The clinical course of a 79-year-old stroke survivor in the setting of a late-onset COVID-19 infection

Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), no specific antiviral drug has been proven effective for the treatment of patients with severe complications. However, a nucleoside prodrug remdesivir (GS-5734) was recently approved by the Food and Drug Administration for the treatment of hospitalized patients with COVID-19. Preclinical data in animal models of coronavirus diseases have demonstrated that early treatment with remdesivir leads to improved survival and decreased lung injury. Recent clinical data have demonstrated the clinical activity of remdesivir in terms of shorter recovery period and higher odds of improved clinical status in patients with COVID-19. Here, the story of a 79-year-old patient, with 11-year-old left hemiparesis, concomitant cardiovascular disease, infected with SARS-CoV-2, and the clinical improvement after administration of remdesivir during his second hospitalization period is reported.

Kajian Literatur: Intervensi Religius Islam dan Dampaknya pada Pasien Stroke

Introduction: Stroke becomes the main factor of longterm disability. Changes in physical condition increase the risk of psychological disorders. Indonesian citizen has Islam religion mostly. The study of Islamic religious intervention was few. Religious interventions had been conducted however no review described the Islamic religious interventions and the impacts. This study aimed to describe the intervention of Islamic religious and its impacts among stroke patients. Methods: The research method used scoping review using databases such as Sciendirect, CINAHL, Medline, Taylor & Francis, JSTOR, PubMed, and search engine Google Advance. The criteria for the articles reviewed were articles in English or Indonesian with the SINTA index 1-2, articles published on 2010-2020, articles accessed in full text, method was quasi experiment or randomized control trial, articles were original research. The key words were Islamic spiritual or religious and stroke. Search results obtained five articles that required the inclusion criteria. Results: Review found that memorizing of Al Qur’an, listening Al Qur’an, motivation and prayer, salah prayer and Quranic teaching. Impacts of Islamic spiritual and religious intervention have positive impact in patient’s physiological and psychological such as increased functional communication, independence, improvement of neurological clinical outcome, motoric function, balance, motivation, quality of life, and decreased the anxiety and depression. Conclusion: Islamic spiritual or religious intervention in stroke survivor was the part nursing care that promising improved clinical outcome.

Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

<p>Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.</p>

Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

<p>Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.</p>

Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

Background Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs). Methods A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes. Results The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were “distribute educational materials” (n = 11), “assess for readiness and identify barriers and facilitators” (n = 11), and “conduct educational outreach visits” (n = 10). “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies. Conclusions This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field’s ability to draw conclusions about effective implementation strategies across diverse practice settings.

Self-care interventions in stroke survivor–caregiver dyads: a protocol for systematic review and meta-analysis

IntroductionStroke is known as one of the leading causes of mortality and disability worldwide. Self-care plays a significant role in improving the quality of life, self-efficacy and many other outcomes of stroke survivors. However, it is a dyadic phenomenon where patient self-care and the caregiver contribution to self-care are inter-related in terms of predictors and outcomes. Currently, there is still no systematic assessment conducted to examine the overall effectiveness of self-care interventions carried out in stroke survivor–caregiver dyads and explore the effect on stroke survivor and/or caregiver outcomes.MethodsWe plan to conduct a systematic review and meta-analysis of the evidence regarding the self-care interventions carried out in stroke survivor–caregiver dyads. We will undertake a systematic search of multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials and four Chinese databases (CNKI, CBM, WANFANG and VIP) from inception to July 2021 for the purpose of collecting the relevant articles. The eligible studies are defined as those original researches, written in English or Chinese, on self-care interventions in stroke survivor–caregiver dyad samples. Two independent researchers will be deployed to identify the eligible trials according to the selection criteria and extract the relevant data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist has been used for this protocol. We will use the Cochrane Risk for Bias tool to assess the risk of bias for randomised controlled trials.Ethics and disseminationIn our review, any identifiable patient data will be excluded, which removes the need for ethical approval and participant consent. The final results of our study will be published in an open-access peer-reviewed journal, and abstract will be presented at suitable national/international conferences.PROSPERO registration numberCRD42021239824.

