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Purpose: To study the perspectives and experiences of stroke survivors and partners of stroke survivors regarding sexual issues and perceived rehabilitation needs. Methods: Using semi-structured interviews, 15 stroke survivors and 14 partners of stroke survivors (median age of 65 years, range 29 to 85) provided information about sexual issues experienced after stroke and their perspectives on how to address sexual concerns in a rehabilitation setting. A qualitative thematic analysis was applied to transcribed interviews to identify and describe common themes within the data relevant to the aim of the study. A quantitative analysis was utilized to elucidate the frequency of themes by demographic characteristics that were not readily apparent using a qualitative method alone. Results: Seven themes were identified. Two related to the effects of stroke on sexual life: physical/functional changes and relationship changes. Five related to addressing sexual issues in the process of rehabilitation: (1) difficulty in patients and providers talking about sexual matters, (2) little to no discussion of poststroke sexuality, (3) need for tailoring education to an individual or couple's unique needs, (4) provider rapport and competence, and (5) timing of poststroke sexual education. Conclusions: Poststroke sexual issues are complex and suggest the need for the development of a biopsychosocial model of education and treatment intervention. Rehabilitation programs need to evaluate the level of training and services provided to address poststroke sexual issues. Development of clinically useful poststroke sexual adjustment assessment tools and interventions is warranted. [ABSTRACT FROM AUTHOR]

Objectives: To identify the frequency and characteristics of patients admitted to inpatient rehabilitation (IPR) following a stroke who are able return to oral feedings and have their feeding tube (FT) removed prior to discharge from IPR, the timing of FT removal, and implications for outcomes. Methods: Medical records were identified by admission rehabilitation impairment code (RIC) for stroke (RIC 01), and reviews were completed by two physiatrists and two speech language pathologists. At random, 25% of the charts were reviewed by a second rater for data quality control. Measures collected during the chart review included the following: age, gender, onset of stroke, rehabilitation length of stay (LOS), admission and discharge FIM[TM], discharge destination, diet level, and feeding tube status. Results: One hundred forty-three patients were identified as subjects for this investigation who had an FT and were NPO upon IPR admission. Overall, 46.9% (67/143) of the patients returned to three meals daily prior to discharge from IPR. The mean days post stroke onset until returning to three meals daily was 38.43 days (SD= 26.36). Twenty percent (30/143) of the patients were able to have their FT tube removed priorto dischargefrom IPR. Factors associated with returning to three meals included gender (ie, female), longer IPR LOS, and higher admission FIM[TM] scores at IPR. Factors associated with removal of the feeding tube included a longer IPR LOS and younger age. Patients who were able to have their FT removed were more likely to be discharged to home. Conclusion: Individuals with longer IPR LOS were more likely to return to three meals daily and have their feeding tubes removed prior to discharge. [ABSTRACT FROM AUTHOR]

Purpose: To describe and evaluate a Community Stroke Navigation program. Method: A pretest-post test evaluation design was used. Community-dwelling stroke survivors were offered the services of a Community Stroke Navigator to assist them and their care partners with ongoing needs. Services included case coordination, emotional support, 'just in time' education, coaching, advocacy, and accompaniment. The community reintegration and physical and emotional well-being of the stroke survivors and their care partners were measured just prior to and 4 months following service provision. The Community Stroke Navigator's notes and qualitative interviews were analyzed to categorize the interventions. Results: Forty-one stroke survivors and 32 care partners received navigation services. The stroke survivors had experienced their stroke 1 month to 30 years previously (mean 4.7 years, SD 6.4 years). Thirty-five stroke survivors and 26 care partners took part in both the pretest and posttest. Posttest results demonstrated a small improvement in community reintegration among the stroke survivors but no significant change in community reintegration on the part of the caregivers and no alteration in physical and emotional health among either stroke survivors or care partners. Conclusion: Community Stroke Navigation has the potential to make an impact on community reintegration. [ABSTRACT FROM AUTHOR]

