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1.
Background
Living in close emotional and physical proximity to a person who has suffered a stroke may alter almost every aspect of daily living and will inevitably impact family life. Age seems to be a factor in the experiences of stroke sufferers’ close relatives after the stroke.Objectives
This study aimed to illuminate the experience of being a middle-aged close relative of a person who has suffered a stroke; 1 year after the stroke sufferer's discharge from a rehabilitation clinic.Participants
Nine middle-aged close relatives of persons with a confirmed diagnosis of a first-time stroke were consecutively included in the study and interviewed.Methods
The narrative interviews were audio-taped, transcribed verbatim and analyzed using a thematic content analysis. The study was part of a longitudinal study.Results
Four themes emerged from the data, intertwined and in conflict with one another. A turning point was reached, and the inevitability of an altered future became self-evident, so much so that the middle-aged close relatives felt forced to accept and become reconciled to a changed way of living, even if feelings of grief from loss were still present. The middle-aged close relatives’ process of coming to awareness and recognition of their own needs was part of a complex interplay of emotions, in which they learned to leave feelings of shame and guilt behind. They experienced movement from self-denial to self-recognition in their search for their own well-being and the recovery of their strength for a functioning family life. Even if they experienced a greater sense of freedom, they still face living life within limits. A significant challenge appears to be the effects of the personality changes among the person with a stroke, and the resulting sense of being an outsider. Relatives struggled with health care providers for visibility and confirmation. Their experiences were ones of standing alone, outside a closing door to the rehabilitation. Their ability to work, the benefits of functioning home care, and support from their family helped them through these challenges.Conclusion
This study highlights the middle-aged relatives’ realization that they will live an inevitability altered future. Individually, the stroke sufferer's relatives need support in their relationships within the family for emotional confirmation and to help them recognize and verbalize their needs without feeling guilt; gaining these supportive factors may help the relatives to recover their sense of well-being and give strength for a future, properly functioning family life. 相似文献2.
Background
Women with coronary artery disease (CAD) have reported worse health-related quality of life (HRQOL) than men.Objectives
The purpose of this study was to explore HRQOL in women with CAD undergoing coronary angiography. Specifically, the effects of age and depressive symptoms on HRQOL were examined.Method
Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. A total of 1034 women underwent coronary angiography between February, 2004 and January, 2005. Questionnaires measuring HRQOL and depressive symptoms were mailed within 1 week of index cardiac catheterization.Results
There were 437 women (42.3%) who responded to the questionnaires. After adjusting HRQOL scores for sociodemographic and clinical variables, depressive symptoms were the strongest predictor of HRQOL; increased age was associated with worse physical functioning and positive disease perception; higher BMI with anginal stability; revascularization with anginal stability and treatment satisfaction.Conclusion
Overall, the variables measured accounted for a small proportion of the variance in HRQOL. Further research is needed to understand the complex relationship among age, depressive symptoms, and HRQOL in women with CAD. 相似文献3.
Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.
Objective
To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.Design
Cross-sectional study.Setting
Motor performance laboratory.Participants
Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.Interventions
Not applicable.Main Outcome Measures
Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.Results
Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.Conclusions
Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements. 相似文献4.
Yavuzer G Selles R Sezer N Sütbeyaz S Bussmann JB Köseoğlu F Atay MB Stam HJ 《Archives of physical medicine and rehabilitation》2008,89(3):393-398
Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseo?lu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial.
Objective
To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke.Design
Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months.Setting
Rehabilitation education and research hospital.Participants
A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke.Interventions
Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks.Main Outcome Measures
The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument).Results
The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS.Conclusions
In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity. 相似文献5.
Jeffrey S. Kreutzer Lisa J. Rapport Jennifer H. Marwitz Cynthia Harrison-Felix Tessa Hart Mel Glenn Flora Hammond 《Archives of physical medicine and rehabilitation》2009,90(6):939-946
Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. Caregivers' well-being after traumatic brain injury: a multicenter prospective investigation.
