The effectiveness of home-based individual tele-care intervention for stroke caregivers in South Korea

KIM S.S., KIM E.J., CHEON J.Y., CHUNG S.K., MOON S. & MOON K.H. (2011) The effectiveness of home‐based individual tele‐care intervention for stroke caregivers in South Korea. International Nursing Review 59 , 369–375 Purpose: The purpose of this study was to develop effective intervention programmes that can reduce family caregiver burden as they provide care to stroke patients so that family caregivers can adapt to and deal with the new circumstances from the early stages of stroke. We also intended to verify the effectiveness of the developed programme. Methods: This study employed a quasi‐experimental design with a repeated‐measures analysis. We included five hospitals specialized in stroke care in Seoul Metropolitan areas. Seventy‐three patients from these hospitals agreed to participate in this study. Results: The score of family caregiver burden decreased by 8.07 (±18.67) in the experimental group and increased by 1.65 (±7.47) in the control group, which was a significant difference (t = 2.257, P = 0.027) between pre‐ and post‐intervention. The family caregiver burden of experimental group was significantly lower than the control group (F = 3.649, P = 0.033). Conclusions: The home‐based individual tele‐care intervention, in addition to the hospital‐based group programme, was cost‐effective and supportive in reducing family caregivers' burden by providing relevant information for their needs in timely manner.     

Neurobiological aspects of recovery from aphasia in stroke

The rate, duration and the predictability of natural recovery, the effect of therapy, and major contributory factors are reviewed, with special emphasis on aphasia. The most likely mechanism of second-stage recovery is physiological and functional substitution by connected areas in the brain. Recovery from aphasia shows a predictable time course. Aphasia type overlaps severity to a great extent and language components depend on the test method and patient selection. Comprehension probably recovers better than other modalities. The pattern of evolution of aphasic syndromes and an overall prognostic guide are presented.     

Clinical effectiveness of dramatherapy in the recovery from neuro-trauma

Purpose: To investigate the clinical effectiveness of a short course of dramatherapy (an eclectic term encompassing all the arts therapies), delivered in a one-to-one interaction, in a sample of 10 patients in a neuro-rehabilitation unit. Method: Each participant received five individual one-to-one sessions of therapy over a 5 week period. A semi-structured interview was carried out with each participant following the course. Results: Qualitative analysis of the taped interviews elicited how the therapy contrasted and complemented the rest of the rehabilitation setting and therapies and how it helped psychological adjustment to severe disabilities resulting from neurotrauma. There were four ways in which it appeared to empower the participants and nurture their self esteem. It provided them with a sense of personal space in an otherwise institutional setting; it allowed escapism and enjoyment; it awakened creativity and a sense of potency; and it provided a metaphor to explore personal issues. Conclusion: Dramatherapy made an important contribution to the healthy adjustment of some patients both to hospital life and to acquired disability. The reports from the patients indicated that this approach to rehabilitation should be further incorporated and developed in neuro-rehabilitation.     

Clinical effectiveness of dramatherapy in the recovery from neuro-trauma

Purpose: To investigate the clinical effectiveness of a short course of dramatherapy (an eclectic term encompassing all the arts therapies), delivered in a one-to-one interaction, in a sample of 10 patients in a neuro-rehabilitation unit. Method: Each participant received five individual one-to-one sessions of therapy over a 5 week period. A semi-structured interview was carried out with each participant following the course. Results: Qualitative analysis of the taped interviews elicited how the therapy contrasted and complemented the rest of the rehabilitation setting and therapies and how it helped psychological adjustment to severe disabilities resulting from neurotrauma. There were four ways in which it appeared to empower the participants and nurture their self esteem. It provided them with a sense of personal space in an otherwise institutional setting; it allowed escapism and enjoyment; it awakened creativity and a sense of potency; and it provided a metaphor to explore personal issues. Conclusion: Dramatherapy made an important contribution to the healthy adjustment of some patients both to hospital life and to acquired disability. The reports from the patients indicated that this approach to rehabilitation should be further incorporated and developed in neuro-rehabilitation.     

