Stroke Rehabilitation Facilities Research Articles

Nature-Based Design in Stroke Rehabilitation Environments: A Scoping Review.

To identify, examine, and map the characteristics of knowledge of nature-based design in stroke rehabilitation facilities, examine how research in this field has been conducted and identify gaps in knowledge. Many stroke survivors have wide ranging impacts, resulting in long hospital stays to undertake rehabilitation. The physical environment can influence brain recovery; however, there is limited evidence to support the design of effective rehabilitation environments. Conversely, the health benefits available from connection with nature are well established. A nature-based design approach may have benefits and implications for the physical environment of inpatient stroke rehabilitation facilities; however, it is unclear what evidence exists in this field. This scoping review followed the JBI methodological guidance for the conduct of scoping reviews, with systematic searches of six databases. Twenty-eight studies were included in the review. Aims and research methods varied widely. Investigations in 19 studies related to gardens and other designed outdoor nature-based environments. Other studies explored natural analogues, nature inside, inside/outside connections, and the natural environment. Findings from the studies were spread across the fields of design, use, exposure to, and engagement in nature-based environments. The characteristics of knowledge underpinning nature-based design in stroke rehabilitation environments are highly diverse, and significant gaps exist in the evidence base. A framework developed during this review for mapping knowledge on the intentions and impacts for spaces and services in this field assisted to identify these gaps and may be applied to other areas of healthcare design research.

The role of the physical environment in stroke recovery: Evidence-based design principles from a mixed-methods multiple case study.

Hospital design can impact patient outcomes, but there is very little healthcare design evidence specific to stroke rehabilitation facilities. Our aim was to explore, from the patient perspective, the role of the physical environment in factors crucial to stroke recovery, namely, stroke survivor activity (physical, cognitive, social), sleep, emotional well-being, and safety. We conducted a mixed-methods multiple-case study at two inpatient rehabilitation facilities in Victoria, Australia, (n = 20 at Case 1, n = 16 at Case 2) using "walk-through" semi-structured interviews, behavioural mapping, questionnaires, and retrospective audit. Four interrelated themes emerged: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed patterns in patient activity; stroke survivors spent over 75% of their time in bedrooms and were often inactive. Convergent mixed methods analysis was used to generate a new conceptual model of the role of the physical environment in stroke survivors' behaviour and well-being, highlighting the importance of variety and interest, privacy without isolation, and patient-centred design. This model can be used by designers, healthcare providers, and policy makers to inform the design of rehabilitation environments.

Non-Modifiable Factors Associated with Medication-Adherence among Stroke Survivors in Lagos State, Nigeria

Stroke is the world's second most common cause of mortality and the third most common cause of morbidity and disability. Recurrent strokes make up a significant number of stroke admissions to the emergency room. This condition is largely preventable by identifying and addressing the risk factors involved. Hence, this study examined the non-modifiable risk factors associated with medication adherence among stroke survivors in Lagos state, Nigeria. A descriptive cross-sectional survey was conducted using a multistage sampling technique, including 386 stroke survivors from 10 stroke rehabilitation facilities in Lagos state. A validated structured interviewer-administered questionnaire was used for data collection. Data were analyzed using descriptive statistics, Chi-square and Binary logistic regression at a significance level of 5%. The participants' mean age was 52.42 ± 12.143. Results showed that participants aged 51-60years were more likely to adhere to their medication than other age groups. The result also showed no association existed between the age of stroke survivors and medication adherence (OR = 1.119, CI = 0.941-1.332, p = 0.549), ethnicity and medication adherence (OR = 1.176, CI 0.89-1.55, p = 0.211), and the gender (OR = 1.147, CI = 0.748-1.761, p = 0.665). However, there is a significant association between number of stroke and medication adherence (OR = 0.699, CI = 0.499-0.980, p = 0.038). This study's findings highlight important gaps in the factors that influence and are associated with medication adherence. Therefore, other non-modifiable factors asides from the ones assessed in this study should be researched.

Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Cleveland clinic Abu Dhabi: Stroke patients journey from referring hospital to discharge, methodology

Healthcare organizations in the United Arab Emirates (UAE), are looking for ways to improve the quality of services and to increase productivity. In the UAE stroke patients receive healthcare services from acute hospitals, dedicated stroke centers, rehabilitation and home care facilities. Cleveland Clinic Abu Dhabi (CCAD) is a stroke referral center that operates as a 24/7 comprehensive neurovascular service providing thrombolysis and thrombectomy. Objectives: We aimed to map the journey of the stroke patients admitted to CCAD from the referring provider to post-acute care.

