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Turning Ability in Stroke Survivors: A Review of Literature  [PDF]
Haidzir Manaf,Maria Justine,Mazlifah Omar,Khairil Anuar Md Isa,Zoolfaiz Salleh
ISRN Rehabilitation , 2012, DOI: 10.5402/2012/284924
Abstract: The aim of this paper is to explore the research literature on the turning ability among stroke survivors. Stroke is one of the top five leading causes of death and disability in Malaysia. Stroke survivors reported a higher rate of fall incidences with turning while walking has been the major contributor in most of the incidences. The attentional task requires stroke survivors to have higher cognitive and attention function, and sound muscle coordination in order to perform multitask activities such as driving, walking and turning while talking, carrying an object (holding a plastic bag), navigating corners and overcoming obstacles within the base of support. Most of the previous studies have focused on the kinematic and gait parameters measurement of turning ability among stroke survivors. However, studies conducted on muscle activity using electromyography to evaluate the time pattern of muscle contraction during turning event is lacking. With regards to dual-task ability among stroke survivors, there is insufficient information or research into dual task (motor and cognitive) ability during turning. Further studies are needed to understand the effects of dual-task activity on muscle activity and gait parameters and how this impairment affects the turning ability. This needs to be addressed in order to prevent falls among stroke survivors. 1. Introduction Stroke or cerebrovascular accident is the second most common cause of death and disability worldwide [1]. In Malaysia, epidemiological data in 2002 showed that stroke was one of the top five leading causes of death with a mortality rate of 11.9 per 100,000 population [2]. In addition, the National Stroke Association of Malaysia highlighted that around 40,000 Malaysian are disabled due to stroke every year [3]. This indicates that the high number of stroke incidences may increase demand of health services as well as increases burden to caregivers. Stroke is defined as the “rapidly developing signs of focal (or global) disturbance of cerebral function, which is lasting more than 24 hours (unless interrupted by surgery or death), with no apparent nonvascular cause” [4]. In other words, stroke is a disease caused by the disruption of blood vessels in the brain, such as ischemic and hemorrhagic [5]. Consequently, those who survived are presented with significant impairment that may affect sensorimotor, swallowing, perception, vision, emotion, cognitive, and communication which in turn may predispose them to various complications and long-term disability [6]. Fall seems to be the most common reported
Young Women Stroke Survivors and Their Desire for Peer Support  [PDF]
Sharon-Dale Stone
ISRN Stroke , 2014, DOI: 10.1155/2014/231725
Abstract: The concerns of young stroke survivors are not well known. The aim of this paper is to draw on data from a larger study to show that young women who survived a hemorrhagic stroke desire access to peer support, but there is not widespread access to peer support. Open-ended interviews were conducted with an international sample of 28 women to learn about their poststroke experiences and were analyzed qualitatively for common issues and themes. A prominent theme across the interviews was the significance of age-similar peer support. Participants discussed feeling alone and misunderstood and wanting to have access to peer support. In conclusion, peer support may help to enhance psychological well-being, but the survivor’s own understanding of her peers must be centrally considered. 1. Introduction Although stroke is more common in old age, it is not unusual for a young person (under age 65) to have a stroke. Estimates of stroke incidence according to age vary, but it appears that approximately 30% of strokes occur in people under the age of 65, and 3-4% occur in people aged 40 or younger [1]. For people aged 20–44, an American study found an incidence rate of 23 per 100,000 per year [2]. Regarding stroke in children, estimated incidence rates vary between 1.5 and 5.1 per 100,000 per year [3]. Young people appear more likely than old people to have a hemorrhagic stroke [2, 4]—typically (but not always) caused by a ruptured aneurysm or arteriovenous malformation (AVM); and survivors of hemorrhagic stroke are likely to be left with residual impairments that are not immediately obvious [5]. For example, cognitive impairments are commonly found as a long-term consequence of stroke at a young age, although this remains an understudied topic [6]. Young survivors of stroke not only contravene popular ideas about stroke as a disease of old age, but they must often negotiate a social world in which there is little understanding that not all impairments are visible. This situation can create significant psychological distress. Researchers in the UK, for example, found in focus groups with young stroke survivors that they “bemoaned the widespread lack of awareness of stroke in younger people, reflected in poor service provision and general ignorance about the impairments that stroke leaves behind, which are often invisible or not easily comprehensible” [7]. These concerns about lack of awareness about stroke under age 65 and the invisibility of stroke-related impairments were also discussed in this author’s [8, 9] previous research on women who survived hemorrhagic