Somatosensory evoked response and recovery from stroke

The purpose of this study was to evaluate median nerve short latency somatosensory evoked potentials (SEP) as prognostic indicators of functional outcome after right cerebral infarction. Twenty-six patients with right cerebral infarction were admitted to a rehabilitation unit and were classified into three groups based on the evoked potentials measured on admission. The SEP classification and nine other variables reported to predict recovery after stroke were evaluated for prediction of the final outcome measure, the Barthel Scale, using stepwise multiple regression analysis. Patients with normal SEP achieved a mean Barthel score of 95 +/- 3.9 SD, while patients with an amplitude asymmetry on SEP showed a mean Barthel score of 77.5 +/- 17.5 SD. The group with absence of cortical potentials had a mean Barthel score of 59.5 +/- 21.3 SD. Six predictors (Barthel admission score, SEP, electroencephalogram, Brunnstrom staging of the arm at the time of admission, joint position sense, and hemihypesthesia) were highly correlated with the Barthel outcome score (p less than 0.05 for all). The linear regression equation with three predictors (Barthel admission score, SEP, and homonymous hemianopsia) provided the best prediction of Barthel outcome score (p = 0.005). These data indicate that the Barthel admission score is the best predictor of functional level after stroke rehabilitation. Knowledge of the median SEP and homonymous hemianopsia improve this prediction.     

Promoting psychosocial well-being following a stroke: developing a theoretically and empirically sound complex intervention

BackgroundThe psychosocial consequences of stroke are complex and comprehensive and include substantial and longlasting impacts on mood, identity, social relationships, return to work and quality of life. Many studies have explored possible interventions to prevent or treat psychosocial problems, but the results have generally been disappointing. Very few studies have provided adequate theoretical accounts of the mechanisms assumed to contribute to positive outcomes.ObjectivesTo describe the development of a psychosocial nursing intervention aimed at promoting psychosocial health and well-being and to stimulate dialogue about how to develop and report theoretically and empirically sound complex interventions in nursing.DesignA systematic, stepwise approach was used, consistent with the framework recommended for developing and evaluating complex interventions by the UK Medical Research Council.Data sourcesSystematic reviews of empirical studies regarding the psychosocial consequences and needs of patients following stroke; qualitative, experiential studies of stroke and stroke recovery; theories of psychosocial well-being, coping, life skills, narrative approaches to rehabilitation and guided self-determination.Review methodsEach systematic review was examined to determine the major psychosocial challenges and needs experienced by stroke survivors, focusing on how these challenges and needs developed over the illness trajectory, how previous interventions had sought to address them and the effective mechanisms assumed to affect the level of success of interventions. Qualitative studies were examined to reveal the subjective experiences of stroke and stroke recovery, paying particular attention to the development of needs across time and context. A qualitative synthesis of the major characteristics of the trajectory of stroke rehabilitation and recovery during the first year was developed. Theories were examined to illuminate possible effective mechanisms and actions aimed at promoting psychosocial well-being during the stroke recovery process.ResultsA dialogue-based intervention comprising eight encounters between stroke survivors and trained health care workers was designed, based on narrative theories, empowerment philosophy and guided self determination. Worksheets and a guiding topical outline were developed to support the dialogue.ConclusionsThe UK Medical Research Council framework facilitated the systematic development of an empirically and theoretically informed complex nursing intervention aimed at promoting post-stroke psychosocial well-being.     

The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers

This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms. Computer workers with frequent or long-term neck and upper limb symptoms were randomised into the work style group (WS, n=152), work style and physical activity group (WSPA, n=156), or usual care group (n=158). The WS and WSPA group attended six group meetings. All meetings focused on behavioural change with regard to body posture, workplace adjustment, breaks and coping with high work demands (WS and WSPA group) and physical activity (WSPA group). Pain, disability at work, days with symptoms and months without symptoms were measured at baseline and after 6 (T1) and 12 months (T2). Self-reported recovery was assessed at T1/T2. Both interventions were ineffective in improving recovery. The work style intervention but not the combined intervention was effective in reducing all pain measures. These effects were present in the neck/shoulder, not in the arm/wrist/hand. For the neck/shoulder, the work style intervention group also showed an increased recovery-rate. Total physical activity increased in all study groups but no differences between groups were observed. To conclude, a group-based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long-term. The combined intervention was ineffective in increasing total physical activity. Therefore we cannot draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms.     