Built environments for inpatient stroke rehabilitation services and care: a systematic literature review

ObjectivesTo identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke,...

EFFECTIVITY OF NINTENDO WII AS REHABILITATION THERAPY IN POST STROKE PATIENTS: A SYSTEMATIC REVIEW

Post stroke patients need medical rehabilitation to live an independent life. Nintendo Wii technology presents an alternative choice that is quite safe, feasible, and has a high potential in rehabilitating &amp; restoring motor function in post stroke patients. Although it has been widely used as adjunct therapy in stroke rehabilitation facilities throughout the world, only a few acknowledge its effectivity in post-stroke patients. This study aims to conduct a systematic review in order to identify and assess the results used in evaluating Nintendo Wii technology as rehabilitation therapy for stroke patients. Thus, the study used for this research is systematic review. Materials included in this study are research/studies found in NCBI, PubMed, Cochrane and other relevant online databases. From this research, it is found that Virtual Reality (VR) such as Nintendo Wii considered as an additional rehabilitation therapy that provides a significant improvement in various aspects of exercise therapy, such as; balance; walking ability; statistical and dynamic strengths; motivation as well as socialization; and recovery of physical function in stroke patients. Nintendo Wii can also be used safely in stroke patients and there have been no reports of side effects from this therapy.

Evaluation of an OSA risk stratifying and treatment protocol during inpatient rehabilitation of post-stroke patients

To evaluate outcomes, outside of a clinical trial setting, of a protocol utilizing overnight oximetry (NOx) to risk stratify post-stroke patients for obstructive sleep apnea (OSA) followed by autoadjusting continuous positive airway pressure (APAP) treatment in patients considered high risk for OSA. Retrospective observational study of post-stroke patients at an academic inpatient stroke rehabilitation facility. Patients underwent NOx, and those at high risk for OSA (oxygen desaturation index 3%>10 per hour) were attempted on a trial of APAP, and further stratified into high risk adherent with treatment (HRAT) or high-risk failed treatment (HRFT). Change in functional independence measure (FIM) was used to assess recovery. Two hundred twenty-four post-stroke patients underwent NOx, with 120 (53%) considered high risk for OSA. Twelve (10%) were compliant with APAP treatment (>4h/night on > 70% of nights). No difference in change in FIM scores was observed for HRAT versus HRFT [total FIM change - 5.8, 95% CI (- 13.9, 2.2); motor FIM change - 4.5, 95% CI (- 11.5, 2.4); cognitive FIM change - 1.3, 95% CI (-3.8, 1.2)]. A subgroup analysis matched 14 HRAT patients (using adherence criterion of APAP usage > 50% of nights) to 35 HRFT patients. A statistically significant, but clinically irrelevant, difference in total FIM change was observed (HRAT vs HRFT, difference between means - 5.2, p = 0.03). The use of APAP in high-risk patients was poorly tolerated and did not improve post-stroke recovery. Further studies with larger sample sizes are needed to determine the effect of APAP treatment on short-term recovery.

A Framework for Designing Inpatient Stroke Rehabilitation Facilities: A New Approach Using Interdisciplinary Value-Focused Thinking.

Aim:To use Value-Focused Thinking to investigate what is important in the design of inpatient stroke rehabilitation facility buildings.Background:Many stroke patients require inpatient rehabilitation in a dedicated facility. Rehabilitation facilities are healthcare spaces, but they are also learning spaces where patients practice targeted tasks to acquire new skills and to reacquire skills and abilities that were compromised as a result of their stroke. There is currently no consensus regarding how the design of inpatient rehabilitation facilities could be optimized for patients’ learning.Method:We used Value-Focused Thinking to develop a framework of what interdisciplinary experts consider important for inpatient stroke rehabilitation facility design. Two workshops were conducted. The following experts were invited to participate: past patients with experience of stroke rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation academics; healthcare environments academics; learning environments academics; architects, designers, and wayfinders with experience designing healthcare or learning environments; and healthcare design policy makers.Results:Thirty experts participated. The experts’ final framework included 16 criteria that were considered fundamentally important for inpatient stroke rehabilitation facility design, and 14 criteria that were considered instrumentally important. Inpatient stroke rehabilitation facility design should maximize efficiency, maximize effectiveness (i.e., patients’ clinical and functional outcomes), foster emotional well-being, and maximize safety. Opportunities to practice physical, cognitive, and social activity were considered important for patients’ outcomes.Conclusions:Value-Focused Thinking was an effective and equitable means of engaging experts from multiple disciplines. Designers, planners, and developers of inpatient stroke rehabilitation facilities should consider the rehabilitation-specific framework developed in this study alongside evidence from other healthcare settings.

