Psychological nursing to patients after stroke

INTRODUCTIONEarlypsychologicalnursingmayhaveaneffectnottobeignoredonearlyrehabilitationofpatientsafterstroke．PSYCOLOGICALCHARACTERISTICSAFTERSTROKEThepsychologicalcharacteristicsofpatientsafterstrokemainlydis－playdepressingemotion，hypologiaandeasytocry，sensitiveandsuspicion．Someofthemgraspcertainmedicalknowledgeandtheycancontroltheirblood－sugar，blood－pressureandblood－lipidproperlybeforestroke．Itisdifficultforthemtounderstandtogetstroke．Thustheycan＇tobeytreatmen…     

‘Masterstroke: a pilot group stroke prevention program for community dwelling stroke survivors’

Objectives: To explore whether a pilot secondary stroke prevention group program for community-dwelling chronic stroke survivors assisted participants in modifying their lifestyle to reduce their risk of secondary stroke. Design: A mixed methods study (quantitative and qualitative). Setting: Community. Subjects: Twenty-two community dwelling, chronic stroke survivors. Intervention: The Masterstroke program incorporated a secondary prevention stroke group program over a 9-week period with two 2-h sessions weekly (1 hour for education and 1 hour for exercise). The exercise component incorporated fitness, strength, mobility and balance and education focused on secondary stroke prevention whilst also providing chronic condition self-management support. Main measures: Timed Up and Go (TUG), Six Minute Walk Test (6MWT), Fat and Fibre Barometer, The Stroke and Aphasia Quality of Life Scale (SaQoL-39), and questionnaires for salt intake and stroke knowledge. Qualitative outcomes were participants’ perceptions. Data analysis involved an inductive thematic approach with constant comparison. Results: There were insufficient participants for results to reach statistical significance in all categories, however, statistically significant results where achieved with regards to knowledge, TUG, salt intake and quality of life (QoL) scores. Qualitative responses explored participants’ experience of the Masterstroke program; results confirmed increases in knowledge about stroke and exercise tolerance, successfulness of a group program and lifestyle modification post stroke. Conclusions: Participation in the Masterstroke program for community dwelling stroke survivors resulted in significant improvements in knowledge, functional balance, dietary behaviours and quality of life. Qualitative interviews support the participants’ implementation of lifestyle changes essential for reducing risks of secondary stroke. Results support the utilisation of this model and warrants rigorous investigation regarding long-term impacts of an education and exercise program on community dwelling stroke survivors.

Implications for Rehabilitation

• A program which incorporates exercise and education in a group setting may improve health-related quality of life and functional performance for community dwelling, chronic stroke survivors.

• It is feasible for a multidisciplinary team to implement a secondary stroke prevention group program for community dwelling, chronic stroke survivors.

     

Is fatigue after stroke associated with physical deconditioning? A cross-sectional study in ambulatory stroke survivors

Lewis SJ, Barugh AJ, Greig CA, Saunders DH, Fitzsimons C, Dinan-Young S, Young A, Mead GE. Is fatigue after stroke associated with physical deconditioning? A cross-sectional study in ambulatory stroke survivors.

Objective

To determine the relationship between a measure of fatigue and 2 indices of physical fitness, lower limb extensor power (LLEP) and walking economy.

Design

This was a cross-sectional study of patients with stroke. Fatigue was assessed by vitality (VIT) score of the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 (SF-36v2). LLEP of the unaffected limb was measured using a lower leg extensor power rig. Walking economy was calculated by measuring oxygen consumption (mL·kg^–1·m^–1) during walking at a comfortable speed. Bivariate analyses were performed relating VIT to indices of fitness. Multiple regression analyses were also performed and included age, sex, and either SF-36v2 emotional role function or SF-36v2 mental health, as predictors of VIT.

Setting

Community setting.

Participants

Participants (N=66; 36 men; mean age ± SD, 71.0±9.9y) were all community dwelling, had survived a stroke, were able to walk independently, and had completed their stroke rehabilitation.

Interventions

Not applicable

Main Outcome Measures

The main outcome measure is SF-36v2 (VIT), with walking economy and LLEP of the limb unaffected by the stroke being independent variables.

Results

Walking economy was not significantly related to VIT (R=–.024, P=.86, n=60). LLEP was positively related to VIT in bivariate analysis (R=.38, P=.003, n=58). After controlling for age, sex, and SF-36 emotional role function (or SF-36v2 mental health if the extreme outlier was excluded), LLEP remained a significant predictor of VIT.

Conclusions

We found an association between fatigue and reduced LLEP. If a larger study confirms these findings, it would support the need to develop and test interventions to increase LLEP as a treatment for fatigue after stroke.     

