National Stroke Association Research Articles

An Investigation of Syntactic Impairment in Relative Clauses of a Non-Fluent Aphasic Patient

This paper reports on a study on the typical characterization of syntactic impairment in relative clauses found in a patient diagnosed with non-fluent aphasia or also known as Broca ‘s aphasia at National Stroke Association of Malaysia (NASAM), Petaling Jaya, Malaysia. The study adopts the theory of Chomsky’s (1981) Government and Binding Theory that consist of (D)eep Structure and (S)urface Structure as a framework for the description of syntactic impairment and adopts an influential hypothesis by Grodzinsky’s (1990) Trace Deletion Hypothesis (TDH) concerning agrammatism. The sentence structure used in this study is syntactically identical to the base order subject-verb-object (SVO) except for the movement of the object to the beginning of the sentence known as derived order that will result to the formation of object-subject-verb (OSV) in English, and thus enable examination of syntactic movement in agrammatic comprehension. This study involves one patient with non-fluent aphasia, native speaker of Tamil and speaker of English as second language from NASAM, performing a sentence - to-picture matching test. This study reveals the patient’s comprehension of subject relative clauses (SVO structure) are significantly above chance level, but object relative clauses (OSV structure) are at chance level. This study reveals that the score obtained by the patient is within the percentage and performance level (standard norm) proposed by Grodzinsky. These results also show that the non-fluent aphasic patient’s ability to comprehend the relative clauses that involve movement of a noun phrase is impaired.

Assessing the Risk of Stroke among the Patients with Diabetes Mellitus in a Tertiary Care Hospital

Diabetes mellitus is a recognised independent risk factor for stroke as it contributes to the progression of atherothrombotic cerebrovascular lesions. Diabetic patients have a 1.5 to 3 times higher risk of stroke, especially cerebral infarction, than non-diabetic subjects. The study aimed to assess the level of risk on stroke among the patients with diabetes mellitus in a tertiary care hospital of South India. The study design was cross sectional descriptive research type. The study participants (n=196) were having diabetes type I or type II, above 18 years, with or without comorbidity who attended diabetic out-patient department of the hospital. National stroke association’s stroke risk score card was used to assess the level of risk on stroke; data was collected by face to face interview method. Majority of the diabetic patients had caution level of risk (n=166, 84.7%); 30 (15.3%) patients had high level of risk and none of the participants (0%) had low level of risk. The level of risk of stroke among the patients with diabetes mellitus mean and standard deviation was 13.87+2.288. The study showeds that diabetics had risk of getting stroke though not high risk. The patients following healthy life style can prevent stroke in future.

Barriers to physical activity of stroke survivors in Singapore: A face-to-face cross-sectional survey

Background Physical activity (PA) levels of stroke survivors are far from recommended levels. To develop specific interventions targeted at improving PA after stroke, there is a need to consider the barriers to PA faced by stroke survivors. Objective To use the comprehensive Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to identify intrapersonal, interpersonal, organizational and community barriers to PA faced by stroke survivors in Singapore. Methods We conducted a face-to-face survey with stroke survivors recruited from Singapore National Stroke Association platforms. Participants were eligible for the study if they were 21 years old and above, had a medical diagnosis of stroke, and had a weak arm or leg. Results 38 stroke survivors participated in the survey. More than half had moderate or moderately severe disability, and needed assistance for activities of daily living or walking. Of the 63 barriers spanning across intrapersonal, interpersonal, organizational and community domains, the top three most commonly reported barriers include lack of accessible classes/programs at fitness centre (21/38; 55%), lack of assistance from fitness centre staff (19/38; 50%) and feelings of tiredness/fatigue (18/38; 47%). Of the top 10 most commonly reported barriers, four were organizational barriers, four were intrapersonal barriers and two were community barriers. Conclusions Stroke survivors in Singapore want to participate in PA, but are often limited by barriers associated with fitness centres, self and the environment in the wider community.

