiver age, and caregiver quality of life. The realm of caregiver quality of life is both dynamic and contextual. Knowledge of the effects of the contextual factors enables the health services and professionals to respond appropriately to assist in foreseeing and alleviating those factors that negatively affect caregiver quality of life. As it is understood that caregivers provide support for the patient with stroke, promoting the caregiver‟s well-being in turn will promote patient care and their ultimate well-being.

M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2008 / Introduction It is widely recognised that stroke is a multi-factorial disorder in which platelets play a crucial role in thrombus formation resulting in ischaemic stroke. Platelet adhesion and aggregation are initiated by the interaction of various platelet glycoproteins (GP’s) such as GPIbα, which binds to von Willebrand Factor and GPIIb/IIIa a fibrinogen receptor. Recent studies have shown that the GP’s are polymorphic and the polymorphisms described within GPIbα such as Kozak- 5T/C, the variable number of tandem repeats (VNTR) and the Human Platelet antigen 2 (HPA2), have been implicated in the development of stroke, while the PIA polymorphism of GPIIb/IIIa was found to contribute to “aspirin resistance”. Therefore, these polymorphisms may be potentially important for early detection and early intervention and thus setting the need to provide for a high volume genotype testing at health care centres. One of the most used techniques to determine platelet function is platelet aggregometry. However, the major disadvantages of platelet aggregation is that it is influenced by a number of environmental factors and its access is limited to tertiary health centres. Platelet aggregation measures the functional expression of platelets, which is known to deteriorate over time. It is for this reason that new methods at molecular level such as polymerase chain reaction (PCR) are needed to explore the role of genotypic expressions, which are not influenced by environmental factors. Currently, conventional PCR is used to detect platelet polymorphisms in the research settings and has limitations as a routine diagnostic test. Furthermore, it is time consuming and is prone to contamination. With the recent advances in real-time PCR it is possible to genotype large sample batches rapidly without compromising on the quality, accuracy and precision of results. This study aims to adapt conventional PCR methodology onto a real-time platform for detecting platelet polymorphisms that have been implicated in both stroke and aspirin resistance. Materials and methods A total of 60 caucasian patients classified as having ischaemic stroke by virtue of MRI and Doppler analysis from the Stroke Clinic at the Johannesburg Hospital were enrolled for this study. Healthy caucasian individuals (38), age and gender matched were enrolled as controls. DNA samples were extracted from all the subjects and the prevalence of the Kozak –5T/C, HPA-2, VNTR and GPIIIa PIA polymorphisms were determined first by using conventional PCR and then the real-time LightCycler TM PCR method. Results The frequency of the unfavourable alleles ( the PIA2 allele for the GPIIIa PIA polymorphism, the T allele for the Kozak –5T/C polymorphism, the B allele for the HPA-2 polymorphism and the C allele for the VNTR polymorphism) of the different GP’s were higher in the stroke patients when compared to the control subjects but did not reach statistical significance. There was complete statistical agreement between the results obtained for the conventional PCR as compared to the results obtained for real-time PCR except for the VNTR polymorphism, due to the difficulty in designing and the unavailability of probes for the real-time PCR assay. However, it is important to note that adapting the real-time PCR as a new methodology would greatly benefit both the patients and the clinicians by providing early detection and the possibility of early therapeutic intervention. Conclusion Therefore in conclusion, it is possible to perform not only conventional PCR for platelet polymorphism but also real-time PCR on a large scale without compromising on the quality, accuracy and precision on platelet polymorphisms that play a significant role in stroke and aspirin resistance. However, a larger population based study needs to be performed to confirm the findings.

