Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

 With nothing here on how to improve cognitive impairment; useless!

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

Alexandra Björck^1*Marie Matérne^2,3Mialinn Arvidsson Lindvall^2,4Gustav Jarl^2,5

• ¹School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ²University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ³School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
• ⁴School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
• ⁵Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Purpose: The aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life.

Materials and methods: This cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65–91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman’s correlation coefficient and multiple logistic regression in the analyses.

Results: The average MoCA score was 21.7 points (range: 4–30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20–0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2–6.8).

Conclusion: The study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life. Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke.

Introduction

Stroke is a leading cause of long-term disability worldwide, impacting the lives of more than 100 million individuals (1, 2). Stroke disrupts cerebral blood flow, causing tissue damage and neurological deficits. The neuroplasticity enables the brain to adapt and reorganize post-stroke, aiding recovery (3) but a common consequence of stroke is poststroke cognitive impairment (PSCI). PSCI is a broad term that includes conditions ranging from mild cognitive impairment to dementia. Common disorders are problems with memory, attention, executive abilities, language, visual processing, and information management (4, 5). Usually, PSCI occurs within 3 months post-stroke, but can also develop over time (3). One year after stroke onset, one in four stroke survivors has PSCI (6, 7), and approximately seven of 10 stroke survivors will develop PSCI over time (8). PSCI often gives negative consequences on problem solving, organized planning and social interaction (9, 10), which has a negative effect on individuals’ overall health and well-being. There is a prioritized and ongoing global effort to understand the complexity of PSCI and develop interventions to prevent cognitive decline (11). PSCI predominantly affects the older population, which is growing globally (11, 12), making it a priority in stroke research (11). An emerging issue in stroke research is investigating how cognitive function is connected to other biopsychosocial factors to develop personalized interventions (4).

Previous research has indicated that PSCI affects several biopsychosocial aspects. It affects the overall recovery process poststroke due to the negative impact on the body’s motor function recovery (13). PSCI makes it more challenging to participate in physical rehabilitation; therefore, persons with PSCI are less physically active (14). Individuals with PSCI are also more prone to psychological deficits such as depression and fatigue (15, 16), which further affects their ability to engage in various leisure and social activities (17). PSCI affects both basic and instrumental activities of daily living, such as dressing, performing personal hygiene and household chores, and cooking (18). It also impairs communication (19), participation in social activities and interactions with others (18, 20). Despite extensive PSCI research, the understanding of how different levels of PSCI affect biopsychosocial factors in older stroke survivors is incomplete. There is also limited research exploring which factors are associated with a successful return to daily life for older persons with PSCI. Previous studies investigating factors associated with return to daily life and leisure activities after stroke have shown that cognitive ability, age, and mobility are important factors (21, 22). However, most related studies have focused on younger stroke survivors (23, 24).

This study adopted a biopsychosocial perspective and used the International Classification of Functioning, Disability and Health (ICF) model (25) as a framework. This approach was chosen to capture the complexity of the interaction between PSCI and daily life. The study aimed to investigate (1) the associations between levels of cognitive impairment and biopsychosocial factors and (2) how these factors are associated with return to daily life. Through comprehensive insights into these biopsychosocial factors, poststroke well-being and recovery can be enhanced, allowing for tailored interventions for affected individuals.

More at link.

Goal Setting with ICF (International Classification of Functioning, Disability and Health) and Multidisciplinary Team Approach in Stroke Rehabilitation

What the hell is this shit? You don't need to know anything other than survivors want 100% recovery.

Goal Setting with ICF (International Classification of Functioning, Disability and Health) and Multidisciplinary Team Approach in Stroke Rehabilitation

    Matilde Leonardi Email author
    Klemens Fheodoroff

    Matilde Leonardi
        1
    Email author
    Klemens Fheodoroff
        2

    1.Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
    2.Gailtal-KlinikHermagorAustria

Abstract

Stroke-associated impairments display a wide variety of clinical signs and symptoms. Therefore, a multidisciplinary team with different experts working closely together is necessary for effective stroke rehabilitation.(Why? What the fuck is your definition of effective? 10% full recovery? If so you need to be fired.)

In rehabilitation of stroke patients, a holistic view on functioning and disability is necessary to establish an individualized and comprehensive treatment program. The WHO International Classification of Functioning, Disability and Health (ICF) provides a common language to describe individual functioning in a given context suitable for a shared documentation system.

Goal setting has become a central component of effective communication and decision-making in rehabilitation practice, both as part of the process and as a person-centred outcome measure for stroke rehabilitation. Nevertheless, agreed standards on goal setting and evaluation still need to be defined.(The only goal in stroke is 100% recovery. If that is not your goal, GET THE HELL OUT OF STROKE.)

