Abstract TP141: Navigation Services for Stroke Survivors and Caregivers Post-discharge

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Julia B Richards ◽  
Amy Larson ◽  
Jamie Charbonneau
Keyword(s):  
Caregiver Burden ◽  
Barriers To Care ◽  
Stroke Recovery ◽  
Community Living ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Patient Centered ◽  
Post Stroke ◽  
Medical Issues ◽  
Healthcare It

Background: Patient navigation is a community-based intervention designed to help clients identify and overcome barriers to care. Navigation is a widely used, evidence-based model for patient-centered healthcare. It is well documented that stroke survivors and caregivers face enormous obstacles in returning to their community living situations post-stroke. Purpose: National Stroke Association’s Stroke Recovery Navigator Program is designed to reduce barriers to care, lower incidence of secondary stroke, eliminate re-hospitalization due to post-stroke conditions, and provide support for adjusting to community living. Method: National Stroke Association implemented a pilot program to determine if navigation is an effective intervention for stroke survivors and caregivers. Clients were referred to the program upon discharge from partner hospitals. Clients completed either the Reintegration to Normal Living Index (RTNLI) or the Zarit Screening Measure of Caregiver Burden (respectively) at enrollment and at graduation. Results: The Stroke Recovery Navigator Program received 180 referrals with 90 clients converted to active participation. Stroke survivors made up 82% of participants and caregivers 18%. RTNLI scores went up and Caregiver Burden scores went down when clients received navigation services. During the pilot phase, 12 stroke survivors were re-hospitalized, 4 for stroke-related issues; 8 for new medical issues. Post-pilot evaluations of participants showed that 95% of respondents believe the program provides a valuable service. Referral source surveys revealed that more than half of their patients received information about the program at discharge. Conclusions: Navigation for stroke survivors and caregivers shows increased reintegration to normal living and reduced caregiver burden scores. Clients receiving navigation were re-hospitalized below the levels documented in recent studies. Based on these findings National Stroke Association concludes that navigation post-stroke results in positive outcomes for survivors, caregivers and hospitals.

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

Abstract P211: Stroke Recovery Navigator to Improve Post Stroke Recovery

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Erin Rindels ◽  
Anna Taylor ◽  
Aurora Quigley ◽  
Keyword(s):  
Social Support ◽  
Caregiver Burden ◽  
Statistical Significance ◽  
Intervention Group ◽  
Demographic Characteristics ◽  
Stroke Recovery ◽  
Control Group ◽  
Post Discharge ◽  
Additional Information ◽  
The Impact

Social support impacts recovery after stroke. Patient centered navigation programs provide social support and have shown benefit with other patient populations. The purpose of this study is to determine if there is a difference in outcomes for stroke survivors and caregivers who receive navigation services post-discharge. The study used a multi-center quasi-experimental before-after design to examine the impact of a telephone-based stroke navigation. Selected recruitment sites were nine facilities without navigation programs. Facilities provided information to survivors and caregivers about Stroke Recovery Navigator (SRN) prior to discharge and made referrals to the program. Participants were randomized into control and intervention groups using a computer-generated coin flip. Navigators completed telephone assessments within a week of referral. Navigators received the following trainings: Patient Navigation Fundamentals, motivational interviewing, and mental health first aid. The Reintegration to Normal Living (RNLI) scale was completed by all survivors and the Zarit Caregiver Burden scale was completed by all caregivers. The control group completed the initial and final assessments using these tools. In addition to these assessments, the intervention group received an individualized navigation plan and weekly contact by the SRN. The study randomized 301 individuals (82 caregivers, 219 survivors), with completion rate of 32%. Caregiver demographic characteristics and baseline caregiver burden scores were not statistically significant. Caregiver burden in the intervention group were lower compared to the control group, but not statistically significant (p=0.25). Demographic characteristics for survivors were similar between groups. RNLI score for survivors was slightly higher for the intervention group (p<0.10). To achieve statistical significance additional participants were needed. In conclusion differences in quality of life for survivors and caregivers were not statistically significant between the groups. Additional information on the benefits of an SRN program is needed to support its implementation. However, important lessons were learned to improve such program and its design.

STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

2017 ◽  
Vol 15 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Chloe Witty ◽  
Thomas Heffernan ◽  
Leigh Riby
Keyword(s):  
Verbal Memory ◽  
Digit Span ◽  
Qualitative Interviews ◽  
Stroke Survivor ◽  
Self Report ◽  
Stroke Recovery ◽  
Step Test ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

scholarly journals Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

2020 ◽  
Vol 30 (2) ◽  
pp. 339-348
Author(s):  
Joy N. J. Buie ◽  
Yujing Zhao ◽  
Suzanne Burns ◽  
Gayenell Magwood ◽  
Robert Adams ◽  
...  
Keyword(s):  
Racial Differences ◽  
Motor Skills ◽  
Stroke Recovery ◽  
Fine Motor ◽  
Stroke Survivors ◽  
Factors Associated ◽  
Post Stroke ◽  
Stroke Disability ◽  
The Impact

Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339

Predictors of Caregiver Burden of Moderate and Severe Stroke Survivors: A Cross-Sectional Study from South India

2021 ◽  
pp. 251660852098054
Author(s):  
Usha M. Khanapur ◽  
Jacob John ◽  
Arun Mathai Mani ◽  
Sanjith Aaron
Keyword(s):  
Caregiver Burden ◽  
Cross Sectional Study ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Decompressive Hemicraniectomy ◽  
The Mean

Introduction: Caregivers have an important role in stroke recovery, especially after the acute phase of treatment. Caregiving for stroke survivors is associated with caregiver burden. Knowledge of factors influencing this caregiver burden is important for both the patient and the caregiver. Aim: To study the prevalence and predictors of major caregiver burden in survivors of moderate to severe stroke treated both conservatively and with surgical decompression. Methods: A community-based cross-sectional study where caregivers of stroke survivors with moderate to severe disability at discharge (modified Rankin Scale >3) were assessed between 3 months and 3 years of discharge. Results: Caregivers of 115 stroke survivors (82 conservatively treated and 33 who underwent decompressive hemicraniectomy) were studied. The majority (80%) were females. The mean period of caregiving was 18.8 ± 10.3 months (range 3-44 months). Major caregiver burden was seen in 36% (confidence interval [CI] = 27.3-44.7%). The significant predictors of major caregiver burden were daily caregiving for ≥4 hours (adjusted odds ratio [AOR] 5.3; CI = 1.84-15.3), patient activities of daily living dependency (AOR 3.66; CI = 1.03-13.03), and caregiver being the spouse (AOR 4.52; CI = 1.25-16.3). A total of 17% of the caregivers stopped working. Only (18%) had health insurance and 59% had borrowed money for treatment. A total of 88% of caregivers were happy regarding their decision to opt for surgery despite their current burden. Conclusion: Caregivers had stress in various domains. Shortening the caregiving hours especially in the initial months may help reduce the burden since the caregiver burden is also influenced by the patient’s dependency which improves over time.

scholarly journals Post-stroke Depression in the Very Elderly Rate and Predictive Factors

2020 ◽  
Author(s):  
Elias Smadja ◽  
Nicolas Chausson ◽  
Manvel Aghasaryan ◽  
Olga Lainé ◽  
Sofiane Saddedine ◽  
...  
Keyword(s):  
Rating Scale ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Very Elderly ◽  
Stroke Incidence ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
Acute Stroke Unit ◽  
Potential Factors

