Hands-on Training for Caregivers of Post-Stroke Inpatients

OBJECTIVE: To assess the impact of active training ("hands-on training") caregivers on their attitudes for handling the patients and to examine the effectiveness of hands-on training in improving psychosocial outcomes for stroke patients and their caregivers. METHOD: The subjects were 59 stroke patients and their family caregivers. They were randomly divided into two groups: a control group and a training group. The training group received active hands-on training about personal care with handling techniques. We collected the data through interviewing the patients and their caregivers on admission and at discharge. The stroke patients and caregivers were evaluated with the functional status, caregiver appraisal scale, psychological state, quality of life. RESULTS: Caregivers in the training group experienced a significant reduction in caregiving burden and anxiety (p<0.05). There were no differences in depression or physical health between the two groups, although caregivers in the intervention group were found to have significantly better mental health. Patients in the caregiver training group also experienced less anxiety and better mental health (p<0.05), and had a modest benefit in functional status (independence in activities of daily living) (p<0.05). CONCLUSION: A hands-on training for caregivers of post-stroke inpatients resulted in reducing burden of care and anxiety while improving psychosocial outcomes for caregivers, proving that the hands-on training might be helpful in caregivers of stroke inpatients.

Selection of Aerobic Exercise Intensity Using Heart Rate Reserve in Stroke Patients

OBJECTIVE: To determine the intensity of aerobic exercise in stroke patients using heart rate reserve (HRR) by comparing maximal oxygen consumption (VO2max) and VO2 at % HRR in maximal exercise test of treadmill, arm ergometer and bicycle ergometer. METHOD: Twenty nine stroke patients who could walk independently were included. Maximal exercise test using treadmill, arm ergometer and bicycle ergometer was performed. Heart rate, rating of perceived exertion, minute ventilation, oxygen consumption and respiratory exchange ratio were measured through respiratory gas analysis. When the standard criteria for maximal oxygen consumption (VO2max) was achieved, each test was terminated. We compared the measured VO2max with the VO2 at % heart rate reserve (HRR) and figured out the statistically significant % HRR point. RESULTS: Twenty-four (82.7%), twenty-four (82.7%) and twenty-five (86.2%) patients completed maximal exercise test using treadmill, arm ergometer and bicycle ergometer. Most patients who completed maximal exercise test satisfied the VO2max criteria with VO2 plateau at the end of the exercise test (41.3~48.2%) or RER > 1.0 (79.3~82.7%) or peak HR >age-predicted maximal heart rate (APMHR)-10 or peak HR > 70% {208-(0.7 x age)} when they took beta- blockers (6.8~13.7%). The differences between measured VO2max and VO2 above 60% HRR at treadmill test, 65% HRR at arm ergometer test, 65% HRR at bicycle ergometer test were not statistically significant (>0.05). CONCLUSION: Exercise above 60% HRR at treadmill test, 65% HRR at arm and bicycle ergometer test can be useful as aerobic exercise intensity in stroke patients.

Validation of Gugging Swallowing Screen for Patients with Stroke Based on Videofluoroscopic Swallowing Study

OBJECTIVE: To evaluate the clinical validity of gugging swallowing screen (GUSS) scale in comparison with the findings of videofluoroscopic swallowing study (VFSS) for subacute and chronic stroke patients, though GUSS was developed in order to screen dysphagia in acute stroke patients. METHOD: The subjects of this study were thirty-five patients who had stroke for more than 3 months and were showing the symptom of dysphagia. GUSS, VFSS and clinical examination were performed respectively by three different physiatrists. These tests were performed at intervals of 24 hours or less. The result of GUSS was compared with videofluoroscopic dysphagia scale (VDS) based on VFSS, Clinical dysphagia scale (CDS), and ASHA scale based on clinical patterns. RESULTS: The result of GUSS was in a significant correlation with VDS, CDS, and ASHA scale (p<0.01). GUSS predicted aspiration very efficiently (area under the curve=0.928; 95% CI, 0.833 to 1.022). The cutoff value of 12 point showed sensitivity of 89.5%, specificity of 87.5%, and negative predictability of 87.5%. CONCLUSION: The GUSS is considered as an effective and convenient screening tool to evaluate stroke patients with dysphagia irrespective of stroke stages.