Problems of new caregivers of persons with stroke.

Nine adult caregivers new to the role of caring for persons with stroke, upon discharge from rehabilitation centers in Ohio and Michigan and living farther away from formalized support services than urban caregivers, were enrolled for 3 months in a Web-based intervention project that examined the feasibility of the intervention and described the experience of caring. This article is an analysis of qualitative data from the intervention project that used a rigorous protocol to examine 68 perceived problems reported in caring. Problem themes in order of most to least frequent were 1) having independence issues, 2) dealing with emotions, 3) living with physical limitations, 4) managing co-morbid conditions, 5) balancing it all, 6) participating in physical therapy, and 7) having sleeping issues. These problems were related to four of Orem's universal self-care requisites. Although the total number of problems decreased over time, "balancing it all" was the only problem that increased. This may be due to the resumption of the caregivers' regular activities or increased caregiving responsibilities. Nurses could use these findings to identify and focus on self-care needs of caregivers and to implement problem-resolution strategies.     

Perception of Quality of Life by Chinese elderly persons with stroke

Purpose : The purpose of this study was to initiate an investigation into the conceptualization of Quality of Life (QOL) for Chinese elderly people with stroke, living in the community in Hong Kong, and to explore whether a unique definition for this population might be needed.

Method : Focus group interviews were conducted with seven elderly people with stroke and six healthy elderly individuals from community-based elderly centres in Hong Kong. A content analysis was conducted on interview data to determine the conceptual characteristics of QOL for participants with stroke, and to compare QOL components valued by both groups.

Results : Results appeared to support the assumptions in the literature about the multi-dimensionality of the QOL concept, its inclusion of both subjective and objective components, the interrelatedness of components and their integrated contribution to global QOL. The QOL components identified reflected a global QOL definition which included non-health-related life aspects such as money and housing. Similarities and differences were evident in the QOL components identified by both groups. These differences seemed to be best explained by the effects stroke had on the former group.

Conclusions : The findings suggest that a QOL definition unique to Chinese elderly people with stroke may be warranted. Further research and refinement of the QOL conceptualization for this population are the necessary precursors to accurate QOL measurement and the planning and delivery of effective health services to help them achieve optimal QOL.     

Perception of Quality of Life by Chinese elderly persons with stroke

Purpose : The purpose of this study was to initiate an investigation into the conceptualization of Quality of Life (QOL) for Chinese elderly people with stroke, living in the community in Hong Kong, and to explore whether a unique definition for this population might be needed. Method : Focus group interviews were conducted with seven elderly people with stroke and six healthy elderly individuals from community-based elderly centres in Hong Kong. A content analysis was conducted on interview data to determine the conceptual characteristics of QOL for participants with stroke, and to compare QOL components valued by both groups. Results : Results appeared to support the assumptions in the literature about the multi-dimensionality of the QOL concept, its inclusion of both subjective and objective components, the interrelatedness of components and their integrated contribution to global QOL. The QOL components identified reflected a global QOL definition which included non-health-related life aspects such as money and housing. Similarities and differences were evident in the QOL components identified by both groups. These differences seemed to be best explained by the effects stroke had on the former group. Conclusions : The findings suggest that a QOL definition unique to Chinese elderly people with stroke may be warranted. Further research and refinement of the QOL conceptualization for this population are the necessary precursors to accurate QOL measurement and the planning and delivery of effective health services to help them achieve optimal QOL.     

Fried表型衰弱量表及FRAIL量表在社区老人衰弱筛查中的应用

目的对比两种衰弱的筛查方法,早期发现存在衰弱及衰弱前期的患者,及时给予指导及干预。方法 2015年5月至2016年12月对北京月坛社区65岁以上老人按照年龄分层,进行随机抽样横断面调查,月坛社区610名老年人应用Fried表型衰弱量表及FRAIL量表进行衰弱筛查,应用Kappa值评价两种衰弱筛查方法的效果,使用SF-36量表评估月坛社区老人的生活质量,比较无衰弱、衰弱前期及衰弱老人的SF-36评分。结果 610名社区老年人中,Fried量表筛查出衰弱前期老人34.4%,衰弱老人11.3%;FRAIL量表检出衰弱前期老人39.7%,衰弱老人8.4%,Fried量表与FRAIL量表一致性检验的k=0.791,P0.01。无衰弱、衰弱前期及衰弱老人的SF-36评分差异有统计学意义(P0.05)。结论 FRAIL量表和Fried表型衰弱量表具有较好的一致性,均适用于社区老人衰弱筛查,FRAIL量表简洁易行,更适合社区推广应用。衰弱是影响老年人生活质量的重要因素。     

