Recovering Motor Function fter Stroke
Stroke and Motor Learning

Strategies for Recovering Motor Function after Stroke

Strategies for Recovering Motor Function after Stroke

On an annual basis, close to a million U.S. citizens are hospitalized for stroke and their length of stay averages 5.3 days (NHLBI, 2013). Close to 60% of these are first time stroke patients. In terms of morbidity, stroke is responsible or 1.7 million mericans currently suffering from chronic physical and/or cognitive impairment. With nearly 80% of all stroke survivors suffering from limb impairment (reviewed by Thieme et al., 2012), there is a great need for remedial strategies that minimize the level of disability these patients suffer from. This report will review recent research in the area of upper limb rehabilitation strategies to better understand progress being made in this area of research.

ssessing Upper Limb Motor Impairment

s Higgins and colleagues (2011) discuss, there is a lack of standardization concerning functional evaluation…...

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All instruments, except the modified Ashworth Scale and Star Cancellation Test, revealed all treatment groups experienced significant improvement after 20 therapy sessions over the course of 5-week intervention (p < 0.002) (Thieme et al., 2012). In contrast to this finding, the Ashworth Scale and Star Cancellation Test revealed between group differences. The Ashworth scale, which is used to assess changes in passive finger and wrist movement resistance, revealed that individual mirror therapy patients experienced significant improvement in finger flexors (p < 0.001), but not for wrist flexors (p = 0.08) and that intergroup difference were significant for finger flexors only (p < 0.05). The Star Cancellation Test, which is designed to measure visuospatial neglect, revealed individual therapy patients improved significantly more compared to the control group (p < 0.01). Importantly, the five-week intervention reduced the level of visuospatial neglect experienced by individual and group patients, but the mock therapy group had increased visuospatial neglect. These findings suggest that individual mirror therapy can significantly reduce the magnitude of visuospatial neglect for the affected arm of a stroke patient.

A similar approach for improving a patient's mind-body connection is constraint-induced movement therapy (reviewed by Brunner, Skouen, and Strand, 2012). This is done by restricting the good arm during tasks requiring the use of an arm, thereby forcing the patient to rely more heavily on the impaired arm. In contrast, bilateral arm training is believed to be superior to constraint-induced therapy by some researchers based on the theory that both sides of the brain are required for proper retraining of the impaired arm.

To try and resolve this controversy, Brunner and colleagues (2012) conducted a randomized controlled study to directly compare the efficacy of both strategies. They found no statistically-significant difference between the two strategies for a number of tasks after 4 hours of training for 4 weeks. The outcomes were measured using the Action Research Arm Test, Nine-Hole Peg Test, and the Motor Activity Log and both treatment groups improved significantly by the post-treatment and 3-month follow-up assessments (p < 0.010-0.001). These findings suggest that either the constraint-induced movement or bilateral arm training therapy approaches are equally effective in improving the use of the impaired arm

Coping Styles in Middle Aged Stroke Survivors
Extant literature has been dedicated to coping styles in middle aged stroke survivors. Rochette et al. (2006) conducted a study to evaluate the adaptation process, participation as well as depression over a period of six moths in souses and fists-stroke individuals. In their study they described the changes in the process of adaptation (both coping and appraisal) within six months after the very fist stroke with the aim of identify the domains of the process of adaptation that is related to the participation as well as the depressive symptoms for the affected persons and their spouses. The study design employed by Rochette et al. (2006) was a descriptive longitudinal approach that was conducted over the initial six months after the first-stroke. Data was collected from two groups at three different times; in the initial two weeks after stroke (T1) and then after three months…...

Nursing
Mary Young is a 71-year-old Aboriginal Australian female. She has present with a number of different health issues, including osteoporosis, hypercholesterolaemia, atherosclerosis, atrial fibrillation and Type 2 diabetes. She has been feeling fatigued for the past several months, and her current admission was on account of increasing dizziness, blurred vision and persistent headache. She was found to have suffered an ischaemic stroke, of moderate to severe status. This paper will outline the primary admission diagnosis, the nursing problems, nursing management strategies and discharge planning for Mary.

Primary Admission Diagnosis

Mary was admitted to the ED with left-sided hemiparesis, aphasia, and hypertension. She had an irregular pulse rate. An ECG revealed atrial fibrillation. A thrombotic ischaemic stroke was suspected and confirmed on CT. She has now been stabilized, and has been admitted to the medical ward for clinical management and rehabilitation.

