scholarly journals Inflammatory Signaling in Post-Stroke Fatigue and Depression

2018 ◽  
Vol 80 (3-4) ◽  
pp. 138-148 ◽  
Author(s):  
Hongmei Wen ◽  
Kristianna B. Weymann ◽  
Lisa Wood ◽  
Qing Mei Wang
Keyword(s):  
Quality Of Life ◽  
Independent Living ◽  
Stroke Rehabilitation ◽  
Sickness Behavior ◽  
The United States ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Efficient Management ◽  
Inflammatory Processes

Background: In the United States, stroke continues to be the cause for long-term disability. Of the patients with a first stroke, up to 75% will experience post-stroke fatigue (PSF) in the first year following stroke. PSF is one of the most disabling symptoms in stroke survivors; it decreases quality of life, increases mortality, and is a barrier to stroke rehabilitation. Given the incidence of stroke and the prevalence and detrimental impact of PSF on quality of life, independent living, and overall survival, efficient management of PSF must be a priority in stroke rehabilitation. The cause of PSF remains unknown. The burden of fatigue in stroke survivors is influenced by other stroke-related symptoms, most notably post-stroke depression (PSD). It is well known that stroke induces a systemic inflammatory response that is the trigger for sickness behavior, of which fatigue and depression are predominant symptoms. Summary: To date, only a handful of studies have sought to explore the relationship between stroke-induced inflammation and PSF and PSD. In this review, we describe this evidence, highlight the strengths and weaknesses of these existing studies, and suggest further experiments that may further support the association between stroke-related inflammatory processes and stroke-related symptoms. Key Messages: The current concept and further research are important for a more specific therapeutic intervention for PSF and PSD.

scholarly journals Stroke Survivor and Caregiver Perspectives on Post-Stroke Visual Concerns and Long-Term Consequences

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Theresa M. Smith ◽  
Monique R. Pappadis ◽  
Shilpa Krishnan ◽  
Timothy A. Reistetter
Keyword(s):  
Quality Of Life ◽  
Community Support ◽  
Stroke Survivor ◽  
The United States ◽  
Stroke Survivors ◽  
Care Providers ◽  
Post Stroke ◽  
Vision Care

Approximately 800,000 people in the United States have a stroke annually. Up to two thirds of stroke survivors have some visual problems, which result in disability and can affect survivors’ overall rehabilitation outcomes. Although some post-stroke visual impairments can be corrected and respond well to intervention, ocular signs can be subtle and may not be recognized or reported by the stroke survivor but rather by a vigilant caregiver. The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers. This study employed a qualitative design using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities. Interviews were recorded and transcribed verbatim. Comparative content analysis was used to identify vision-related themes by two independent coders. All research team members completed quality checking of coding. Twenty participants (11 stroke survivors and 9 caregivers) expressed visual concerns or consequences following stroke: (1) eye movement problems, (2) perceptual issues, and (3) consequences of vision problems or issues, which affected their daily life/quality of life. Stroke survivors and caregivers reported receiving vision care from (1) eye doctors, (2) occupational therapists, and (3) other healthcare professionals. All vision care providers need to be observant of potential post-stroke visual concerns. Stroke survivors should have a thorough vision evaluation to optimize their independence in everyday activities and quality of life.

Abstract P428: Effects of Tai Chi on Physical Function and Quality of Life in Chronic Stroke

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ruth E Taylor-Piliae ◽  
Tiffany M Hoke ◽  
Joseph T Hepworth ◽  
L. Daniel Latt ◽  
Bijan Najafi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Physical Function ◽  
Tai Chi ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Sf 36 ◽  
Fall Rates

