脑卒中后遗症患者主要家庭照顾者照顾需求的研究

目的探讨脑卒中后遗症患者其主要家庭照顾者的照顾需求情况,并分析其影响因素。方法采用便利抽样法,抽取115例脑卒中后遗症患者其主要家庭照顾者进行问卷调查。结果脑卒中后遗症患者主要家庭照顾者照顾需求得分处于中等水平(57.04±5.85),其中照顾需求最高的为康复训练,其次为疾病管理,照顾者文化程度、是否伴慢性病及患者生活自理能力是主要家庭照顾者照顾需求的影响因素。结论脑卒中后遗症患者主要家庭照顾者对于康复训练及疾病管理方面存在较高的需求,医务人员应当加强相关方面的指导与教育,同时推进延续性护理的发展,以保证脑卒中后遗症患者及其主要家庭照顾者在医院或家庭均能够得到持续的个体化护理指导和健康教育。     

住院脑卒中患者主要照顾者照顾负担与积极感受的相关性研究

目的：调查住院脑卒中患者主要照顾者照顾负担和积极感受的现状,并探讨两者之间的关系。方法应用Zarit照顾者负担量表和照顾者积极感受量表,将260例住院脑卒中患者的主要照顾者作为研究对象进行调查。结果260例住院脑卒中患者的主要照顾者的照顾负担为轻、中度,积极感受为中等偏高水平,责任负担与生活展望呈显著负相关,照顾负担总分与积极感受总分呈负相关。结论医护人员应对住院脑卒中患者的主要照顾者的照顾负担进行个体化干预,以减轻照顾负担,提高其个人积极感受,最终提高生活质量。     

脑心康复师主导的脑卒中照顾者培训计划表在脑卒中后运动康复中的应用及效果

目的 探讨脑心康复师主导的脑卒中照顾者培训计划表在脑卒中后运动康复中的应用及效果。方法 按入院先后顺序选2022年1月-2022年6月在某三甲医院神经内科收治的符合标准的患者及照顾者各80例，按随机数字表法分成观察组和对照组各40例；对照组按传统康复方案进行脑卒中后康复训练；观察组采用脑心康复师主导的照顾者培训计划表；对2组患者进行入院时、出院当天、入院后3个月这3个时间段的肢体运动功能及生活自理能力比较，同时对照顾者进行3次同时间段的焦虑评分。结果 2组组内比较出院时与入院时各指标均有明显差异(P<0.05),且观察组患者的3个时间段的简易Fugl-meyer运动量表(Fugl-Meyer assessment scale, FMAS)评分、Barthel指数及满意度评分明显高于对照组，但照顾者的焦虑评分低于对照组(P<0.05)。结论 脑心康复师主导的脑卒中照顾者培训计划表能帮助照顾者出院后对患者进行运动康复的管理，有助于激发照顾者及患者的潜能，促进患者的运动功能及生活自理能力的恢复，降低照顾者的焦虑情况，提高患者满意度。     

脑卒中患者及其照顾者生存质量研究进展

脑卒中具有高患病率、高病死率、高致残率和高复发率的特点,它影响着全球约1500万人,其中有60％的脑卒中患者死亡或遗留永久的残疾.大多数脑卒中患者生活在社区,需要家庭照顾者(主要是他们的配偶)给予帮助.然而,脑卒中导致的功能缺损和各种相关因素阻碍了患者的康复,并使得患者及其照顾者的生存质量下降.本文对影响脑卒中患者及其照顾者生存质量的相关因素进行全面性回顾分析,从而为制定脑卒中患者的康复治疗方案提供客观依据.     

老年脑卒中患者配偶照顾者照顾行为现状及影响因素分析

目的：基于自我管理模式评估老年脑卒中患者配偶照顾者的照顾行为，了解其照顾行为现状及相关影响因素。方法采用自制照顾行为评估问卷对78例脑卒中患者配偶照顾者进行问卷调查。结果配偶照顾者疾病自我管理相关照顾行为得分26.74±3.78，处于低等水平。配偶年龄、照顾年限是影响其照顾行为的主要因素（P＜0.05）。结论医院及相关部门需给予配偶照顾者相关的教育和指导，改善其照顾行为，提高其照顾水平，进而改善脑卒中患者的康复效果，使其早日回归社会。     