The aim of this ethnographic study was to explore and describe the lay care (self-care) phenomenon in Thai culture. Spradley's (1979) ethnographic method was utilised to investigate the meaning of lay care, the lived experiences of 10 individuals who had suffered a stroke and their family caregivers in caring for the sick person at home.The meanings and perceptions of self-care from the individuals' and their families' perspectives, were explored, including the practices and cultural issues relating to care at home. The data collection was undertaken over a 10 month period in Songkla Province, southern Thailand. The major sources of data were the transcripts of semi-structured informal interviews, focus group discussions, field notes of participant observations and interviews with other individuals who were knowledgeable of health services and cultural issues relating to care and treatment in the community.Data analysis revealed a number of themes related to family relationships, and home and community care. These themes included the lived experience at both home and healing centres, experiences with change and loss after the stroke and coping with these, perceptions of care-receiving and caregiving, scope of the family's responsibilities in the caregiving role, caregiving burden, factors influencing the quality of care and the recipient's satisfaction with care. Other themes related to support and health services: Western and traditional medicine, social networks and religion. These themes were discussed from three perspectives: the individual, the family and community resources.The results of the study support the concept of interdependence of family members, and to a lesser extent their wider social network, in health and illness. Consequently the model of care developed from this study focuses on the family, with the family as a whole contributing to the ++ / well-being of its members through both the promotion of family members' health and the restoration of the health of the family with a sick member(s). Implications of this model of care were identified for nursing practice, education and research.

Thesis (Sc.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Therapy to restore functional movement of stroke patients is based on assumptions about what deficits occur in motor control as a result of stroke. These assumptions are derived from observational studies of movement behavior. The success of therapy to restore voluntary movement has been limited, perhaps as a result of insufficient information concerning the characteristics of movement post stroke. Technology now exists to quantitatively describe the characteristics of movement behavior. In this study WATSMARTtm, a non-contact, optoelectric motion analysis system, was used in combination with surface electromyography to measure voluntary movement in the symptomatic and nonsymptomatic arms of five subjects with left hemiparesis as they attempted to reach to one of three targets placed to require movement inside and outside of extensor synergy. Each subject was tested five times over approximately a nine week period. Results indicated that the symptomatic arms were significantly less able to generate muscular activity and to move in a smooth coordinated way [execute the program] than the nonsymptomatic arms whose scores were essentially within normal limits. Target location made no significant difference to the speed or smoothness of movement, but did significantly affect level of muscle activity because of the biomechanical demands of each location. Over the two month period, there were no significant improvements in the nonaffected arms, as would be expected. In the affected arms, amplitude of peak velocity and sense of limb position significantly improved. Improved amplitude of peak velocity was related more to a decrease in the discontinuity of movement (r=-.49, p<.02), a sign of increased maturity of reach, than to electrical activity of the prime movers (anterior deltoid: r=.l9; biceps: r =.37, p<.05). Since the goals of therapy to restore functional movement are to reverse deficient aspects of movement, the findings suggest that strengthening and relearning of motor programs would be appropriate therapeutic goals for these patients. The effectiveness of therapy to actually reverse these deficits must, of course, be established in future studies. / 2031-01-01

