Post-stroke Experience Research Articles

Stroke survivors’ perceptions of living with disability in urban Ghana- a qualitative study

BackgroundStroke prevalence is one of the most pressing issues in many sub-Saharan African countries. Stroke survivors often face disabilities, mental health problems, and experience stigma. Research on post-stroke experiences and interventions is limited, particularly in low and middle-income countries, including Ghana. This study aims to contribute to this gap by investigating experiences of everyday life following a stroke in urban Ghana.MethodA qualitative in-depth study involving 14 interviews with stroke survivors who attended physiotherapy at Accra Physiotherapy and Sports Injury Clinic. Qualitative analysis was conducted to analyse the data.ResultsData analysis generated four themes; [1] Mobility limitations; [2] Psychosocial burden [3] Employment Limitations [4] Financial burden.ConclusionStroke survivors with disabilities perceive themselves as non-functional members of society, which limits their options for a normal life and undermines their well-being. A more in-depth understanding of these issues can contribute to strategies, interventions, and policies that address these problems.

Life after stroke: changes in sensory health and the impact on participation

ABSTRACT Background Research has demonstrated that adults post-stroke may experience sensory impairments across different sensory systems. There is a gap in research describing how sensory changes after stroke affect participation in health promoting activities. Objectives The purpose of this study is to understand how changes in sensory health after stroke affect participation in meaningful activities. Methods We adopted a qualitative phenomenological design to conduct four focus groups with ten participants: two focus groups with a cohort of adults post-stroke (n=5) and two focus groups with a cohort of stroke rehabilitation therapists and stroke caregivers (n=5). Focus group transcripts were coded using open and focused coding with NVivo software to develop themes. Results Participants reported changes in their visual, vestibular, proprioceptive, olfactory, gustatory, tactile, and auditory systems that affected their participation in meaningful activities. Participants also reported that they experienced insufficient resources and therapies addressing their sensory health after their stroke. Analyses yielded the following themes:(1) it’s hidden and invisible;(2) sensory changes affect participation and can be overwhelming; and (3) it’s easy to stay inside: sensory changes negatively affect social participation. Conclusions Adults post-stroke experience sensory changes that restrict their participation in meaningful activities including social activities; however, these changes were often missed. More research is needed to further explore the impact of changes in sensory health and understand needs regarding the development of assessment tools and intervention protocols to address the sensory health of adults post-stroke in the clinic, home, and community.

Social participation mediates the relationship between self-efficacy and loneliness among people with stroke during COVID-19: a cross-sectional study

ABSTRACT Background People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura’s self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals’ emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. Objectives Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. Methods 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. Results The total effect of self-efficacy on loneliness was significant (b = -0.36, p = .01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [−0.24, −0.01]; direct effect, b = -0.25, 95% CI [−0.03, 0]). Conclusions Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy.

Post-stroke experiences and health information needs among Chinese elderly ischemic stroke survivors in the internet environment: a qualitative study.

Elderly stroke survivors are encouraged to receive appropriate health information to prevent recurrences. After discharge, older patients seek health information in everyday contexts, examining aspects that facilitate or impair healthy behavior. To explore the experiences of older stroke patients when searching for health information, focusing on search methods, identification of health information, and difficulties faced during the search process. Using the qualitative descriptive methodology, semi-structured interviews were conducted with fifteen participants. Participants associated the health information they sought with concerns about future life prospects triggered by perceived intrusive changes in their living conditions. Based on the participants' descriptions, four themes were refined: participants' motivation to engage in health information acquisition behavior, basic patterns of health information search, source preferences for health information, and difficulties and obstacles in health information search, and two search motivation subthemes, two search pattern subthemes, four search pathway subthemes, and four search difficulty subthemes were further refined. Older stroke patients face significant challenges in searching for health information online. Healthcare professionals should assess survivors' health information-seeking skills, develop training programs, provide multichannel online access to health resources, and promote secondary prevention for patients by improving survivors' health behaviors and self-efficacy.