Background: Poor physical function and quality of life are ubiquitous post-stroke. Effective interventions to improve physical function and quality of life for stroke survivors are critically needed. Objective: Examine the effect of a Tai Chi (TC) intervention on physical function and quality of life. Methods: In a single-blind randomized clinical trial community-dwelling stroke survivors, aged ≥ 50 years and ≥ 3 months post-stroke, were assigned to: Yang style 24-posture TC (n=53), SilverSneakers® (SS, n=44) strength and range of movement exercise, or Usual Care (UC, n=48) for 12 weeks. TC and SS attended a 1-hour class 3 times/week, while UC had weekly phone calls. Standardized measures for Physical Function were the Short Physical Performance Battery (SPPB), Fall Rates and 2-Minute StepTest; and for Quality of Life were the Medical Outcomes Study SF-36, Center for Epidemiological Studies Depression and Pittsburgh Sleep Quality Index. Results: A total of 145 stroke survivors (47% women, mean age=70 years, time post-stroke=3 years, ischemic stroke=66%, hemiparesis=73%) enrolled. During the intervention, TC participants had 2/3 fewer falls (n=5 falls), than the SS (n=14 falls) and UC (n=15 falls) groups (χ2=5.60, p=0.06). All groups had improvements in the SPPB score (F 1,142 =85.29, p<0.01), after the 12-week intervention. Post-hoc tests following a significant interaction for the 2-Minute StepTest (F 2,142 =4.69, p<0.01) indicated TC (t 53 =2.45, p=0.02) and SS (t 44 =4.63, p<0.01) groups had significantly better aerobic endurance over time, though the UC group did not (t 48 =1.58, p=0.12). All groups reported better perceived physical (SF-36 PCS, F 1,142 =4.15, p=0.04) and mental health (SF-36 MCS, F 1,142 =15.60, p<0.01), after the intervention. There were no significant within group changes in perceived physical health (p>0.05), while significant improvements in perceived mental health (p < 0.05) were observed within all groups. No significant changes in depressive symptoms or sleep quality were observed (p>0.05). Attrition was 10% (n=14), and intervention adherence rates were 85%. Conclusions: Goals of stroke rehabilitation are to prevent disability, improve physical function and quality of life. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Our data suggest that a 12-week TC intervention may be more effective in reducing fall rates than SS or UC. Future studies examining the effectiveness of TC to reduce fall rates; and improve physical function and quality of life for community-dwelling stroke survivors are recommended.

Abstract TMP49: Depressive Symptoms After Stroke are Linked Longitudinally between Stroke Survivors and Their Family Caregivers

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David L Roth ◽  
Orla C Sheehan ◽  
Jin Huang ◽  
J. D Rhodes ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Family Caregivers ◽  
Short Form ◽  
Well Being ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Clinically Significant

Background: Multiple previous investigations have documented persistent elevations in depressive symptoms after stroke for stroke survivors and for family caregivers. However, relatively few studies have examined both groups simultaneously, and none have tested for possible predictive linkages in longitudinal analyses. Methods: We collected interview data from 248 stroke survivors and their primary family caregivers who were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) project. CARES is an ancillary study to the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke survivors and caregivers were interviewed at 9-, 18-, 27- and 36-months after an adjudicated stroke event. Measures administered to both groups included the 20-item Center for Epidemiological Studies Depression Scale (CESD) and the 12-item Short Form Health Survey (SF-12) of health-related quality of life. Cross-lagged panel analyses were used to investigate linkages between stroke survivors and caregivers over time on these measures. Results: Clinically significant levels of depressive symptoms, as defined by a score of 16 or more on the CESD, were found for 17.0% of the stroke survivors and 13.7% of the caregivers at 9-months after stroke. Longitudinal models revealed that high stroke survivor depressive symptoms at 9-months post-stroke predicted increases in caregiver depressive symptoms at 18-months post-stroke (standardized adjusted regression coefficient = 0.18, p = 0.003). No longitudinal predictive effects were found for caregiver depressive symptoms on stroke survivor outcomes or for the SF-12 measures. Conclusions: Clinically significant levels of depressive symptoms were relatively rare 9-months after stroke in this population-based sample of stroke survivors and family caregivers. Stroke survivor depressive symptoms longitudinally predict caregiver depressive symptoms, but caregiver well-being was not found to longitudinally predict stroke survivor depression or quality of life. Treating elevated depressive symptoms in stroke survivors may also improve caregiver well-being.

