Medicine and Health Sciences Commons^™

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 …

Kinematic And Kinetic Comparisons Of Arm And Hand Reaching Movements With Mild And Moderate Gravity-Supported, Computer-Enhanced Armeo®Spring: A Case Study, Qussai M. Obiedat

Theses and Dissertations

Background: Stroke has been recognized as a leading cause of serious long-term disability in the United States (U.S.) with 795,000 people experience a new or recurrent stroke each year (Roger et al., 2011). The most apparent defect after stroke is motor impairments (Masiero, Armani, & Rosati, 2011). Statistically, half of stroke survivors suffer from upper extremity hemiparesis and approximately one quarter become dependent in activities of daily living (Sanchez et al., 2006). There is strong evidence that intensity and task specificity are the main drivers in an effective treatment program after stroke. In addition, this training should be repetitive, functional, …

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 …

Effect Of Rat Strain Stereotactic Coordinates On Infarct Volume, Saagar K. Sanghvi

Browse all Theses and Dissertations

Ischemic stroke makes up 87% of all hospital-admitted stroke cases annually; the primary treatment for these cases is intravenous administration of tPA within a 3.5 hour window from stroke onset. A long-term delayed ischemic stroke treatment proposed by this study was a combination of the pharmaceuticals Fluoxetine (SSRI), Simvastatin (statin), and ascorbic acid (Vitamin C). 51 adult rat subjects (10-12 months of age; 44 Sprague Dawley, 7 Long Evans) were given a combination of the drugs for 31 days. Drugs were given through voluntary oral administration via sugar cookie-dough balls to reduce inhibition of neurogenesis through stress-related glucocorticoid production. Drug …

Usefulness Of The Mms And S5 For Assessing Medication Management Capacity For Clients Post-Stroke, Jessica Jean Bolduc

Occupational Therapy Program Student Theses, Dissertations and Capstones

Occupational therapists need a means to efficiently and accurately screen a client’s medication management capacity, especially for clients post-stroke. Most therapists are not aware of, nor do they utilize specific assessments for medication management capacity, partly due to lack of thorough assessments. The purpose of this study was to compare the scores of the ManageMed Screen (MMS), the Screening for Self-Medication Safety Post Stroke (S5), and the Montreal Assessment of Cognition (MoCA) on a population of rehabilitation clients post-stroke to evaluate consistency of scores and determine their usefulness in clinical practice. All screens were designed for use in occupational therapy; …

Multifactorial Modulation Of The Blood-Brain Barrier: Relationship To Stroke, Bei Zhang

Theses and Dissertations--Nutritional Sciences

The blood-brain barrier (BBB) is a dynamic interface, mainly consisting of highly specialized brain microvascular endothelial cells (BMECs) that segregate the central nervous system (CNS) from the peripheral circulation. Impairment of the BBB, due to disruption of tight junction (TJ) proteins and inflammatory responses, may initiate and/or contribute to the progress of CNS disorders, including stroke. Stroke is the second leading cause of death worldwide. It has been shown that aging and environmental pollutants can induce brain endothelium dysfunction, and are considered as risk factors for stroke.

Deficiency of telomerase is highly linked with aging-associated vascular diseases. Evidence indicates that …

Is Dabigatran Superior To Warfarin In Treating Patients With Atrial Fibrillation?, Kelly Higgins

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Dabigatran is superior to Warfarin in patients with atrial fibrillation.

STUDY DESIGN: Review of three English language primary studies published in 2007, 2009, and 2010.

DATA SOURCES: Three randomized control trials found using Cochrane Database.

OUTCOME(S) MEASURED: Outcomes measured were presence or absence of stroke or systolic embolism and intracranial hemorrhage. The absence of these events preserved neurologic function in patients with atrial fibrillation.

RESULTS: In both VKA-naïve and VKA-experienced patients, Dabigatran 150 mg was superior to Warfarin in both the prevention of stroke …

Is Electrical Muscle Stimulation Effective In The Progression Of Oral Feeding, For Patients With Dysphagia, Caused By A Stroke?, Kristen Iaconelli

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of …

Ability And Skill Retraining With Task-Oriented Intervention To Improve Functional Independence In Persons With Stroke, Trista Thacker

Online Theses and Dissertations

The purpose of the study was to examine the difference that ability and skill retraining used with task-oriented intervention can make on functional independence (as measured by FIM subscales) in persons with stroke. The findings of this study can contribute to the body of literature to support occupational therapy. Review of related literature includes background support for the use of FIM with the stroke population through analysis of the psychometric properties of the instrument. Also, the review of related literature provides support for the use of ability and skill retraining and task-oriented interventions with the stroke population. This supports the …

Evaluating Discharge Readiness Of Patients At A Primary Stroke Center, Amanda Green

DNP Projects

The diagnosis of stroke is very prevalent in healthcare and it is estimated that someone in the United States suffers from a stroke every 40 seconds (Lloyd-Jones et al., 2009). In order to optimally prepare these patients for discharge and improve patient outcomes, it is important to understand the needs of the patient and caregiver and to meet these needs. In order to evaluate this, the focus of this project was to evaluate the discharge readiness of patients at a primary stroke center. “Discharge Needs of the Stroke Patient and Caregiver” focuses on a review of the literature in order …

Developing The Rehabilitation Education For Caregivers And Patients (Recap) Model: Application To Physical Therapy In Stroke Rehabilitation, Megan M. Danzl

Theses and Dissertations--Rehabilitation Sciences

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.

Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. …