Exploring the Poststroke Experiences and Needs of South Asian Communities Living in High-Income Countries: Findings from a Scoping Review.

Despite the high prevalence of stroke among South Asian communities in high-income countries, a comprehensive understanding of their unique experiences and needs after stroke is lacking. This study aimed to synthesize the literature examining the experiences and needs of South Asian community members impacted by stroke and their family caregivers residing in high-income countries. A scoping review methodology was utilized. Data for this review were identified from seven databases and hand-searching reference lists of included studies. Study characteristics, purpose, methods, participant characteristics, results, limitations, recommendations, and conclusions were extracted. Data were analyzed using descriptive qualitative analysis. In addition, a consultative focus group exercise with six South Asian community members who had experienced a stroke and a program facilitator was conducted to inform the review interpretations. A total of 26 articles met the inclusion criteria and were analyzed. Qualitative analysis identified four descriptive categories: (1) rationale for studying the South Asian stroke population (e.g., increasing South Asian population and stroke prevalence), (2) stroke-related experiences (e.g., managing community support versus stigma and caregiving expectations), (3) stroke service challenges (e.g., language barriers), and (4) stroke service recommendations to address stroke service needs (e.g., continuity of care). Several cultural factors impacted participant experiences, including cultural beliefs about illness and caregiving. Focus group participants from our consultation activity agreed with our review findings. The clinical and research recommendations identified in this review support the need for culturally appropriate services for South Asian communities across the stroke care continuum; however, more research is necessary to inform the design and structure of culturally appropriate stroke service delivery models.

Exploring the life experiences of stroke survivors in Nigeria using the interpretive phenomenological analysis

BackgroundThe consequence of living as a stroke survivor has received significant attention in literature from different parts of the world. Enriching social relations and other factors are reported to influence the post-stroke experience. Differences in health systems, cultural factors and available resources have made it apt to explore the experience of life after a stroke in Nigerian stroke survivors. This study explored the lived experiences of Nigerian adult stroke survivors, with a focus on their concerns, hopes, dreams and daily routine experiences.MethodsThis qualitative study employed a phenomenological approach based on in-depth interviews with stroke survivors. Interpretative phenomenological analysis was used to analyse the in-depth exploration of the personal experiences of these stroke survivors and the meanings they attached to that experience.ResultsThe participants in this study described their experiences, emphasising both the visible loss of mobility and emotional issues related to their condition. Three superordinate themes were identified: (1) stroke presentation; (2) affect, coping, and adaptation; and (3) social supports.ConclusionThe study concluded that the experience of Nigerian stroke survivors is unique as it is a blend of supportive and non-supportive care scenarios, which is greatly associated with environmental and other intrinsic variables. Post-stroke mobility strongly influences the overall stroke experience.

Stress in Caregivers of Stroke Patients During Rehabilitation: An Observational Study.

Stroke causes a high burden of death and disability all over the world. The majority of stroke survivors continue to have difficulties, and their families must shoulder a considerable portion of the expenditures of ongoing rehabilitation and long-term care. In India, stroke rehabilitation is still underachieved due to various reasons leading to delay or incomplete recovery of the patients thus adding up more burden on the caregivers. Thus, studying the caregiver burden of stroke rehabilitation will help policymakers tackle this issue faced by our lower economically challenged citizens. The objective is to measure the perceived burden on caregivers during stroke rehabilitation. The observational study was conducted by interviewing the stroke survivors' caregivers and visiting the physiotherapy OPD using the caregiver burden scale/questionnaire. The study had 76 caregivers, 51.32% were women and 48.68% were men. The average age for caregivers was 42 years and 55 years for patients. The average duration of giving care was six months. The perceived caregiver burden score was low (mean-19.61) suggesting that not all assistance is associated with stress. The correlation of each burden measure with Modified Rankin Scale for disability is significantly correlated (r=0.7, P<0.0001). Further investigation revealed that caregivers had considerably higher levels of stress when the patient needed to exercise, walk or use the restroom. A low yearly income, a higher secondary education, and a small number of family members were shown to be connected with individuals who scored the highest on stress. Based on this study, we conclude that people with low income residing in nuclear families require more support for caregiving during rehabilitation. We recommend that health and welfare policy measures be developed to lessen caregiver burden in order to improve caregivers' post-stroke experiences.