协同护理对住院脑卒中患者主要照顾者照顾负担的影响

脑卒中主要是老年人常发生的脑血管病变,具有高发性、高复发率、康复慢、不可预测性等特点,给患者、家庭和社会造成了沉重的负担[1]。急性脑卒中患者致残率在存活者中高达80%以上[2]。家庭主要照顾者负担加重,直接影响主要照顾者健康情况、经济情况、心理情况、生活质量等,引起社会的高度重视。近年来提倡一种新颖的护理模式—协同护理,即在责任制护理基础上,通过护理干预,充分利用患者及主要照顾者的护理能力,     

住院脑卒中患者照顾者照顾负担与照顾行为调查

目的了解脑卒中照顾者照顾负担的现状并分析其影响因素。方法采取便利抽样法,抽取105例脑卒中患者的家庭照顾者进行面对面问卷调查。结果脑卒中照顾者的照顾负担平均得分为(40.50±6.96)分,照顾行为则为(42.79±7.23)分,二者均处于中等水平;多元线性回归分析显示,性别、照顾行为是影响家庭照顾者照顾负担得分的主要因素。结论应重视对脑卒中照顾者照顾知识及心理调节的指导,尤其应加强对女性和照顾行为较差照顾者的心理状态评估,提高照顾者生活质量,促进患者早日康复。     

脑卒中患者主要照顾者创伤后成长水平与社会支持的相关性研究

目的：了解脑卒中患者主要照顾者的创伤后成长水平与社会支持现状，探讨其创伤后成长水平与社会支持的相关性。方法：选择福建医科大学附属第二医院神经内科收治的处于急性期或病情稳定期以及多次发作的脑卒中患者的主要照顾者作为调查对象，采用创伤后成长评定量表和领悟社会支持量表进行问卷调查。结果：脑卒中患者主要照顾者创伤后成长评定量表及领悟社会支持量表的平均评分分别为(70.15±5.31)分和(53.32±6.18)分，均不受性别的影响。脑卒中患者主要照顾者的创伤后成长评定量表评分与领悟社会支持量表评分、家庭内源性支持和家庭外源性支持呈正相关(r=0.446，r=0.292，r=0.572；P均0.05)。结论：脑卒中患者主要照顾者创伤后成长属于高等水平，社会支持属于中等水平，其创伤后成长水平与社会支持程度呈正相关。     

脑卒中吞咽障碍患者疾病病耻感与主要照顾者负担的关系：家庭复原力和个体复原力的链式中介效

目的 分析家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和主要照顾者 照顾负担之间的中介效应。方法 采用便利抽样法,选择 2022 年 12 月— 2023 年 8 月于新疆医科大学 第一附属医院康复医学科住院的 235 例脑卒中吞咽障碍患者及其主要照顾者作为研究对象。采用疾病 病耻感量表（SSCI）、个体复原力量表（CD-RISC-10）、照顾者负担量表（ZBI）及家庭复原力量表（WFRQ-R-CHI）对脑卒中吞咽障碍患者的心理状态、个体复原力及其主要照顾者的照顾负担情况及家庭复原力进 行调查。采用Spearman 相关分析患者的病耻感状态、个体复原力、主要照顾者负担及家庭复原力的相关 性。采用Process V4.1插件中的Model 6和Amos软件构建链式中介模型。结果 脑卒中吞咽障碍患者主 要照顾者的 ZBI 得分为 50（42,59）分,处于中度负担水平。患者的 SSCI 得分为 87（72,95）分。Spearman 相关分析显示,脑卒中吞咽障碍患者疾病病耻感与照顾者负担呈正相关,与家庭复原力和个体复原力 呈负相关,照顾者负担与家庭复原力和个体复原力呈负相关,家庭复原力与个体复原力呈正相关（均P＜ 0.01）。家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和照顾者负担中起链式中介效应, 占总效应量的 69.04%。结论 降低患者疾病病耻感可减轻照顾者负担,同时也可从增强脑卒中吞咽障 碍患者的家庭复原力和个体复原力的角度出发,探索减轻脑卒中吞咽障碍患者主要照顾者负担的干预 方案。     