User-Centered Mobile Applications for Stroke Survivors (MAPPS): A Mixed-Methods Study of Patient Preferences

ObjectiveInvestigate stroke survivors’ (SS) preferences for a hypothetical mHealth app for post-stroke care and to study the influence of demographic variables on these preferences. DesignMixed-methods, sequential, observational study. SettingFocus groups (phase 1) were conducted to identify SS perceptions and knowledge of mHealth applications (apps). Using grounded theory approach, recurring themes were identified. A multiple-choice questionnaire of 5 desired app features was generated using these themes and mailed to SS (national survey, phase 2). SS’ demographics and perceived usefulness (yes/no) for each feature were recorded. In-person usability testing (phase 3) was conducted to identify areas of improvement in user interfaces of existing apps. Summative telephone interviews (phase 4) were conducted for final impressions supplementary to national survey. ParticipantsSS aged >18 years recruited from study hospital, national stroke association database, stroke support and advocacy groups. Non-English speakers and those unable to communicate were excluded. InterventionsNone. Main Outcome Measures(1) Percentage of SS (phase 2) identifying proposed app features to be useful. (2) Influence of age, sex, race, education, and time since stroke on perceived usefulness. ResultsNinety-six SS participated in focus groups. High cost, complexity, and lack of technical support were identified as barriers to adoption of mHealth apps. In the national survey (n=1194), ability to track fitness and diet (84%) and communication (70%) were the most and least useful features, respectively. Perceived usefulness was higher among younger SS (P<.001 to .006) and SS of color (African American and Hispanic) (ORs 1.73-4.41). Simple design and accommodation for neurologic deficits were main recommendations from usability testing. ConclusionsSS are willing to adopt mHealth apps that are free of cost and provide technical support. Apps for SS should perform multiple tasks and be of simple design. Greater interest for the app's features among SS of color may provide opportunities to address health inequities.

Effectiveness Test of Stroke Risk Detection Application Model, Stroke Risk Scorecard

Stroke is a disease caused by impaired blood circulation to the brain. This disease is a non-communicable disease that can be prevented by controlling stroke risk factors. STRIC (Stroke Risk Score Card) is a stroke risk detection application resulting from the development of a stroke risk detection model by the National Stroke Association. This study aims to determine the sensitivity, specificity, and accuracy of the application of the early stroke risk detection model (STRIC) in detecting stroke risk. Descriptive analytics by conducting stroke risk assessment using the Stroke Risk Scorecard (STRIC) App. The total sample was 60 people, consisting of 30 post-stroke people and 30 non-stroke people. The sensitivity value of the STRIC application is 91.67% which means that the ability to predict stroke risk for those who have experienced a stroke is very high. The specificity value of the STRIC application was 77.78%; this means that the measurement capability of the STRIC application provides a non-stroke (negative) result of 77.78% or very good. The accuracy value of the STRIC application is 83.33%, which means that the ability of the STRIC application to detect the risk of stroke in all subjects tested correctly is 83.33%. Applying the STRIC application can help prevent stroke and improve the prognosis for high-risk individuals.

Risk factors for ischemic cerebral stroke in patients with acute amaurosis fugax

ObjectifSelon la National Stroke Association et l'American Heart Association, l'ischémie rétinienne, comme celle qui se produit pendant une amaurose transitoire (AT), est une forme d'accident vasculaire cérébral (AVC). Notre étude visait à évaluer les facteurs de risque d'accident ischémique cérébral chez les patients hospitalisés en raison d'une AT aiguë. MéthodesOn a consulté la base de données NIS (National Inpatient Sample) pour recenser les patients d'au moins 21 ans qui avaient reçu un diagnostic primaire d'AT au moment de leur admission (code 362.34 de la neuvième édition de la classification internationale des maladies [ICD-9]) entre 2002 et 2014. Les mesures liées aux comorbidités et les incidents qui sont survenus pendant l'hospitalisation ont été recensés à l'aide des codes ICD-9 pertinents. On a eu recours au logiciel IBM SPSS 25 et au package R pour réaliser les analyses statistiques. RésultatsUn total pondéré de 12 142 patients a été identifié. Les troubles concomitants les plus fréquents au sein de cette cohorte présentant une AT comprenaient l'hypertension, la dyslipidémie, le tabagisme, la coronaropathie et le diabète de type 2. Selon l'analyse de régression multiple, certaines affections concomitantes – hypercoagulabilité, vascularite systémique, coronaropathie et athérosclérose – constituent des facteurs de risque indépendants d'accident ischémique cérébral en présence d'AT. En revanche, la dyslipidémie a été associée à une réduction du risque. Le risque était 5 fois plus élevé chez les Asiatiques et les personnes provenant des îles du Pacifique, comparativement aux Caucasiens. ConclusionOn a diagnostiqué un accident ischémique cérébral et un infarctus du myocarde chez 0,3 % à 0,9 % des patients hospitalisés en raison d'une AT aiguë. L'hypercoagulabilité, la vascularite systémique, la coronaropathie et l'athérosclérose étaient des facteurs de risque indépendants d'accident ischémique cérébral, chacun multipliant le risque par plus de 3. Les patients qui présentent ces facteurs de risque conjointement à une AT aiguë doivent faire l'objet d'une surveillance étroite en raison du risque de thrombose généralisée aiguë.

