脑卒中患者亲属对脑卒中康复知识知晓情况的调查

目的了解脑卒中患者亲属对脑卒中康复知识的知晓情况。方法采用方便抽样法对2015年2月至2016年2月脑卒中住院患者亲属850例进行问卷调查。统计实际调查人数、康复知识获取途径、脑卒中康复知识的知晓情况。结果实际接受调查者共822例,587例亲属(71.41%)表示有康复知识的获取途径,且大多数信息是从医务人员宣教中获得(64.05%),其他渠道不足50.00%。脑卒中早期症状、脑卒中危险因素和脑卒中康复功能锻炼知晓率分别是27.35%~62.17%、25.91%~66.42%和23.84%~62.41%。脑卒中康复知识的知晓程度与患者亲属的年龄、学历、职业相关,但亲属性别以及与患者的关系对脑卒中康复知识的知晓程度影响不明显。结论脑卒中患者亲属对脑卒中康复知识的知晓程度总体偏低,缺乏对脑卒中危险因素、早期症状和康复功能锻炼知识的掌握,医务工作者要针对重点亲属人群进行宣传教育。     

Team functioning and patient outcomes in stroke rehabilitation

OBJECTIVE: To evaluate the relationship between rehabilitation team functioning and stroke patient outcomes. DESIGN: Prospective observational study. SETTING: Veterans Administration (VA) inpatient and subacute rehabilitation units. PARTICIPANTS: Forty-six VA rehabilitation teams, including 530 rehabilitation team members from 6 disciplines (medicine, nursing, social work, physical therapy, occupational therapy, speech language pathology) and 1688 stroke patients treated by the teams. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ten scales assessing team member perceptions of team functioning (communication, perceived effectiveness, physician involvement, physician support, teamness, utility of quality information, innovation, interprofessional relationships, order and organization, task orientation) and 3 primary patient outcome variables-functional improvement, discharge home, and length of rehabilitation stay (LOS). RESULTS: Three of the 10 measures of team functioning were significantly associated with patient functional improvement ( P <.05): task orientation, order and organization, and utility of quality information. One measure of team functioning-effectiveness-was significantly associated with LOS ( P <.05). None of the team variables predicted discharge destination. Aspects of team functioning that were important to outcomes differed depending on the outcome of interests. Efforts directed toward improving team activities and relationships, including collaborative planning and problem solving and the use of feedback information, may enhance rehabilitation treatment effectiveness. CONCLUSIONS: Characteristics of team functioning predict selected rehabilitation outcomes.     

Friedman家庭评估模式在康复期脑卒中患者社区护理中的应用

目的探讨Friedman家庭评估模式在康复期脑卒中患者家庭康复中的应用效果。方法采用以家庭为基础的对照试验研究。将80例出院的脑卒中恢复期患者按出院先后顺序随机分为观察组和对照组,各40例。观察组采用Friedman家庭评估模式为指导的家庭康复护理干预。对照组采用常规的出院随访。结果观察组患者在运动功能、日常生活活动能力、生活质量方面均较对照组提高显著,差异有显著意义（P〈0．05）。结论应用Friedman家庭评估模式进行家庭护理干预可有效提高恢复期脑卒中患者的居家康复效果。     

脑卒中患者的家庭护理与康复指导

目的探讨脑卒中患者家庭护理和康复训练指导方法。方法对34例首次发生脑卒中的患者于出院后进行家庭护理方法的指导,实施肢体、语言功能训练及日常生活康复训练,分别采用Fugl-m eyer与Barthel评分方法评定患者的运动能力和日常生活能力。结果通过家庭护理和康复训练指导,提高了脑卒中患者的运动和日常生活功能评分。结论家庭护理和康复训练指导相结合,能够有效改善脑卒中患者的生存质量。     

Expectations of stroke patients and their relatives of rehabilitation

The expectations towards rehabilitation held by 45 stroke patients and their relatives were investigated. It was found that the expectations held by the relatives are more realistic and not quite as optimistic as those held by the patients. The patients above all hoped for physical-vocational restoration, the relatives on the other hand more for emotional-social recovery. Also dealt with are the expectations and notions of patients and relatives in respect of duration, location and material rank of rehabilitation. Pointed out are the difficulties to be reckoned with on account of the divergent expectancies of patients and relatives toward rehabilitation.     