Background: Stroke impacts the domains known to be important for driving and is a primary condition for driving evaluation referrals. Given the high prevalence of stroke, the objective was to summarize the evidence regarding risk of crashes and traffic citations post stroke. Methods: A structured review of six databases was conducted to retrieve studies that included stroke as a separate exposure from other disorders and measured crashes or traffic citations as an outcome. Results: Four cohort and three case-control studies met the inclusion criteria. Five of the seven studies found increased odds or risk ratios ranging from 1.9 to 7.7, while two found an association of 0.8. Only one result was statistically significant (RR = 2.7). One study examined the outcome traffic citations and found no significant association. Conclusion: There is cause for concern regarding increased risk of crashes post stroke. Future studies that examine the impact of stroke severity and sequelae will help health professionals, families, and those with stroke make informed decisions regarding driving post stroke. This review indicates that drivers with stroke have an increased risk of crashing compared to their counterparts without stroke, as demonstrated by increased risk estimates in five out of the seven studies that have examined this issue. This review also points to an urgent need for rigorous studies investigating the risk of crashes according to specific stroke sequelae: an understanding of crash risk based on stroke severity, impairments, and function will assist clinicians in making informed decisions regarding the need for comprehensive driving evaluation and the potential for driver retraining for specific subgroups. [ABSTRACT FROM AUTHOR]

Purpose: Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. Method: A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. Results: Thirteen occupational therapists participated in the NGT meeting. Strongest consensus emerged for the inclusion of cognitive components of attention and speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). Conclusion: Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between independence in daily activities at discharge from rehabilitation and the degree of resumption of social roles 6 months later in older adults with stroke. Method: A total of 111 adults participated (mean age 77 years). Daily activities were measured using portions of the Functional Measurement of Autonomy System (SMAF). Social roles, measured using the social roles section of the Assessment of Life Habits (LIFE-H), included responsibilities, interpersonal relationships, community life, and leisure domains. Regression analyses were performed to evaluate the association between daily activities and social roles in conjunction with several capability variables. Results: Independence in daily activities increased the variances of the total scores for the responsibilities and community life models social role domains by 7% to 8%. The total explained variances ranged from 47% to 52% with corresponding beta values for daily activities ranging from -0.37 to -0.41. The lack of association between independence in daily activities and both leisure and interpersonal relationships was striking. The lowest scores were in the leisure domain. Conclusion: The association between daily activities at discharge and social roles 6 months following rehabilitation varies depending on the social role domain. Leisure may not be sufficiently addressed during rehabilitation warranting a 'second wave' of rehabilitation upon return to the community. [ABSTRACT FROM AUTHOR]

Background and Purpose: Driving a motor vehicle is an essential activity of daily living for adults; however, few studies have examined the effects of driving cessation on community integration among stroke survivors. The present study investigated this relationship as well as social support and gender as potential moderators of outcome. Method: Ninety pairs of stroke survivors and informants participated. Objective community integration (mobility, occupation, social integration) was assessed via informant ratings, whereas subjective community integration and social support were assessed via self-report. These poststroke outcomes were compared for survivors who did and did not resume driving post stroke. Results: Multivariate analysis of covariance (MANCOVA) indicated that drivers were more mobile and made more productive use of their time than did non-drivers, even after accounting for stroke severity and use of alternative transportation. Two interaction effects were observed: Drivers with high social support showed better community integration than did non-drivers and drivers with low social support. Additionally, among men, non-drivers fared substantially worse than drivers, whereas among women, drivers and non-drivers showed equivalent community integration. Conclusion: Driving status has unique and substantial influence on community integration following stroke. Social support facilitated community integration but did not substantially buffer the effects of driving cessation. Although men and women resumed driving at equal rates, driving cessation showed differential effects for men and women in regard to their community integration. Research is needed to design interventions that promote full engagement in community living among persons who cease driving after stroke. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle. DESIGN: To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0 degrees, 30 degrees, 60 degrees, and 90 degrees knee flexion in a case-control manner. SETTING: Research laboratory in a rehabilitation hospital. PARTICIPANTS: Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0 degrees to 90 degrees knee flexion. RESULTS: At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P< or =.048) and smaller pennation angle, especially for more extended knee positions (P< or =.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P< or =.044) and shorter fascicle length (P< or =.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05). CONCLUSIONS: This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation. Copyright © 2009 by the American Congress of Rehabilitation Medicine [ABSTRACT FROM AUTHOR]