Post‐stroke seizure—Do the locations, types and managements of stroke matter?

SummaryObjectiveTo determine the incidence of post‐stroke seizures and the associated risk factors in a government‐restructured hospital in Singapore.MethodsThis retrospective study included consecutive patients (age ≥21 years) admitted to the stroke rehabilitation facility at Changi General Hospital, Singapore, between June 2008 and May 2017, with a minimum post‐discharge follow‐up of 6 months. Patients with known epilepsy central nervous system infection or tumor, a history of neurosurgery and or missing data were excluded from study. To determine the incidence of seizures, the patients’ hospital records, including those for all initial and subsequent admissions and outpatient follow‐ups, were reviewed. All prescribed medications were checked and documented. Seizures were diagnosed on the basis of clinical examination with or without electroencephalography.ResultsIn total, 722 patients (women, 38%) with a mean age of 64 years were included. Of these, 48 (6.64%) experienced post‐stroke seizures during a follow‐up period of 6–108 months. The incidence of seizures was significantly higher in patients with hemorrhagic stroke (42%, p = 0.010), those with ischemic partial anterior circulation stroke (PACS) (27%, p = 0.025), those who underwent a neurosurgical procedure after stroke (p < 0.001), those with a low activated partial thromboplastin time (APTT) at admission (mean, 25.6; p = 0.015), and those using levodopa (21%, p < 0.001). Neurosurgical intervention after stroke (odds ratio [OR] 6.2, 95% confidence interval [CI] 2.9–13.1; p < 0.001), APTT (per‐unit increase; OR 0.86, 95% CI 0.76–0.98; p = 0.028), and underlying ischemic heart disease (IHD; OR 2.2, 95% CI 1.08–4.60; p = 0.029) were found to be independent predictors of seizure occurrence after stroke.SignificancePost‐stroke seizure incidence from our study is 6.64%, with a median follow‐up of 49 months. Among patients with stroke, those with underlying IHD, those who undergo a neurosurgical procedure, and those with a low APTT at admission need careful monitoring. Levodopa should be used with caution and withdrawn as soon as possible.

An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation.

To determine whether a simple oral hygiene protocol improves the oral health of inpatients in stroke rehabilitation. Poor oral health can lead to serious complications, such as pneumonia. The comorbidities associated with stroke, such as dysphagia, hemiparesis and cognitive impairment, can further impede independent oral care. International stroke guidelines recommend routine oral care but stop short of detailing specific regimes. The oral health assessment tool (OHAT) was conducted by speech-language pathologists with 100 patients with and without dysphagia in three metropolitan inpatient stroke rehabilitation facilities. A simple nurse-led oral hygiene regime was then implemented with all participants, which included twice daily tooth brushing and mouth rinsing after lunch, and oral health was measured again one week later. Initially, dysphagia was negatively associated with OHAT scores, and independence for oral hygiene was positively associated with oral health. After one week of a simple oral hygiene regime, the OHAT scores available for 89 participants indicated an improvement on average for all participants. In particular, 59% of participants with dysphagia had an improvement of 1 or more points. None of the participants developed pneumonia. A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect.

Using a complex adaptive system lens to understand family caregiving experiences navigating the stroke rehabilitation system.

BackgroundFamily caregivers provide the stroke survivor with social support and continuity during the transition home from a rehabilitation facility. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity of care and complex adaptive systems were integrated to examine the transition from a stroke rehabilitation facility to the patient’s home. This study provides an understanding of the interacting complexities at the macro and micro levels.MethodsA convenient sample of family caregivers (n = 14) who provide care for a stroke survivor were recruited 4–12 weeks following the patient’s discharge from a stroke rehabilitation facility in Ontario, Canada. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed and inductive content analysis and the theory of Complex Adaptive Systems were used to interpret the perceptions of family caregivers.ResultsHealth system policies and procedures at the macro-level determined the types and timing of information being provided to caregivers, and impacted continuity of care and access to supports and services at the micro-level. Supports and services in the community, such as outpatient physiotherapy services, were limited or did not meet the specific needs of the stroke survivors or family caregivers.ConclusionRelationships with health providers, informational support, and continuity in case management all influence the family caregiving experience and ultimately the quality of care for the stroke survivor, during the transition home from a rehabilitation facility.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1795-6) contains supplementary material, which is available to authorized users.

Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial

Objective: To determine the effect of a workplace intervention programme on the rate of return to work of previously employed stroke survivors in the Gauteng province of South Africa. Design: A randomised controlled trial. Setting: Participants’ workplaces and three hospitals with stroke rehabilitation facilities. Subjects: Eighty stroke survivors between the ages of 18 and 60 years who were employed at the time of stroke onset. Intervention: The workplace intervention programme was tailored according to functional ability and workplace challenges of each stroke survivor. The control group received usual stroke care which took into consideration job requirements but without workplace intervention. Main outcomes: The primary outcome was return to work rate. Secondary outcomes included activities of daily living (ADLs), mobility, basic cognitive function and perceived quality of life. Results: At six months follow-up 60% (n = 24) of stroke survivors in the intervention group returned to work compared to 20% (n = 8) in the control group (P <0.001). The odds ratio for return to work for stroke survivors in the intervention group was 5.2. For every unit increase in the ADLs and cognitive assessment score, the odds of return to work increased by 1.7 and 1.3 respectively; those who returned to work had better quality of life than those who did not return to work (P = 0.05). Conclusion: A workplace intervention consisting of workability assessments and workplace visits was effective in facilitating return to work for stroke survivors in the Gauteng province of South Africa.

'Not another UTI ... '

Malaria includes a global disease burden with approximately 300-500 million cases worldwide annually. Varied symptomatology creates a diagnostic challenge. This is a case report of a stroke rehabilitation facility resident who developed Plasmodium ovale infection, several months post-exposure. Physicians should maintain a broad list of differential diagnoses, thinking beyond the range of common diagnoses.

Return to work services rendered for patients at stroke rehabilitation facilities in Gauteng Province, South Africa

Background: Stroke survivors have lower quality of life than their apparently healthy counterparts and returning to work may contribute to their life satisfaction. The potential for people to return to work following stroke may be enhanced by targeted programmes or directed input, however little is known about the availability of such programmes in South Africa. The aim of this study was to establish current practice in return to work (RTW) intervention programmes for patients with stroke. Method: A cross sectional survey was performed using a self administered questionnaire which was posted with an information document to 53 stroke rehabilitation facilities within the Gauteng province in South Africa and 36 facilities responded. Results: Seventeen of the 36 clinical settings referred patients to facilities offering RTW services; 12 facilities did not refer patients for RTW and did not offer RTW services and seven facilities offered RTW services. Of the seven facilities that rendered post stroke RTW services five communicated with the employer to discuss reasonable accommodation and four did assessments for potential to return to work. The most common reason given by the 29 facilities for not offering RTW services was that they referred patients to other therapists who offered these services. The second most common reason was the unemployment status of the patient at the time of having stroke. Conclusion: A small number of clinical facilities in the Gauteng province of South Africa assess their patients in order to establish potential for return to work after stroke and a small number of clinical facilities render RTW intervention for patients with stroke.

Adherence to Canadian Best Practice Recommendations for Stroke Care: Vascular Cognitive Impairment Screening and Assessment Practices in an Ontario Inpatient Stroke Rehabilitation Facility

Background: The Canadian Best Practice Recommendations for Stroke Care suggest that (1) all patients with stroke should be screened for cognitive impairment and (2) persons who are detected as having cognitive impairment on a screening test should receive additional cognitive assessment. The purpose of this study is to determine whether care in an Ontario inpatient stroke rehabilitation facility is consistent with these recommendations. Methods: Stroke patients discharged from an inpatient stroke rehabilitation program located in Southwestern Ontario, Canada, from May to October 2009 were included in this study. Charts were reviewed to identify current screening and assessment practices. The percentages of patients formally screened and/or assessed as well as differences between those who were and were not screened are reported. Results: The study included 123 patients (62 male; mean age = 67.3, SD 15.1). During inpatient rehabilitation, 82.9% of patients were screened using a formal cognitive screening instrument. Patients with cognitive and/or communication deficits were significantly less likely to be screened than those with intact cognitive and communicative abilities. Although 77.5% of those screened scored below the threshold for cognitive impairment, evidence of referral for a comprehensive cognitive assessment was found for only 3 patients. Conclusions: Although the majority of patients were screened for cognitive impairment while in inpatient rehabilitation, few patients were referred for a comprehensive diagnostic examination. On the basis of these results from a single inpatient stroke rehabilitation unit, it appears that specific cognitive deficits are likely underidentified in stroke rehabilitation patients in Ontario.

