Medicine and Health Sciences Commons^™

Treatment Of Blunt Cerebrovascular Injury - A Systematic Review And Meta-Analysis, Multicenter Retrospective Review, And Protocol For A Feasibility Randomized Controlled Trial, Jovana Momic

Electronic Thesis and Dissertation Repository

Blunt cerebrovascular injury (BCVI) is an often-overlooked clinical problem that can result in stroke and cause devastating, potentially permanent, neurologic disabilities in young and otherwise healthy trauma patients. Early diagnosis and treatment of BCVI can reduce the risk of stroke and prevent disability, however, treatment also carries a risk of bleeding complications. More research is needed to understand the optimal management strategy to reduce the risk of stroke while minimizing bleeding complications.

The aim of this thesis is to review and critically appraise the literature to better understand the efficacy of various treatment strategies in preventing stroke following BCVI, evaluate …

Exploring The Relationship Between Hemispheric Prefrontal Cortex Activation, Standing Balance, And Fatigue In Individuals Post-Stroke: A Fnirs Study, Sarthak Kohli

Electronic Thesis and Dissertation Repository

Balance impairments are common after stroke. Reasons for this are multifactorial and include motor dysfunction and fatigue. Limited research has explored the combined effects of post-stroke fatigue and balance on brain activation patterns. Research has shown that prefrontal cortex (PFC) activation may be involved in both motor control and fatigue throughout the recovery process post-stroke. The aim of this thesis was to determine whether: (1) PFC activation levels change between standing balance tasks, (2) PFC hemispheric activation is asymmetric during standing balance tasks, and (3) fatigue levels are associated with task-based activation. Patients with hemiparesis were recruited from the inpatient …

Health Providers Perspectives On The Access And Use Of Formal Health And Social Services By Stroke Caregivers, Hannah Pollock

Electronic Thesis and Dissertation Repository

Informal stroke caregivers, comprised of family and friends, can experience prolonged stress that places them at risk of poor health and social outcomes. These caregivers may benefit from formal health and social services, but they are often underused and challenging to access. This qualitative interpretive description study sought to explore health providers’ perspectives on the factors that impact stroke caregivers' access and use of formal health and social services. In addition, it sought to explore health providers' experiences and how they perceive their role in supporting stroke caregivers'. In-depth, semi-structured interviews were conducted with 18 health providers. Through inductive thematic …

In-Hospital Outcomes Following Left Atrial Appendage Closure, Shubrandu S. Sanjoy

Electronic Thesis and Dissertation Repository

Left atrial appendage closure (LAAC) is a non-pharmacologic approach for stroke prevention in patients with atrial fibrillation. The impact of comorbidity burden on adverse outcomes following LAAC is very important for clinical decision making. Cohort-based observational study was conducted to evaluate the association of comorbidity burden with in-hospital complications. Of 3294 participants (mean age was 75.7±8.2 years), 60% were male and 86% whites. The majority of participants undergoing LAAC presented with a significant number of comorbid conditions. The occurrence of in-hospital major adverse events (MAE) was 4.6%. Women and patients exhibiting higher Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.14, …

Rehabilitation Of Post-Stroke Aphasia In Ghana, Keren Sarpomaa Kankam

Electronic Thesis and Dissertation Repository

Aphasia is one of the most common consequences of stroke and affects the communication and social functioning of approximately 30-35% of stroke survivors. Despite the importance of speech-language pathology (SLP) services for individuals with post-stroke aphasia, aphasia rehabilitation services in sub-Saharan Africa are riddled with challenges. Through interviews, demographic information, and syllabi reviews, we examined the SLP assessment and treatment services available for individuals with post-stroke aphasia in Ghana and the challenges the stakeholder groups encounter in providing and identifying such services. Results of the study identified challenges with the current post-stroke aphasia services in Ghana, and thus the need …

Applications Of Ct Perfusion-Based Triaging And Prognostication In Acute Ischemic Stroke, Eric A. Wright

Electronic Thesis and Dissertation Repository

CT Perfusion (CTP) is a minimally invasive imaging technique that aids acute ischemic stroke (AIS) triage and prognostication by determining tissue viability based on hemodynamic parameters. The goals of this research are to determine: 1) CTP thresholds for estimation of infarct and penumbra volume, 2) how CTP scan duration impacts infarct and penumbra volume estimates, and 3) reliability of CTP for predicting functional outcomes following intra-arterial therapy (IAT).