Post-Stroke Experiences and Rehabilitation Needs of Community-Dwelling Chinese Stroke Survivors: A Qualitative Study.

Stroke survivors encounter significant limitations in daily life activities and face increased risk of health complications such as stroke recurrence. Considering the escalating demand for personalised community rehabilitation services, this qualitative study was conducted to understand the current recovery experiences, needs, and expectations of community-dwelling stroke survivors. Fifty stroke survivors were recruited from two tertiary teaching hospitals and community centres in two provinces in mainland China. Semi-structured interviews were carried out, and participants were asked to describe their experiences of stroke, current lifestyles, exercise habits, and rehabilitation needs and expectations. Resulting data were thematically analysed. The majority of participants were first-time stroke survivors (80%) and lived with their family or caregivers (92%). Four main themes and twelve sub-themes emerged from the data: (1) shifts in social life, (2) shaken sense of self and perceived helplessness, (3) complex rehabilitation needs, and (4) perceptions and patterns of physical activity. Findings suggest that though survivors recognised their need for further rehabilitation, their demands remained unmet due to a combination of personal and external factors such as limited mobility and the absence of supportive companions and accessible facilities. The enhancement and diversification of home rehabilitation strategies are therefore necessary to make community rehabilitation more accessible and equitable.

“Well in in this neighborhood I have walked, not at all”: Stroke survivors lived experience in the outdoor environment

Stroke survivors face unique challenges in the outdoor environment when returning to their home community following a stroke. Challenges include navigating uneven terrain, social stigma, and adapting to changes in functioning. Outdoor environments may serve as potential points of intervention to promote independence and participation post stroke. This study aimed to understand lived post-stroke experience in the outdoor environment as it pertains to independent mobility. MethodsQualitative semi-structured interviews were conducted with 20 stroke survivors (8 males, 12 females; mean age 64.2 years: range 45 years–90 years). Participants were eligible if they were over the age of 45, could communicate in English, lived outside a nursing home, able to walk safely outdoors, were a minimum of six-months post stroke, and had no severe cognitive impairment. Interviews with participants were tape recorded, audio files were transcribed verbatim, codes were created and applied to transcripts, and themes were generated using interpretative phenomenological analysis. ResultsPost-stroke experiences in the outdoor environment were multidimensional. Three themes emerged from the stroke survivors’ description of personal experiences in the outdoor environment. These themes included feelings of vigilance, employing adaptation strategies, and management of dynamic relations between the self and context. DiscussionThe findings highlight the post-stroke experience traversing the outdoor environment. Investing in the public outdoor environment to remove barriers and install facilitators could reduce feelings of apprehension and hypervigilance while walking in the outdoor environment. Future research is needed to evaluate the role of environmental interventions on hypervigilance in the outdoor environment post stroke.

Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol

IntroductionSouth Asian groups experience a higher burden of stroke and poorer functional outcomes after stroke than their White counterparts. However, within the stroke literature, there has been little focus on...