脑卒中患者家属康复知识水平与患者康复效果的关系研究

目的了解脑卒中患者家属康复知识的掌握情况与患者康复训练效果的关系。方法将200名患者及家属随机分为对照组和宣教组,每组包括患者和家属各50人。对照组只进行常规治疗和简单的康复说明;宣教组除常规指导外,还逐个进行有针对性的康复知识宣教及具体的康复训练指导,强调家属的积极参与作用。对比分析干预前后两组患者肢体功能改善情况和对应患者家属康复知识的掌握情况,并分析患者肢体功能改善情况及患者家属康复知识掌握的相关性。结果宣教组患者功能恢复情况好于对照组,尤其在上肢功能、下肢功能及平衡功能恢复方面,2组之间的差异有统计学意义（均P〈0.05）。脑卒中患者家属康复护理知识掌握情况与患者肢体功能的恢复情况之间存在正相关关系。结论对患者家属进行康复护理知识与技能宣教可促进患者功能恢复。     

Family functioning assessed by family members in Finnish families of heart patients.

BACKGROUND: The role of family is central to the wellbeing and health of individuals. Family attitudes, habits and routines affect the way individuals promote their health. Family functioning and family health are threatened when one family member develops heart disease. AIMS: The aim of the study was to describe family functioning and to ascertain factors related to family functioning of families with heart patient as assessed by family members. METHODS: Data collection was done using a questionnaire (FAFHES) in 2000. The sample consisted of 161 family members of patients receiving treatment on two medical wards. The data were analysed by means and tested by parametric and non-parametric tests. The multivariate method used was stepwise regression analysis. RESULTS: The better the family values were materialized and the greater the family's contribution to family health, the better the family's functioning is. Concrete aid was also related to family health. The more concrete aid the family received from nurses, the better family functioning is. When the background variables were included, values and activities remained in the model, but two new variables explained family functioning: family member's age and knowledge of health issues. The older the family member is and the better the knowledge in the family is, the better is family functioning. CONCLUSION: Family functioning of families with heart patients can be supported and developed by family nursing, e.g. concrete aid from nurses. Other aspects of support, e.g. consideration of family member's age and knowledge of health issues also need to be further considered and studied as the basis of care.     

A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers

Aims. To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan. Background. Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families. Design. A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers. Methods. The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver‐oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale. Results. Caregivers in the experimental group had significantly better nurse evaluation and self‐evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self‐evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs. Conclusions. This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge. Relevance to clinical practice. This caregiver‐oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers’ preparation and the satisfaction of their needs during the discharge transition.     

Inspiring hope in our rehabilitation patients, their families, and ourselves

When confronted with a devastating disability or chronic illness, rehabilitation nurses play a key role in inspiring hope for patients and their families. This article examines strategies nurses can implement in everyday practice: creating an environment of hope in a rehabilitation unit; assisting patients to manage their negative feelings about their disability; relieving chronic neuropathic pain; sustaining patient relationships with staff and family; helping patients to forgive themselves and others; enhancing patient intimacy with others; using literature to promote hope; acknowledging a patient's belief that nothing is impossible; using humor therapeutically; and maintaining hope for the moment. It is the moment-the time we spend with our patients-that is essential. In that moment, we are promoting hope.     