Health Related Quality of Life of Stroke Survivors: Experience of a Stroke Unit  [cached]
S. A. Abubakar1,S. A. Isezuo
International Journal of Biomedical Science , 2012,
Abstract: Background: Stroke has a major impact on survivors including Health related Quality of life (HRQoL). HRQoL measurements are potentially more relevant to patients than measurements of impairments or disability and are an important index of outcome after stroke that can facilitate a broader description of disease and outcome. This study examined the factors associated with HRQoL of stroke survivors. Methods: In a cross-sectional and descriptive correlational design, 62 patients were prospectively enrolled and interviewed 3 months post stroke in neurology out-patient clinic. After case identification, functional status (handicap) was determined using the Modified Rankin Scale (MRS), while Zung Depression Self-Rating Scale (ZDS) was used to determine presence of depression. HRQoL was assessed using the Stroke Impact Scale-16 (SIS-16). Age, sex, duration of formal education, depression and degree of disability were correlated with HRQoL in multiple logistic regressions. Results: The mean age of patients was 54.4 ± 9.9 years. Mean duration of formal education was significantly higher in males than females (p value=0.007). About one third (29%) of the stroke survivors were depressed and more than half (54.8%) had good recovery. Function status measured by modified Rankin Scale and depression were independent determinants of poor HRQoL. Conclusion: Functional status and depression were identified as independent factors affecting HRQoL of stroke survivors.
Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors
Srivastava Abhishek,Taly Arun,Gupta Anupam,Murali Thyloth
Annals of Indian Academy of Neurology , 2010,
Abstract: Objectives: To evaluate (1) the prevalence of operationally defined depressive disorder (ICD-10) in chronic stroke subjects and (2) the relationship of post-stroke depression (PSD) with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration), cognition (mini mental state examination), depressive ideation (Hamilton Depression Rating Scale - HRDS), impairment (Scandinavian Stroke Scale), balance (Berg Balance Scale), ambulatory status (Functional Ambulation Category), walking ability (speed), and independence in activities of daily living (Barthel Index). Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10) of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days) were included in the study. Eighteen of the 51 participants (35.29%) met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05). Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05) and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.
Homocysteine as a potential biochemical marker for depression in elderly stroke survivors  [cached]
Michaela C. Pascoe,Sheila G. Crewther,Leeanne M. Carey,Kate Noonan
Food & Nutrition Research , 2012, DOI: 10.3402/fnr.v56i0.14973
Abstract: Background: Elderly stroke survivors have been reported to be at risk of malnutrition and depression. Vitamin B-related metabolites such as methylmalonic acid and homocysteine have been implicated in depression. Objective: We conducted a study exploring the relationship between homocysteine and post-stroke depression. Design: Three methodologies were used: Observational cohort study of elderly Swedish patients (n=149) 1.5 years post-stroke, assessed using Diagnostic and Statistical Manual of Mental Disorders, Montgomery sberg Depression Rating Scale and serum blood levels of methylmalonic acid and homocysteine. Results: Homocysteine significantly correlated with depressive symptomatology in stroke survivors (β = 0.18*). Individuals with abnormal levels of methylmalonic acid and homocysteine were almost twice more likely to show depressive symptomatology than those with normal levels (depressive symptoms 22%; no depressive symptoms 12%). Comparison of methylmalonic acid and homocysteine levels with literature data showed fewer stroke survivors had vitamin deficiency than did reference individuals (normal range 66%; elevated 34%). Conclusions: Homocysteine is significantly associated with depressive symptomatology in elderly Swedish stroke survivors.
