Medicine and Health Sciences Commons^™

Exploring The Use Of The Bimanual Arm Trainer For Improving Upper Extremity Motor Function In Stroke Patients., Manuel G. Wilfred

Seton Hall University Dissertations and Theses (ETDs)

Background and purpose

There are few evidence-based treatment options to address recovery in patients with severe upper extremity impairment post-stroke. Although robotic treatment options have been widely explored with variable outcomes, the contribution of bimanual training to improve upper extremity control and coordination has not yet been fully explored. To date, the mirrored motion Bimanual Arm Trainer (BAT) has not specifically been investigated for its effectiveness in stroke patients. This study explored the usefulness of the bimanual arm trainer in improving upper extremity function in stroke patients with severe deficits and its impact on quality of life.

Methods

Twenty-three patients …

Carer Information Needs Following A Family Member's Right Hemisphere Stroke, Christyn Davidson

Electronic Theses and Dissertations

Background: Previous studies have explored information needs for carers of persons with aphasia; however, there is minimal research on information needs of carers with right hemisphere disorder (RHD). RHD describes cognitive and communication impairments a person experiences following a right hemisphere stroke or brain injury. Carers have an important role in rehabilitation and the long-term quality of life of a person with RHD. This study explores the information needs for carers following a family member’s right hemisphere stroke throughout different periods of recovery.

Methods/Procedures: Participants completed online surveys and a semi-structured phone interview. Analysis of the interviews revealed four major …

Ischemic Stroke, Rachele Gualtieri

Nursing Student Class Projects (Formerly MSN)

Stroke is one of the leading causes of death in the United States, and a very large percentage of those who suffer a stroke experience an ischemic stroke. It is detrimental that the healthcare providers caring for these patients are proficient in understanding the pathophysiology and treatment of a stroke to preserve maximal function of the brain and promote a full recovery. It is also crucial that providers are aware of risk factors for stroke, events leading up to an ischemic injury, and the events that follow an ischemic injury. This poster discusses the underlying pathophysiology, signs and symptoms, risk …

An Eye Opener In Stroke: Mitochondrial Dysfunction And Stem Cell Repair In Stroke-Induced Retinal Ischemia, Hung Vu Thien Nguyen

USF Tampa Graduate Theses and Dissertations

Stoke is a leading cause of disability and mortality across the globe, making it a global health crisis. However, treatments for stroke remain limited with narrow therapeutic time window. Visual impairment negatively affects patients’ quality of life. During stroke, the disruption in blood flow might affect both brain and eye resulting in cerebral and retinal ischemia. Currently, there is a lack of treatment option that targets both cerebral and retinal ischemia. Ischemic stroke pathology is complex and multiphasic. The ischemic event is followed by a secondary cascade of inflammatory cytokines exacerbating the initial focal injury and expanding into the penumbra. …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

Neurodynamics Under Different Walking Speeds In Individuals With Chronic Post-Stroke Hemiparesis, Corey Ackley, Kiley Aki, Joshua Arias, Jassie Trinh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is the leading cause of long-term disability in adults worldwide. The ability to return to walking is often a main goal of rehabilitation in individuals with chronic post-stroke hemiparesis. To increase walking speed, non-neurologically impaired individuals produce greater ankle propulsion force at push-off with greater ankle dorsiflexion angles in swing phase with no change in ankle muscle co-contraction index in the swing phase. It remains unclear if individuals post-stroke would adopt similar neuromuscular strategies. Therefore, our aim was to examine the effect of altered walking speeds on propulsion force at push-off, ankle dorsiflexion angle during swing, …

Modulation Of Corticospinal Excitability Using Cathodal Transcranial Direct Current Stimulation To Improve Walking In Individuals With Chronic Post Stroke Hemiparesis, Neil Drobitch, Kylie Henry, Sage Lyons, James Schomig