Background: Stroke research and rehabilitation has traditionally focussed on the physical impact of a stroke, with less attention given to associated psychosocial factors. This study aimed to identify psychosocial predictors of health-related quality of life (HRQoL) in chronic stroke survivors and examine differences between nondepressed and depressed participants. Method: Participants were recruited primarily from six major metropolitan hospital databases. A total of 135 first-ever stroke survivors aged 25DL96 years who were 6 to 24 months post stroke and community-dwelling were studied longitudinally over 6 months. HRQoL and psychosocial factors (optimism, self-esteem, perceived control, depressive status, and social support) were measured at baseline, 10 weeks, and 6 months. Results: Psychosocial factors were significantly associated with HRQoL at every time point, accounting for 33% to 53% of the variance after controlling for demographic and clinical characteristics. At least 26% of all participants reported clinically significant depressive symptoms throughout the study. Compared to nondepressed participants, depressed participants had significantly poorer scores for HRQoL, social support, optimism, self-esteem, perceived control, and physical functioning. There were improvements in participants' physical health, social participation, depressive status, and optimism over the course of the study. Conclusion: These findings highlight the important role that psychosocial factors play in chronic stroke survivors' HRQoL and have implications for stroke rehabilitation programs: rehabilitation that targets poststroke depression and psychosocial adjustment to stroke has the potential to improve HRQoL for chronic stroke survivors, independent of functional impairment. [ABSTRACT FROM AUTHOR]

Purpose: This evaluation compared a new self-management program with land and water exercise (Moving On after STroke or MOST) to a standard education program (Living with Stroke or LWS). Participants: Of 30 persons with stroke (average age 68 and 2 years post stroke), 18 selected MOST and 12 chose LWS. Sixteen care partners participated. Method: Assessments at baseline, program completion, and 3-month follow-up included the Reintegration to Normal Living (RNL) Index, Activity-specific Balance Confidence (ABC) scale, exercise participation, and goal attainment (for the MOST group). Program delivery costs were calculated and focus groups conducted to examine participant expectations and experiences. Results: Social support was an important benefit of both programs, but only MOST participants improved significantly on the RNL (p < .05) and ABC (p < .001). Seventy-eight percent of all short-term personal goals in MOST were achieved, and overall goal attainment was above the expected level. At follow-up, a higher percentage of MOST participants were enrolled in exercise programs (p < .05). Conclusion: Although self-management programs with exercise are more costly to deliver than standard educational programs, these preliminary results indicate that such programs may be more effective in helping persons with stroke and care partners deal with the challenges of living with stroke. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this qualitative study was to explore factors that motivated older adults with ischemic stroke to engage in a task-oriented treadmill aerobic exercise (T-AEX) intervention study. Method: Participants included community-dwelling individuals post stroke with mild-to-moderate hemiparetic gait deficits who completed a 6-month T-AEX study. A total of 29 participants attended focus groups or individual telephone interviews. Results: Thirty-nine codes were identified and were reduced to 8 themes: personal goals supported by 7 codes, psychological benefits supported by 8 codes, physical benefits supported by 10 codes, research-associated supervised treadmill exercise benefits supported by 5 codes, objective and verbal encouragement received supported by 4 codes, social support related to exercise supported by 2 codes, improvement in instrumental activities of daily living supported by 2 codes, and self-determination supported by 1 code. All themes reflected factors that influenced subjects' willingness to participate in the study and adhere to the exercise intervention. Of the themes identified, personal goals, physical benefits, and psychological benefits occurred most frequently. Conclusion: This qualitative study provides information that may be used to enhance motivation to exercise in individuals with stroke and promote carryover and integration of exercise behaviors into everyday life. [ABSTRACT FROM AUTHOR]