The Triglyceride Paradox in Stroke Survivors: A Prospective Study  [PDF]
Minal Jain,Anunaya Jain,Neeraja Yerragondu,Robert D. Brown,Alejandro Rabinstein,Babak S. Jahromi,Lekshmi Vaidyanathan,Brian Blyth,Latha Ganti Stead
Neuroscience Journal , 2013, DOI: 10.1155/2013/870608
Abstract: Objective. The purpose of our study was to understand the association between serum triglycerides and outcomes in acute ischemic stroke (AIS) patients. Methods. A cohort of all adult patients presenting to the Emergency Department (ED) with an AIS from March 2004 to December 2005 were selected. The lipid profile levels were measured within 24 hours of stroke onset. Demographics, admission stroke severity (NIHSS), functional outcome at discharge (modified Rankin Scale (mRS)), and mortality at 3 months were recorded. Results. The final cohort consisted of 334 subjects. A lower level of triglycerides at presentation was found to be significantly associated with worse National Institutes of Health Stroke Scale (NIHSS) ( ), worse mRS ( ), and death at 3 months ( ). After adjusting for age and gender and NIHSS, the association between triglyceride and mortality at 3 months was not significant ( ). Conclusion. Lower triglyceride levels seem to be associated with a worse prognosis in AIS. 1. Introduction Ischemic stroke is the third leading cause of death worldwide with 5 million annual deaths [1]. Every years approximately 795,000 people experience a stroke and someone dies of stroke in the United States every 3-4 minutes [2]. One of the prominent objectives of stroke research has been to investigate factors that could potentially improve stroke outcome. Acute factors affecting stroke outcome such as awareness of symptoms [3], blood pressure [4], elevated glucose [5], and electrocardiographic intervals [6] have all been of interest. In this paper, we turn our attention to the lipid profile in the setting of acute ischemic stroke. It is known that high serum lipids including triglycerides constitute major risk factors for stroke [7, 8]. Little has been reported to date on the role of triglycerides in acute stroke and their role in poststroke recovery. The few studies that have evaluated this association have reported diverse associations [9–12]. The purpose of our research was to study the relation between poststroke serum triglyceride levels and functional stroke outcome, in a large prospective cohort of acute ischemic stroke patients. 2. Methods This study is a substudy of an Emergency Department (ED) acute stroke registry. The ED Stroke registry is an institutional review board approved prospective consecutive cohort study. All adult patients presenting to the ED of our academic tertiary care centre with a diagnosis of acute ischemic stroke were eligible for inclusion. For this substudy, pediatric stroke patients (age <18 years), patients with hemorrhagic
Social Participation after Stroke: One-Year Follow-Up of Stroke Survivors in Nigeria  [PDF]
Grace O. Vincent-Onabajo
ISRN Stroke , 2013, DOI: 10.1155/2013/532518
Abstract: Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns of social participation were examined independently and also in relation to initial stroke severity. Results. Overall social participation significantly improved over 12 months ( ), while significant improvements were observed only in the mobility, physical independence, and work and leisure domains at P equals 0.04, 0.04, and 0.05, respectively. In spite of the improvement in the work and leisure domain, the domain recorded the lowest level of participation. Social participation also differed by initial stroke severity with severe stroke survivors having the lowest level of participation across 12 months after stroke. Conclusions. The poor outcome in the work and leisure domain of social participation and in individuals with initial severe stroke has implications for planning and provision of appropriate long-term stroke rehabilitation. 1. Introduction Social participation is a component of human functioning that reflects the complexity of a person’s roles beyond the performance of activities of daily life [1]. Defined as an individual’s involvement in life situations [2], social participation is increasingly being recognized as an important aspect of life. Furthermore, appropriateness in the dimensions of social participation such as community life, leisure, educational and occupational activities, social integration, and economic self-sufficiency have been linked with improved well-being and quality of life in general populations [3, 4] as well as in those with chronic diseases such as stroke [5, 6]. Stroke is a life changing disease that often entails lifelong consequences including social ones [7]. With increasing rates of survival after stroke, there is a growing need for evidence-based interventions that will enhance social functioning and participation in survivors. However, devising, planning, and provision of appropriate interventions may require adequate data on patterns of social participation after stroke. Existing studies from Western and Asian countries are varied with reports on improvement [8, 9], deterioration [10, 11], and stability [12, 13] in
Weight Bearing Asymmetry and Functional Ambulation Performance in Stroke Survivors
B. O. A. Adegoke,O. Olaniyi,C. O. Akosile
Global Journal of Health Science , 2012, DOI: 10.5539/gjhs.v4n2p87
Abstract: This study evaluated asymmetry of weight bearing on the lower limbs and the association between percentage weight bearing asymmetry (PWBA) and functional ambulation performance in ambulant stroke survivors. Participants were 53 stroke survivors (male = 35, female = 18) aged 40-86 years (mean=58.87; SD=9.21years) with hemiparesis. Weight bearing through the lower limbs in standing was assessed by two juxtaposed bathroom weighing scales while functional ambulation performance was evaluated with the Emory Functional Ambulation Profile (E-FAP). Data were summarized with mean and standard deviation and further analyzed using the Pearson product moment correlation at 0.05 alpha level. Participants bore 60.3% (SD =7.1%) of their body weights on the unaffected legs and had a mean PWBA of 20.8 % (SD=14.7%). There was a significant positive correlation (r = 0.675, p < 0.0001) between PWBA and total E-FAP scores of participants. PWBA could hence be used to monitor functional ambulation recovery in stroke survivors.