Thrombotic ischaemic strokes are caused by a number of factors. Among them, Mary…...

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References

Collo, S., Feigin, S. & Dudley, M. (2007). Post-stroke fatigue -- where is the evidence to guide practice? New Zealand Medical Journal .Vol. 120 (1264) 1-9.

Gordon, C., Hill, C. & Ashburn, A. (2008). The use of conversational analysis: Nurse-patient interaction in communication disability after stroke. Journal of Advanced Nursing. Vol. 65 (3) 544-553.

Hinkle, J. & Guanci, M. (2007). Acute ischemic stroke review. Journal of Neuroscience Nursing. Vol. 39 (5) 285-293.

ISC. (2016). Ischaemic stroke. Internet Stroke Center Retrieved April 19, 2016 from  http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/

Interventions for: PYELONEPHITIS
While most UTIs affect the urethra and bladder, pyelonephritis comes about when there is progression of a urinary tract infection to the upper urinary system. Pyelonephritis, by definition, "is a bacterial infection of the renal pelvis, tubules, and intestinal tissue of one or both kidneys" (Smeltzer, Bare, Hinkle, Cheever, 2010). The infection could be unpleasant and painful and is worse than cystitis. It is important to note, from the onset, that pyelonephritis does not cause serious or long-term harm if promptly treated. However, delays in treatment could bring about permanent kidney damage. In essence, there are two kind of pyelonephritis -- chronic and acute. While acute pyelonephritis has got to do with the unanticipated development of inflammation in the kidney, chronic pyelonephritis is a persistent or perennial infection that refuses to clear. The latter is rare and could result in kidney scarring and failure. Interventions for both will…...

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References

Bope, E.T. & Kellerman, R.D. (2011). Conn's Current Therapy 2012.Philadelphia, PA: Elsevier Health Sciences.

National Institutes of Health (2016). Stroke. Retrieved from  https://www.nlm.nih.gov/medlineplus/ency/article/000726.htm 

Smeltzer, S, C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner and Suddarth's Textbook of Medical-Surgical Nursing, Vol 1. New York, NY: Lippincott Williams & Wilkins.

The treatment approach is constraint-induced movement therapy as an early option for patients’ post-stroke. The kind of scoring to help determine a patient’s functional level is the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) (Auwal Abdullahi, 2014). To identify level of physical ability, this scoring system allows for assessment of balance, joint functioning, and motor functioning around 4 months after stroke. Patients will have initial pre-intervention motor function score taken (FMA) and then given the treatment modality. It is important to continually assess motor function starting at the beginning of intervention, then in the middle and finally towards the end of intervention for a total of two weeks (Yue, Liu, Huai, Gao, & Zhang, 2017). Some barriers/obstacles are related to the type of therapy involved. Modified Constraint-Induced Movement Therapy (mCIMT) is a method used to improve a patient’s mobility and functionality in the often more affected upper extremity post stroke…...

Aphasia
In the world of post strokes or major brain injury there are many difficulties to overcome. One such difficulty is aphasia. The most common way to treat aphasia is through speech therapy, by using various techniques with picture images to repeat words. This gives the patients the ability to remember the words that they learned. However there is a newer treatment, Melodic Intonation Therapy (MIT). This treatment has better results than the traditional therapy. The article, "From Singing to Speaking: Why Singing may Lead to Recovery of Expressive Language Function in Patients with Brocas's Aphasia" by Schlaug, Marchina, Norton (Schlaug, 2008), tries to prove that MIT works better on Patients with Broca's Aphasia.

Aphasia is a condition which is an inability to communicate or understand through language, which is either through speech, reading, writing, or listening. Aphasia is caused by brain injury usually to the left hemisphere of the brain where…...

Kathy Smith and Jillian Michaels:
Different Strokes for Different Folks

Not all exercise videos are created equal and we can say the same thing about the instructors that create them. One might think that one aerobics exercise video is like all others but this is not the case. Many aerobic instructors have their own style and two popular instructors that demonstrate this point are Kathy Smith and Jillian Michaels. Kathy Smith, for example, has been making fitness videos for decades and her style is comfortable and relaxed. Jillian Michaels, on the other hand, approaches working out as something that should feel like a challenge and if it does not feel challenging, it probably is not being performed correctly. Two videos that illustrate these different but effective styles are Smith's Build Muscle, Shrink Fat and Michaels' 30-Day Shred.