This article focuses on the impact of increased duration of exercise therapy on functional recovery after stroke. A comprehensive literature search using multiple databases was used to identify all relevant randomized controlled trials. Their quality was reviewed by two independent assessors, and a narrative systematic review and meta-analysis was completed. Methodological quality of all the 20 randomized controlled trials (RCTs) identified had a median of 6 points (range 5-8) on the 10-point PEDro scale. A meta-analysis was completed for studies that had a common outcome measure. For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) were expressed as standardized mean differences (SMD). The results of the meta-analysis demonstrated that increased duration of exercise therapy time has a small but positive effect on activities of daily living as measured by the Barthel Index (SES 0.13; CI 0.01-0.25; Z = 2.15; p = .03) and that these improvements are maintained over a 6-month period (SES 0.15; CI 0.05-0.26; Z = 2.8; p = .00). Pooling reported differences in the various upper and lower extremity outcome measures demonstrated no significant SESs. However, the meta-analysis is supportive of the hypothesis that additional, focused exercise on the lower extremity has a favourable effect on lower extremity impairment and walking speed. The narrative review raises a number of issues that need to be considered in the development of future RCTs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The clinical functional evaluation is the usual method for dysphagia screening in patients with acute stroke. This study compared two methods of evaluation--with liquid and semisolid viscosities. METHOD: Twenty-six patients with stroke onset within 7 days--with a mean age of 63.5 +/- 12.4 years--were prospectively evaluated for deficit severity, swallowing mechanisms, chest X-ray studies, and late (30 days after discharge) assessment of disability with the modified Rankin Scale. RESULTS: Tests using water and pudding correlated poorly (p < .001). The water test exhibited higher sensitivity for detection of problems in laryngeal protection, and the test with pudding was more sensitive for the functional analysis of dysphagia itself. Abnormalities in the water test were associated with weak spontaneous cough, while a normal pudding test correlated well with oral feeding 30 days after hospital discharge. The initial neurological severity correlated with results from both tests. No patient had pulmonary infiltrates 72 hours after testing or pneumonia up to 30 days after hospital discharge. CONCLUSION: The two evaluation methods should be used to both decrease the risk of aspiration and increase the likelihood of a safe and early reintroduction of oral feeding. [ABSTRACT FROM AUTHOR]

This article reports the findings of a multiple case study tracing the long-term (3-10 years post event) recovery patterns of 8 stroke survivors who had participated in an unusually enriched recovery environment for at least 2 years. Data sources included extended interviews as well as archival records from that period. Shared aspects across cases included the following: (a) the singular importance of this social educational environment to their respective recoveries, (b) extended grief and new anxiety problems co-occurring with recovery during the first years, and (c) shared temporal patterns of recovery trajectory, including the multi-year duration of functional improvement. Findings are discussed within the context of recent research in mental health, adult education, and neuroscience. Recovery models that embrace the dynamic interplay of real-life environments, events, and goals situated in an individualized yet social context suggest the potential for an integrated recovery paradigm within the rehabilitation sciences. [ABSTRACT FROM AUTHOR]