Chapter 2 introduced an experimental study for determining ischemia-time dependent thresholds for brain infarction using multimodal imaging in a porcine stroke model that is easier to implement than previous large animal stroke …

Evaluating White Matter Changes And Executive Function In Rat Models Of Mediodorsal Thalamic Stroke And Neuroinflammation, Jessica Garabon

Electronic Thesis and Dissertation Repository

Recent literature has supported a relationship between vascular disease and its role in the progression of cognitive impairment. Previous studies have demonstrated that white matter inflammation (WMI) in the brain is a common pathological outcome following stroke. Moreover, WMI has been shown to be the strongest predictor of cognitive decline following stroke. Finally, previous work in our lab has demonstrated, using a rodent model of striatal stroke, that WMI is correlated with post-stroke cognitive impairment. The current study aimed to further investigate the role of WMI in post-stroke cognitive impairment by utilizing a mediodorsal thalamic (MD) stroke model in the …

Assessing The Impact Of Caregiver Outcomes On Function And Reintegration Of Stroke Survivors Participating In A Community Stroke Rehabilitation Program., Spencer R. Thompson

Electronic Thesis and Dissertation Repository

There is a limited amount of literature evaluating the relationship between caregivers, and the stroke survivors’ function and reintegration. The objectives were to evaluate the association between caregivers’ lifestyle changes on function and the role of functioning as a moderator between caregiving and reintegration among stroke survivors receiving community-based rehabilitation. Data were collected from January 2011 to January 2016. A one-way repeated measures analysis of variance and multivariable linear regression were performed on Functional Independence Measure, Bakas Caregiving Outcomes Scale, Reintegration to Normal Living Index across admission, discharge, and follow-up. Mean age was 70.2±13.17 years with 58% males (n=200). A …

The Impact Of Resource Availability On Patterns Of Discharge To Inpatient Rehabilitation After Stroke In Ontario, Canada, Matthew J. Meyer

Electronic Thesis and Dissertation Repository

Stroke is a leading cause of death and disability in Canada. As patients, their families, and their friends adjust to life after stroke, organized rehabilitation can play an important role in functional recovery and improving quality of life. Best-practice recommendations suggest that moderately-to-severely impaired patients receive care in an inpatient rehabilitation unit and more mildly impaired patients in out-of-hospital settings (outpatient clinics or in-home). However, data from Ontario (Canada’s most populous province) suggest that post-stroke rehabilitation resources in both settings may be lacking. This has led to concern that some patients may be receiving rehabilitation that is not appropriate for …

Characterizing Knee Loading Patterns In People Post-Stroke, Stephanie Marrocco

Electronic Thesis and Dissertation Repository

Post-stroke temporal gait asymmetry (TGA) could cause excess loading of the non-paretic leg which may cause musculoskeletal (MSK) issues in the knee. This thesis investigated knee loading during gait and its relationship to TGA post-stroke. Methods: Gait analysis was conducted in nine people post-stroke. Gait was classified as symmetric (TGS) or asymmetric and external knee adduction (KAM) and flexion moments (KFM) were calculated. Participants were compared to healthy older adults (n=109) on KAM and KFM. The proportion of individuals with increased loading was compared between the TGS and TGA groups. Results: Six and four participants exhibited increased loading …

Mirror Therapy For The Lower-Extremities Post-Stroke, Lucas David Crosby

Electronic Thesis and Dissertation Repository

Despite extensive rehabilitation post-stroke gait remains slow, variable and asymmetric. There is a need for simple interventions to improve lower-extremity motor control and walking ability. Mirror therapy is a promising intervention though little attention has focused on its use on the lower-extremities post-stroke. This thesis investigates the feasibility and potential effects of a bilateral lower-extremity mirror therapy intervention (LE-MT) post-stroke. A case series involving three participants, who performed twelve 30 minute sessions of LE-MT over four weeks, is presented. Session duration and number of repetitions completed improved over the course of the intervention indicating LE-MT post-stroke is feasible. Some cases …