住院脑卒中主要照顾者照顾积极感受及影响因素

目的探讨住院脑卒中主要照顾者照顾积极感受现状及影响因素。方法 2013-08—12选择平顶山市某三级综合医院260例脑卒中主要照顾者,使用照顾者积极感受量表(positive aspects of caregiving,PAC)、脑卒中患者及主要照顾者一般资料进行调查。结果自我肯定(25.46±4.43)分,展望(13.04±2.57)分,积极感受总分(38.50±6.8)分。多元逐步回归显示,家庭月收入、婚姻状况、是否与患者同住、自觉健康状况是照顾者积极感受影响因素,可解释51.2%的总变异量。结论脑卒中主要照顾者照顾积极感受存在,且为中等偏上水平;临床工作者应结合其影响因素给予针对性支持,以提高主要照顾者心理健康及生活质量水平。     

成都市社区卒中家庭照料者的康复知识与需求现状调查

目的 了解社区卒中家庭照料者的康复知识与康复需求状况。方法 对200例卒中患者家庭照料者的基本情况,对康复基本知识的掌握情况和影响因素及康复需求进行问卷调查。结果 （1）成都社区卒中家庭照料者女性占59%、中年和老年人居多（均为44%）,主要是配偶照料（57.5%）;（2）大多数卒中患者照料者的康复知识缺乏,其康复知识的得分与文化程度、年龄有相关性（P分别为<0.001和0.007）;（3）81%的家庭照料者对社区康复有需求。结论 需要加强宣传,提高社区卒中患者及其家属的康复知识知晓率,积极推广社区康复以满足其需求。     

北京卒中社区康复的现状调查分析

目的 调查了解北京市丰台区社区居民对卒中康复相关知识的认知情况以及社区康复现状。方法 在北京市丰台区两个社区内采用随机抽样方法随机抽样198名卒中患者,194名卒中患者看护人,填写自行设计的调查表。结果 调查显示约9.7%的患者及9.3%的看护人表示对康复治疗很了解或比较了解。约65.2%的患者和63.0%的看护人希望能够在社区进行康复。但只有34.4%的患者和42%的看护人曾经进行过社区康复。结论 北京市丰台区两社区居民对卒中康复治疗的相关知识仍比较缺乏,社区康复开展率较低,但是对康复的需求量仍较大。需要进一步加强康复治疗相关知识的宣传,同时进一步普及社区康复。     

Caregiver assessment of personal adjustment after stroke in a Veterans Administration Medical Center outpatient cohort

We evaluated 80 stroke patients to examine the contributions of caregiver anxiety, self-care ability, age, time since onset, marital and residential status, and need for health care services on personal adjustment as reported by caregivers. Mean age of the patients was 65.4 years, and the average time from stroke onset to evaluation was 415 days. Multiple regression analyses indicated that a significant amount of variance in patient adjustment was accounted for by caregiver anxiety (R2 = 0.28, p less than 0.05) and patient self-care ability (R2 = 0.13, p less than 0.05). Compared with community norms, stroke patients were reported to be more depressed, confused, and anxious and they demonstrated fewer household management skills. Stroke patients were not different from a normative sample on measures of interpersonal involvement or social activity. Caregivers had high levels of anxiety compared with norms. Our results may aid in developing methods for identifying stroke patients and caregivers at risk for suboptimal adjustment.     

上海卢湾区瑞金二路街道脑梗死患者后遗症功能障碍状况及康复状况调查

目的分析上海卢湾区瑞金二路街道脑梗死后遗症患者功能障碍状况及康复状况,以便为社区康复模式的制定提供依据。方法采用问卷调查方法对上海卢湾区瑞金二路街道社区居民调查,筛选脑梗死患者322例,对有效问卷278份进行数据整合分析。结果上海卢湾区瑞金二路街道脑梗死后遗症患者存在肢体偏瘫的比例为19.78%,吞咽功能障碍的比例为7.2%,而认知障碍和感觉障碍的比例分别为64.43%和44.6%,男性在运动、言语、吞咽功能障碍方面较女性严重,女性认知障碍较男性明显(P0.05,男性生活自理、交流障碍较女性严重(P0.05),所有脑梗死后遗症患者未就诊康复和未接受康复治疗的比例分别为64.43%和44.6%。结论上海卢湾区瑞金二路街道脑梗死后遗症患者认知障碍和感觉障碍比例高,言语、吞咽功能障碍和认知障碍方面存在性别差异;从患者接触康复的情况看今后的社会康复开展仍有很大发展空间;建立社区康复模式时要充分关注性别差异及认知及感觉障碍方面的康复。     