Background: In individuals post stroke, cardiovascular and functional capacity is frequently reduced independent of severity. The psychological consequences of this reduction have only been briefly investigated. This study investigated the relationship between functional capacity and health-related quality of life (HRQoL) in individuals post stroke. Method: Thirty subjects with a mild stroke were tested 60 +/- 27 months (mean +/- SD) post stroke. Functional capacity was quantified with the 6-minute walk test (6MWT) and perceived HRQoL was evaluated by using the Stroke Impact Scale (SIS) version 3.0 questionnaire. Results: The 6MWT distance walked was 353 +/- 137 m, that is, 63% of the distance predicted for healthy adults. HRQoL was reduced with the lowest SIS scores in the domains of strength, hand function, and participation domains and the highest scores in the domains of mobility, communication, activities of daily living/instrumental activities of daily living (ADL/IADL), and memory. The SIS domains of hand function, strength, mobility, ADL/IADL, and participation were all positively correlated with 6MWT distance, with the strongest correlation for the latter four domains. Conclusion: Reductions in both functional capacity and HRQoL were documented. Functional capacity was positively correlated with six of the HRQoL domains and was strongest with the SIS domains most related to demands made on the individual throughout the day. [ABSTRACT FROM AUTHOR]

Chronic upper extremity hemiparesis following stroke is a significant impairment that can limit a person's independence in all aspects of ADL, IADL, and functional mobility. Although recovery of functional independence may be more efficient using traditional compensatory techniques, these therapeutic methods often do not encourage integration of the hemiparetic arm and hand. In contrast, the task-oriented approach to motor recovery of poststroke hemiparesis emphasizes integration of the impaired limb into all functional tasks via skill-based training. Cortical changes have been documented following skill-based training of the upper limb in the healthy animal model. Additionally, the combination of subthreshold cortical stimulation combined with skill-based forelimb training in the induced-stroke rat model has demonstrated better outcomes than training alone. Preliminary research with human stroke survivors using task-oriented training and subthreshold cortical stimulation has shown promising results. The purpose of this article is to introduce an upper limb training protocol that was used in a national multisite trial that compares cortical stimulation in conjunction with taskoriented training to training alone. [ABSTRACT FROM AUTHOR]

An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke. Two case studies are presented to illustrate some of the difficulties encountered in the rehabilitation of these individuals. Unlike hemispheric stroke, the characteristic consequences of brainstem stroke include ataxia, dysarthria, and diplopia. Additionally, individuals with brainstem stroke may suffer from severe dysphagia and may require enteral feedings. Unlike the rehabilitation of patients with hemispheric stroke, where there is an impressive and relatively comprehensive research literature, there has been surprisingly little research published on the rehabilitation of patients with brainstem stroke despite the fact they represent a significant number of patients admitted to stroke rehabilitation units. [ABSTRACT FROM AUTHOR]

Purpose: Qualitative data regarding stroke survivors' recovery experiences were used to describe factors important in the development of fear of falling (FoF) during the first 6 months after stroke. Method: Stroke survivors were interviewed 1 and 6 months after stroke to obtain data on their experiences related to stroke recovery trajectory. Analyses identified FoF as a naturally occurring part of stroke survivors' descriptions of their everyday lives. Interviews were reexamined to identify and describe personal experiences related to FoF in this population. Results: Forty-two (32%) veterans who participated in the larger study discussed FoF during the first 6 months after stroke. Analyses indicate three important factors may be associated with the development of poststroke FoF: (a) the initial fall coinciding with stroke onset, (b) perception of poststroke body changes, and (c) a pervasive everyday fear of future falls. Conclusion: These factors related to FoF need to be further studied in the poststroke population. It is possible that individualized interventions may be necessary to assist stroke survivors to manage FoF, decrease fear, and reduce falls after discharge home poststroke. [ABSTRACT FROM AUTHOR]

Hip fracture after stroke is a frequently occurring and costly complication. The bone quality of stroke survivors is affected by decreased mobility, asymmetric weight bearing, and impaired vitamin D stores. Simultaneously, the risk of falling after stroke is often increased by various impairments. Yet, attempts to limit falls are not enough to prevent fractures. Closer attention to bone health is also needed. Bone markers, which reflect the dynamics of bone remodeling, are becoming more available. Activity is necessary for bone health, but there are no clear guidelines for the type and amount of therapeutic exercise. New metrics for studying bone mineral density and exercise are on the horizon. Finally, there appears to be a role for bisphosphonate prophylaxis in a yet-to-be-defined at-risk population of stroke survivors. The purpose of this review is to discuss the setting for hip fracture after stroke and assess emerging treatments and technologies that may be used to combat the problem. [ABSTRACT FROM AUTHOR]

