Medicine and Health Sciences Commons^™

Comparing The Application Of Assessment Tests On Patients With Cerebrovascular Accident: The Mini-Mental Status Examination-Chinese Test Versus The Luria-Nebraska Neuropsychological Battery-Screening Test, Tingchia Wang, Yuhsin Wu, Naiwen Guo, Maohsiung Huang, Jyonghuei Su

Rehabilitation Practice and Science

Purposes: Patients with stroke often experience neurocognitive impairment; thus, an effective screening test should be developed. The Mini-Mental Status Examination-Chinese (MMSE-C) test and the Luria-Nebraska Neuropsychological Battery-Screening (LNNB-S) test are two commonly used tests for assessing cognitive impairment. In Taiwan, few studies have been conducted on the applicability of cognitive assessment tests. In the present study, we examined the assessment effectiveness of the MMSE-C and LNNB-S and compared them regarding their assessment effectiveness for impairment in various brain regions. Methods: This study was a retrospective study. Medical records from the 2005-2014 period for patients with stroke at the rehabilitation division …

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

The Effect Of A Powered Ankle Foot Orthosis On Walking In A Stroke Subject: A Case Study, Ali Pourghasem, Ismail Ebrahimi Takamjani, Mohammad Taghi Karimi, Mohammad Kamali, Mohammad Jannesari, Iman Salafian

Department of Mechanical and Materials Engineering: Faculty Publications

[Purpose] Standing and walking are impaired in stroke patients. Therefore, assisted devices are required to restore their walking abilities. The ankle foot orthosis with an external powered source is a new type of orthosis. The aim of this study was to evaluate the performance of a powered ankle foot orthosis compared with unpowered orthoses in a stroke patient.

[Subjects and Methods] A single stroke subject participated in this study. The subject was fitted with three types of ankle foot orthosis (powered, posterior leg spring, and carbon ankle foot orthoses). He was asked to walk with and without the three types …

Stroke As A First Presentation Of Malignancy, Farheen Niazi, Puneet Kakar, Ratneshwari Jha, Reena Dhami, Farook Edoo

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a frequent complication in patients with cancer occurring in nearly 15% of the cases. However cerebrovascular disease as the first presentation of malignancy has rarely been reported. We report two such cases who were admitted with acute stroke but were later on found to be having malignancy. Routine workup was unrewarding in both patients. Both patients developed pulmonary embolism as well during hospital stay suggesting hypercoagulable state as likely etiology. Reaching to the final diagnosis was an arduous journey but can help guide other clinicians facing similar cases. Non Hodgkins B cell lymphoma and Carcinoma Gall bladder were …

Aspirin Resistance Predicts Adverse Cardiovascular Events In Patients With Symptomatic Peripheral Artery Disease, Tilak Pasala, Jennifer Soo Hoo, Mary Kate Lockhart, Rehan Waheed, Prasanna Sengodan, Jeffrey Alexander, Sanjay Gandhi

The Texas Heart Institute Journal

Antiplatelet therapy reduces the risk of myocardial infarction, stroke, and vascular death in patients who have symptomatic peripheral artery disease. However, a subset of patients who take aspirin continues to have recurrent cardiovascular events. There are few data on cardiovascular outcomes in patients with peripheral artery disease who manifest aspirin resistance.

Patients with peripheral artery disease on long-term aspirin therapy (≥4 wk) were tested for aspirin responsiveness by means of the VerifyNow Aspirin Assay. The mean follow-up duration was 22.6 ± 8.3 months. The primary endpoint was a composite of death, myocardial infarction, or ischemic stroke. Secondary endpoints were the …

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing to …

Atrial Fibrillation And Stroke In Elderly Patients, Geetanjali Dang, Imaan Jahangir, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

The increasing prevalence of stroke, with an estimated annual cost of $71.5 billion, has made it a major health problem that increases disability and death, particularly in patients with atrial fibrillation. Although advanced age and atrial fibrillation are recognized as strong risk factors for stroke, the basis for this susceptibility are not well defined. Aging or associated diseases are accompanied by changes in rheostatic, humoral, metabolic and hemodynamic factors that may contribute more to stroke predisposition than rhythm abnormality alone. Several thromboembolism-predisposing clinical characteristics and serum biomarkers with prognostic significance have been identified in patients with atrial fibrillation. Although anticoagulation …