Objective
To describe frequency and magnitude of caregivers' emotional distress and life satisfaction using standardized assessment procedures; compare distress levels among spouses, parents, and other caregivers; and identify risk factors.Design
Prospective collaborative cohort study.Setting
Six Traumatic Brain Injury Model System Centers providing neurotrauma care, rehabilitation, and outpatient follow-up.Participants
Caregivers (N=273) of patients who were 1, 2, or 5 years postinjury.Interventions
Acute neurotrauma care, inpatient interdisciplinary brain injury rehabilitation, and postacute services.Main Outcome Measure
Brief Symptom Inventory-18 Depression, Anxiety, and Somatic dimensions.Results
Levels of Depression, Anxiety, and Somatic symptoms were equally prevalent, with 1 in 5 caregivers scoring above the cutoff in each area. The proportion of participants with 1, 2, and 3 elevations was 17.9%, 5.5%, and 10.6%, respectively. Conversely, approximately two thirds (65.9%) had no scores exceeding cutoffs. Distress levels among spouses, parents, and other caregivers were comparable. Higher caregiver distress was associated with caring for survivors who had worse functional status, received more supervision, were less satisfied with life, and used alcohol excessively.Conclusions
Depression, Anxiety, and Somatic symptoms are common among caregivers. Findings substantiate the importance of clinical care systems addressing the needs of caregivers in the long term as well as survivors. 相似文献6.
Tang WK Lau CG Mok V Ungvari GS Wong KS 《Archives of physical medicine and rehabilitation》2011,(9):1462-1467
Tang W-K, Lau CG, Mok V, Ungvari GS, Wong K-S. Burden of Chinese stroke family caregivers: the Hong Kong experience.
Objective
To ascertain the clinical and sociodemographic factors associated with family caregivers' burden in Chinese patients with stroke in Hong Kong.Design
Cross-sectional design.Setting
Stroke Clinic.Participants
Patients (N=123) from a stroke clinic and their family caregivers.Interventions
Not applicable.Main Outcome Measures
Predictive factors of family caregivers' burden in Chinese stroke patients in Hong Kong. Caregivers' burden was assessed with the Caregiving Burden Scale (CBS). Patients' and caregivers' sociodemographic data and clinical characteristics were recorded. Physical and psychological conditions were measured and rated with the following instruments: Cumulative Illness Rating Scale, Geriatric Depression Scale (GDS), Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Lubben Social Network Scale, Modified Life Event Scale (MLES), Hospital Anxiety and Depression Scale (HADS), and a single question about fatigue.Results
In the univariate analysis, the CBS score had significant correlations with certain characteristics of caregivers (sex, GDS, HADS, depressive symptoms, fatigue, and MLES) and those of patients' (sex, age, education, GDS). Regression analysis revealed that caregivers' GDS and patients' education were the independent correlates of the CBS.Conclusions
The severity of depressive symptoms in Chinese stroke caregivers and patients' education are independent factors associated with the caregivers' burden. Further studies evaluating interventions on caregivers' burden should include the assessment and management of mood disorders. 相似文献7.
Helene L. Soberg Erik Bautz-Holter Olav Roise Arnstein Finset 《Archives of physical medicine and rehabilitation》2010,91(3):481-488
Soberg HL, Bautz-Holter E, Roise O, Finset A. Mental health and posttraumatic stress symptoms 2 years after severe multiple trauma: self-reported disability and psychosocial functioning.