Default Strategy Used by Broca’s Aphasic Patient During a Sentence Comprehension

This paper reports on a study on the use of default strategy by Broca’s aphasic patient during a speech comprehension using sentence to picture matching test. The test was undertaken at The National Stroke Association of Malaysia (NASAM), Petaling Jaya, Malaysia. The current study employs the theory of Grodzinsky’s (1990) Trace Deletion Hypothesis (TDH) as an explanation for the Broca aphasic patient’s ability to comprehend active and passive sentences using a default strategy. TDH also characterises Broca aphasic patient as a good comprehender of active sentences and as a bad comprehender of passive sentences. Christensen’s (2001) Sentence to Picture Matching Test has been adopted in this study to investigate the Broca aphasic patient’s comprehensibility of both active and passive sentences. The findings of this study support the account of TDH in which Broca’s aphasic patient has been using the default strategy during their active and passive sentences comprehension process and due to the usage of the strategy, the patient is considered as a good comprehender of active sentences and a bad comprehender of passive sentences. The default strategy used by the Broca’s aphasic patient has affected their understanding of the sentence structures overall.

Stroke survivors\u2019 preferences regarding study participation in rehabilitation research

BackgroundTo pursue high quality research, successful participant recruitment is essential, but recruitment rates are often low. This is specifically true in target populations with impairments, for instance, among stroke survivors. Previous studies focusing on recruitment have mainly relied on information from professionals, and there is therefore a need to contribute with new methodological insights to how potential rehabilitation research participants describe their interest and preferences to participate in research. The purpose of this study was to generate knowledge about stroke survivors’ interest in participating in rehabilitation research, reasons for being interested or not, and preferred forms and foci of rehabilitation interventions. An additional aim was to describe preferences regarding survey administration modes and processes for recruitment to studies.MethodThis cross-sectional study recruited Swedish residents who had sustained a stroke, initially by using advertisement on the National Stroke Association’s website, flyers posted at local occupational and physical therapy offices and at local stroke/senior organization meetings. Secondly, participants were recruited through a local stroke register. The survey, administered either in a paper form returned by postal mail; online or as a phone interview with 128 stroke survivors.ResultsMost of the participants were interested in participating in rehabilitation research, particularly younger persons (p = 0.001) and those closer to stroke onset (p = 0.047). Contribution to research, possibility to try new rehabilitation interventions and meeting others in the same situation were reasons that attracted an interest to participate. Other important aspects were related to motivation, individual needs, as well as how skilled the people who provided the intervention were. Participants preferred group-based programs, and programs focusing on regaining lost functions were highly requested. A majority wanted to be contacted through postal mail (70%) and most of them (90%) used the paper form to respond to the survey.ConclusionsA range of personal and external aspects, including challenges related to digitized administration modes, should be considered to achieve high participation rates in rehabilitation research targeting stroke survivors. The importance of addressing individual needs and prerequisites in an individualized manner should not be underestimated and might be a useful strategy to recruitment success.

Efficacy of Bilateral Lower Limb Training over Unilateral to Re-educate Balance and Walking in Post-stroke Survivors: A Protocol for Randomized Clinical Trial

Background: One of the significant causes of morbidity worldwide and an essential contributor to disability is Stroke. As said by the National Stroke Association, nine post-stroke survivors out of 10 experience some degree of weakness post-stroke. The hemiplegic patients with sub-acute stroke, who will undergo training to both the lower limb overtraining to only involved side will have an improvement in balance and walking. The goal of this study is to see how much training to both the lower limb improves functional recovery in patients who have had a subacute stroke compared to unilateral, more insufficient limb training.&#x0D; Objective: The goal of this study was to see how training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients.&#x0D; Methods: A randomized clinical study with assessor blinding will be conducted with participants with subacute stroke (n=40). Participants will be randomized to one of two groups after performing baseline assessments: Group A or Group B.1st group will receive training only to the hemiparetic side, i.e., Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation, and 2nd group participants will receive bilateral training, i.e., Strengthening to the unaffected side along with Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation to the affected side. During the therapy period, we will assess lower limb function through static and dynamic balance, walking, and gait measures.&#x0D; Results: The purpose of the research is to look into the effect of training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. The results of this study will be based on the outcome measures that are static and dynamic balance in the stroke patients and walking.&#x0D; Conclusion: The study's findings will shed more light on the benefits of training to both the lower limb overtraining to only involved side in patients post-stroke. If this trial proves successful, it will help post-stroke patients improve their balance and walking.