Abstract Background: Post-stroke depression (PSD) affects 25–32% stroke survivors. PSD is quality-of-life altering and negatively impacts stroke recovery and mortality. Stroke incidence increases exponentially with age, especially >65 years, but no studies have yet specifically evaluated PSD in older stroke survivors. Because the very elderly are more prone to developing depression, we hypothesized a relatively high PSD rate for them. Methods: Consecutive stroke patients ≥75 years old, admitted to an acute stroke unit, were screened for depression with the Montgomery-Åsberg Depression Rating Scale or Aphasic Depression Rating Scale for aphasic patients, ≥15 days to 1-year post-stroke. Potential factors predictive of PSD were assessed. Results: Among 441 consecutive stroke patients, only 78 (17%) patients were evaluated because of high mortality and exclusion criteria. Among them, 44.8% (35/78) developed PSD: 22/78 (28.2%) mild and 11/78 (14.1%) moderate. Multivariate analysis retained only ≥1 mRS-point gain as being independently associated with PSD (OR, 6.2 (95% CI, 1.3–29.2), P=0.020). Conclusion: Our results confirmed the expected high PSD rate in patients ≥75 years, and suggest that PSD should be sought systematically or prophylactic antidepressants prescribed >15 days post-stroke for patients with ≥1 mRS-point gain.

scholarly journals Socio-demographic and Clinical Correlates of Community Reintegration of Stroke Survivors in Nigeria

2020 ◽  
pp. 1-7
Author(s):  
Muhammad Usman Ali ◽  
Auwal Yahaya Garba ◽  
Adewale Luqman Oyeyemi ◽  
Mamman Ali Masta ◽  
Fatima Kachallah Gujba ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Sampling Technique ◽  
Haemorrhagic Stroke ◽  
Public Hospitals ◽  
Rehabilitation Services ◽  
Stroke Survivors ◽  
Community Reintegration ◽  
Post Discharge ◽  
Post Stroke ◽  
The Impact

Background: Low level of community reintegration among stroke survivors is a major obstacle to rehabilitation services post discharge from acute care. Few studies have assessed the impact of community reintegration on stroke survivors in Nigeria. This study investigates community reintegration and associated factors among stroke survivors in Maiduguri, Nigeria. Methodology: Purposive sampling technique was used to recruit 55 stroke survivors attending rehabilitation services from two public hospitals in Maiduguri. Community reintegration was assessed with the Reintegration to Normal Living Index (RNLI) questionnaire, while information on sociodemographics (e.g., age group, gender, employment status, educational status) and clinical characteristics (e.g., post stroke duration, types of stroke, side of affectation) was obtained using the data form. Logistic regression analyses with odd ratios were used to test the associations between community reintegration and sociodemographic and clinical characteristics. Results: The mean age and post stroke duration of the participants were 44.69±13.06 years and 17.25±24.90 months respectively. The participants’ community reintegration scores showed that 60%, 38.2% and 1.8% have no integration, mild to moderate reintegration and complete reintegration respectively. The results indicated that stroke survivors with a stroke duration greater than 8 months (OR=3.32, C.I=1.08-10.27) and those with haemorrhagic stroke (OR=4.67, C.I=1.05-20.66) were more likely to be reintegrated into the community than their counterparts with 6-8 months post stroke duration and ischaemic stroke, respectively. There was significant association between community reintegration and sociodemographic characteristics such as post stroke duration and type of stroke. Conclusions: Rehabilitation strategies should focus on clinical characteristics of the stroke survivors when planning and delivering effective community reintegration interventions.

Abstract 3861: The Effect of Stroke Survivor and Caregiver Family Function and Mutuality on Post Stroke Depression

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kyler M Godwin ◽  
Paul Swank ◽  
Sharon K Ostwald
Keyword(s):  
Structural Model ◽  
Inpatient Rehabilitation ◽  
Stroke Survivor ◽  
Mediating Effect ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Family Function ◽  
Her Family ◽  
Post Stroke ◽  
Post Stroke Depression