Objectives
To describe mental health and posttraumatic stress symptoms (PTSS) for patients with severe multiple trauma at 2 years postinjury. Further, objectives were to examine relationships between PTSS and factors related to the person, injury, and postinjury physical and psychosocial functioning from the time of return home to 2 years after injury. The final aim was to identify predictors of PTSS and mental health at 2 years.Design
Prospective cohort study with a 2-year follow-up.Setting
Hospital and community setting.Participants
Patients (N=99) age 18 to 67 years with multiple trauma and a New Injury Severity Score (NISS) greater than 15 treated at a regional trauma referral center. Mean age ± SD was 35.3±14.2 years; 83% were men. Mean NISS ± SD was 34.9±12.7.Intervention
Not applicable.Main Outcome Measures
Postinjury psychologic distress associated with depression on the Medical Outcomes Study 36-Item Short-Form Health Survey Mental Health scale and PTSS on the Post-Traumatic Symptom Scale 10 (PTSS-10) at 2 years post injury. Self-reported physical, mental, and cognitive functioning at the return home and 1 and 2 years, and coping strategies.Results
Mean PTSS-10 score ± SD at 2 years was 25.6±12.2. Twenty percent had a PTSS-High score, indicating posttraumatic stress disorder (PTSD). Twenty-seven percent had Mental Health scores indicating depression. Predictors of PTSS were sex (female), younger age, avoidant coping, pain, mental health, and cognitive functioning on the return home, which explained 70% of the variance in PTSS-10 score.Conclusions
Twenty percent had a PTSS-High score indicating PTSD at 2 years postinjury. The personal factors sex (female), younger age, and avoidant coping and the functional factors pain, mental health, and cognitive functioning predicted PTSS at 2 years. 相似文献8.
Lois E. Finch Johanne Higgins Sharon L. Wood-Dauphinee Nancy E. Mayo 《Archives of physical medicine and rehabilitation》2009,90(9):1584-1595
Finch LE, Higgins J, Wood-Dauphinee SL, Mayo NE. A measure of physical functioning to define stroke recovery at 3 months: preliminary results.
Objective
To develop a physical functioning measure through Rasch analysis conceptualized using the International Classification of Functioning, Disability and Health (ICF).Design
Observational cohort study.Setting
Acute-hospital and community-based study.Participants
Subjects (N=235) hospitalized with postacute stroke and reassessed in the community at 3-months (mean age, 71.6±12.9y).Interventions
None.Main Outcome Measures
Functional assessments 3 months poststroke included self-report and observational indices and tests commonly used to evaluate stroke survivors. Sociodemographic information was also collected. Rasch analysis assisted in combining the items across ICF components to develop the measure. Items were retained based on fit to the model and relationship to the construct; reliability and validity were assessed.Results
The best 44 items formed the Physical Functioning Measure at 3 months (F3m) measure of functioning evaluating limb movement, balance, activities of daily living, and participation. All Rasch model assumptions were met. Both item and person reliably (.96) indicated a stable hierarchy, while precision varied from .51 to 1.2 logits. Early evidence for construct validity is adequate.Conclusions
The F3m combines patient reported and observed ratings of performance items into a single measure quantifying functioning with good preliminary psychometric properties that with further testing can assist in directing and evaluating interventions and recovery. 相似文献9.
Beeta Y. Homaifar Lisa A. Brenner Peter M. Gutierrez Jeri F. Harwood Caitlin Thompson Christopher M. Filley James P. Kelly Lawrence E. Adler 《Archives of physical medicine and rehabilitation》2009,90(4):652-1785
Homaifar BY, Brenner LA, Gutierrez PM, Harwood JF, Thompson C, Filley CM, Kelly JP, Adler LE. Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury.
Objectives
Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives.Design
This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI.Setting
This study was completed at a Veterans Affairs (VA) Medical Center.Participants
Participants were veterans eligible to receive VA health care services.Interventions
Not applicable.Main Outcome Measures
Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV).Results
We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%).Conclusions
Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment. 相似文献10.
Samantha L. Backhaus Summer L. Ibarra MA Daniel Klyce MS Lance E. Trexler PhD James F. Malec PhD 《Archives of physical medicine and rehabilitation》2010,91(6):840-848
Backhaus SL, Ibarra SL, Klyce D, Trexler LE, Malec JF. Brain Injury Coping Skills Group: a preventative intervention for patients with brain injury and their caregivers.