A Descriptive Study to Assess the Risk of Stroke among Patients with Hypertension and Type 2 Diabetes Mellitus at a Selected Hospital, Bangalore

Objective: Stroke is a major public health problem, both in developed and developing countries. Stroke is becoming an important cause of early death and disability in India due to increasing prevalence of the major key modifiable risk factors like type 2 diabetes mellitus and hypertension. Hence there is an urgent need for recognition of stroke risk factors and its warning signs. With this intention the present study aimed to assess the risk of stroke among patients with hypertension and type 2 diabetes mellitus. Methods: A non-experimental, descriptive survey method was adopted. Samples were selected by using quota sampling technique and 60 hypertensive and type 2 diabetes mellitus patients who met the inclusion criteria were selected for the study. Data were collected by an interview technique using a modified stroke risk assessment tool by the National Stroke Association, USA. Results: Out of 60 samples 48.3% of them were in high-risk category, 28.3% were in caution and 23.3% in low-risk category. There was a significant association found in relation to socio demographic variables such as education qualification, type of family, type of diet, weight and complications of hypertension (P&lt;0.05). Discussion: The findings of the study suggested that there is an increased risk of stroke in hypertension and type 2 diabetes patients which can be aggravated by other risk factors and co-morbid conditions. Hence modifying these risk factors by changing lifestyle can help in prevention of stroke. Keywords: Stroke, risk assessment, hypertension and type 2 diabetes mellitus, comorbid conditions.

AGRAMMATIC PATIENT’S DUAL CODING PROCESS IN SENTENCE COMPREHENSION

This paper reports on a study on the dual coding process involved in an agrammatic patient when comprehending sentences using a sentence to picture matching test. The test was undertaken at The National Stroke Association of Malaysia (NASAM), Petaling Jaya, Malaysia. The current study employs the theory of Paivio’s (1991) Dual Coding Theory (DCT) as an explanation for the agrammatic patient’s ability to comprehend active and passive sentences and adopts an influential hypothesis by Grodzinsky’s (1990) Trace Deletion Hypothesis (TDH) concerning agrammatism that characterises agrammatic patients as a good comprehender of Subject Verb Object (SVO) sentence structure, the active sentence but as bad comprehenders of Object Verb Subject (OVS) sentence structure, the passive sentences. A comprehension test, the Sentence to Picture Matching Test designed by Christensen (2001) has been adopted in this study to examine the suitability of dual coding theory as an explanation for the agrammatic patient’s comprehension ability. The performance of the patient’s comprehension pattern in this study supports the account of TDH and in general, the findings of this study suggest that sentence to picture matching test could be used to investigate the dual coding process of the agrammatic patient.