Early Sleep Apnea Detection and Treatment in Stroke Rehabilitation

Background: To assess whether the presence of obstructive sleep apnea is associated with changes in the motor, cognitive and functional outcomes in stroke patients. To investigate whether early intervention of obstructive sleep apnea impact the outcomes. Method s: We performed overnight polysomnography in 25 patients admitted to the stroke rehabilitation unit. Those with an apnea/hypopnea index (AHI) > 10 per hour were randomized to standardized 30 day rehabilitation program with or without the addition of Bi level positive air pressure treatment at night. Cognitive, motor and functional status were assessed at baseline and at 30 days. Results: The early Bi Level Possitive Air Pressure treatment in the obstructive sleep apnea group (n = 13) produced improvements of the motor scores compared to patients who did not receive it (n = 12). The group with BiPAP treatment showed significant improvements in the The Fugl-Meyer Upper Extremity Motor Assessment score (p = 0.05) and the The Fugl-Meyer Lower Extremity Motor Assessment score (p = 0.019) compared with the group without BiPAP treatment. Conclusions: Early obstructive sleep apnea detection and treatment suggest that BiPAP treatment plays a role in motor recovery of stroke patients. The observations suggest that polysomnography evaluation looking for obstructive sleep apnea should be part of the standardized evaluation of stroke patients at admission to stroke rehabilitation facilities. doi:10.4021/jnr55w

Early Sleep Apnea Detection and Treatment in Stroke Rehabilitation

Background: To assess whether the presence of obstructive sleep apnea is associated with changes in the motor, cognitive and functional outcomes in stroke patients. To investigate whether early intervention of obstructive sleep apnea impact the outcomes. Method s: We performed overnight polysomnography in 25 patients admitted to the stroke rehabilitation unit. Those with an apnea/hypopnea index (AHI) &gt; 10 per hour were randomized to standardized 30 day rehabilitation program with or without the addition of Bi level positive air pressure treatment at night. Cognitive, motor and functional status were assessed at baseline and at 30 days. Results: The early Bi Level Possitive Air Pressure treatment in the obstructive sleep apnea group (n = 13) produced improvements of the motor scores compared to patients who did not receive it (n = 12). The group with BiPAP treatment showed significant improvements in the The Fugl-Meyer Upper Extremity Motor Assessment score (p = 0.05) and the The Fugl-Meyer Lower Extremity Motor Assessment score (p = 0.019) compared with the group without BiPAP treatment. Conclusions: Early obstructive sleep apnea detection and treatment suggest that BiPAP treatment plays a role in motor recovery of stroke patients. The observations suggest that polysomnography evaluation looking for obstructive sleep apnea should be part of the standardized evaluation of stroke patients at admission to stroke rehabilitation facilities. J Neurol Res. 2011;1(4):145-152 doi: https://doi.org/10.4021/jnr55w

Post-stroke Infections - Diagnosis, Prediction, Prevention and Treatment to Improve Patient Outcomes

Despite modern stroke treatment in dedicated stroke units and rehabilitation facilities, infection remains the most important medical complication after ischaemic stroke. Pneumonia and urinary tract infections are the most frequent post-stroke infections. Post-stroke infections not only prolong hospitalisation but also constitute a leading cause of early and long-term mortality and morbidity. They are commonly attributed to neurological sequelae such as immobilisation due to motor paralysis or dysphagia as a risk of aspiration. Recently, stroke-induced impairment of immunological competence has been described. This immunodepression syndrome promotes the development of post-stroke infection. Knowledge about risk factors for post-stroke infections, early and proper diagnosis and a deliberate decision for anti-infective treatment are of evident importance, but all of these are considered major challenges for stroke neurologists. In this article we will discuss new insights into diagnostic approaches and risk factors for post-stroke infections. Furthermore, we will focus on preventative approaches and the current treatment options.