家庭康复对脑卒中患者运动功能的影响

目的探讨家庭康复治疗对脑卒中患者运动功能的影响。方法为 10 6例脑卒中患者提供社区指导性家庭康复治疗并观察疗效。结果家庭康复治疗对 10 6例脑卒中患者均有效 ,且开始治疗时间越早 ,效果越好。结论家庭康复治疗在脑卒中患者的治疗中具有重要作用     

亚急性脑卒中患者康复过程中优势与非优势脑半球功能变化差异

目的 基于功能性近红外光谱技术探讨亚急性脑卒中患者康复过程中优势与非优势大脑半球功能变化的差异。方法 2019年9月至2020年6月,北京博爱医院亚急性脑卒中住院患者26例,其中左侧偏瘫患者10例(非优势半球组),右侧偏瘫患者16例(优势半球组),均行相同的单侧上肢任务导向作业治疗,共4周。训练前后,采用上肢动作研究量表、Fugl-Meyer评定量表上肢部分和握力进行评定,采用功能近红外光谱氧合血红蛋白浓度计算双侧感觉运动皮质、运动前皮质、前额叶皮质的平均β值。结果 治疗后,两组各项临床评定均改善(|t|> 3.253, P <0.05)。优势半球组上肢动作研究量表评分和握力改善程度大于非优势半球组(|t|> 2.154, P <0.05)。时间、脑区、组别主效应均不显著(F <0.542, P> 0.05),脑区与组别交互效应显著(F=4.226, P <0.01)。优势半球组,病灶同侧运动前皮质β值大于病灶对侧(P=0.030),对侧前额叶皮质β值低于同侧感觉运动皮质β值(P=0.024)、同侧运动前皮质(P=0.003)和同侧前额叶皮质β...     

Postdischarge nursing interventions for stroke survivors and their families

BACKGROUND: The physical, cognitive, and emotional sequelae of stroke underscore the need for nursing interventions across the continuum of care. Although there are several published studies evaluating community interventions for stroke survivors, the nursing role has not been clearly articulated. AIM: The aim of this paper is to report a study to describe, using a standardized classification system, the nursing interventions used with stroke survivors during the initial 6 weeks following discharge home. METHODS: In the context of a randomized controlled trial, two nurse case managers provided care to 90 community-dwelling stroke survivors who were assigned to the intervention arm of the trial. The nursing documentation was analysed, using the Nursing Intervention Classification (NIC) system, to identify and quantify the interventions that were provided. FINDINGS: Stroke survivors received, on average, six different interventions. There was a trend for those who were older, more impaired, and who lived alone to receive more interventions. The most commonly reported interventions included those directed towards ensuring continuity of care between acute and community care, family care, and modifying stroke risk factors. The study was limited to the nursing documentation, which may represent an underestimation of the care delivered. CONCLUSIONS: The NIC system was useful in capturing the interventions delivered by the nurse case managers. Nursing interventions are often not clearly articulated and less often use standardized terminology. Describing nursing activities in a standard manner will contribute to an increase in nursing knowledge and to evidence-based practice.     

Social functioning assessment in stroke patients

The influence of depression, intellectual function, and physical impairment on patient reports of social functioning was assessed by comparing responses obtained from 30 stroke patients with those obtained from an outside informant who knew the patient well. There was relatively good agreement between patient and other for both the overall score on the Social Functioning Examination (SFE) and individual items related to specific aspects of social functioning. Differences between scores obtained from a patient and outside informant were not significantly related to either depression, moderate degrees of intellectual impairment, relative closeness of patient and informant or to degree of physical impairment. These data suggest that valid SF assessments can be made either by a stroke patient who is capable of being interviewed or by a familiar outside informant. In addition, the prognostic utility of the SFE was examined by interviewing 50 patients during the acute stroke period and following them over six months. Social functioning in-hospital scores were not found significantly related to 6-month scores for either depression, intellectual impairment, or physical impairment, but depression and in-hospital impairment significantly predicted social functioning at 6-month follow-up. These data suggest that the most impaired stroke patients are the most likely to undergo social deterioration during the post-stroke period and may require the greatest amount of social intervention. Whether treatment of these variables significantly affects 6-month outcome remains an intriguing question for further study.     