The Relationship Of Plantar Sensation With Standing Balance And Gait Post-Stroke, Stephen Parsons

Electronic Thesis and Dissertation Repository

Gait and balance dysfunction after stroke limit independence and quality of life. Numerous contributing factors have been investigated but the role of sensation deficits has received little attention. This thesis investigated the relationship between plantar cutaneous sensation and 1) standing balance, 2) gait, and 3) use of vision to compensate for sensory loss with a secondary analysis of data from individuals with subacute stroke. Associations between standing balance, gait and sensation were investigated with Spearman correlations. Individuals classified as impaired or intact sensation were compared on gait and standing balance measures. This thesis found plantar sensation is related to standing …

Investigation Of Sox9 Ablation On Neuroplasticity And Recovery After Ischemic Stroke, Bethany Robin Lenore Bass

Electronic Thesis and Dissertation Repository

Neuroplasticity is a key factor in post-stroke functional recovery. A chief inhibitor of post-stroke neuroplasticity is the expression of chondroitin sulfate proteoglycans (CSPGs). Recent research has shown that the transcription factor SOX9 is responsible for upregulating the expression of CSPGs in the injured central nervous system. Accordingly, CSPG levels are significantly lower in mice with the Sox9 gene conditionally knocked out. The purpose of this study was to determine how Sox9 ablation affects neuroplasticity and recovery after stroke. Behavioural test results revealed that Sox9 KO mice exhibited significantly improved functional recovery after stroke compared to controls. This correlated with increased …

Causes Of Post Stroke Falls Along The Care Continuum: Implications For Improving Patient Safety, Mona Madady

Electronic Thesis and Dissertation Repository

In Western countries stroke is responsible for 10-12% of all deaths. In 2000, strokes cost $3.6 billion for the Canadian healthcare system and lost productivity due to premature death and long-term disability. Falls are a frequent occurrence at all stages of post-stroke recovery and can have significant negative impacts. While information about the incidence and risk factors of falling among stroke survivors is available, considerably less is known about the specific factors contributing to falls and the circumstances surrounding these adverse events. The purpose of this project was to identify similarities between systemic factors of falls in stroke survivors across …

The Effect Of Selective Hypothermia On Stroke Volume, Thomas K. Mattingly

Electronic Thesis and Dissertation Repository

Hypothermia is a well-established neuroprotectant. Selective hypothermia to the ischemic area may eliminate side effects while improving induction time. We studied the effect of selective hypothermia on stroke volumes in adult domestic swine. Under general anesthesia, one MCA was occluded transcranially for 3 hours followed by 3 hours of reperfusion. In half the animals, hypothermia was induced during reperfusion via a dual-lumen balloon occlusion catheter placed in the carotid ipsilateral to the ischemic region. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated blinded to the intervention. In a series of animals, the mean temperature achieved was …

Improving Acute Stroke Management With Ct Perfusion Imaging: Approaches To Treatment Guidance And Brain Tissue Salvage, Christopher D. D'Esterre

Electronic Thesis and Dissertation Repository

CT Perfusion (CTP) provides measurement of perfusion at the capillary level which can be used to characterize tissue viability, and blood-brain-barrier (BBB) compromise. Using CTP, the goals of this research are to: 1) select patients that will benefit from acute stroke treatment, and 2) determine if pre-stroke neuroprotection reduces stroke severity.

Chapter two investigates the cerebral blood volume (CBV) parameter in a small acute ischemic stroke (AIS) patient set. Overestimation of the acute CBV defect is caused by incomplete wash-out of the CT contrast due to a shortened CTP acquisition time (“truncation artifact”).

