Background Stroke is a major global health concern which affects the health related quality of life (HRQOL). As the prevalence of stroke is increasing especially in lower-middle income countries, it is vital to identify the factors associated with the HRQOL of affected individuals. Available literature for post stroke HRQOL and the associated factors are mainly from high income countries. Therefore, we conducted this study to identify the factors associated with HRQOL of stroke survivors using a stroke specific measure. Methods A longitudinal study was conducted with the participation of 257 stroke survivors. Participants were followed up after 3 months at the neurology and medical clinics in the Teaching Hospital, Karapitiya, Sri Lanka. Health related quality of life was assessed using the validated version of Stroke Aphasia Quality of Life (SAQOL)-39 generic scale. Pearson correlation, independent sample t-test, one-way ANOVA and regression analysis were used to identify the factors associated with quality of life. Results Mean age of the participants with stroke was 66.1 (SD 11.7) years. The mean overall HRQOL was 3.15 (SD 0.96) as measured by the SAQOL-39 g. The socio-demographic factors which had significant associations with HRQOL were; gender, level of education, marital status, occupation and monthly income (p < 0.05). The clinical factors which had significant associations with HRQOL were; level of dependence and disability, type of stroke, side of the lesion, type of aphasia, level of language impairment, receiving physiotherapy and speech therapy and follow up care (p < 0.05). The results of regression indicated six independent predictors [F (6,234) = 42.6, p < 0.05], with an R2 of 0.52. The HRQOL was significantly predicted by the level of dependence (β = .43, p < .01), level of language impairment (β = .20, p < .01), age (β = −.23, p < .01), type of stroke (β = −.19, p < .01), side of the lesion (β = .17, p < .01) and the level of education (β = .12, p < .05). Conclusion Severe degree of dependence, severe level of language impairment, older age, hemorrhagic stroke, and lesions in the left side were associated with lower HRQOL. Higher education level was associated with higher HRQOL scores.
Background: Health-related quality of life (HRQOL) is an important measure that enables evaluation of rehabilitation outcomes. Stroke and Aphasia Quality of Life Generic Scale–39 (SAQOL-39g) is a disease-specific questionnaire that measures HRQOL of patients with stroke. This study was conducted to adapt the preliminary version of proxy-rated Sinhala version of the SAQOL-39g. Methods: The study was conducted with the participation of 115 proxies of the patients with stroke. The SAQOL-39g was translated and back translated, and culturally adapted by evaluating the items of the questionnaire. The culturally adapted scale was evaluated for its internal consistency, test-retest reliability, and validity. Results: The mean age of the patients with stroke was 67.07 (standard deviation [SD] = 11.2) years; males comprising two-thirds of the study sample (67% [n = 77]). The proxy-rated Sinhala version of the SAQOL-39g showed excellent internal consistency (α = 0.98 [overall score]), 0.97, 0.96, and 0.95 for physical, communication, and psychosocial domains, respectively. The intraclass correlation coefficient (ICC) was 0.92 for overall, and 0.93, 0.92, and 0.91 for physical, communication, and psychosocial domains, respectively. Factor analysis extracted 3 factors with 72.4% of the variance. Conclusions: Proxy-rated Sinhala version of the SAQOL-39g is a psychometrically sound, reliable, and valid tool to assess the post-stroke quality of life of Sinhala-speaking patients with stroke and aphasia.
BackgroundBilateral motor training (BMT) is a useful method to modify the excitability of the corticospinal system. The effects of artificial symmetrical movement on corticospinal excitability through functional electrical stimulation (FES) or transcranial magnetic stimulation (TMS) have not been reported. Therefore, we compared motor-evoked potentials (MEPs) following TMS over the ipsilateral primary motor cortex (M1) of voluntary movements after conventional BMT and repetitive artificial symmetrical movements generated through FES and TMS.MethodsSurface electromyograms of the abductor pollicis brevis (APB) muscles were recorded bilaterally in 12 healthy participants. Three sessions with different protocols were conducted: (1) bilateral finger training (BFT) involving bilateral thumb abduction, (2) right APB-triggered TMS of the ipsilateral M1 (APB-triggered i-TMS), and (3) right APB-triggered contralateral median nerve stimulation (APB-triggered c-MNS). Each protocol consisted of 360 trials for 30 min. Resting motor threshold (RMT), MEPs induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention.ResultsRMT showed no significant effect of intervention, time, or interaction. MEP amplitude showed a significant effect with time. MEP amplitude significantly increased at 0, 20, and 40 min post-intervention in BFT; at 0, 20, 40, and 60 min post-intervention in APB-triggered i-TMS; and at 20 and 40 min post-intervention in APB-triggered c-MNS in comparison to the baseline values. SICI was significantly decreased at 0 min post-intervention in the BFT and APB-triggered i-TMS protocols. ICF was significantly increased at 0 min post-intervention in the BFT and at 20 min post-intervention in the APB-triggered c-MNS protocol.ConclusionThe main finding of the present study was the long-lasting increase in MEP amplitude in all three mirror-symmetrical movement protocols. The observed changes are long-lasting and comparatively strong. However, the underlying neural mechanisms seem to be slightly different across the three protocols. Thus, whether voluntarily or artificially caused, repetitive symmetrical mirror movements enhance corticospinal excitability.
Bilateral motor training is a useful method for modifying corticospinal excitability. The effects of bilateral movement that are caused by artificial stimulation on corticospinal excitability have not been reported. We compared motor-evoked potentials (MEPs) of the primary motor cortex (M1) after conventional bilateral motor training and artificial bilateral movements generated by electromyogram activity of abductor pollicis brevis (APB) muscle-triggered peripheral nerve stimulation (c-MNS) and transcranial magnetic stimulation of the ipsilateral M1 (i-TMS). A total of three protocols with different interventions—bilateral finger training, APB-triggered c-MNS, and APB-triggered i-TMS—were administered to 12 healthy participants. Each protocol consisted of 360 trials of 30 min for each trial. MEPs that were induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) that were induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention. MEP amplitude significantly increased up to 40 min post-intervention in all protocols compared to that at the baseline, although there were some differences in the changing pattern of ICF and SICI in each protocol. These findings suggest that artificial bilateral movement has the potential to increase the ipsilateral cortical excitability of the moving finger.
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