Gunnel Carlsson

Consequences of mild stroke in persons <75 years -- a 1-year follow-up.

Background and Purpose: Mild strokes can be neglected regarding subtle sequels as fatigue, and cognitive and emotional changes. We have addressed this topic by exploring late consequences of an initially mild stroke (Barthel score ≧50). Accordingly, we assayed impairment, disability and handicap data 1 year after the first-ever stroke in persons <75 years, focusing on symptoms as fatigue, concentration difficulties, memory disturbances, emotional lability, stress resistance, anxiety and uneasiness, symptoms comprised in the astheno-emotional disorder (AED), and its relation to life satisfaction. Results: The mean value of the Barthel Index was 99.5 (SD 0.5) and 25% scored 0–1 on the Oxford Handicap Scale. AED was diagnosed in 71% of the patients, and fatigue was experienced by 72%. AED correlated significantly with life satisfaction, handicap and depression. Life satisfaction was significantly below that of norm values according to satisfaction with life as a whole, sex life and ability to manage selfcare. Conclusions: Our findings emphasize that ‘hidden dysfunctions’ not so easily discovered within the hospital context are common consequences of mild stroke. The concept of mild stroke as principally founded in motor function or ability in P-ADL therefore seems to be insufficient with respect to the patient long-term perspective.

Enhanced independence: experiences after regaining grip function in people with tetraplegia

Abstract Purpose: To explore how surgical reconstruction of grip affects everyday life for patients with tetraplegia, with special emphasis on patients perspective of their perceived changes. Design: Qualitative method. Subjects: Eleven people (aged 22–73) with tetraplegia who had undergone surgical reconstruction to restore grip function. Methods: Qualitative interviews were conducted 7–17 months after surgery and analysed using Grounded theory. Results: The core concept describing the participants experienced gains after grip reconstructive surgery was “enhanced independence”. It was associated with changes in both practical and psychological aspects of independence. Practical aspects identified were: “perform more activities”, “smoother everyday life”, “renewed ability to participate in social activities”, “less dependence on assistance” and “less restricted by physical environment”. Psychological aspects of independence included “regained privacy”, “increased manageability”, “regained identity”, “recapture a part of the body” and “share positive experiences with relatives and friends”. Encompassing all categories was the concept “self-efficacy in hand control”. It was seen as a result included in the enhanced independency core but also as an important factor for the development of all the other categories. Conclusion: Participants in this study experienced enhanced independence after grip reconstructive surgery and rehabilitation. The enhanced independence included both practical and physical aspects and it influenced all domains using the International Classification of Function, Disability and Health model; body function and structure, activities, participation, personal factors and environmental factors. Implications for Rehabilitation Patients with tetraplegia experience grip reconstruction as a useful intervention, an enhanced independence, related to their improved hand control. The increased hand control impacted not only physical aspects but also practical and psychological aspects. It also influenced social and community participation and the interference the environment had on the person. Self-efficacy was both a result of the intervention and a catalyst allowing the subcategories to develop. Therefore, self-efficacy in hand control seems to be an important factor to focus on during the rehabilitation process.

From regained function to daily use: experiences of surgical reconstruction of grip in people with tetraplegia

Abstract Purpose: To capture patients’ relearning processes from regained function to improvements in daily life after grip reconstructive surgery in tetraplegia. Subjects: Eleven people with tetraplegia who underwent grip reconstructive surgery during February 2009 to March 2011. Methods: Qualitative interviews were conducted 7 to 17 months after surgery and analysed using grounded theory. Results: Determination to reach a higher level of independence was the core concept to integrate regained function into daily life. There were 3 phases identified; “Initiate activity training,” “Establish hand control in daily activities,” and “Challenge dependence.” Between the phases psychological stages occurred, first; “a belief in improved ability”, and later in the process; “confidence in ability”. The process to fully integrate regain function in daily life was described as long and time-consuming. However, the participants claimed it useful to do the skills training in their home environment, without long-term in clinic rehabilitation. Conclusion: Relearning activities in daily life after a grip reconstruction is a time-consuming and demanding process. It includes skills training, mental strategies and psychological stages together with environmental and social factors. Accordingly, rehabilitation after grip reconstruction in tetraplegia should focus on both grip skills and psychological stages, to encourage that patient’s keep their determination and achieve greater independence. Implications for Rehabilitation There is a stepwise process to transform improved function into daily use. The most important factor to transform improved function into daily use was motivation to reach a higher independence. Other important factors were; skills training, use of individual learning strategies, belief and confidence in personal ability, social and environmental factors. There was a long and demanding process to fully transform the improved function into daily use. The participants preferred to do activity training in the specific environment, usually at home.

Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery – A qualitative study

Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Methods and findings Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. Conclusion This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.

A qualitative exploration of post-acute stroke participants’ experiences of a multimodal intervention incorporating horseback riding

Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors’ experiences and perceptions of horseback riding in the context of multimodal interventions. Aim To explore stroke survivors’ experiences of participation in a multimodal group-based intervention that included horseback riding. Methods An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Findings Four broad themes were identified from the analysis. These themes were: transformative experiences; human–horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. Conclusion A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.

Inter-rater reliability and face validity of the Executive Function Performance Test (EFPT):

Introduction Occupational therapists need an instrument to assess executive dysfunctions before patients are discharged from acute wards. The Executive Function Performance Test (EFPT) appears to be suitable, since it evaluates dysfunctions in complex activities. The aim of this study was to translate the EFPT from English into Swedish and to evaluate its properties when used with older persons with mild stroke in an acute setting. Method The study consisted of three parts: (1) a translation procedure using a forward and backward method; (2) evaluation of face validity; (3) inter-rater reliability by four raters (two pairs) who made 34 assessments in 17 older patients with mild stroke in an acute ward. Results The inter-rater reliability for the EFPT was good. The median was 88% of the percentage agreement. No occasional disagreement was found between the raters, but there was a systematic disagreement in one out of 20 items. The translation and face validity process resulted in further clarification of the semantic and cultural equivalence of the EFPT, and the manual was changed accordingly. Conclusion This study showed that inter-rater reliability was good and that the EFPT was found to be an interesting assessment, although further research is needed.