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Individuals who have experienced a pyramidal cerebrovascular accident (pCVA) often exhibit impairments to volitional control of corresponding motor tasks. Promising effects in motor response, post-application of transcranial direct current stimulation (tDCS), have been reported in studies on individuals with the ability to achieve independent gait for 20 minutes. These studies mainly examined the effects of combined tDCS with locomotor training on lower extremity function among higher functioning individuals post-stroke. The purpose of this study was to determine the effect of tDCS among individuals post-stroke who may not have independent ambulatory capabilities, focusing on motor response and less …

Exploring The Complexities Of Real World Upper Limb Performance After Stroke, Kimberly Waddell

Arts & Sciences Electronic Theses and Dissertations

Stroke is the leading cause of long-term disability in the United States. Hemiparesis, or weakness on one side of the body, is a common impairment following a stroke. Approximately 80% of individuals with stroke will experience upper limb paresis, with only a small percentage regaining full functional use of their paretic upper limb. Individuals report ongoing difficulties with incorporating their paretic upper limb into routine activities after a stroke. Rehabilitation interventions often try to increase real world upper limb use by improving what an individual is capable of doing (i.e. capacity) in the rehabilitation clinic. Both clinicians and researchers assume …

The Effect Of Meditation On Stroke-Survivor Resilience: Secondary Analysis Of Existing Data, Mary Love

Dissertations & Theses (Open Access)

Purpose: To test the effect of meditation on resilience of community-dwelling stroke survivors, and to identify resilience predictor variables in these survivors.

Methods: Sub-study with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression (MEND). Paired samples t-test was used to evaluate the effect of meditation on resilience of stroke-survivors (n=20) in the intervention group. Bivariate analysis and general linear modeling (GLM) were used to identify demographic, clinical, and psychological predictor variables of baseline resilience for all stroke survivors (n=34).

Results: The increase in stroke-survivor resilience scores from baseline (mean 3.46, SD=.81) to intervention completion …

Comparative Effectiveness And Safety Of Non-Vitamin K Antagonists Oral Anticoagulants And Warfarin In Elderly Patients With Non-Valvular Atrial Fibrillation And Diabetes, Siddhi Korgaonkar

Electronic Theses and Dissertations

Results: The matched sample consisted of 4578 patients (2291 in each group). NOACs were found to significantly reduce the risk of stroke/SE compared to warfarin (Hazard Ratio (HR): 0.373, 95% confidence interval (CI): 0.247 - 0.564, p<0.001); but, no significant difference was seen between NOACs and warfarin in terms of reducing the risk of MI (HR: 0.864, CI: 0.594 – 1.257, p=0.446). NOACs were found to significantly reduce the risk of ICH (HR: 0.500, CI: 0.300 – 0.834, p=0.008) and OB (HR: 0.608, CI: 0.424 – 0.870, p=0.007); but no difference was seen in the risk of MGB (HR: 0.862, CI: 0.640 – 1.160, p=0.326) between NOACs and warfarin. NOACs were also found to reduce the risk of all-cause mortality (HR: 0.783, CI:0.656 – 0.873, p=0.007). The composite of effectiveness and safety outcomes, and all-cause mortality was statistically significant proving superior overall effectiveness and safety of NOAC therapy to warfarin therapy in terms of risk reduction (HR:0.685, CI:0.587 – 0.801, p<0.001).

Predictors Of Admission For Stroke Or Transient Ischemic Attack Patients, Jessica Janice Tucker

Walden Dissertations and Doctoral Studies

Approximately 11% of patients diagnosed with a stroke or a transient ischemic attack are readmitted to the hospital, creating a cost burden of nearly $2 billion per year for Medicare beneficiaries. Because researchers and policy makers consider hospital readmission for patients with strokes or transient ischemic attack to be an indicator for the delivery of quality care, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare reimbursement in 1 year for excessive readmissions, potentially impacting the financial sustainability of various healthcare organizations. The ecological systems theory allows for the understanding …

Community Education Through A Stroke Champion Program, Michele Gribko

Walden Dissertations and Doctoral Studies

Stroke is the fifth leading cause of death and primary cause of long-term disability in the United States. Public awareness of stroke symptoms and ability to activate the emergency medical system (EMS) quickly are essential for early treatment. At a large Joint Commission-certified Comprehensive Stroke Center with over 6,000 employees, a stroke champion program that included both clinical and nonclinical volunteers was initiated to determine whether stroke champion volunteers could learn and disseminate information about stroke symptoms and the importance of activating EMS within their community. Roger's diffusion-of- innovation framework was used to design and evaluate the outcome of the …