SSRI treatment-associated stroke: causality assessment in two cases

OBJECTIVE: To assess the probability of cerebrovascular adverse drug reactions (CV-ADRs) due to treatment with selective serotonin-reuptake inhibitors (SSRIs) using 2 causality methods. case summaries: Two patients with the possibility of SSRI-related stroke were referred for causality assessment. Causality assessment was performed using an adverse drug reaction probability scale, as well as clinical and radiologic parameters. A 31-year-old white man, who had been receiving paroxetine 200 mg/day over a period of 3 years, developed ischemic stroke involving left middle cerebral artery. The second patient was a 46-year-old white woman with a history of recurrent depression who developed delirium and ischemic stroke while she was taking a combination of paroxetine 50 mg/day, trazodone 200 mg/day, and bupropion 150 mg/day. DISCUSSION: Carotid and cardiothromboembolism were found to be the major etiological factors for ischemic stroke. Accounting for the temporal relation, prior reports of SSRI treatment-associated CV-ADRs, and the pharmacologic action of serotonin on coagulation and the vascular system, the possible contribution of SSRIs to stroke in these patients was considered. An objective causality assessment using the Naranjo probability scale revealed that a CV-ADR was possible. However, the nature of the stroke, plus clinical and radiologic findings, were inconsistent with known pathophysiologic mechanisms linking SSRIs and stroke in these patients. CONCLUSIONS: Causality assessment may improve unbiased recognition, management, and voluntary reporting of infrequent adverse effects such as SSRI treatment-related cerebrovascular accident.     

Work values: A comparison of non-disabled persons with persons with paraplegia

A number of studies focus on factors that might explain the low level of employment of persons with paraplegia without questioning the social representations connected to work. Being employed is considered a priori as beneficial, constituting an important objective for rehabilitation. However sociologists have recently pointed out that work, as a means of self fulfilment, is a 'constructed' rather than a 'natural' category.

The comparisons of the representations of work given by two groups: persons with paraplegia (n = 350), and non-disabled persons (n = 327) show that persons with paraplegia are more likely than non-disabled persons to consider work as a source of personal fulfilment and social recognition and less likely to positively value the fact of not-working. In addition, a demonstrated satisfaction with not working, among persons of working age, is clearly more significant among non-disabled persons than among persons with paraplegia. Among these, some of them who have generally made up their mind about not working declare that they feel satisfied being unoccupied. This satisfaction is explained, in part, by expressed representations of work. The authors suggest a reflection on the place of work in rehabilitation programmes.     

Validity of pain intensity assessment in persons with cerebral palsy: a comparison of six scales.

Chronic pain is a common condition in persons with cerebral palsy (CP), although there is a paucity of research studying CP-related pain. One of the barriers to a better understanding of pain in persons with CP is the lack of information concerning the validity of pain measures that may be used with this population. The purpose of this study was to determine the relative validity of several pain measures in a sample of persons with CP-related pain. Six pain rating scales and measures of depression and pain interference were administered to a sample of 45 adults participating in a longitudinal study of pain in persons with CP. An additional 24 persons with CP were administered 5 of the 6 pain intensity scales. The results of factor analyses support the validity of each measure of pain in this sample of persons with CP. However, an examination of the pattern of associations between each of the pain ratings with measures of pain interference and depression suggest that the 7-point Faces Scale may be somewhat less valid than the other measures.     

Performance of psychomotor skills: a comparison of two teaching strategies.

This study compares two teaching strategies: textbook assignment and videotape with no faculty assistance, and textbook assignment and videotape with faculty assistance (demonstration of skills and supervised practice) to determine their effect on outcome performance (measurement of blood pressure) and on the student's perceived level of confidence. The intent of the study was to ascertain if the use of mediated instruction without faculty input would decrease faculty-student contact time without adversely affecting performance outcomes. Results of the study revealed that faculty contact is an important factor when students are learning to perform a basic psychomotor skill. It was concluded that mediated instruction is not appropriate as a complete substitute for faculty contact.     

Biomechanic modeling of sit-to-stand to upright posture for mobility assessment of persons with chronic stroke

OBJECTIVE: To test the suitability of using biomechanic measures associated with a minimum measured input model (MMIM) approach to assess mobility of people with chronic stroke during the execution of a sit-to-stand (STS) to upright posture motor task. DESIGN: Single group, observational. SETTING: Institutional settings in the United States and Italy. PARTICIPANTS: Twenty-nine subjects with chronic unilateral lower-limb impairments and resultant mobility limitations secondary to stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Manual measurement of lower-limb strength; performance-based tests including repeated chair standing, walking speed, and standing balance; and ground reactions measured with a force platform during STS and upright posture. The ground reactions were fed to a telescopic inverted pendulum model of the musculoskeletal system. Parameters representing the model outputs were compared with performance-based and strength measures to assess, respectively, motor ability and impairment-related changes in subjects' motor strategies. RESULTS: The parameters derived from the model effectively differentiated between motor strategies associated with different performance-based scores, and allowed the identification of relevant difficulties encountered in STS execution. These difficulties could be associated with different strength scores. This was also true for subjects scoring the maximum in both performance-based and strength tests. CONCLUSIONS: The MMIM is a relatively inexpensive and noninvasive approach that enhances mobility assessment of hemiparetic subjects with different motor ability levels. It provides information that correlates well with performance-based and strength scores and, in addition, it allows for subject-specific motor strategy identification.     