Albuminuria Changes And Cardiovascular And Renal Outcomes In Type 1 Diabetes: The Dcct/Edic Study., Ian H De Boer, Xiaoyu Gao, Patricia A Cleary, Ionut Bebu, John M Lachin, Mark E Molitch, Trevor Orchard, Andrew D Paterson, Bruce A Perkins, Michael W Steffes, Bernard Zinman

Epidemiology Faculty Publications

Background and objectives In trials of people with type 2 diabetes, albuminuria reduction with renin-angiotensin system inhibitors is associated with lower risks of cardiovascular events and CKD progression. We tested whether progression or remission of microalbuminuria is associated with cardiovascular and renal risk in a well characterized cohort of type 1 diabetes.

Design, setting, participants, & measurements We studied 1441 participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study. Albumin excretion rate (AER) was quantified annually or biennially for up to 30 years. For each participant, albuminuria status was defined over time as normoalbuminuria (AER …

Methods And Systems For Prognosis And Diagnosis Of Brain Damage, Mark A. Lovell, Bert C. Lynn, Melissa A. Bradley-Whitman

Sanders-Brown Center on Aging Faculty Patents

The presently-disclosed subject matter includes methods and devices for diagnosing, prognosing, and treating brain damage in a subject, including brain damage caused by stroke or a traumatic brain injury (TBI). The methods can comprise providing a sample obtained from the subject, exposing the sample to an antibody selective for a visinin-like protein, detecting the presence of a complex that includes the antibody and the visinin-like protein, and diagnosing and/or prognosing the subject as having brain damage if there is the presence of the complex. Embodied methods can also comprise administering a treatment for brain damage if the subject includes the …

Puzzleart Therapy: Connecting The Pieces In Search Of Answers, Jennifer Fortuna

Open Journal of Occupational Therapy: Occupation and the Artist

Alli Berman has been an artist, educator, author, and lecturer for more than 25 years. Her art can be found in private, corporate, and nonprofit collections around the world. Berman is the creator of PuzzleArt, a series of small abstract paintings that combine to form a modular puzzle. When a stroke impacted Berman’s quality of life, she turned to art for answers. Engagement in a meaningful activity, such as painting, provided her motivation and strength for continued physical and psychological healing. The PuzzleArt concept evolved from a simple exercise that helped Berman to fit all of the missing pieces back …

Puzzleart Therapy: Connecting The Pieces In Search Of Answers, Jennifer Fortuna

The Open Journal of Occupational Therapy

Alli Berman, a New York based artist, provided the cover art for the Fall 2016 issue of The Open Journal of Occupational Therapy (OJOT). “Sunlight Underwater” is a 12 piece PuzzleArt painting made from acrylic on American maple that measures 22x30. The PuzzleArt concept began as a simple exercise that evolved into a therapeutic modality. When a sudden stroke impacted Berman’s well-being and quality of life, it was art that helped her to make connections during recovery.

A Comparison Of Neuromuscular Electrical Stimulation And Acupuncture To Traditional Dysphagia Therapy In Stroke Patients, Rachel A. Hale, Dr. Ann E. Perreau

Communication Sciences and Disorders: Student Scholarship & Creative Works

A comparison of neuromuscular electrical stimulation and acupuncture to traditional dysphagia therapy in reducing dysphagia in individuals who suffered a stroke.

Awareness About The Signs, Symptoms And The Risk Factors Of Stroke In Patients With Stroke: A Multicentre Study, Nausheen Farooq, Haider Darain

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this survey was to determine the levels of awareness regarding symptoms, warning signs and risk factors of stroke in patients with stroke. For the latter purpose, a total of 500 participants who had stroke were recruited from four different hospitals of Rawalpindi and Islamabad. Patients who were already diagnosed by physicians with either type of stroke (haemorrhagic and ischemic) were included in this trial. Data was collected through a questionnaire and was analysed in SPSS version 20. Both male and female population were included in this study. The minimum age for the patients to be included was …