脑塞通丸治疗中风恢复期有效性和安全性的临床研究

目的评价脑塞通丸治疗中风恢复期(中经络,气虚血瘀证)安全性和有效性。方法采用分层区组随机、双盲双模拟、阳性平行对照、多中心试验设计方法。将符合中风恢复期(中经络,气虚血瘀证)诊断标准的受试者按3∶1比例随机分为试验组和对照组,试验组服用脑塞通丸,对照组服用偏瘫复原丸,疗程为8周。以美国国立卫生研究院脑卒中量表(NIHSS)评分、中医证候积分为主要指标,以日常生活活动能力量表(Barthel)指数评分、中医证候单项疗效为次要指标,并对其安全性进行评价。结果与基线比较试验组和对照组治疗8周后NIHSS评分均降低,Barthel指数评分均升高,组内比较差异均有统计学意义;治疗8周后相对基线NIHSS评分变化值,组间比较差异有统计学意义,试验组优于对照组;治疗8周后相对基线Barthel指数评分变化值,组间比较差异无统计学意义。中医证候疗效两组比较,差异均有统计学意义,试验组总有效率为87.42%,对照组总有效率为73.58%,试验组优于对照组。试验组与对照组的不良事件发生率组间差异无统计学意义,两组均无严重不良事件发生。结论脑塞通丸治疗中风恢复期(中经络,气虚血瘀证)疗效确切,安全性好。     

护理干预对提高脑卒中恢复期患者生活质量的研究

目的：探讨护理干预对提高脑卒中患者恢复期生活质量的影响。方法：将150例脑卒中患者随机分为干预组和对照组各75例,采用日常生活能力量表（ADL）和生活质量量表（SF-12）对两组刚出院脑卒中恢复期患者进行测评,6个月后进行相同测评,并对比结果;另外统计出院6个月时患者的抑郁症焦虑症发生率和脑卒中的复发率,并对比结果。结果：干预组和对照组比较,出院时ADL、SF-12评分无统计学差异（P〉0.05）。进行护理干预后6个月再次比较两组评分,以及抑郁症焦虑症发生率和脑卒中的复发率,出现明显差异,具有显著统计学意义（P〈0.05）。结论：护理干预可显著提高脑卒中恢复期患者出院后生活质量,值得推广学习。     

脑卒中患者全程康复护理效果的比较

目的研究全程康复护理干预对脑卒中患者患侧肢体感觉运动功能和生活质量的影响。方法将80 例急性脑卒中患者随机分为实验组41人和对照组39人。实验组患者进行早期康复护理并持续至出院后3月,于入院时、出院时和出院后3月分别行患侧肢体感觉运动功能评估;于出院后1周和出院后3月行生活质量评定。结果康复组患者患肢运动功能(A部、B部、C部、D部、G部)明显提高,生活质量亦有明显提高,统计学检验有意义(P<0．05或P<0．01),而感觉功能、关节疼痛分值(E部、F部)经检验差异无显著意义(P>0．05)。结论全程康复护理干预可有效提高脑卒中患者患肢运动功能和生活质量。     

Neuroimaging experimental studies on brain plasticity in recovery from stroke

Topographical cortical organization of sensorimotor area has been shown to be highly plastic, altering his configuration in response to training in different tasks in healthy controls and neurological patients. The term 'brain plasticity' encompasses all possible mechanisms of neuronal reorganization: recruitment of pathways that are functionally homologous to, but anatomically distinct from, the damaged ones (eg, non-pyramidal corticospinal pathways), synaptogenesis, dendritic arborisation and reinforcement of existing but functionally silent synaptic connections (particularly at the periphery of core lesion). The study of neuroplasticity has clearly shown the ability of the developing brain--and of the adult and ageing brain--to be shaped by environmental inputs both under normal conditions (ie, learning) and after a lesion. Neuronal aggregates adjacent, or distant to a lesion in the sensorimotor area can progressively adopt the function of the injured area. Imaging studies indicate that recovery of motor function after a lesion (i.e. stroke) is associated with a progressive change of activation patterns in specific brain structures. Transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) can detect reshaping of sensorimotor areas; they have a high temporal resolution but have several limitations. TMS can only provide bidimensional scalp maps and MEG depicts three-dimensional spatial characteristics of virtual neural generators obtained by use of a mathematical model of the head and brain. However, the use of objective methods that assess brain reactivity to a physical stimulus (i.e., TMS) or to a sensory input (ie, electrical stimulation to hand and fingers) can integrate information from self-paced motor tasks, because the resolution of abnormal activation over time could be secondary to recovery. Functional MRI (fMRI) and positron emission tomography (PET), on their own, have insufficient time resolution to follow the hierarchical activation of relays within a neural network; however, because of their excellent spatial resolution, they can integrate the findings of TMS and MEG. An integrated approach constitutes, at present, the best way to assess the brain plasticity both under normal conditions and after a lesion.     