Here, we highlight some aspects with relevance for multidisciplinary team building and coordination and for using the ICF in the context of stroke rehabilitation; how to describe individual levels of functioning and disability and to set treatment goals as well as to identify barriers and facilitators to individual functioning and health.

Social Participation as a goal of the post-stroke rehabilitation program: a literature review

What a fucking waste. A literature review that should already be in that complete database of stroke protocols and research. 

Social Participation as a goal of the post-stroke rehabilitation  program: a literature review

REVIEW Manual Therapy, Posturology & Rehabilitation Journal. ISSN 2236-5435. Copyright © 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non- commercial use, distribution, and reproduction in any medium provided article is properly cited. Social Participation as a goal of the post-stroke rehabilitation program: a literature review Felipe Heylan Nogueira de Souza 1 , Edson Meneses da Silva Filho 1 , Leandro Gonçalves Cezarino 1 , Egmar Longo Araújo de Melo1 , Ênio Walker Azevedo Cacho 1
ABSTRACT
Introduction: Stroke is considered one of the leading causes of long-term disability worldwide. Physical, cognitive and psychological disabilities resulting from stroke can lead to a wide variety of activity limitations and participations restrictions.
Objective: To verify the incidence of articles in the literature that used physiotherapy programs aimed at social participation and to analyze if these programs are based on domains of the International Classification of Functioning Disability and Health (ICF) in post-stroke people. Method: It was selected any type of study that presented post-stroke human sample over 18 years of age with no gender restriction, to be written in any language and year of publication, to have used physical rehabilitation as a form of treatment and social participation assessed by ICF as outcome. The descriptors and Boolean operators: stroke, rehabilitation, International Classification of Functioning Disability and Health, social participation, were used in the sample search strategy in database PEDro, PubMed, Web of Science and Scielo.
Results: After applying the inclusion/exclusion criteria, five articles remaining. Assessment tools for participation in daily and social activities were not consensual in the range of areas that needed to be addressed in stroke rehabilitation. A single study used the ICF-based design model in its program. Conclusion: There are few studies that have measured the various characteristics of social participation using the ICF as a tool. More studies are needed to create an ideal standardization and strategy that direct interventions to improve specific aspects of social participation, including the involvement in activities that provide post-stroke individuals interaction with society. Keywords: Stroke; International Classification of Functioning, Disability and Health; Social Participation. Corresponding author: Edson Meneses da Silva Filho Rua Vila Trairi, S/N; Centro; Santa Cruz (RN), Brazil. CEP: 59200-000. Phone:+55 (81) 9 9470 6661; +55 (81) 3631 1304 Email: meneses.edson@yahoo.com.br 1

Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz (RN), Brazil. Financial support: None. Submission date 24 July 2017; Acceptance date 15 September 2017; Publication date 11 October 2017 http://dx.doi.org/10.17784/mtprehabjournal.2017.15.503 INTRODUCTION Described as a multidimensional concept, the social participation is defined by the International Classification of Functioning, Disability and Health (ICF) as involvement of a person in a real-life situation, representing a social perspective of functionality(1, 2) . Social participation is considered as one of the most relevant fundamental results to a successful recovery, however, individuals after cerebrovascular accident (CVA) have shown dissatisfaction with their own ability to develop some of its aspects such as socializing, tours and travelling (3) , so the ICF considers that the functionality is the result of complex interactions, among the health and environmental measures as well as personal factors conditions (1) . Corroborating the ICF, some authors state that several factors may affect the social participation, such as, the restrictions due to changes in functionality, limitations in activities and the interference of environmental and personal factors (2, 4) . Among the physical and social consequences, those which are generated by the stroke are one of the important health problems in industrialized countries (5) . Those impacts on functionality may result in neurological and functional changes, in which generate limitations in daily live activities of these subjects (4, 6) . The consequences of stroke and the complex recovery process often require the necessity for various therapeutic interventions (7, 8) . The knowledge regarding the treatments which promote the best results may help optimize its effects and provide a better functionality for these patients (2) . The successful recovery of a stroke should result in a quality of life and degree of participation in the community similar to the previous injury, however, not all patients have access to care and rehabilitation that they need (9, 10) . The provision of rehabilitation services after discharge is essential to promote independence and reintegration of patients in the community (10) . Although many interventions and measurements are not aimed at social participation, even though it is considered one of the most important and fundamental factors for a successful recovery, there is the necessity to measure what the studies have been using to 2 Social Participation as a goal of the post-stroke rehabilitation MTP&RehabJournal 2017, 15: 503 assess the social participation of people who had stroke, in order to suggest a standardization of the use of more sensitive tools to classify the social participation in this population. Therefore, and present study aimed to determine the incidence of articles which used physical therapy programs for the social participation and analyze if these programs are based on the ICF domains in people who had stroke.