The human hand is inherently complex and versatile. Its use in everyday activities requires its careful positioning relative to the arm and fine adjustments of the fingers to secure the object in the hand to perform a desired task. Understanding the mechanics of prehension requires an appreciation of the anatomy, biomechanics, kinematics, and control of the hand. This article summarizes these complex mechanisms as well as the central nervous system control of hand movement. We propose a measure to characterize the biomechanics of palmar arch modulation during grasping. We also highlight questions to be investigated in future studies to stimulate further understanding of the motor control of hand function and of the recovery of hand functioning after neurological injury. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the frequency of use of medications to maintain bone health for patients with stroke. This study was undertaken at an urban academic rehabilitation center to determine the prevalence of use of agents that could reduce bone loss in the stroke population. Method: A clinical database was searched for all patients 18 years old and over with stroke. The sample included 1,219 inpatients and 2,776 outpatients. Demographic information (age, gender, and race) and medications were obtained for each patient. Results: Among inpatients with stroke, 7.1% were taking osteoporosis medications (bisphosphonates, calcitonin, parathyroid hormone, or hormone replacement therapy), 11.3% were taking calcium supplements, 5.9% were taking vitamin D supplements, and 45.1% were taking multivitamin supplements. Among outpatients with stroke, 5.7% were taking osteoporosis medication, 5.8% were taking calcium supplements, 2.2% were taking vitamin D supplements, and 16.0% were taking multivitamin supplements. Patients being treated with specific osteoporosis therapies tended to be older and female by calculated odds ratios. The use of multivitamins was not related to age, gender, or race. Conclusion: Overall, relatively few stroke patients were taking osteoporosis medications or supplements. There is a need to increase the recognition, prevention, and treatment of bone loss in this high-risk population. [ABSTRACT FROM AUTHOR]

Purpose: It is estimated that 50% to 75% of individuals who experience a stroke have persistent impairment of the affected upper limb (UL). There is a need to identify the best training strategies for retraining motor function of the UL. One intervention showing promise is virtual reality (VR), using either immersive or nonimmersive technology. Before recommending VR for use in clinical practice, it is important to understand the evidence regarding its effectiveness. Method: Two questions about the effectiveness of VR for UL rehabilitation in stroke were posed: (1) Is the use of immersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? (2) Is the use of nonimmersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? Results: There is level 1b evidence suggesting an advantage to training in immersive VR environments versus no therapy in UL rehabilitation, and level 5 evidence for training in immersive VR versus conventional therapy. There is level 4 evidence showing conflicting results for training in nonimmersive VR versus no therapy, and level 2b evidence for training in nonimmersive VR versus conventional therapy. Conclusion: The current evidence on the effectiveness of using VR in the rehabilitation of the UL in patients with stroke is limited but sufficiently encouraging to justify additional clinical trials in this population. [ABSTRACT FROM AUTHOR]

The general objective of the 'Rehabilitation Medicine Summit: Building Research Capacity' was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1. researchers; 2. research culture, environment, and infrastructure; 3. funding; 4. partnerships; and 5. metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report. [ABSTRACT FROM AUTHOR]