Objective
To determine whether training in coping strategies will improve psychologic functioning and self-efficacy in survivors of brain injury (BI) and caregivers.Design
Randomized controlled pilot study with measurements at baseline, postintervention, and 3-month follow-up.Setting
Postacute rehabilitation clinic.Participants
Survivors of BI (n=20) and caregivers (n=20).Interventions
The Brain Injury Coping Skills Group is a 12-session, manualized, cognitive-behavioral treatment (CBT) group providing psychoeducation, support, and coping skills training. Effects of this preventative intervention were examined on emotional functioning and perceived self-efficacy (PSE).Main Outcome Measures
Brief Symptom Inventory-18 (BSI-18) and Brain Injury Coping Skills Questionnaire.Results
Analyses revealed that the Brain Injury Coping Skills group showed significantly improved PSE compared with the control group immediately posttreatment (F=14.16; P=.001) and maintained this over time. PSE assessed posttreatment predicted global distress at 3-month follow-up across groups (ρ=-.46). No differences between treatment and control groups were apparent on the BSI-18 posttreatment. However, the control group showed increased emotional distress at 3-month follow-up while the Brain Injury Coping Skills group remained stable over time.Conclusions
Few CBT studies have included survivors of BI and caregivers together in group treatment or included a control group. No prior studies have examined the role of PSE specifically. Prior intervention studies show inconsistent effects on emotional functioning, raising questions regarding the role of intervening variables. This study offers a new conceptualization that PSE may moderate longer-term emotional adjustment after brain injury. Results indicate that PSE is an important and modifiable factor in helping persons better adjust to BI. 相似文献11.
Josep Lluís Conde-Sala Josep Garre-Olmo Oriol Turró-Garriga Joan Vilalta-Franch Secundino López-Pousa 《International journal of nursing studies》2010,47(10):1262-1273
Background
Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences.Objectives
The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers.Design
Cross-sectional analytic study.Settings
All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain).Participants
Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers.Methods
The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers.Results
The results show greater burden among adult-child caregivers (p < .05), who experience more feelings of guilt (p < .001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p < .001). Living with the patient has a notable influence on burden among adult children (p < .001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p < .05) and progressively worse mental health (p < .01). However, the correlations between burden and mental health were strongest in daughters (p < .001).Conclusion
The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle. 相似文献12.
Maegan D. Sady Angelle M. Sander Allison N. Clark Mark Sherer Risa Nakase-Richardson James F. Malec 《Archives of physical medicine and rehabilitation》2010,91(10):1542-1550
Sady MD, Sander AM, Clark AN, Sherer M, Nakase-Richardson R, Malec JF. Relationship of preinjury caregiver and family functioning to community integration in adults with traumatic brain injury.
Objective
To investigate the relationship of preinjury caregiver and family functioning to community integration outcomes in persons with traumatic brain injury (TBI).Design
Inception cohort.Setting
Three TBI Model Systems inpatient rehabilitation facilities.Participants
Persons with TBI (N=141) and their caregivers admitted to inpatient rehabilitation and followed up at 1 to 2 years after injury.Interventions
Not applicable.Main Outcome Measures
Community Integration Questionnaire and the Social and Occupation scales of the Craig Handicap Assessment and Reporting Technique.Results
There were significant interactions of several preinjury caregiver and family variables with injury severity. For persons with complicated mild/moderate injury, better family functioning was associated with greater home integration, and less caregiver distress was associated with better social integration. For persons with severe injuries, greater caregiver perceived social support was associated with better outcomes in productivity and social integration.Conclusions
Preinjury caregiver and family characteristics interact with injury severity to affect outcomes in persons with injury. Research on outcomes should include measures of caregiver and family functioning. Early interventions targeted toward decreasing caregiver distress, increasing support, and improving family functioning may have a positive impact on later outcomes. 相似文献13.