急性脑卒中老人接受神经营养药物联合早期康复治疗的转归

在1年的时间里,对入住浙江大学附属第一医院老年病科的60例老年急性脑卒中患者给予神经营养药物联合早期康复治疗,借助Hunt-Hess 量表、功能独立性评测、简易智力测定量表和日常生活能力量表,对患者入院时和出院时的肢体运动、认知功能和日常生活自理能力变化做出了评估。纳入的60位患者平均住院时间35 d。出院时有40例患者存在不同程度的认知功能损害,56例接受康复治疗评估的脑卒中患者中,25例（45%）在日常生活方面获得了自理能力,11例（20%）日常生活的部分时间里需要有人照顾,20例（36%）在基本生活上需要全天24 h有人照顾。     

Three different points of view in stroke rehabilitation: patient,caregiver, and physiotherapist

Abstract

Background:

The similarities or differences of the threesome (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation.

Objective:

The aim of this qualitative study was to investigate the perspectives of the threesome, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you?

Methods:

The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices.

Results:

One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physiotherapists, were included to the study. When the theme 1 were examined, we found that the patients’ first priority was functional abilities (ICF: body function and structure) such as using the hands and feet while the caregivers and physiotherapists prioritized self-care problems (ICF: activity and participation). The most common response to the theme 2 was “being in same health condition before the disease” (ICF: activity and participation) among the patients and caregivers and “being able to move arm and leg on the affected side” (body function and structure) among the physiotherapists.

Conclusion:

As a conclusion, problems faced by the patients, caregivers, and physiotherapists were perceived under the same ICF domain and that caregivers’ and physiotherapists’ priorities were the same.     

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyper-homocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modiifed Rankin Scale scores were increased at discharge. Six months atfer discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved signiifcantly in young stroke patients atfer professional rehabilitation, but the number of patients who returned to society within 6 months atfer stroke was still small.     

Motor and perceptual impairments in acute stroke patients: effects on self-care ability

The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.     

The Role of Personalized Virtual Reality in Education for Patients Post Stroke—A Qualitative Case Series

Background: Education is essential to promote prevention of recurrent stroke and maximize rehabilitation; however, current techniques are limited and many patients remain dissatisfied. Virtual reality (VR) may provide an alternative way of conveying complex information through a more universal language. Aim: To develop and conduct preliminary assessments on the use of a guided and personalized 3D visualization education session via VR, for stroke survivors and primary caregivers. Methods: Four poststroke patients and their 4 primary caregivers completed the 3D visualization education session as well as pre- and postintervention interviews. Each patient had a different stroke etiology (i.e., ischemic thrombotic stroke, ischemic embolic stroke, hemorrhagic stroke, and transient ischemic attack followed by ischemic stroke, respectively). This new approach uses preintervention interview responses, patient MRI and CT datasets, VR head mounted displays, 3D computer modeling, and game development software to develop the visualization. Pre- and postintervention interview responses were analyzed using a qualitative phenomenological methodology approach. Results: All participants safely completed the study and were highly satisfied with the education session. In this subset of participants, prior formal stroke education provision was limited. All participants demonstrated varied improvements in knowledge areas including brain anatomy and physiology, brain damage and repair, and stroke-specific information such as individual stroke risk factors and acute treatment benefits. These improvements were accompanied by feelings of closure, acceptance, and a greater motivation to manage their stroke risk. Conclusions: Preliminary results suggest this approach provides a safe and promising educational tool to promote understanding of individualized stroke experiences.     

Thai stroke patient caregivers: who they are and what they need

BACKGROUND AND PURPOSES: Primary informal caregivers play a significant role in providing care to stroke survivors after having been discharged from the hospital. Our aims were to describe the characteristics of Thai stroke caregivers and to explore their needs while providing care to their stroke relatives. METHODS: Using open-ended questions, we individually interviewed 20 caregivers of stroke survivors to identify their characteristics and their own needs. Additional field notes were made during all interviews. RESULTS: Our findings revealed that the majority of Thai informal stroke caregivers in this study were female, mostly daughters, with the exception of 2 Thai primary stroke caregivers found to be nieces. The majority of caregivers provided care to their stroke relatives 24 h per day. The four major categories of informal rehabilitation were: physical, psychological, social, and spiritual rehabilitation activities. Assistance, information and social support were the three main needs of the caregivers. CONCLUSION: Based on these findings, appropriate nursing information and assistance focusing on rehabilitation and stroke caregivers' needs should be provided to Thai stroke caregivers performing informal care to ensure that both patients and caregivers have the best possible quality of life.