Brain plasticity in recovery from stroke: an MEG assessment

The aim of this paper was to deepen understanding about the role played by brain plasticity in obtaining clinical recovery. Eighteen patients, who had recovered partially or totally from dysfunctions due to a monohemispheric infarction within the middle cerebral artery territory, underwent magnetoencephalographic (MEG) recordings of rolandic areas cerebral activity both in rest state (spectral power properties) and in response to the electrical stimulation of the contralateral median nerve (M20 and M30 cortical sources). MEG evaluation was performed in acute (T0: mean 5 days from ischemic attach) and post-acute phase (T1: median 6 months). At T1, all the inter-hemispheric asymmetries were reduced for both spontaneous and evoked activity parameters with respect to T0. In post-acute phase, lower cortical excitability, higher delta and theta power and lower spectral entropy were associated to a worse clinical state. An unusual recruitment-as revealed by an excessive inter-hemispheric asymmetry of M20 cortical source position-correlated with higher level of clinical amelioration in the patients who showed a partial recovery. In addition to confirmative evidence that "normalization" of neural activity in both the affected and unaffected hemispheres subtends best clinical recovery, present data provide support to the positive role of cerebral plasticity phenomena--i.e. unusual neural recruitments--to regain lost functions in those patients unable to achieve total recovery.     

早期康复及针刺对急性脑卒中患者运动功能的影响

目的 观察早期康复和针刺治疗对急性脑卒中偏瘫患者运动功能的影响。方法 125例急性期脑卒中患者随机分为早期康复针刺治疗组（34组）,早期康复治疗组（39例）、单纯针刺治疗组（21例）、药物治疗对照组（31例）。应用Bobath疗法和针刺疗法治疗,以神经功能缺损评分（NFI）、简式Fugl-Meyer评分（FMA）、Barthel指数（MBI）、临床疗效和治疗效率作为观察疗效指标。结果 早期康复针刺组疗效明显优于单纯早期康复组、单纯早期针刺组和对照组。单纯早期康复组明显优于单纯早期针刺组和对照组,单纯早期针刺组明显优于对照组。结论 急性脑卒中早期介入康复治疗和针刺治疗,二种疗法相互结合应用,优于单一治疗,因此二者合用是促进脑卒中康复的有效方法。     

Disaster intervention: long-term psychosocial benefits in Armenia

This paper describes a unique situation in which disaster intervention following a massive earthquake led to significant, uninterrupted, psychosocial benefits to the entire country, and an intervention program that continues to evolve. The mental health program initially provided service to the victims, and then, training to local professionals during which personnel simultaneously conducted clinical research. Members of the mental health team made a life-long commitment to the country, and continue their activities to expand its impact on public health policy. The difficult history and life circumstances of the Armenian people provided the opportunity for disaster interventions to have extensive psychosocial benefits.     

脑卒中后抑郁早期干预对运动功能恢复和再发脑卒中的影响

目的:探讨脑卒中后抑郁的早期干预对发病后3个月时的运动功能及3年内再发性脑卒中发生率的影响。方法:将2000-01/2004-08南阳市中心医院收治180例诊断为脑卒中后抑郁的患者随机分为治疗组90例和对照组90例,两组的神经功能缺损程度无统计学差异(P>0.05)两组的基础治疗相同,疗程1个月。而治疗组在确诊为脑卒中后抑郁的同时给予抗抑郁治疗:氟西汀20mg/d,连续服用3个月。结束后两组用脑卒中患者临床神经功能缺损程度评分标准评定患者的病情严重程度;用汉密顿抑郁量表评定抑郁程度。结果:治疗组治疗后汉密顿抑郁量表评分为6.4±6.2,治疗前为18.5±6.0;差异有非常显著性意义(P<0.01);治疗后神经功能缺损程度评分:治疗组为10.4±8.5;对照组为22.6±8.9,差异有显著性意义(P<0.05);3年内再发性脑卒中的发生率治疗组为7%,对照组为31%,差异有显著性意义(P<0.05)。结论:脑卒中后抑郁的早期干预可降低神经功能缺损的积分,减少3年内再发性脑卒中的发生率。