Thesis (M.A.)--Boston University

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No description available.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Rehabilitation is recognised as important in helping stroke survivors achieve their highest levels of functional independence and best quality of life. Conversely, a lack of rehabilitation services, and other environmental barriers, can prevent the attainment of optimal levels of functioning and advanced outcomes, such as community integration and employment. Aim of the study: To determine if uninsured stroke survivors living in the Helderberg Basin (Western Cape) reached their optimal rehabilitation outcome levels and if not, what environmental barriers contributed to this. Methods: A descriptive study was conducted. Quantitative data was obtained from 53 participants, who were selected through proportional stratified random sampling. Demographic information and the health status of participants were recorded. Other instruments utilised were the Stroke Impact Scale (SIS3), Modified Barthel Index (MBI), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), language screening test and the ICF Core Set for Stroke (Environmental Factors). Outcome levels were categorised as described by Landrum, Schmidt and McLean, 1995. Data was subjected to statistical analysis. Qualitative data was obtained from five participants, who were chosen by means of purposive sampling. Data were analysed according to predetermined themes. Results: Six (11%) participants were classified as being on rehabilitation level 1; 21 (40%) on level 2; 16 (30%) on level 3; 8 (15%) on level 4; 2 (4%) on level 5. According to the MBI, 65% of participants required assistance with activities of daily living LOTCA scores showed that most difficulty was experienced with tests for visuomotor organization and thinking skills. Participants experienced varying degrees of difficulty with the speech and language test. A mean score of 50.84 for questions related to feelings on the SIS3 is indicative of underlying depression. Stroke survivors received limited physiotherapy and occupational therapy and even less speech therapy and dietary counselling. Occupational therapy had a significant impact on MBI (<0.01) and SIS3.6 (community mobility) (0.02) scores. Six (12%) reported assistance from a social worker. No psychological counselling was reported by any participant. A limited number of assistive devices, focussing mainly on mobility appliances had been issued. Participants regarded the most significant environmental barriers as being lack of assets (89%), transportation (88%) and general social support services, systems and policies (87%). Qualitative data showed a lack of counselling, education and training by health professionals regarding primary and secondary prevention of stroke and rehabilitation. Conclusion: Numerous environmental barriers impacted on the achievement of advanced rehabilitation outcomes. In addition to shortcomings in the primary and secondary prevention of stroke, many of the minimum standards for rehabilitation, as stipulated in the Western Cape Comprehensive Service Plan for the Implementation of Healthcare 2010, were not being met. Recommendations include establishing a designated stroke unit at Helderberg Hospital, ensuring transport, and improving the referral system to existing rehabilitation services. Increased input from core disciplines essential to stroke rehabilitation has the potential to improve outcomes. A concerted effort by health professionals is required in terms of counselling, education and training with regards to primary and secondary prevention of stroke and rehabilitation. / AFRIKAANSE OPSOMMING: Inleiding: Daar word algemeen aanvaar dat rehabilitasie na 'n beroerte uiters belangrik is, want dit kan beroerte oorlewendes help om die hoogste moontlike vlak van onafhanklikheid te bereik. Daarenteen kan‘n gebrek aan rehabilitasiedienste en omgewingsstruikelblokke verhoed dat ‘n oorlewende weer sy volwaardige plek in die samelewing en werksplek inneem. Doel van die projek: Om vas te stel of beroerte oorlewendes, woonagtig in die Helderberg Kom (Weskaap), sonder mediese versekering, wel hulle hoogste vlak van funksionering bereik het, en indien nie, om vas te stel watter omgewingsstruikelblokke bydraende faktore was. Metode: ‘n Beskrywende studie is uitgevoer. Kwantitatiewe data is verkry van 53 deelnemers wat lukraak gekies is deur gestratifiseerde, ewekansige steekproefneming. Demografiese inligting en die gesondheidstatus van deelnemers is aangeteken. Ander toetse wat gebruik is, is die Stroke Impak Skaal (SIS3), Gewysigde Barthel Indeks, Loewenstein Arbeidsterapie Kognitiewe Bepaling (LOTCA), taalsiftingstoets en die ICF kern stel vir beroerte (omgewingsfaktore). Uitkomsvlakke was bepaal, soos beskryf deur Landrum, Schmidt en McClean, 1995. Die data is statisties geanaliseer. Kwalitatiewe data was verkry van vyf deelnemers wat deur middel van doelgerigte steekproeftrekking gekies is. Tydens data analise is voorafbepaalde temas geidentifiseer. Resultate: Ses (11%) deelnemers was geklassifiseer as op rehabilitasie vlak 1; 21 (40%) op vlak 2; 16 (30%) op vlak 3; ag (15%) op vlak 4; twee (4%) op vlak 5. Volgens die MBI het 65% van die deelnemers bystand nodig vir daaglikse aktiwiteite. LOTCA uitslae toon dat die grootste probleme ondervind is met toetse vir visumotoriese organisasie en denkvermoëns. Deelnemers het verskillende grade van probleme ondervind met die spraak en taaltoets. ‘n Gemiddelde telling van 50.84 vir vrae met betrekking tot gevoelens in die SIS3, mag aanduidend wees van onderliggende depressie. Beroerte oorlewendes het min fisioterapie en arbeidsterapie ontvang en nog minder spraakterapie en raad van dieetkundiges. Arbeidsterapie insette het 'n beduidende impak op MBI telling (<0.01) en SIS3.6 (mobiliteit in die gemeenskap) (0.02) gehad. Ses (12%) het aangedui dat hulle hulp van maatskaplike werkers ontvang het. Nie een van die deelnemers het sielkundige berading ontvang nie. Beperkte hoeveelhede en tipes hulpmiddels is uitgereik, en was meesal om mobiliteit te verbeter. Volgens deelnemers was die grootste struikelblokke 'n gebrek aan bates (89%); vervoer (88%) en algemene sosiale ondersteuningsdienste, stelsels en beleid (87%). Kwalitatiewe data het 'n gebrek aan berading, onderrig en opleiding by gesondheidswerkers in terme van primêre en sekondêre voorkoming van beroerte en rehabilitasiedienste getoon.