Experiences of mood changes and preferences for management within stepped psychological care from the perspective of spouses of people with aphasia

ABSTRACT Background Spouses of people with aphasia are at an increased risk of depression and other mood problems. Despite this, there is limited research addressing the experiences and preferences for psychological care of spouses. Aims To describe, from the perspective of spouses of people with aphasia: (a) the experience of mood changes, depression, and current practice after post-stroke aphasia for themselves and the person with aphasia; and (b) preferences of care within a stepped psychological care framework. Methods Four spouses of people with aphasia participated in two in-depth, semi-structured interviews each. Eight interviews were transcribed verbatim and analysed using Interpretive Description. Results Four core themes were identified: (1) Stroke and aphasia results in mood changes for both the spouse and the person with aphasia; (2) Spouses and people with aphasia experience a lack of psychological supports and other services; (3) Relationships with family, friends, health professionals, and the person with aphasia can influence mood in the post-stroke experience; (4) The implementation of stepped psychological care to stroke rehabilitation is important for spouses and people with aphasia. Conclusion Spouses experienced largely negative impacts of stroke and aphasia on their mood and wellbeing. They held positive views about the need for psychological care and identified various preferences for intervention. Health professionals may consider the preferences of spouses when providing psychological interventions and support.

Characterization and clinical implications of ankle impedance during walking in chronic stroke

Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering, these concepts are described as stiffness and damping, or collectively as joint mechanical impedance, when considered with limb inertia. Typical clinical assessments of these properties are obtained while the patient is at rest using qualitative measures, and the link between the assessments and functional outcomes and mobility is unclear. In this study we quantify ankle mechanical impedance dynamically during walking in individuals post-stroke and in age-speed matched control subjects, and examine the relationships between mechanical impedance and clinical measures of mobility and impairment. Perturbations were applied to the ankle joint during the stance phase of walking, and least-squares system identification techniques were used to estimate mechanical impedance. Stiffness of the paretic ankle was decreased during mid-stance when compared to the non-paretic side; a change independent of muscle activity. Inter-limb differences in ankle joint damping, but not joint stiffness or passive clinical assessments, strongly predicted walking speed and distance. This work provides the first insights into how stroke alters joint mechanical impedance during walking, as well as how these changes relate to existing outcome measures. Our results inform clinical care, suggesting a focus on correcting stance phase mechanics could potentially improve mobility of chronic stroke survivors.

Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study.

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors’ performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors’ recovery outcomes.

Measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) 2.0: a systematic review protocol.

The aim of this review is to critically appraise and summarize the quality of the measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) version 2.0. The Stroke Specific Quality of Life Scale version 2.0 was developed as a comprehensive measure in assessing the quality of life of stroke survivors. The shortened version and cross-culturally translated versions are further developed in different countries. A systematic review will clarify the levels of reliability and validity of all versions. The population of interest for this review will include adult stroke survivors of either sex diagnosed with a stroke (ischemic or hemorrhagic) who have no other comorbidities affecting their quality of life. The SS-QOL version 2.0 will be the specific instrument of interest, and the quality of life of stroke survivors will be the construct of interest in this review. The measures of reliability, validity, and responsiveness will be assessed as outcomes. Only the studies evaluating the reliability, validity, and responsiveness of all versions of the SS-QOL 2.0 will be included in the review. A literature search will be conducted for published studies in MEDLINE and Embase, and unpublished data in Google Scholar and ProQuest Dissertations and Theses. After a three-step search strategy, study selection will be done by two reviewers independently. Then, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology will be applied for assessment of methodological quality, data extraction, and synthesis. PROSPERO CRD42020211727.

The experience of uncertainty for patients, families and healthcare providers in post-stroke palliative and end-of-life care: a qualitative meta-synthesis.

recent data show that there is limited evidence and guidance regarding the best practices for the integration of palliative care (PC) and end-of-life (EOL) post-stroke. The purpose of this meta-synthesis is to understand the PC/EOL experiences after a stroke. a meta-synthesis was conducted to answer the following research question-What are post-stroke PC/EOL experiences from the perspectives of patients, families and healthcare professionals (HCPs)? This approach was completed through two main phases-a systematic search and appraisal of the literature and reciprocal translation with interpretive triangulation of the extracted data. Databases searched were MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute and CINAHL databases (from their inception to April 2020). After data were extracted, a qualitative exploratory design was used to evaluate the PC/EOL in post-stroke experiences. the search identified 696 studies. A total of 14 studies were included in this meta-synthesis as they satisfied our eligibility criteria. Uncertainty post-stroke was the overarching main theme that emerged across post-stroke PC/EOL experiences. Within this theme of uncertainty, opportunities to decrease uncertainty emerged from two interdependent themes-presence of cohesive communication and shared dynamic decision process for both families and HCPs. to mitigate the degree of uncertainty post-stroke, HCPs should be present, provide clear direct communication and incorporate the value-based goals of care within their medical treatment plan. These findings suggest that future research is needed to focus on how PC approaches can be integrated into stroke care programmes.