441 An Atypical Case of Marantic Endocarditis in Undiagnosed Antiphospholipid Syndrome

Marantic endocarditis (ME) is difficult to differentiate from infective endocarditis (IE) [[1]Bussani R. F DE-G Pesel G. Zandona L. Sinagra G. Grassi S. et al.Overview and Comparison of Infectious Endocarditis and Non-infectious Endocarditis: A Review of 814 Autoptic Cases.In vivo (Athens, Greece). 2019; 33: 1565-1572PubMed Google Scholar]. We demonstrate an atypical case of ME presenting as an independently-mobile mass and severe MR. A 57-year-old man presented with a right parietal stroke secondary to mitral valve(MV) endocarditis. Past history was significant for a provoked pulmonary embolus. Family history was insignificant. Transthoracic (TTE) and transoesophageal echocardiogram revealed a 1.1x0.6cm independently-mobile MV vegetation with severe mitral regurgitation (MR) and normal left atrium size. He was clinically euvolaemic. Empiric antibiotics were commenced. Inflammatory markers were normal and blood cultures negative. He was considered for MV surgery. Preoperative coagulation studies revealed an incidental elevated activated partial thromboplastin time (APTT) (77s) which did not correct with mixing studies. Thrombophilia screen demonstrated high anti-cardiolipin >2024 and beta-2-glycoprotein-1 antibodies >6100. A diagnosis of ME due to presumed antiphospholipid syndrome (APLS) was established. Multidisciplinary decision was made to trial anticoagulation with warfarin over surgery. TTE at 4 months demonstrated resolution of the vegetation with mild mitral incompetence. While rare(prevalence 0.9-1.6%), ME is associated with high morbidity and mortality [[2]Gundersen H. Moynihan B. An Uncommon Cause of Stroke: Non-bacterial Thrombotic Endocarditis.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2016; 25: e163-e164Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar]. Causes of ME can be inflammatory, autoimmune or malignant [[3]Ahmed S. Jani P. Yamani M.H. Ailawadhi S. Alegria V.R. Ailawadhi M. Marantic Endocarditis Associated With T-Cell Large Granular Lymphocytic Leukemia: First Report of Its Occurrence With a Lymphoproliferative Malignancy in Adults.Journal of oncology practice. 2018; 14: 625-627Crossref PubMed Scopus (2) Google Scholar]. ME commonly affects the MV [[4]Murtaza G. Iskandar J. Humphrey T. Adhikari S. Kuruvilla A. Lupus-Negative Libman-Sacks Endocarditis Complicated by Catastrophic Antiphospholipid Syndrome.Cardiology research. 2017; 8: 57-62Crossref PubMed Google Scholar] and presents with embolic phenomena [[5]Deppisch L.M. Fayemi A.O. Non-bacterial thrombotic endocarditis: clinicopathologic correlations.American heart journal. 1976; 92: 723-729Crossref PubMed Scopus (122) Google Scholar]. ME vegetations typically attach firmly to valve leaflets and move with them compared to independently-mobile infective vegetations [[6]Bouma W. Klinkenberg T.J. van der Horst I.C. Wijdh-den Hamer I.J. Erasmus M.E. Bijl M. et al.Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature.Journal of cardiothoracic surgery. 2010; 5: 13Crossref PubMed Scopus (59) Google Scholar]. Significant valvular regurgitation is rare. Surgical treatment in ME is seldom required with the mainstay treatment being therapeutic anticoagulation [[6]Bouma W. Klinkenberg T.J. van der Horst I.C. Wijdh-den Hamer I.J. Erasmus M.E. Bijl M. et al.Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature.Journal of cardiothoracic surgery. 2010; 5: 13Crossref PubMed Scopus (59) Google Scholar]. Our case highlights the value of a multidisciplinary approach to endocarditis and importance of a thorough history and scrutiny of investigations.

The XI Russian Congress of Neurologists and IV Congress of the National Stroke Association, June 15-19, 2019

The XI Russian Congress of Neurologists and IV Congress of the National Stroke Association, June 15-19, 2019

Antidepressant pharmacotherapy and poststroke motor rehabilitation: A review of neurophysiologic mechanisms and clinical relevance.

According to the National Stroke Association, stroke is the leading cause of adult disability in the United States, where it is estimated that about 795,000 strokes occur on an annual basis. Minimizing the disability burden of a stroke routinely involves behavioral therapies such as physical and occupational therapy, as well as pharmacologic interventions. The positive effect of antidepressants on functional outcomes for patients with poststroke depression is well known and practiced. In the past 15 years, a growing body of evidence has demonstrated that antidepressant pharmacotherapy and selective serotonin reuptake inhibitors specifically have a role in the functional recovery from strokes even in the nondepressed population. The mechanisms by which antidepressants improve motor recovery following stroke are multifactorial, but it is clear that the process involves augmentation of cerebral blood flow, cortical excitation, and potentiation of neural growth factors all resulting in enhancement of neurogeneration. This review will examine the existing evidence and mechanisms behind antidepressant use for motor recovery in stroke patients and discuss the major human clinical trials that have been conducted surrounding this topic. The evidence clearly suggests that antidepressants have a positive impact on poststroke functional recovery regardless of the presence of depression, and although large-scale randomized, controlled trials are still ongoing, antidepressants are emerging as a promising pharmaceutical means of actively lessening the burden of disability following stroke.