In chapter three we examine the prognostic …

An Investigation Into The Combined Effects Of Β-Amyloid Toxicity And Cerebral Ischemia On The Pathological Expression Of Gangliosides., Jeffrey D. Hepburn

Electronic Thesis and Dissertation Repository

Identifying mechanisms underlying the synergistic pathological interaction between stroke and Alzheimer’s disease (AD) can effectively guide future therapeutic strategies for these highly co-morbid conditions. Aberrant ganglioside expression marked by the pathological accumulation of ganglioside GM3 is common to stroke and AD, yet it is unclear whether GM3 is synergistically enhanced in a comorbid model, or if GM3 is a viable therapeutic target. Adult male Wistar rats received a unilateral ischemic striatal infarct via endothelin-1 (ET-1) injection alone or in combination with bilateral intracerebroventricular injection of the β-Amyloid 25-35 peptide (Aβ) to induce generalized Aβ toxicity (Aβ/ET-1). Animals were sacrificed after …

Adherence To Canadian Best Practice Recommendations For Stroke Care: The Case Of Post-Stroke Depression, Katherine L. Salter

Electronic Thesis and Dissertation Repository

Context: Canadian best practice recommendations for identification and treatment of post-stroke depression (PSD) have been established, but whether they have been adopted is not known.

Objectives: To compare current with recommended best practice.

Methods: A retrospective chart review from 5 inpatient rehabilitation programs in Southwestern Ontario was completed and a short online survey addressing current practices, opinions and attitudes regarding PSD conducted.

Results: Screening for PSD was documented in 41 of 294 patient records. Of the 41 patients screened, 16 were referred for assessment and 6 diagnosed with PSD. However, 113 patients (38.9%) received pharmacotherapy. Most staff …

Shift Work And Cardiovascular Events: Systematic Review And Meta-Analysis, Manav V. Vyas

Electronic Thesis and Dissertation Repository

The prevalence of shift work is increasing in the general population. There is conflicting epidemiologic evidence on the association between shift work and cardiovascular disease. We performed a systematic review and meta-analysis of observational studies that measured shift work-cardiovascular disease associations. We screened 12,350 articles and identified 35 eligible studies. The pooled risk ratios (RR) for myocardial infarction, all coronary events and ischemic stroke were 1.23 (95% confidence interval [CI] 1.15 to 1.31, I² = 0), 1.24 (95% CI 1.10 to 1.39, I² = 85%) and 1.05 (95% CI 1.01 to 1.09, I² = 0), respectively. The …

Three-Dimensional Ultrasound Measurements Of Carotid Atherosclerosis In Vulnerable Patient Populations, Daniel N. Buchanan

Electronic Thesis and Dissertation Repository

Atherosclerosis is a progressive disease that leads to plaque development and is associated with cardiovascular events such as myocardial infarction and stroke. Several biomarkers have been established as surrogates of plaque development yet none can provide direct, noninvasive, rapid measurements of atherosclerotic disease. Three-dimensional Ultrasound (3DUS) image acquisition is safe, inexpensive and fast, however 3DUS image measurements are limited due to time consuming manual image analyses. In addition, the true clinical meaning of 3DUS carotid imaging measurements has not yet been established. A semi-automated approach for the estimation of 3DUS Total Plaque Volume (TPV) was developed with similar variability and …

Motor Control Of Exercise That Emphasizes Speed Post-Stroke, Vicki L. Gray

Electronic Thesis and Dissertation Repository

Purpose: To investigate whether a single session of closed kinetic chain (CKC) and open kinetic chain (OKC) exercises emphasizing speed post-stroke could evoke changes in the motor control and whether these improvements would transfer to postural tasks.

Methods: Thirty-two individuals post-stroke and 32 age- and sex- matched controls performed a single session of 50 fast squats and steps (Chapter 3). Internal perturbations (arm raise/load drop) were used to assess postural responses before exercises (Pre), immediately after exercises (Post) and 15 minutes after exercises (Retention) (Chapter 4). Eleven individuals post-stroke performed a single session of 50 fast knee and ankle OKC …