Background: Post-stroke depression is common among both stroke survivors and their caregivers. This secondary data analysis explored the effect that stroke survivor and caregiver family function and mutuality, a measure of the perceived positive aspects of the caregiving relationship, had on the depression of spousal dyads over the first 12 months post discharge from inpatient rehabilitation. Methods: Longitudinal meditational analysis was employed to examine the mediating effect of mutuality on the dyads’ perception of family function and caregiver and stroke survivor depression over time. The model was estimated in MPlus version 6.1 using bootstrap estimation with 1000 draws. The final structural model had good model fit to the data with a chi square ( df= 16; N = 132) of 17.55, p =.35, a comparative fit index (CFI) of 0.996, and root mean square error of approximation (RMSEA) of 0.027 (CI = 0-.087). Results: This study included 159 stroke survivors and their spousal caregivers who were an average (standard deviation) age of 66.4 (9.1) and 62.5 (10.5) years, respectively. The majority of stroke survivors were predominately male and non-Hispanic white, although almost 40% of the sample was represented by ethnic minorities. Mutuality was not found to mediate the relationship between caregivers’ and stroke survivors’ perception of family function at baseline and their own or their partners’ depression at 12 months as hypothesized. However, caregivers who perceived healthier family functioning at baseline and stroke survivors who had higher perceived mutuality at 12 months had lower depression at one year post discharge from inpatient rehabilitation (-.117, p=.048; -1.007, p=.034, respectively). Additionally, caregiver mutuality at 6 months, but not at baseline or 12 months, was found to be inversely related to caregiver depression at 12 months (-1.06, p=.04). Conclusions: This study highlights the importance of focusing on the relational aspects of stroke. A stroke does not only happen to the stroke survivor. It affects his or her family, and it oftentimes changes the life of both the stroke survivor and their spousal caregiver. Health professionals should encourage couples who have experienced a stroke to focus on the positive aspects of the caregiving relationship to mitigate post-stroke depression.

Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Alyssa J Herzig ◽  
Nancy Mayo ◽  
Syd Miller
Keyword(s):  
Length Of Hospital Stay ◽  
Critical Factor ◽  
Self Report ◽  
Screening Tools ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
C Statistic ◽  
Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

Abstract WP173: Mexican Americans Less Likely to Return to Work Following Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Lesli Skolarus ◽  
Jeffrey J Wing ◽  
Lewis B Morgenstern ◽  
Lynda D Lisabeth
Keyword(s):  
High School ◽  
Return To Work ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Ethnic Difference ◽  
Public Health Problem ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Post Stroke

Introduction: Lost earnings are the largest driver of the projected $2.2 trillion in stroke costs over the next 4 decades. Mexican Americans (MA) are more likely to have a working age stroke and suffer greater post-stroke disability than non-Hispanic whites (NHW). Thus, we explored ethnic differences in post-stroke return to work and whether sociodemographics and stroke severity contribute to ethnic differences. Methods: Ischemic stroke patients were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) study from August 2011-December 2013. Employment status was obtained at baseline and 90-day interviews conducted with patients or proxies. Sequential logistic regression models were built to assess ethnic difference in return to work after accounting for: 1) age (<65 vs ≥65), sex; 2) 90-day NIH stroke score, and 3) education (<high school vs. ≥high school). Results: Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke of which 125 completed the 90-day outcome interview. There were no ethnic differences in sex or the proportion over the age of 65. MAs had less education (5% vs. 24% college graduate, p<0.01) and greater median 90-day stroke severity (2 vs. 1, p=0.02) than NHWs. Forty-nine (40%) stroke survivors returned to work. MAs were less likely to return to work (OR= 0.45, 95% CI 0.22-0.94) than NHWs. This difference remained after accounting for age and sex (OR=0.45, 95% CI 0.21-0.94). The ethnic difference was attenuated and became non-significant after adjusting for stroke severity (0.59, 95%CI 0.24-1.24) and further attenuated after accounting for education (0.85, 95% CI 0.32, 2.22). In the fully adjusted model, lower stroke severity and higher education were associated with return to work. Conclusion: MAs are less likely to return to work after stroke than NHWs. This finding is important given that MAs are younger and poorer at the time of their stroke suggesting a crucial public health problem. Future work should consider including return to work as part of patient centered outcomes and efforts to optimize stroke recovery.

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