Materials of the XI Russian Congress of Neurologists and IV Congress of the National Stroke Association

Materials of the XI Russian Congress of Neurologists and IV Congress of the National Stroke Association

Pseudobulbar Affect: What Nurses, Stroke Survivors, and Caregivers Need to Know.

Pseudobulbar affect (PBA) is a neurologic condition that can happen after a patient has had some kind of neurological insult. In this syndrome, involuntary, uncontrollable, and inappropriate emotional outbursts unrelated or out of proportion to the situation are common symptoms. This can be very frustrating and scary. Because stroke survivors and their caregivers are overloaded with information during the transition from hospital to home, information about PBA is not usually discussed. In a survey by the National Stroke Association, 53% of stroke survivors reported that they had some of the symptoms of this disorder. Even if they discussed these symptoms with their health care providers, less than half were given a diagnosis, and less than a quarter received any kind of treatment. The purpose of this article is to give nurses more information about PBA so they can share this with patients and families/significant others and encourage them to seek help if they experience these symptoms once discharged. It is hoped that increased knowledge about this condition will lead to better diagnosis and treatment and increased quality of life for stroke survivors.

Abstract TP312: Developing a Mobile Application for Stroke Informal Caregivers

Background: Following stroke, many survivors require assistance with activities of daily living from untrained individuals. These informal caregivers assume multiple new responsibilities, which can generate stress, especially when their own needs are inadequately addressed during a patient’s recovery. Methods: A nationwide survey mailed to 11,720 stroke survivors through the National Stroke Association with a cover letter asking them to give the IRB approved informed consent and survey to their informal caregiver, if applicable. The 17 question survey asked caregivers about demographics, if they own a cell/smart phone, and the caregiver’s opinion about what resources in a mobile app (if any) would be useful – namely: 1) scheduling multiple tasks, 2) finding information about stroke resources, 3) finding local resources, 4) tracking fitness and diet, and 5) communication with their stroke survivor. The survey was developed using focus groups in 2 states. For all questions logistic regression determined if there were racial, gender, or age disparities. Results: 396 stroke caregivers [(299 (76%) female, 96 (24%) African-American, 42 (11%) Hispanic/Latino, and 210 (53%) Caucasian], aged 20-99 years (mean 59.5 ± 13.3) returned surveys; 96% owned a cell phone; 60% of all caregivers owned a smart phone. Caregivers in this sample reported features of the app to be important including: doctor/rehab appointments (80%, 95% CI, 76-84%), links to trustworthy medical information (84%, 95% CI 80-87%), stroke support groups in my area (81%, 95% CI 77-85%), exercises (76%, 95% CI 71-80%), and a touch screen with useful phrases (76%, 95% CI 71-80%). When examining the utility of the 5 app resources (outlined above), Latino (88%-74%) and African-American (84%-77%) caregivers reported the highest rate of usefulness across the 5 aspects). As age increased, the caregivers’ reporting of mobile app usefulness decreased ( p &lt; 0.05). However, in the oldest group (63+), 67-79% of caregivers reported that all 5 resources would be useful in a mobile app. Conclusions: Implementation of a mobile app unique to stroke caregivers with resources is desired by this diverse, national sample of informal caregivers and holds potential to alleviate stress and improve patient’s recovery.

Abstract WP379: What Informal Caregivers Want in a Mobile Application: Evidence-based Interventions

Background: Nurses play a critical role supporting informal caregivers of stroke patients and thus need evidence of best, client centered interventions. Although there is a growing literature evaluating interventions, there is a paucity of research that begins with and engages caregiver stakeholders in identifying interventions, especially with the use of mobile health technologies. Research Question: What do stroke survivor informal caregivers want in a mobile application? Methods: A cross-sectional, descriptive study of informal stroke caregivers from a national convenience sample of the National Stroke Association database was conducted using a 17-item survey mailed to stroke survivors asking their caregivers to identify useful educational content/knowledge and resources. Descriptive statistics and logistic regressions were performed to analyze data and examine the relationships among demographic variables and caregiver needs. Results: Of 396 respondents, 76% were female (mean age 59 years +/-13.3; range 20-99); 53%, Caucasian; 24%, African-American; 11%, Hispanic/Latino. A majority (76% to 81%) of respondents wanted information about scheduling tasks and appointments, local resources, internet resources, fitness and diet tracking, and tools for communication with the stroke survivor; 81% of respondents wanted information about support groups. Ninety-six percent of caregivers owned a cell phone; 60% of which were smart phones. As age increased, reported usefulness of the app decreased (p = 0.05). There were no significant differences related to gender, race/ethnicity, or whether or not the caregiver owned a smartphone. Conclusion: Consistent responses across population groups suggest that nurses can use the findings to develop mobile applications for smartphone users, to use the content to develop written resource guides for discharge planning, and to customize care plans to support stroke caregivers with and without smartphones. Discharge plans for informal caregivers should include specific information about stroke survivor services, how to arrange healthcare appointments, educational materials about strokes, and guidance in best methods for communicating with the stroke survivor.