Reducing 30-Day Readmissions For Patients With Stroke, Faith Omomen Ighile

Walden Dissertations and Doctoral Studies

In a stroke-certified 500-bed acute care hospital, the 30-day readmission rates for patients discharged to rehabilitation centers or skilled nursing facilities were higher than the rates for patients discharged to home. A review of data by the stroke team showed 44 patients readmitted within 30 days of initial stroke discharge between October 2016 and January 2017. The rate of re-admission for those discharged home was 41% (18 patients), whereas the rate for those discharged to acute inpatient rehabilitation, long-term acute care, or skilled nursing facilities was 59% (26 patients). The practice-focused question for this project assessed whether using a re-admission …

Hemoglobin A1c And The Development Of Heart Disease In African American Men, Heather Walzel

Walden Dissertations and Doctoral Studies

Several studies have been conducted that link poor control of hemoglobin A1c (HbA1c) to an increased risk of heart disease. However, there are limited published studies that link HbA1c and heart disease based on ethnicity and gender. To address this gap in literature, the purpose of this study was to assess the association between HbA1c and heart disease in African American males (aged 30-64 years old) while controlling for education, income, and access to care. The research questions were focused on establishing an association between HbA1c values and heart disease in African American men through the lens of the health …

Improving Early Mobilization In Acute Stroke Patients Through Best Practice Education, Angela Christine Middleton

Walden Dissertations and Doctoral Studies

Nonadherence to best practice guidelines in early mobilization in acute stroke increases the time from admission to mobilization and may increase residual long-term stroke effects. Early mobilization following an acute stroke is known to decrease long-term and secondary disability. The purpose of this project was to decrease the time from admission to mobilization in the acute stroke patient population by improving knowledge of best-practice guidelines in early mobility using an educational intervention for advanced practice nurse practitioners, physicians, and registered nurses. The practice-focused question for this project asked whether a staff educational program based on best-practice guidelines would decrease the …

Ky Stroke Encounter Quality Improvement Project: An Evaluation Of The Differential Administration Of Tpa In Acute Ischemic Stroke, Payton Malone

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

No abstract available

The Impact Of Depression On Treatment Outcomes For Patients With Aphasia Who Participate In An Intensive Comprehensive Aphasia Program (Icap), Harley B. Kincheloe

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Abstract

Background: Aphasia is a multi-modal impairment resulting from left-hemisphere stroke. Aphasia is often accompanied by post-stroke depression. Acquiring aphasia and depression is seen to hinder quality of life and rehabilitative outcomes. Traditional stroke therapy often does not monitor or treat psychological difficulties such as depression. Such psychological difficulties hinder progress in recovery and may need to be addressed in therapy to ensure the best possible outcomes.

Aims: In response to the lack of psychological support for persons with aphasia, this literature review aims to explore the impact of depression on functional outcomes. Furthermore, this literature review will explore how …

Evidence-Based Music Therapy Treatment To Elevate Mood During Acute Stroke Care, Jessica L. Rushing

Theses and Dissertations--Rehabilitation Sciences

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The …

Treatment Fidelity In The Very Early Rehabilitation In Speech (Verse) Randomised Controlled Trial: An Exploration Of Treatment For Aphasia, Emily Louise Brogan

Theses: Doctorates and Masters

Background

Aphasia is a neurological condition that affects the expression and/or comprehension of language and can have considerable impact on a person’s quality of life. Treatment for aphasia from speech language pathologists is effective. However, more information is needed on the nature of effective intervention including consideration for what therapy is provided, when it is commenced and how it is delivered. Treatment fidelity is concerned with ensuring research treatment protocols are implemented as they were intended, which assists in uncovering the specifics of how and why treatments work. When treatment fidelity is investigated thoroughly, researchers and research consumers can be …