Wai K. Tang Jin Y. Lu Yang K. Chen Vincent C. Mok Gabor S. Ungvari Ka S. Wong 《Archives of physical medicine and rehabilitation》2010,91(10):1511-1515
Tang WK, Lu JY, Chen YK, Mok VC, Ungvari GS, Wong KS. Is fatigue associated with short-term health-related quality of life in stroke?
Objective
To evaluate the relation between poststroke fatigue and short-term health-related quality of life (HRQOL) in Chinese patients with first or recurrent stroke.Design
Cross-sectional survey.Setting
Acute stroke unit of a general hospital.Participants
A total of 458 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.Interventions
Not applicable.Main Outcome Measures
HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at 3 months after the subjects' index stroke. Fatigue was evaluated by using the Fatigue Severity Scale (FSS). The correlation between the FSS and SF-36 scores was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, social support, global cognitive functions, neurologic deficits, and depressive symptoms.Results
Univariate analysis revealed that fatigue was a significant correlate of all SF-36 domain scores. The magnitude of correlation was highest for the vitality domain (r=−.605, Bonferroni corrected P<.05) and lowest for the physical functioning domain (r=−.202, Bonferroni corrected P<.05). Canonic correlation analysis indicated that FSS was strongly related to the HRQOL with a loading of −.678. Increasing fatigue was associated with a lower HRQOL. The association between FSS and HRQOL remained significant in the subsequent multivariate regression analysis, having adjusted for possible confounders.Conclusions
These findings suggest that fatigue has an impact on short-term HRQOL in Chinese stroke patients. The early identification and treatment of fatigue may improve HRQOL of stroke patients. 相似文献14.
William D. Hula Patrick J. Doyle Shannon N. Austermann Hula 《Archives of physical medicine and rehabilitation》2010,91(3):400-259
Hula WD, Doyle PJ, Austermann Hula SN. Patient-reported cognitive and communicative functioning: 1 construct or 2?
Objectives
To examine the dimensionality of scales for measuring patient-reported cognitive and communicative functioning in a sample of stroke survivors and to evaluate the consequences for measurement of treating them as a single, undifferentiated construct.Design
Secondary analysis of existing cross-sectional data.Setting
Data were collected in outpatient rehabilitation clinics and in the community.Participants
Unilateral stroke survivors (N=316) 3 months or more postonset referred for participation in research.Interventions
Not applicable.Main Outcome Measures
The Burden of Stroke Scale cognition and communication domain scales were evaluated by using confirmatory factor analysis, Rasch analysis, and tests of differential item functioning (DIF). To evaluate the impact of multidimensionality on the measurement of individual patients, separately estimated cognition and communication scores were compared. Combined and separately estimated scores were also examined for responsiveness to group differences in the presence of cognitive and communicative impairment.Results
Factor analysis and Rasch model fit analyses equivocally supported the unidimensionality of the item pool. DIF analyses between participants with right versus left hemisphere stroke suggested multidimensionality. Scaling cognition and communication items separately resulted in different person scores for a significant number of patients and greater responsiveness to group differences.Conclusions
Patient-reported scales assessing communication along with more general cognitive activities may possess an internal structure that is inconsistent with a unidimensional measurement model with potential negative consequences for measurement. 相似文献15.
Anita D. Mountain R. Lee Kirby Gail A. Eskes Cher Smith Hilary Duncan Donald A. MacLeod Kara Thompson 《Archives of physical medicine and rehabilitation》2010,91(4):596-601
Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study.
Objectives
Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills.Design
Prospective, uncontrolled pilot study using within-participant comparisons.Setting
Rehabilitation center.Participants
Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke.Interventions
Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2).Main Outcome Measures
Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P).Results
The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining (P=.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events.Conclusions
Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training. 相似文献16.
17.
Fan Gao Thomas H. Grant Elliot J. Roth Li-Qun Zhang 《Archives of physical medicine and rehabilitation》2009,90(5):819-2500
Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.