Two decades of nation-wide community-based stroke support - The Singapore National Stroke Association.

The Singapore National Stroke Association, registered in 1996, offers support and information to stroke survivors and caregivers, and aims to raise public stroke awareness. In the last 20 years, we have developed programs to equip stroke survivors and caregivers with knowledge, life skills, comfort, and opportunities for socialization and reintegration. We have on-going public education and advocacy initiatives. Obtaining funding, member recruitment, volunteer retention, and leadership renewal are on-going challenges. Singapore National Stroke Association will continue to strive for the betterment of stroke survivors, their caregivers, and the public.

Empowering Individuals with Aphasia and Visual Impairments through Effective Communication

Advances in medicine have enabled an aging population to survive neurological events such as strokes more frequently. Consequences of a stroke can be widespread and severe, and it is currently the leading cause of long-term disability in Canada (Public Health Agency of Canada [PHAC], 2011). The PHAC report indicated that in 2009 approximately 315,000 Canadians were living with the consequences of strokes (PHAC, 2011). Consequences of strokes may include hemiplegia, reduced cognition and emotional control, difficulty with language (aphasia), and visual impairment, to list a few of the impairments and disabilities that may occur (Warren, 2008). To address the needs of individuals with language impairments resulting from strokes, there is a need for low vision rehabilitation professionals (optometrists, ophthalmologists, low vision therapists, high technology assessors, orientation and mobility instructors, rehabilitation counsellors, independent living skills teachers, and occupational and physical therapists) to become familiar with the impact of neurological events on an individual's ability to communicate. An individual who has survived a stroke may be left with multiple impairments including those that affect vision and communication. Visual impairment is a possible result, and it may present as a defect of visual fields, impaired eye movements, and problems with perception or cortical blindness (Hillis, 2007; Jones & Shinton, 2006; Rowe et al., 2009). Up to a quarter of stroke survivors may have vision loss, according to the National Stroke Association (2012). It is not unusual to encounter patients who had a neurological event with multiple impairments (including vision loss) when assessing and implementing a low vision rehabilitation plan. This report describes some communication strategies that may be utilized to create a successful low vision rehabilitation assessment and plan for a patient with a coexisting visual impairment and aphasia following a stroke. WHAT IS APHASIA? Following a neurological event, some individuals experience aphasia, which is an acquired condition following damage to the speech and language areas in the brain and which affects a person's ability to communicate (Hillis, 2007). It is a problem with language, not intelligence (National Aphasia Association, 2015). The areas of the brain that are responsible for language are found on the left side (Damasio, 1992; Hillis, 2007). Individuals with aphasia may have difficulties speaking, understanding what others are saying, and problems with reading and writing. Due to the complex nature of communication, there are several different classifications of aphasia that are widely disputed (Ardila, 2010; Marshall, 2010). The broad and more classic classification used by the National Aphasia Association (2015), the Heart and Stroke Foundation (2013), the American Heart Association (2015), and the National Institute on Deafness and Other Communication Disorders (NIDCD, 2010) when discussing aphasia with the lay community includes three types: expressive aphasia, receptive aphasia, and global aphasia. Expressive aphasia Individuals with expressive aphasia are typically able to understand what is being communicated to them, but have difficulty or are unable to respond either verbally or in writing. This is also known as Broca's aphasia (attributed to the person who discovered the condition and the area of the brain that is thought to be affected) or nonfluent aphasia (as individuals with this type of aphasia exhibit great effort when attempting to speak). Any phrases that the individual uses are generally understood by their unaffected conversational partner, but speaking is very difficult, laborious, and slow. Individuals with expressive aphasia typically choose the correct nouns, but small words are often improperly used (Damasio, 1992; Hillis, 2007). There is a reduction in the length of the sentences expressed (Hillis, 2007). …