The general objective of the 'Rehabilitation Medicine Summit: Building Research Capacity' was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The fi ve elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To design, implement, and evaluate an experiential child advocacy curriculum for pediatric residents. DESIGN: Pilot study including before-after 2-group trial of an educational intervention and a qualitative component. SETTING: A large, hospital-based, urban resident continuity clinic. PARTICIPANTS: General pediatrics residents (N = 29 [PGY: 1-4]). INTERVENTION: Residents and faculty designed a longitudinal curriculum in child advocacy for the continuity clinic, which included community-based and legislative experiences for individual residents as well as clinic-based group activities. Residents reported their experiences to their clinic group at weekly preclinic conferences. In addition, residents presented posters at their year-end residency retreat and wrote grants to fund community projects based on their original findings. EVALUATION: We used a quantitative assessment of child advocacy knowledge, attitudes, skills, and self-reported practices, which residents completed pre- and postintervention (2 clinics) or, for comparison residents, at the beginning and end of the academic year (3 clinics). In addition, we conducted focus-group discussions with residents in the 2 intervention groups to explore unanticipated responses to the new curriculum. RESULTS: Residents who received the intervention (n = 13) had a greater increase in advocacy knowledge (2.62 vs 0.19, P =.005), ability to identify community resources (0.62 vs 0.16, P =.03), self-reported advocacy skills (2.0 vs -0.21, P =.002), and perceived value of advocacy training (0.31 vs -0.19, P =.03) compared with residents who did not (n = 16). In focus groups, intervention residents (n = 17) reported being surprised by community groups' and legislators' responsiveness to resident inquiries, and they expressed enhanced confidence in engaging these groups in dialogue about child policy issues. CONCLUSIONS: A longitudinal continuity clinic-based curriculum in child advocacy had significant positive impact on pediatric residents. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purposes of this study were (a) to examine changes in primary support persons (PSP) depression, physical health, and contextual and coping factors from hospitalization of the stroke survivor through the first 6-10 weeks of home care; and (b) to identify predictors of depression during that time.DESIGN: Prospective, longitudinal.SETTING: Hospital rehabilitation units and a freestanding rehabilitation hospital.POPULATION: The sample of stroke survivors and PSPs was recruited from consecutive patient admissions over 32 months to five hospital rehabilitation units and a freestanding rehabilitation hospital. The majority of PSPs were female, white, and married to the survivor. Among the stroke survivors, 61% were male and 70% were white. Survivors' mean age was 60 years, range 24 to 85, as compared to 58 years of age (range 19-86) for PSPs.INTERVENTIONS: The Stroke Survey questionnaire was used to collect data on the predictor variables, background, appraisal of impact and satisfaction with social support. Illness data were retrieved from the survivors' medical records. Cognition was measured using a 29-item version of the Mini-Mental State Exam (MMSE). Functional status was measured using the Functional Independence Measure (FIM). Family functioning was assessed using the General Functioning Scale of the Family Assessment Device (FAD). Availability of social support was measured using the Interpersonal Support Evaluation List (ISEL). Coping skills were measured using the 66-item, 8-subscale Ways of Coping Questionnaire (WOC). PSP depression was assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D).MAIN OUTCOME MEASURE(S): Reduction in mean PSP depression was significant at T2, but the change in physical health was not significant. Significant changes occurred in survivor function, family functioning, and three of six coping skills. T1 variables accounted for 29% of the variance in T1 PSP depression, with gender and appraisal of impact the strongest of seven predictors. T1 depression, T2 health, family functioning, and avoidance coping were the strongest of seven predictors, explaining 50% of the variance in T2 depression.RESULTS/CONCLUSIONS: The findings support the need for early intervention for new caregivers. A single study that is a longitudinal assessment of family functioning, coping variables, depression, and physical health is unique in the stroke literature. The vulnerability of PSPs and survivors who are living with sudden disability contributed to a higher-than-expected rate of attrition through survivor death and morbidity and through weariness of the PSP. Replication of the current study is needed to confirm the importance of specific predictors and the dynamics of their change over time. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

The rehabilitation agenda that's best for your patient may range from an intensive program in the hospital to a supervised home-based effort. Here's help in sorting out the options. Second of two parts. [ABSTRACT FROM AUTHOR]

Prompt evaluation and intervention after a stroke will produce the best long-range results. Careful screening will help identify the patients most likely to benefit from a rehabilitation program. First of two parts. [ABSTRACT FROM AUTHOR]