Objectives
To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.Design
To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.Setting
Research laboratory in a rehabilitation hospital.Participants
Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).Interventions
Not applicable.Main Outcome Measurements
At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.Results
At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).Conclusions
This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation. 相似文献18.
White JH Magin P Attia J Pollack MR Sturm J Levi CR 《Archives of physical medicine and rehabilitation》2008,89(9):1701-1707
White JH, Magin P, Attia J, Pollack MR, Sturm J, Levi CR. Exploring poststroke mood changes in community-dwelling stroke survivors: a qualitative study.
Objective
To explore the long-term experience of mood changes in community-dwelling stroke survivors at 1, 3, and 5 years after stroke.Design
A qualitative study using a modified grounded theory approach. The primary data collection method was semi-structured interviewing.Setting
Community-dwelling stroke survivors in metropolitan Newcastle, NSW, Australia.Participants
Twelve community-dwelling stroke survivors (6 men, 6 women; age range 43−92y; 4 participants from each cohort) discharged from a tertiary referral hospital.Interventions
Not applicable.Main Outcome Measures
Qualitative outcomes were participants' perceptions using in-depth, semi-structured interviews with participants from 3 community-based cohorts of stroke survivors at 1, 3, and 5 years poststroke.Results
Four main categories of mood change were described by participants including feelings of frustration, reduced self-efficacy, dependency, and loss. Factors that modulated these mood changes included the presence or absence of insight, hope for the future, faith, and support. A modified grounded theory approach was used for data analysis using a process of constant comparison.Conclusions
Mood changes continued well beyond discharge and in some cases commenced after discharge in this sample of stroke survivors. Use of qualitative methodology extends our understanding of the extent and nature of low mood after stroke. There is a need for enhanced services to monitor and address low mood. 相似文献19.
Jansen AP van Hout HP Nijpels G Rijmen F Dröes RM Pot AM Schellevis FG Stalman WA van Marwijk HW 《International journal of nursing studies》2011,48(8):933-943
Background
It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers. However, diagnosing dementia often occurs late in the disease. This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care.Objectives
To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers.Design
Randomized controlled trial with measurements at baseline and after 6 and 12 months.Setting
Primary care in West-Friesland, the Netherlands.Participants
99 pairs of community-dwelling older adults with dementia symptoms (defined as abnormal screening for symptoms of dementia) and their primary informal caregivers.Intervention
12 months of case management by district nurses for both older adults and informal caregivers versus usual care.Measurements
Primary outcome: informal caregiver's sense of competence. Secondary outcomes: caregiver's quality of life, depressive symptoms, and burden, and patient's quality of life. Process measurements: intervention fidelity and caregiver's satisfaction with the quality of case management.Results
Linear mixed model analyses showed no statistically significant and clinically relevant differences over time between the two groups. The process evaluation revealed that intervention fidelity could have been better. Meanwhile, informal caregivers were satisfied with the quality of case management.Conclusion
This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers. One possible explanation is that case management, which has been recommended among diagnosed dementia patients, may not be beneficial if offered too early. However, on the other hand, it is possible that: (1) case management will be effective in this group if more fully implemented and adapted or aimed at informal caregivers who experience more severe distress and problems; (2) case management is beneficial but that it is not seen in the timeframe studied; (3) case management might have undetected small benefits. This has to be established.Trial registration ISCRTN83135728. 相似文献20.
Elizabeth R. Skidmore Ellen M. Whyte Margo B. Holm James T. Becker Meryl A. Butters Mary Amanda Dew Michael C. Munin Eric J. Lenze 《Archives of physical medicine and rehabilitation》2010,91(2):203-207
Skidmore ER, Whyte EM, Holm MB, Becker JT, Butters MA, Dew MA, Munin MC, Lenze EJ. Cognitive and affective predictors of rehabilitation participation after stroke.