The Relationships Between Health Literacy, Self-Efficacy And Readiness For Change To Health Promotion Behaviors In Urban Black Women, Millie Hepburn

Seton Hall University Dissertations and Theses (ETDs)

Problem: Black women have been shown to experience higher rates of morbidity and mortality as a result of stroke, cardiovascular disease, hypertension, diabetes and overweight or obesity than women of other races/ethnicities. The ability to avert certain health problems, such as cardiovascular disease, hypertension, diabetes, stroke and overweight or obesity is known to be directly related to active engagement in health promotion behaviors, yet Black women are consistently less likely to engage in these behaviors than are white women. Improved understanding of the various factors that impact individual health promotion behaviors to reduce risk, such as health literacy, self-efficacy and …

Ischemic Strokes, Jada Adams

Nursing Student Class Projects (Formerly MSN)

Stroke or cerebrovascular accident (CVA) is the third leading cause of death in the United States (Mvundura, McGruder, Khoury, Valdez, & Yoon, 2011). Ischemic strokes make up about 86% of the strokes that occur, (Patel, & White, 2011) hemorrhagic and cryptogenic strokes make up for the other 15%. The topic that is covered in this poster is ischemic stroke. The biggest way to alter the amount of strokes that happen are to prevent them. More and more risk factors are being found that contribute to strokes. Once the inflammatory and immune response begins once triggered by hypoxia it cannot be …

Translating Modified Ashworth Scale Into Functional Measures And Quantitative Kinematic Values: A Pilot Study, Patrick Frigge

Theses and Dissertations

TRANSLATING MODIFIED ASHWORTH SCALE INTO FUNCTIONAL MEASURES AND QUANTITATIVE KINEMATIC VALUES: A PILOT STUDY

by

Patrick D. Frigge

The University of Wisconsin-Milwaukee, 2016

Under the Supervision of Professor Ying-Chih Wang, PhD

Introduction: Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes. The gold standard for assessing spasticity in stroke patients is the Modified Ashworth Scale (MAS), but the scale is highly subjective to the clinician’s opinion and previous experience and lacks psychometric fidelity. Numerous studies have criticized the scale’s subjectivity and lack of rater reliability. Development of a quantitative spasticity device in routine clinical care …

Intra-Ethnic Diversity In Ischemic Heart Disease And Stroke Mortality Among Hispanics In The United States, Karen Elizabeth Callahan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Hispanics are the largest racial/ethnic minority group in the United States (US), comprising 17% of the total US population in 2014, and projected to increase to 28.6% by 2060. Yet, the intra-ethnic heterogeneity for the second and fourth leading causes of death among Hispanic populations, heart disease and stroke, has never been comprehensively studied. We examined ischemic heart disease (IHD) and stroke mortality among distinct Hispanic subgroups: Caribbean Hispanics (including Puerto Ricans, Cubans, and Dominicans), Mexicans, Central Americans and South Americans, comparing their mortality with non-Hispanic whites (NHWs).

Methods: Five years (2008-2012) of death certificate data from Florida and …

Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrillation: Past, Present, And Future, Ramsey M Wehbe, Ajay Yadlapati

The Texas Heart Institute Journal

No abstract provided.

Experiences Of Stress And Coping Over Time By Caregivers Of Stroke Survivors: A Mixed-Methods Approach, Fang Ye

Dissertations & Theses (Open Access)

Background/ Objectives: Caregivers of stroke survivors often experience physical and mental stress, decreased physical and emotional well-being, high burden of care, social isolation, and neglecting self-care. The majority of previous research studies have identified caregiver experiences during the first one-to-two years post stroke. Little is known about caregiver experiences beyond the first two years of the post- stroke recovery trajectory, indicating a need for longitudinal study of their experiences over time. Therefore, the objectives of this study were to 1) investigate caregiver experiences of stress and coping over 5-7 years post stroke using quantitative methods, and 2) explore through …

Cerebral Venous Thrombosis, Jennifer C. Lyons

Nursing Student Class Projects (Formerly MSN)

A deeper dive into Cerebral Venous Thrombosis including, pathological process, risk factors, signs and symptoms, how to diagnose, treatment, nursing implications and a case study.