Style is the most noticeable difference between the two instructors. Kathy Smith falls into a group…...

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Works Cited

Ambandos, Andrea. 30-Day Shred. (2007). Michaels, Jillian. Lions Gate Productions.

Swimming: Breaststroke
SWIING INSTRUCTION: THE BREASTSTROKE

The traditional breaststroke underwent radical transformation, leading to a bitter controversy, at the 1956 Summer Olympics in elbourne, Australia.

Swimmers had gradually come to understand that they could decrease their lap times by surfacing less often to breathe, because breaking the surface dramatically increases the coefficient of friction between their bodies against the water, thereby adding unnecessary resistance.(Wipkedia)

Several breaststroke competitors were disqualified that year for swimming much of their laps entirely submerged. In order to get around the rule prohibiting extensive underwater swimming, competitors quickly learned to remain submerged as long as possible after the start, before breaking the surface for the first time. As competitors perfected the technique originally pioneered by asaru Furukawa, swimmers began losing consciousness completely, while attempting to swim as far as possible before breaking the water surface for the first time after the official start of the race. Ultimately, extensive rule modifications…...

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Mills, G. Breaststroke: Breathing Every Other Stroke. (2003) © GoSwim.com; Accessed March 20, 2004 at  http://www.goswim.tv/articles/dotw/breastbreath.html 

Salo, G. Teaching Breaststroke (2002);

Accessed March 21, 2004 at  http://www.breaststroke.info/salobreast.htm

Stroke is widely regarded one of the leading causes of deaths in the U.S. Indeed, recent statistical figures paint a grim picture with regard to the number of people who suffer a stroke in the U.S. each year. In basic terms, strokes are triggered by an interruption of blood flow into the brain. In this text, I concern myself with the physiological processes associated with stroke. In so doing, I will amongst other things define the disease and the body systems it affects, its causes, manifestation, and complications. Further, I will also discuss the hereditary or familial factors commonly associated with stroke.
Stroke: An Overview

In basic terms, stroke is said to be "an abrupt onset of neurological functions caused by a sudden reduction of cerebral blood flow, which is due in turn to either an ischemic occlusion or a hemorrhagic episode" (Gulini, Gianelli, Quaglia, and Marrucci, 2000, p. 239). As a…...

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References

Eisenberg, M.G., Glueckauf, R.L. & Zaretsky, H.H. (Eds.). (1999). Medical Aspects of Disability: A Handbook for the Rehabilitation Professional (2nd ed.). New York, NY: Springer Publishing Company.

Gulini, M., Gianelli, M., Quaglia, W. & Marrucci, G. (Eds.). (2000). Receptor Chemistry Towards the Third Millennium. Amsterdam: Elsevier Science.

Huether, S.E. & Mccance, K. (2012). Understanding Pathophysiology (5th ed.). Philadelphia, PA: Elsevier Science.

Mohr, J.P., Grotta, J.C., Wolf, P.A., Maskowitz, M.A., Mayberg, M.R. And Kummer, R.V. (2011). Stroke: Pathophysiology, Diagnosis, and Management (5th ed.). Philadelphia, PA: Elsevier Health Sciences.

Stroke Hearing Impaired
Stroke Victims

Plan: Physical, Occupational, Speech, and Psychological Therapies

Implementation: Daily regimen, with one of the four core areas (physical therapy, occupational therapy, speech therapy, and psychological therapy) emphasized or addressed on each day.

Evaluation: After each session, therapist will write a thorough evaluation of the patient including a progress report. After the end of each six-week period, a thorough progress report will be shared among the various members of the health care team in a collaborative setting.

The follow-up will consist of maintenance therapies in each of the four core areas.

Documentation of Actions and Activities: According to the National Stroke Association (2013), the activities and actions should begin immediately after the stroke. The Physical Therapy sessions will include yoga and other systematic movement interventions to improve coordination, balance, strength, and range of motion. Each week, the therapist will implement a unique type of movement therapy, but will maintain consistency by focusing…...

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References

Hetu, R., Jones, L. & Getty, L. (1993). The Impact of Acquired Hearing Impairment on Intimate Relationships: Implications for Rehabilitation. International Journal of Audiology 32(6).