Veteran stroke survivors’ lived experiences after being discharged home: a phenomenological study

Background Stroke is a leading cause of disability in adults and third cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. Aims To examine Veterans’ lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. Methods Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45–80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. Results Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. Conclusions SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment. IMPLICATIONS FOR REHABILITATION Several implications for clinical practice were identified: Providers should acknowledge Veterans’ challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood. More emphasis should be given to the Veterans’ caregivers’ availability and willingness to help with their loved one’s recovery, work reinstatement status and financial struggles. Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked. Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits. Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system. Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.

Physical rehabilitation and pharmacotherapy of cognitive functions and asthenic disorders in stroke patients

The article deals with the state of cognitive functions (memory, attention and thought process) and asthenic disorders in stroke patients in the process of physical rehabilitation and pharmacotherapy. The study used conventional methods for determining the state of cognitive functions. To improve cognitive abilities in the process of physical rehabilitation in the experimental group of patients, traditional methods and special physical exercises in the form of training tasks for memory, attention and thought processes were used. In the control group of patients only traditional methods of restoration of cognitive functions were used. Both groups of patients took the same drugs to improve cognitive function and relieve symptoms of cerebrogenic asthenia, using classic nootropic drugs (Pyracetam, Phenotropil, Vinpotropil), peptide drugs (Cortexin, Cerebrolysin, Noopept, Semax), antidepressants and tranquilizers (benzodiazepines and non-benzodiazepine). It is determined that the most important indicator of memory quality is short-term memory. In the experimental group in the process of physical rehabilitation revealed an improvement in this memory in 50% of patients, the deterioration of this indicator in 34% of persons, and 16% memory remained at the same level. Short-term memory indices in post-stroke patients of the control group are lower and correspond to: improvement – in 35%, deterioration – in 40%, remained at the same level in 25% of patients. Since the rate of short-term memory is 7 ± 2 units of information, the study showed that in all patients after a stroke, the indicators of storing information in short-term memory have become normal. The study of attention stability revealed that in the control group of patients it is worse than in the experimental group, and that the stability of attention does not depend on the experience of the post-stroke state. Patients with 3 years of post-stroke experience show the same results as patients with 6-month stroke. The study of inductive thinking showed that in both groups of patients it is in good condition. As for the indicators of practical mathematical thinking, 83% of the participants coped with the task in the experimental group, and 17% failed. In the control group, 57% of patients coped with this task, and 43% failed. Only 50% of the patients in the experimental group and 42% of the control group coped with a more difficult task in this type of thinking. The same results were obtained in persons without stroke. This shows that the more difficult tasks of identifying this type of thinking are difficult for people after a stroke. It can be concluded that the mental processes of a person after a stroke are in optimal condition.