Time Lost Is Brain Lost: Impact Of Ischemic Stroke, Paula Severns

Nursing Student Class Projects (Formerly MSN)

Stroke is the leading cause of functional impairment and the fourth leading cause of death in the United States. Annually 795,000 stokes occur with mean annual lifetime cost estimated at $140,000 per person. Approximately every 40 seconds a stroke occurs while every four minutes a stroke death occurs. Stroke is the broad term often used to describe a neurological emergency, of either ischemic or hemorrhagic etiology, affecting blood flow to the brain. Although approximately 90% of strokes are ischemic in nature, both are medical emergencies requiring time sensitive medical intervention. Decreasing modifiable risk factors, public education and recognition, along with …

Exploring The Effect Of An Interdisciplinary Teamwork Intervention In Acute Rehabilitation, Julie K. Cope

Theses and Dissertations

Purpose: The purpose of this study was to explore the efficacy of an interdisciplinary intervention on interdisciplinary teamwork and patient functional outcomes in an acute inpatient rehabilitation unit at a mid-sized regional hospital. Design: Pilot mixed-methods pre-post intervention study. Methods: Interdisciplinary teamwork and patient functional outcomes were measured before and after a teamwork intervention. Interdisciplinary teamwork was measured with the Healthcare Team Vitality Instrument (HTVI) and a qualitative staff questionnaire developed by a content expert. Patient functional outcomes were measured by aggregated Functional Independence Measure (FIM®) scores. Findings: Post-intervention FIM® gain scores increased significantly (p = .008). Staff questionnaire revealed …

Does Generalization Occur Following Computer-Based Cognitive Retraining?—An Exploratory Study, Kitsum Li, Jonathan Alonso, Nisha Chadha, Jennifer Pulido

Kitsum Li

Computer-based cognitive retraining (CBCR) intervention has gained great popularity in recent years. This study aimed to investigate the occurrence of skill generalization to daily living task for individuals with acquired brain injury (ABI) after completion of eight modules of a commercially available CBCR program, the Parrot Software. The study investigated changes in individuals’ global cognition as measured by the Montreal Cognitive Assessment, and changes in individuals’ performance during a medication-box sorting task, a novel instrumental activity of daily living. The medication-box sorting task resembled real life medication management with daily prescribed and over-the-counter medications. Twelve individuals with ABI from a …

1st Place Research Paper: The Effectiveness Of Yoga Therapy On An Adult, Post-Stroke Population: A Systematic Review, Baylor E. Hogan

Kevin and Tam Ross Undergraduate Research Prize

Objectives: The objectives of this paper are to (1) give a brief overview of stroke pathophysiology (2) outline yoga as a therapeutic strategy (3) present the current research on yoga rehabilitation for stroke (4) discuss the efficacy of yoga for chronic stroke.

Methods: Relevant terms were searched in PubMed, Web of Science, Academic OneFile, ScienceDirect, and Google Scholar electronic databases. Studies were excluded if they contained pediatric stroke, non-stroke neurological diseases, or subjects with comorbidities. Statistically significant data was extracted for the primary measures of nine trials.

Results: Four studies measured statistically significant outcomes (p<0.05). These included improvements in balance, independence, endurance, trait anxiety, fear of falling, self-efficacy, pain, strength, range of motion (ROM), activity, participation, and quality of life (QoL). Discussion: Lack of statistical significance in post-stroke depression (PSD) measures may be due to inadequate intervention length or a psychosocial cause of depression. Improvements in balance, flexibility, and strength from yoga participation permitted progress in disability and functionality. Finally, overall health-related quality of life (HRQL) is affected by the severity of mental disorders and physical disability. Yoga can have a positive effect in both domains and therefore, may improve HRQL.