National Stroke Association (2013). Rehabilitation therapy after stroke. Retrieved online:  http://www.stroke.org/site/PageServer?pagename=REHABT 

"Stroke Health Center," (2011). WebMD. Retrieved online:  http://www.webmd.com/stroke/tc/stroke-rehabilitation-overview 

Wharton, T. (2013). Utah firm: Loop helps hearing impaired at movies and more. The Salt Lake Tribune. 24 Oct, 2013. Retrieved online:  http://www.sltrib.com/sltrib/money/57001349-79/loop-hearing-system-technology.html.csp

Patients with aphasia struggle with language disorders including both oral and written communication problems. Also, clinical depression is found to be common among many stroke victims. [NINDS]
Stroke Prevention

Given the high stakes involving both mortality and morbidity, stroke prevention is considered a very vital health care policy. Prevention strategies are usually targeted on controlling the important 'first tier risk factors' which were mentioned earlier. First and foremost among these is to control hypertension. ased on evidence-based practices, the American Heart association recommends that antihypertensive treatment including the use of diuretics and class 1 ACEI drugs be standardized for all patients to prevent recurrent strokes as well as to serve as a proactive intervention against other cardiovascular complications. Since diabetes is considered a high risk factor for stroke, clinical practice also recommends that glucose levels for all diabetic patients with ischemic stroke be maintained near-normoglycemic levels. The AHA guidelines also recommend…...

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Bibliography

1) Washington University, (2010) 'Stroke Information for Patients and Families: U.S. Statistics: ', retrieved Aug 2nd 2010, from,  http://www.strokecenter.org/patients/stats.htm 

2) Larry B. Goldstein, (2009), 'A Primer on Stroke Prevention and Treatment', Pub by American Heart Association.

3) NINDS, 'Post Stroke Rehabilitation Factsheet', retrieved Aug 2nd 2010, from,  http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm 

4) Ralph L. Sacco, MD, MS, @ Robert Adams MD et.al (2006), 'Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack', Stroke. 37:577, available online at,  http://stroke.ahajournals.org/cgi/content/full/37/2/577

The most common cause is blockage of an artery, usually by a piece of atherosclerotic plaque in one of the brain's main arteries that ahs broken off and gotten stuck "downstream." TIA are also caused by blood clots that originate in the heart, travel to the brain, and become lodged in a small artery there. By definition, the symptoms of a TIA last less than 24 hours, in contrast to the symptoms of a stroke, which last longer -- and are often permanent. (Komaroff, 2006, p. 88)
An individual may have one or more experiences with a TIA, though they may have none, prior to the actual stroke vent, often leading up to it, within a year or more of the stroke event. If these symptoms are noted, and even if they go away an individual should still seek care to begin treatment for medical stroke prevention. Individuals should also…...

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References

Better Control of Hypertension Has Reduced Stroke Deaths. (1987, July/August). FDA Consumer, 21, 2.

Centers for Disease Control and Prevention Division of Heart Disease and Stroke (2008). Stroke Fact Sheet. Retrieved, December 5, 2008.  http://www.cdc.gov/DHDSP/library/fs_stroke.htm 

Ha, M., Lee, D., & and Jr.,. R. (2007). Association between Serum Concentrations of Persistent Organic Pollutants and Self-Reported Cardiovascular Disease Prevalence: Results from the National Health and Nutrition Examination Survey, 1999-2002. Environmental Health Perspectives, 115(8), 1204.

Health; Blood Pressure Drugs Can Prevent Strokes, Heart Attacks - Studies. (2008, April 2). Manila Bulletin, p. NA.

Strokes and African-Americans
African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment. The purpose of this study is to examine the issue of African-Americans and stroke. The significance of this study is the additional knowledge that will be added to the already existing base of knowledge in this area of study. The methodology employed in this study is of a qualitative and interpretive nature and has been conducted through a review of literature in this area of study.

Strokes and African-Americans

African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment.

Purpose of the Study

The purpose of this study is to…...