Hope, active coping and well-being in stroke-survivors and caregivers: An actor–partner model analysis

Purpose Stroke is a medical condition cause of suffering for both patients and their caregivers within the family. This paper aimed to assess the influence of the psychological construct of hope and active coping on hedonic wellbeing in patient with stroke and caregiver dyads by determining the dyadic patterns. Methods A baseline study including 200 stroke-survivor (Age 73.63; SD=7.22) and caregiver (62.49; SD=14.44) dyads with actor–partner interdependence model (APIM) estimated by structural equation modelling with maximum likelihood estimation. Herth Hope Index (HHI), Proactive Coping Inventory (PCI) and Personal Wellbeing Index (PWI) were used to measure hope, proactive coping and wellbeing, respectively. Results The APIM analysis revealed that both stroke patients and caregivers demonstrated double actor-only pattern. As such, stroke-survivors’ hope and active coping excreted an actor effect on their own wellbeing with beta = 0.48 (p &lt; 0.01) and 0.16 (p &lt; 0.01), respectively. Similarly, the caregiver also reported an actor effect between hope and wellbeing (beta = 0.84, p &lt; 0.01) as well as active coping with wellbeing (beta = 0.37, p &lt; 0.01). The overall SEM model also fulfilled the criteria for good model fit (χ2 (5.87), p = &gt; 0.05, CFI = 0.98, TLI = 0.96 and RMSEA = 0.07). Conclusions The results suggest that both stroke patients and caregivers’ hedonic wellbeing are holding actor-oriented pattern with the hope and active coping. The implications for clinical practitioners, research and theoretical development are discussed.

How information affects attributions for ambiguous behaviours resulting from stroke

<p>Research has shown that when people see young survivors of stroke, they often misattribute the person’s symptoms to other factors (Wainwright et al., 2013). Consequently, these stroke survivors may suffer feelings of resentment towards, and from their acquaintances. They may also struggle to obtain or retain a job. This thesis examines whether these misattributions for stroke survivors’ symptoms are affected by the information people have about the stroke survivor and the rapidity of the change in their behaviours. Experiment 1 investigated if the stroke survivor’s age (72, 32 or unstated) and the level of information (no information, implied stroke or explicit stroke) for their behaviours influenced people’s attributions. Experiment 1 showed that people attributed the behavioural changes to factors other than stroke when no additional information is present, and they attributed the behaviours to stroke when stroke was explicitly described. When stroke was implied, participants rated stroke as the best explanation but only when the target person was 72. Experiment 2 manipulated the rapidity of the stroke survivor’s behavioural changes to assess the effect on attributions. Experiment 2 showed that people attributed the behaviours to stroke more if only one week had passed, and if the target person was 72, but not when he was 32. It was concluded that young stroke survivors may need to disclose their stroke in order for others to correctly attribute their behaviours, as this could improve their rehabilitation.</p>

How information affects attributions for ambiguous behaviours resulting from stroke

<p>Research has shown that when people see young survivors of stroke, they often misattribute the person’s symptoms to other factors (Wainwright et al., 2013). Consequently, these stroke survivors may suffer feelings of resentment towards, and from their acquaintances. They may also struggle to obtain or retain a job. This thesis examines whether these misattributions for stroke survivors’ symptoms are affected by the information people have about the stroke survivor and the rapidity of the change in their behaviours. Experiment 1 investigated if the stroke survivor’s age (72, 32 or unstated) and the level of information (no information, implied stroke or explicit stroke) for their behaviours influenced people’s attributions. Experiment 1 showed that people attributed the behavioural changes to factors other than stroke when no additional information is present, and they attributed the behaviours to stroke when stroke was explicitly described. When stroke was implied, participants rated stroke as the best explanation but only when the target person was 72. Experiment 2 manipulated the rapidity of the stroke survivor’s behavioural changes to assess the effect on attributions. Experiment 2 showed that people attributed the behaviours to stroke more if only one week had passed, and if the target person was 72, but not when he was 32. It was concluded that young stroke survivors may need to disclose their stroke in order for others to correctly attribute their behaviours, as this could improve their rehabilitation.</p>

The meaning of loneliness to stroke survivors: A qualitative study in Northeast England

This study explored stroke survivors’ experiences of loneliness. Drawing on interviews with 29 community-dwelling stroke survivors living in the Northeast of England, we found several themes: loneliness as being alone, the season or time, lack of understanding from those without any experience of stroke, reduced autonomy, and deterioration of social relations. It is important that healthcare professionals pay attention to the aspects of life that may increase the chances of a stroke survivor becoming lonely after being discharged from hospital, and to measure loneliness in stroke survivors a more valid scale should include items that touch on the aspects reported here.