Improving knowledge and skills for use of medication by patients after stroke: evaluation of a nursing intervention.

OBJECTIVE: The objective of this study was to determine if a tailored nursing intervention, as opposed to usual rehabilitation care, can improve knowledge and behavioral skills for correct use of medication use in aged stroke patients. DESIGN: Stratified random sampling created two homogenous groups: 73 intervention patients, who were provided with the nursing intervention program along with usual rehabilitation care, and 82 controls, who underwent usual rehabilitation care alone. Participants were assessed within the first week of admission to the rehabilitation ward, 3 mos after stroke (at the end of the intervention), and 6 mos after stroke. An assessment instrument measuring correct knowledge and skills concerning medications was used. RESULTS: After 3 and 6 mos, intervention subjects were significantly better than controls in knowledge of shape and dosage of their medications, in knowledge of side effects and correct response to side effects, and in adherence to their dietary regimen. However, for knowledge of color and daily schedule of medications, there were differences at 3 mos, but differences were diminished after 6 mos. CONCLUSIONS: This nursing intervention, tailored to the specific needs of the aged stroke patient, increased the patients' knowledge and skills concerning medication therapy, but to a limited extent and for a limited time.

The Jerusalem TeleRehabilitation System, a new low-cost, haptic rehabilitation approach.

Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises. The Jerusalem TeleRehabilitation System (JTRS) consists of patient and therapist systems plus a central server and database connected via the internet. The system can work in two modes: (1) a cooperative mode in which the therapist and patient are online at the same time, and (2) a stand-alone mode in which the patient uses the system on his own. In both cases, the system will monitor the status and progress of the patient and various parameters of his movement abilities, and prepare reports for the patient and for the therapist. From the clinic, the therapist will be able to change the screen seen by the patient and change the level and types of tasks, as needed. Compared to existing systems, our system will have the following advantages: (1) inexpensive and easy to use; (2) remote monitoring and control of the patient's computer by the therapist in the clinic; (3) more detailed analysis of patient status and progress; (4) a "smart" system which self-adapts to the patient's capabilities in real time, increasing or decreasing the difficulty of the exercise as needed; and (5) a central, international database which, by gathering data on many patients over time, will provide the basis for "smart" therapy and will also facilitate coordinated multicenter research studies.

An improved device for posterior rhinomanometry to measure nasal resistance.

Rhinomanometry is a method for measuring nasal resistance for the purpose of providing an objective evaluation of nasal patency. Posterior rhinomanometry is accomplished without the use of a mask, thus allowing the patient to breathe naturally. Here, we report on the improvements we have made to the existing posterior rhinomanometry system. In this system, nasal airflow is measured indirectly by measuring the pressure differential across a small mesh window in the body plethysmograph. We have calibrated this measurement and developed software that automatically provides the correct values for all airflow rates. Also, we have developed software that automatically corrects for the phase shift caused by the plethysmograph structure. These refinements should provide more accurate values for nasal resistance.

Venom effects on monoaminergic systems.

The monoamines, dopamine, epinephrine, histamine, norepinephrine, octopamine, serotonin and tyramine serve many functions in animals. Many different venoms have evolved to manipulate monoaminergic systems via a variety of cellular mechanisms, for both offensive and defensive purposes. One common function of monoamines present in venoms is to produce pain. Some monoamines in venoms cause immobilizing hyperexcitation which precedes venom-induced paralysis or hypokinesia. A common function of venom components that affect monoaminergic systems is to facilitate distribution of other venom components by causing vasodilation at the site of injection or by increasing heart rate. Venoms of some scorpions, spiders, fish and jellyfish contain adrenergic agonists or cause massive release of catecholamines with serious effects on the cardiovascular system, including increased heart rate. Other venom components act as agonists, antagonists or modulators at monoaminergic receptors, or affect release, reuptake or synthesis of monoamines. Most arthropod venoms have insect targets, yet, little attention has been paid to possible effects of these venoms on monoaminergic systems in insects. Further research into this area may reveal novel effects of venom components on monoaminergic systems at the cellular, systems and behavioral levels.

Movement in the ipsilesional hand is segmented following unilateral brain damage.

Unilateral stroke results in hemiplegia or hemiparesis of the contralateral side of the body. The ipsilateral side of the body, the so-called "good" side, is often assumed to have no deficit. However, there is increasing evidence that the function of the unaffected limbs, especially the upper extremities, is different from that of normal age-matched controls. In the present study, we examined the motor control of both hands of chronic stroke subjects, 6 with left hemisphere brain damage (LHBD) and 5 with right hemisphere brain damage (RHBD). The control group consisted of 5 normal age-matched subjects. The task of the subject was to move a handle by flexing his/her fingers until the target position was reached. The target position was set as 33% of the range of each subject. No time constraints were imposed. The movements of the normal subjects were basically smooth, with few hesitations. In contrast to this, the movements of both hands in the two stroke groups were segmented and characterized by multiple starts and stops. As compared to normals, the time to reach the target, the number of pauses during the movement, and the percent of time spent in pauses, were significantly greater for both hands of the LHBD group. In the RHBD group, the percent of time spent in pauses was significantly greater than the control group for the ipsilesional hand. The increased segmentation seen in the movements of the ipsilesional, as well as the contralesional. hands of the hemiplegic subjects suggests that the motor deficits in stroke patients may be due to a global inability to correctly plan and carry out movements.