Psychosocial functioning of hospitalized Chinese adolescents and their families

The purpose of this study was to describe behavioral and emotional problems, social competence, and family functioning of hospitalized Chinese adolescents and to compare their psychosocial functioning with normative samples of Chinese adolescents and their families. A convenience sample of 103 hospitalized adolescent patients and their families participated. Families came from geographical areas in the Chinese Mainland (5 hospitals) and Hong Kong (2 hospitals). Parents completed a Chinese version of the Child Behavior Checklist for ages 4 to 18 years and the Family Assessment Device. Adolescents responded to a Chinese version of the Youth Self-Report. Youth in the Chinese Mainland and Hong Kong appear to be quite similar in many domains of behavioral functioning. Hospitalized adolescents in Hong Kong and the Chinese Mainland exhibited behavioral and emotional profiles that were qualitatively similar to the norms reported in community samples of Chinese and Chinese-American adolescents, albeit significantly lower than their healthy counterparts. This study examined, for the first time, the psychosocial functioning of hospitalized Chinese adolescents and their families. Our findings contribute to the cultural relevance of measuring adolescent and family responses to a known stressor and are useful for international comparisons by health care providers and researchers.     

抑郁症患者家属社会支持与家庭功能的相关性研究

目的 探讨抑郁症患者家属的社会支持与家庭功能的相关性,为临床干预提供依据.方法 采用家庭功能量表和社会支持量表对60名抑郁症患者家属(研究组)及60名健康志愿者(对照组)的社会支持和家庭功能状况进行调查分析.结果 研究组家庭功能量表评分,除情感卷入维度外,其他维度评分均在不健康家庭功能的范围之内;对照组除行为控制维度外,其他维度评分及总体功能评分均在正常家庭功能范围内.研究组家庭功能量表总体功能及问题解决、交流、角色、情感反应、行为控制维度分和社会支持量表总分均显著高于对照组(P＜0.01).研究组社会支持与家庭功能量表的问题解决、交流、角色、情感反应、行为控制和总体功能呈显著正相关(P＜0.05或0.01).结论 抑郁症患者家属体验到社会支持程度较低,家庭功能有缺陷,良好的社会支持有助于帮助患者家属恢复家庭功能.     

Virtual reality-augmented rehabilitation for patients following stroke

BACKGROUND AND PURPOSE: Recent evidence indicates that intensive massed practice may be necessary to modify neural organization and effect recovery of motor skills in patients following stroke. Virtual reality (VR) technology has the capability of creating an interactive, motivating environment in which practice intensity and feedback can be manipulated to create individualized treatments to retrain movement. CASE DESCRIPTION: Three patients (ML, LE, and DK), who were in the chronic phase following stroke, participated in a 2-week training program (3 1/2 hours a day) including dexterity tasks on real objects and VR exercises. The VR simulations were targeted for range of motion, movement speed, fractionation, and force production. OUTCOMES: ML's function was the most impaired at the beginning of the intervention, but showed improvement in the thumb and fingers in range of motion and speed of movement. LE improved in fractionation and range of motion of his thumb and fingers. DK made the greatest gains, showing improvement in range of motion and strength of the thumb, velocity of the thumb and fingers, and fractionation. Two of the 3 patients improved on the Jebsen Test of Hand Function. DISCUSSION: The outcomes suggest that VR may be useful to augment rehabilitation of the upper limb in patients in the chronic phase following stroke.     

A home rehabilitation program for stroke patients

The purpose of this study was to develop a rehabilitation program wherein the stroke team, patient and family act as partners in the rehabilitation process initially at hospital and subsequently on discharge for 4 weeks in the stroke patient's home. The study attempted to address the stroke patient's functional ability and life satisfaction from a holistic viewpoint. A quasi-experimental design was used. Thirty-two stroke patients participated in the intervention group and nine in the control group. The intervention group improved in functional ability after 4 weeks at home. They also participated in activities and were generally more active than the control group. Ninety percent of the families in the intervention group experienced high life satisfaction levels after the training period. However this satisfaction decreased after 6 months, and one year post-stroke, the patient and family's life satisfaction levels increased once more. It is likely that being given the opportunity to make one's own decisions, to be more active and motivated led to improvements in patients' daily life functions as they were able to carry out their preferred activities in the comfort of their own home. The program shortened the admission time for the intervention group by one-third.     

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients'physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.