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References

National Stroke Association (2010) What is Stroke? Retrieved from:  http://www.stroke.org/site/PageServer?pagename=STROKE 

The Office of Minority Health (2010) U.S. Department of Health & Human Services. Retrieved from: http://minorityhealth.hhs.gov/templates/content.aspx?ID=3022

National Stroke Association (2010) African-Americans and Stroke. Retrieved from:  http://www.stroke.org/site/PageServer?pagename=AAMER 

Neipris, Louis (1998) African-Americans and Stroke Risk. My Optum Health. Retrieved from:  http://www.wtvm.com/global/story.asp?s=12834243

Signs and Symptoms of Stroke

Patients with stroke symptoms are advised to seek out for emergency cure without any dilly-dallying. Definite signs of a stroke rely on the kind of stroke. However all kinds of stroke share several attributes. Warlow (1996, p.2) stated that cerebral embolism stroke generally comes on rather abruptly and is extreme right from the beginning. On the other hand schemic strokes signs consist of reduced vision in one eye or both eyes and stern headache. Other symptoms include feebleness, numbness or facial paralysis or arm and leg paralysis which are normally restricted on one side of the body.

Furthermore, other symptoms of schemic strokes include faintness, stability or coordination failure particularly when pooled with other signs. Hemorrhagic strokes are a bit different and the signs include loss of realization, distorted mental condition and seizure. Other signs include vomiting or stern nausea and extreme hypertension. Lastly, the affected person…...

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Reference List

American Heart Association and American Stroke Association (n.d.). Stoke diagnosis

Retrieved May 14, 2010, from  http://www.americanheart.org 

Caplan, L. R, Dyken, M.L., & Easton, J.D. (1996). American Heart Association Family

Guide to Stroke Treatment, Recovery, and Prevention. New York: Times Books.

Stroke


Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and reviewing health care quality is no longer questioned. However quantifying quality is a difficult task one that involves a subjective element and judgment. Different methods are employed in measuring quality such as level of care provided, administration accuracy, staff sufficiency, hygiene level and therapies provided. The need to combine the facts and figures with judgments and evaluation is a complex process and needs to be done with utmost care. The quality measures need to be evaluated on a regular basis to ensure their relevance and validity in the given circumstances.

Measures used to monitor and review quality:

As the hospital administration began to realize the link between stroke patients death and the quality of service rendered the need to analyze data became inevitable. Quality…...

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References:

AHO, (2006). Joint Commission on Accreditation of Healthcare Organizations: 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Joint Commission Resources, 2005

American Heart Association, (1999) Heart and Stroke Statistical Update. Dallas, Tex. Available at:  http://www.americanheart.org /statistics/index.html.

Donabedian, A. (1988). The quality of care: how can it be assessed? JAMA.. 1988;260:1743-1748.[Abstract/Free Full Text]

Ryan, T. Antman, E., Brooks N. (1999) update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation.. 1999;100:1016 -- 1030.

The concept of self-care has never been more important than it is now, when a pandemic has shut down much of the globe and external stressors are unlike anything most people have seen in their lifetimes.  Generally, when people discuss self-care inside the topic of mental health, they are referring to the importance of caregivers engaging in self-care.  This makes it an excellent topic for a narrative essay, because of how narrative essays are structured.

The concept of self-care is an important one. People who are responsible for helping care for those who....

Traumatic brain injuries, or TBIs as they often called, are injuries to the brain that are caused by outside sources, such as a fall or a blow to the head.  This differentiates them from brain injuries that are caused by internal situations, such as a stroke.  TBIs include a broad group of different types of injuries, from seemingly minor concussions to injuries that clearly and significantly impact the ability to function.  Because they are so varied, there are many different directions you could take in a research paper about TBIs.  To help you decide what direction....

Language development refers to the process by which infants develop their language skills.  Understanding how speech and language develop, as well as understanding speech milestones, can help people assess whether a person’s language development is on-time or is experiencing delays. 

Language Development Essay Topics / Essay Titles

1. The Importance of Hearing Tests in Assessing Language Delays
2. Is There a Difference in Language Acquisition for First and Second Languages?
3. Missing Milestones: Is It Always a Sign of Language Delays?
4. Speech Disorders and Language Disorders: Similarities and Differences
5. Dyslexia as a Language Disorder
6. Structural Speech Challenges
7. Speech Therapy as a Component in....

Looking at how cars were invented and reality quickly became the go-to transportation method for much of the world is fascinating.  While the automobile was invented in Germany and France, Henry Ford, who mastered automation and the mass production of cars, probably deserves much of the credit for the automobile’s early successes.  In fact, Ford’s focuses on wages and affordability probably deserve credit for the rise of the American middle class, suggesting that the history of the automobile and the history of the middle class are inextricably intertwined.

I. Introduction

A. Precursors....