Conclusion: …

Reliability Of Clinical Evaluators Of Spasticity In Patients With Stroke, Tiffany Alvino, Shiney David, Chelsea Gendvil

Dissertations, Theses, and Capstone Projects

Spasticity is characterized by hyperexcitable stretch reflexes with amplitude increases in response to velocity dependent passive movement and resistance. Spasticity is the result of abnormal function of segmental and suprasegmental neuronal circuits. The objective of this study was to determine any positive correlation between three clinical evaluators of spasticity (i.e., the pendulum test, the patellar tendon tap test (PTT), and the Modified Ashworth scale) in their reliability to assess spasticity in people post-stroke. It was hypothesized that the use of force movement sensors along with surface electromyography increases the reliability of the standardized clinical tests. The results show that all …

Accuracy Of Icd-9-Cm Codes By Hospital Characteristics And Stroke Severity: Paul Coverdell National Acute Stroke Program, Tiffany E. Chang, Judith H. Lichtman, Larry B. Goldstein, Mary G. George

Neurology Faculty Publications

Background—Epidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and ICD‐9‐CM codes, stratified by hospital characteristics and stroke severity.

Methods and Results—We used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke‐enriched cohort, we compared agreement between the attending physician's clinical diagnosis and principal ICD‐9‐CM code and determined whether disagreements varied by hospital characteristics (presence of a …

Comparing Direct Factor Xa Inhibitors And Warfarin In The Prevention Of Stroke In Patients With Atrial Fibrillation, Alessandra Lof, Stephanie Pillai

Physician Assistant Capstones, 2016 to 2019

Objective: To evaluate the overall efficacy, advantages, and disadvantages of treatment with direct factor Xa inhibitors as compared to warfarin in the prevention of stroke in patients with atrial fibrillation. Methods: A quantitative meta-analysis was performed on three separate studies, each of which evaluated the efficacy and safety outcomes of a direct factor Xa inhibitor versus warfarin in preventing stroke in patients with atrial fibrillation. The direct factor Xa inhibitors that were evaluated included apixaban, edoxaban, and rivaroxaban. Results: The direct factor Xa inhibitors were found to be as effective, and in some cases more effective, than …

Leukemia Inhibitory Factor As A Neuroprotective Agent Against Focal Cerebral Ischemia, Stephanie Davis

USF Tampa Graduate Theses and Dissertations

Previous publications from this laboratory demonstrated that administration of leukemia inhibitory factor (LIF) (125 µg/kg) to young, male Sprague-Dawley rats at 6, 24, and 48 h after middle cerebral artery occlusion (MCAO) reduced infract volume, improved sensimotor skills, and alleviated damage to white matter at 72 h after the injury. In vitro studies using cultured oligodendrocytes (OLs) showed that LIF (200 ng/ml) also protects against 24 h of oxygen-glucose deprivation through activation of Akt signaling and upregulation of the antioxidant enzymes peroxiredoxin IV and metallothionein III. Other groups have demonstrated that LIF reduces neurodegeneration in animal models of disease, but …

Identifying And Implementing Assessments Of Upper Extremity Motor Control For Patients With Stroke Or Parkinson’S Disease, Julia Albright, Kayla Karelsen, Allison Lucas

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The authors collaborated with a team of clinicians at a skilled nursing facility (SNF) in Gig Harbor, WA to identify the need for measures of UE functional use that are most appropriate to utilize with the two largest client populations at their facility, stroke and Parkinson’s disease (PD). In order to meet the clinical utility characteristics identified as important by the clinicians, the authors searched two databases that contain overviews of assessments. This search identified five stroke assessments and two PD assessments that met the clinical utility parameters outlined by the clinicians. The authors then conducted a systematic literature search …

Effectiveness Of The Bridge/Adapt Program On Functional Skill Generalization After Acquired Brain Injury, Janice S. Li, Diana Lopez, Eugene Cheung, Angela Talamantez

Dissertations, Masters Theses, Capstones, and Culminating Projects

This study explored the effectiveness of the Bridge/Adapt program for generalizing increased cognition to functional skills. Three participants, identified as having significant cognitive impairments as measured by the Cognistat assessment, participated in the Bridge/Adapt program, an eight-week program that includes both remedial and compensatory components. The remedial component used was a computer-based cognitive rehabilitation program called Parrot Software. Past studies have proven computer-based cognitive rehabilitation to be effective in increasing overall cognition. The Bridge/Adapt module is the compensatory component that utilized a variety of strategies and everyday tasks to facilitate the generalization of improved cognition to functional performance. A homework …