Study of acute stroke clinical measuring scale

Objective To explore the possibility of diagnosis types of acute stroke,elevating treatment quality and promoting prognosis with acute stroke clinical measuring scale.Methods To gain a measuring scale formula and simplify this formula after stepwise regression Fisher distinguish analysis to 18 clinical variable of 184 acute stroke patients and to validate its sensitivity,specificity and positive foretell value to diagnosis of acute stroke,Results We gained scale that Y=0.617&;#215;action+0.4856&;#215;BP＋1.241&;#215;headache+0.74&;#215;vomiting+0.955&;#215;cervical resistance-1.215&;#215;TIA－0．727&;#215;heart disease-2.78;sensitivity of this formuta to diagnosis of cerebral infarction and cerebral hemorrhage was 90.5% and 70% respectively,its specificity was 70% and 90.5% respectively,positive foretell value was 71.7% and 89.7%(Y≥ 0 means cerebral hemorrhage,Y&;lt;0 means cerebral infarction).Simple formulta is S=0.5&;#215;action+0.5&;#215;BP+1&;#215;headache+1&;#215;vomiting+1&;#215;cervical resistance-1&;#215;TIA－1&;#215;hear disease-3;its sensitivity was 89.3% and 68%,specificity was 68% and 89.3%,positive foretell value was 70.1% and 88.3%,There was no apparent difference in sensitivity;specificity and positive forelell value between two formulas.Conclusion Acute stroke clinical measuring scale can help early diagnosis,treatment and rehabilitation of cerebral stroke patients.     

Effective evaluation of arterial pulse waveform analysis by two-dimensional stroke volume variation–stroke volume index plots

Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV–SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV–SVI (stroke volume variation index) plot. Arithmetic analysis showed that the relationship between SVV and SV can be drawn as hyperbolic curves. Plotting SVV-SV values in the semi-logarithmic scale showed linear correlations, and the slopes of the linear regression lines theoretically represented average mean cardiac contractility. In clinical measurements in APWA, plotting SVV and SVI values in the linear scale and the semi-logarithmic scale showed the correlations represented by hyperbolic curves and linear regression lines. The plots approximately shifted on the rectangular hyperbolic curves, depending on blood loss and blood transfusion. Arithmetic estimation is close to real measurement of the SVV–SV interaction in hyperbolic curves. In APWA, using SVV as an index of preload and the cardiac index or SVI derived from arterial pressure-based cardiac output as an index of cardiac function, is likely to be appropriate for categorizing hemodynamic stages as a substitute for Forrester subsets.     

Relative factors analysis of depression after stroke

Objective:To study the relative factors of concomitant depression after stroke.Methods:Using Geriatric depression Scale (GDS) and SSS,we scored 121 storke cases who were treated from January 2001 to December 2001,in which 54 cases were concomitant with depression.assessed defect and promotion degree of nervous function,and observed relationship between number of lesion and onset of depression.Result Incidence of depression of cerebral hemarrhage patients was apparently higher than that of cerebral infarction patients(P&;lt;0.05),there was no apparent difference in lesion location and concomitant depression (P&;gt;0.05),incidence of concomitant depression of stroke patients with multiple lesions was apparently higher than that of stroke patients with single lesion.Conclusion Concomitant depression of stroke patients is related to location,number of lesions and severity of stroke.     

Post—stroke dizziness and psychological disturbance

AIM:to study the relationship between post-stroke dizziness and psychological factors.METHODS:To choose 82 cases with dizziness after struke.The patients whose medical treatment were invalid were divided into two groups randomly.The experimental group of 43 cases was treated with antipsychotic and the controls group of 39 cases was treated with consolation.RESULTS:The total effective rate in experimental group was significantly higher than that in the control group (P<0.001),CONCLUSION:It is suggested that though the mental scales scores might be normal,post-stroke dizziness should be treated for a long-term helplessly be just a sign of psychological matter,It ought to be discerned and given pertinent treatments.     

Rehabilitation of mental disturbance in patients with stroke

It is considered now that early rehabilitation interventional mechanism is related to the plasticity of brain that means after injury of neural function,cental nervous system has the ability of compensation and functional recombination.OBJECTIVE：To explore the effects of early rehabilitation on paralysis after cerebral infarction.     

‘Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia’

Purpose. To identify factors which contribute to upper limb recovery, from the perspective of stroke survivors.

Method. A retrospective cross-sectional survey was administered by post to 220 stroke survivors with upper limb impairment who were more than 3 months post-stroke. The content and language for the questionnaire were drawn from a series of focus groups and in-depth interviews with stroke survivors (n = 29). Where possible items or composite scales were replicated or adapted from existing surveys.

Results. Many factors regarding the stroke survivors' commitment to recovery, the type and amount of exercise undertaken and their knowledge of how to progress were associated with self-reported upper limb recovery. The single most important factor was ‘use of the arm in everyday tasks’, which was independently responsible for more than 12% of the variance in recovery. ‘Not enough movement to work with’ was the second most important factor, representing the greatest barrier to recovery.

Conclusions. The findings of this survey highlight many practical day to day factors that may contribute to a stroke survivor's ability to advance the recovery of their upper limb. Stroke recovery services can use this information to tailor their services to ensure these practical concerns are addressed.