The Prevalence of Stroke Survivors in Urban Slums in Enugu, Nigeria  [PDF]
Oluchi Stella Ekenze, Ezeala-Adikaibe Birinus Adikaibe, Onodugo Obinna, Chime Peter, Orjioke Casmir, Onodugo Pauline Nkiruka, Mbadiwe Nkeiruka, Onyekonwu Chinwe, Ijoma Nkemdilim Uchenna, Okoye Julius Uwabunkeonye, Obumneme-Anyim Ijeoma Nnenne, Ekochin Fintan, Ernest Okwundu Nwazor, Emmanuel Uzodimma Iwuozo
Open Journal of Preventive Medicine (OJPM) , 2019, DOI: 10.4236/ojpm.2019.96006
Abstract: Background: Stroke is one of the commonest non-communicable diseases and the commonest cause of death in adult neurology wards. Stroke preva-lence in sub Saharan Africa has dramatically increased over the past decades possibly due to changing life styles, poverty, poor health infrastructures which had led to increased risk factors for stroke. Poor nutrition and lack of access to standard medical care, predispose to high rates of stroke morbidity and mor-tality hence possible low prevalence. Little is known about the prevalence of stroke in people with low socio-economic status in Nigeria. Objectives: The main objective of this study was to determine the prevalence of stroke in two urban slums in south east Nigeria. Materials and Methods: This was a cross sectional descriptive study carried out in two slums in Enugu, South East Nige-ria. Participants were screened using a stroke specific questionnaire and further examined by two independent neurologists for evidence of focal neurological deficits. Analysis was done by SPSS version 22. Results: A total of 1440 par-ticipants were surveyed in the study; 769 (53.4) females and 671 (46.6%) males. About 22.3% (321) screened positive for various neurological diseases out of which 17 (5.3%) had evidence for stroke giving an overall prevalence of 1.2% (males 9 (1.3%) vs females 8 (1%) p = 0.6). The mean age of stroke sur-vivors was 60.1 years, similar in males and females (p = 0.6). The odds ratio for stroke from 40 years showed progress increment doubling between 60 and 70 years and tripled between 40 and 70 years. Age, lower level of education, positive history of hypertension, sickle cell disease, leg swelling and use of snuff positively are correlated with clinical diagnosis of stroke. Conclusion: The prevalence of stroke in two urban slums in Enugu metropolis was 12/1000. Hypertension, diabetes, use of snuff, and low levels of education were signifi-cant risk factors for stroke. Public health educational measures, promoting prevention and early detection of diabetes should be encouraged.
The lived experience of stroke survivors with early depressive symptoms: A longitudinal perspective  [cached]
Siren E. Kouwenhoven,Marit Kirkevold,Knut Engedal,Stian Biong
International Journal of Qualitative Studies on Health & Well-Being , 2011, DOI: 10.3402/qhw.v6i4.8491
Abstract: The aim of the study was to describe the lived experience as it develops over time in stroke survivors suffering from early depressive symptoms.This paper presents a phenomenological hermeneutical interview-study of nine participants at 6, 12, and 18 months after stroke.The participants related the depressive symptoms to the consequences of the stroke, and the experience of loss was crucial. Depressive symptoms was not meaningful on its own, but formed the backdrop of the experience of stroke. Our findings revealed three patterns of experience: (1) finding a restored self; (2) trapped in a different life; and (3) fighting to regain self. Two groups of stroke survivors are particularly vulnerable and should receive special attention: (a) old adults living alone; and (b) adults experiencing serious threats to their commitments such as to work, family, and children.Depressive symptoms have a severe impact on life after stroke. Life circumstances, degree of residual impairment from a stroke, and social context were found to influence people to move along different paths. Older adults living alone and adults experiencing serious threat to their commitments should receive special attention, in terms of further research and in terms of follow-up in clinical practice.More studies investigating the experience of post-stroke depression (PSD) over time and the association between depressive symptoms and loss/grieving are needed. There is also a need for continued empirical research on the identification of effective interventions aimed at prevention or improved coping with PSD.
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