Stroke rehabilitation and recovery

2021 ◽  
Vol 82 (9) ◽  
pp. 1-7
Author(s):  
Alifa Isaacs-Itua ◽  
Sancho Wong
Keyword(s):  
Quality Of Life ◽  
Stroke Rehabilitation ◽  
Stroke Recovery ◽  
Improve Quality ◽  
Post Stroke ◽  
Communication Impairments

Stroke is the UK's leading cause of disability. Stroke rehabilitation can maximise recovery and improve quality of life. This article discusses some post-stroke impairments, including hemiplegia, dysphagia, communication impairments and neglect, and how rehabilitation can address these. Developing techniques of adaptation or compensation is vital, since the extent of stroke recovery is dependent on successful neuroplasticity, with healthy neurons adapting to compensate for damaged ones.

Look closer: The multidimensional patterns of post-stroke burden behind the modified Rankin Scale

2020 ◽  
pp. 174749302095194
Author(s):  
Venesha Rethnam ◽  
Julie Bernhardt ◽  
Hannah Johns ◽  
Kathryn S Hayward ◽  
Janice M Collier ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Barthel Index ◽  
Independent Living ◽  
Self Care ◽  
Modified Rankin Scale ◽  
Post Stroke ◽  
Individual Assessment ◽  
Scale Scores

Background The utility-weighted modified Rankin Scale, representing patient perspectives of quality of life, is a newly proposed measure to improve the interpretability of the modified Rankin Scale. Despite obvious advantages, such weighting imperfectly reflects the multidimensional patterns of post-stroke burden. Aims To investigate multidimensional patterns of post-stroke burden formed by individual domains of Assessment of Quality of Life and Barthel Index for each modified Rankin Scale category. Methods In the A Very Early Rehabilitation Trial (n = 2104), modified Rankin Scale scores and modified Rankin Scale-stratified Barthel Index scores of Self-care and Mobility, and Assessment of Quality of Life scores of Independent Living, Senses, Mental Health and Relationships were collected at three months. The multivariate relationship between individual Assessment of Quality of Life and Barthel Index domains, and modified Rankin Scale was investigated using random effects linear regression models with respective interaction terms. Results Of 2104 patients, simultaneously collected Assessment of Quality of Life, Barthel Index and modified Rankin Scale scores at three months were available in 1870 patients. While individual Assessment of Quality of Life and Barthel Index domain scores decreased significantly as modified Rankin Scale increased (p < 0.0001), the patterns of decrease differed by domains (p < 0.0001). Patients with modified Rankin Scale 0–1 had the largest post-stroke burden in the Mental Health and Relationship domains, while patients with modified Rankin Scale >3 showed the greatest burden in Independent Living, Mobility and Self-care domains. Conclusions Across the modified Rankin Scale, individual domains are varyingly impacted demonstrating unique patterns of post-stroke burden, which facilitates appropriate assessment, articulation and interpretation of the modified Rankin Scale and utility-weighted modified Rankin Scale.

scholarly journals The Patient’s Experience of the Psychosocial Process That Influences Identity following Stroke Rehabilitation: A Metaethnography

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
E. Hole ◽  
B. Stubbs ◽  
C. Roskell ◽  
A. Soundy
Keyword(s):  
Quality Of Life ◽  
Stroke Rehabilitation ◽  
Treatment Compliance ◽  
External Support ◽  
Stroke Survivors ◽  
Patient’S Experience ◽  
Positive Experiences ◽  
Identity Changes ◽  
Over Time

Background and Purpose.Patient experience is increasingly being recognised as a key health outcome due to its positive correlation with quality of life and treatment compliance. The aim of this study was to create a model of how patient’s experiences of rehabilitation after stroke influence their outcome.Methods.A metaethnography of qualitative articles published since 2000 was undertaken. A systematic search of four databases using the keywords was competed. Original studies were included if at least 50% of their data from results was focused on stroke survivors experiences and if they reflected an overarching experience of stroke rehabilitation. Relevant papers were appraised for quality using the COREQ tool. Pata analysis as undertaken using traditional processes of extracting, interpreting, translating, and synthesizing the included studies.Results.Thirteen studies were included. Two themes (1) evolution of identity and (2) psychosocial constructs that influence experience were identified. A model of recovery was generated.Conclusion.The synthesis model conceptualizes how the recovery of stroke survivors’ sense of identity changes during rehabilitation illustrating changes and evolution over time. Positive experiences are shaped by key psychosocial concepts such as hope, social support, and rely on good self-efficacy which is influenced by both clinical staff and external support.

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