高龄髋部骨折合并脑卒中后遗症患者的治疗对策

目的探讨高龄髋部骨折合并脑卒中后遗症患者的治疗方案,探讨其预后的影响因素。方法回顾性分析62例高龄髋部骨折合并脑卒中后遗症患者的临床资料,根据治疗方法分为保守治疗组（12例）、关节置换组（18例）、内固定组（32例）。综合分析比较美国麻醉师协会（ASA）评分、日常生活活动能力指数（Barthel生活指数）、合并症、简易精神状态量表（MMSE）、股骨近端骨小梁类型指数（Singh指数）、骨折后并发症（感染、再发脑卒中、褥疮、深静脉血栓、心力衰竭）等指标。结果3组患者年龄及性别、ASA评分、合并症比较差异均无统计学意义。保守治疗组、关节置换组、内固定组Barthel生活指数分别为52．1±11．4、74．5±21．3、63．84-15．7;骨折后并发症分别为10、3、13例。3组患者组间Barthel生活指数、并发症比较差异均有统计学意义（F=2．45,P〈0．05;X2=9．32,P〈0．05）。保守治疗组与手术治疗的两组Singh指数（X2=11．10,P〈0．05）及MMSE量表（X2=7．40,P〈0．05）比较差异均有统计学意义,而手术治疗的两组间比较差异均无统计学意义（P均〉0．05）。ASA评分、合并症、MMSE量表、治疗策略、骨折前Barthel生活指数均与骨折后Barthel生活指数存在相关性（OR值分别为5．726、7．152、0．047、1．221、5．312,P均〈0．05）。结论对于高龄髋部骨折合并脑卒中后遗症患者应首选关节置换术治疗,预后受患者身心整体状态的影响较大,完整的评估是选择治疗方案前必不可少的步骤。     

Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke

OBJECTIVE: To measure energy cost and gait analysis in persons with stroke with and without a newly developed orthosis. DESIGN: Immediate and long-term (3wk) intervention (before-after trial). SETTING: University medical center. PARTICIPANTS: Volunteer sample of 27 persons with long-term (range, 0.6-19y) hemiparetic stroke. INTERVENTION: Three-week familiarization to the new walking aid. MAIN OUTCOME MEASURES: Energy cost (per distance walked), preferred walking speed (PWS), and step length. Energy cost was examined in all subjects while walking on a treadmill at 3 different velocities (PWS, PWS+30%, PWS-30%) during 3 different situations (without orthosis, with orthosis, after 3-wk orthosis familiarization). Spatiotemporal aspects of the gait pattern were examined using a 6-m instrumented walkway system. RESULTS: Using the orthosis immediately decreased energy cost in persons with stroke during walking at the PWS (P<.001) and significantly increased walking speed (P<.005) and step length (P<.001). After 3 weeks of familiarization to the orthosis, energy cost at the PWS and at PWS+30% showed further improvement in energy cost (P<.05). CONCLUSIONS: The newly developed orthosis immediately decreases energy cost and improves walking speed and step length in persons with long-term stroke. After only 3 weeks of orthosis familiarization, energy cost shows additional improvement.     

The comparison of motor performance between part and whole tasks in elderly persons.

OBJECTIVE: When teaching clients a multistep functional task, therapists tend to break down the task into part tasks with discrete movements. The purpose of this study was to compare the kinematic performance between part and whole tasks in elderly persons. METHOD: A counterbalanced repeated-measures design was used. Twenty elderly persons without motor problems (7 men, 13 women) performed a signature task in two conditions. For the part-task condition, the participants did the task in a step-by-step manner: (a) reach for a pen, (b) bring the pen to the paper, and (c) sign the name. For the whole-task condition, the participants performed the task in an integrated continuous flow. Kinematic performances for two movement segments (i.e., reaching for the pen, bringing the pen to the paper) were compared between conditions. RESULTS: Generally, the whole-task condition elicited a more efficient, more forceful, and smoother movement than the part-task condition. CONCLUSION: The results suggest the importance of keeping a multistep functional task whole.     

Calcium antagonists in geriatric patients: diltiazem in elderly persons with hypertension

Pharmacodynamics and disposition of diltiazem were determined in twelve young (30 to 39 years of age) and twelve elderly (65 to 83 years of age) persons with hypertension after they had received diltiazem by rapid intravenous and long-term oral administration. Plasma disappearance half-life of diltiazem increased similarly and significantly in both groups with long-term dosing (young: rapid intravenous, 3.7 +/- 0.8 hour; long-term oral, 6.3 +/- 1 hour [mean +/- SE]; elderly: rapid intravenous, 3.8 +/- 0.7 hour; long-term oral, 7.2 +/- 2.1 hour; p less than 0.01). During long-term therapy both systolic and diastolic blood pressure was significantly lowered from baseline beyond a 12-hour dose interval, with greater decreases in systolic blood pressure in the elderly. Heart rate was decreased with long-term therapy in both groups. Maximal prolongation of PR interval was greater in the young after the intravenous dose (young: 46 +/- 28 msec; elderly: 24 +/- 11 msec; p less than .01), but this effect was not seen with long-term therapy. These data demonstrate that diltiazem administered every 12 hours is an effective antihypertensive agent in both young and elderly patients.