Relationship between Family Support and Attitudes Towards the Independence of Post-Stroke Patients in Performing Activity Of Daily Living (ADL) At the Neurology Polyclinic of RSUP Dr.M.Djamil Padang In 2017

Stroke is the first cause of serious disability in the world. In general, the condition of patients post-stroke experience interference on the part of the lower or upper extremities and difficulty in speaking. So patients post stroke should routinely perform the activity of daily living to increase self-sufficiency in post-stroke patients. The purpose of this research is to know the relationship of family support and attitude toward self-sufficiency in post-stroke patients in performing the activity of daily living in nerve polyclinic at RSUP Dr. M. Djamil Padang year 2017. This type of research is descriptive analytic, cross-sectional design research. The population in this research the entire post-stroke patients who visited the nerve polyclinic at RSUP Dr. M. Djamil Padang totaled 134 people. The number of samples 45 people taken with accidental sampling techniques. the data analyzed in Univariate and bivariate use test chi-square with a confidence level of 95% with a value of α = 0.05. The results showed more than half 75.6% (34) in post-stroke patients have good family support, more than half 73.3% (33) of the patient's post-stroke has a negative attitude. The results of statistical tests obtained P value (≥ 0.05) mean no relation of family support with independence post-stroke patients in performing the activity of daily living and the P value (&lt; 0.05) means that there is a relation of attitude with independence post-stroke patients in performing the activity of daily living in nerve polyclinic at RSUP Dr. M. Djamil Padang It can be concluded that patients in post-stroke that have good family support and negative attitude at minimum need some help in performing ADL. It is therefore expected to nurse or a health team to provide encouragement and explanation of the importance of doing an exercise routine to achieve independence of the ADL.

The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls.

Autonomic disturbances are a common phenomenon in patients' post-stroke, characterized by hypo function of the para-sympathetic and/or overactive sympathetic system. The impact of autonomic disturbances on physical therapy tasks during the rehabilitation period has not yet been assessed. To describe the response of the cardiac autonomic nervous system during different tasks, among patients and age-matched healthy controls. Nineteen patients in the subacute phase post first-ever ischemic stroke, and 16 controls. The Polar advanced heart rate monitor (RS800CX) was used to record RR intervals at rest, during paced breathing exercise, while performing different types of muscle contractions, and during single and dual task conditions. RR intervals and heart-rate variability (HRV) parameters were significantly lower among patients post stroke, both at rest and during most of the activities tested. Among the control group a significant autonomic adaptation was seen in the form of reduced RR intervals and HRV during muscle contraction and a significant increase in these parameters during slow breathing, no significant changes were observed among patients post stroke. Patients post-stroke experience hyper sympathetic function at rest and less adaptive cardiac autonomic control during different activities, which all may have an impact on rehabilitation outcomes.

Plugging the patient evidence gap: what patients with swallowing disorders post-stroke say about thickened liquids.

Oropharyngeal dysphagia post-stroke is well known, with its presence increasing the risk of poor outcomes in particular aspiration and aspiration pneumonia. Management to minimize the risk of aspiration and improve swallow safety post-stroke includes the treatment of thickened liquids (TL), an established bolus modification intervention. Despite widespread use, there is a lack of robust empirical evidence and minimal patient evidence as to the experience and acceptability of using thickeners by people who experience dysphagia after a stroke. To explore people with swallowing disorders post-stroke experiences of and acceptability regarding the bolus modification treatment of thickened liquids. A qualitative, descriptive study exploring the experiences of individuals given TL after their stroke. A purposive sample of 14 adults was obtained with data collection and generation through the medium of individual semi-structured interviews. Inductive thematic analysis was used to analyse the data. Three overarching themes of 'uncertainty', 'an unpleasant experience' and 'a trade-off' were identified. These themes highlight that participants disliked TL and this dislike may have impacted clinically in terms of adherence, hydration and quality of life. Lack of sensory appeal was important in framing patient dislike. Participants' involvement in and understanding of reasons for prescription of TL was poor leading to uncertainty regarding the treatment. Notwithstanding, some participants felt it was necessary for their stroke recovery. TL can be considered a burdensome treatment from multiple perspectives including product palatability, treatment uncertainty and treatment adherence issues. Despite intensely disliking this treatment, some patients ultimately understand why the treatment is prescribed. Improvements in product palatability are required in order to improve adherence and patient quality of life. Consideration of other treatment options and newer products to manage aspiration post-stroke is also warranted.