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    The experience of whanau caring for members disabled from the effects of stroke : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy at Massey University
    (Massey University, 2003) Corbett, Andrea M
    This thesis explores the experience of whanau caring for members disabled from the effects of stroke. The decision to undertake this study arose from my experience in rehabilitation nursing where I observed Maori accepting the responsibility for the care of their whanau member following a stroke with little assistance from existing rehabilitation and community based services. I wanted to understand why this was so, from the perspectives of the whanau. A review of epidemiological data demonstrated the negative disparity in the incidence of stroke in Maori when compared with non-Maori. Further review of the literature specifically related to Maori health issues revealed that whilst there was acknowledgement of the importance of whanau, kaumatua and kuia to Maori as a society, there was little that dealt with disability issues and stroke in particular. Where issues related to the provision of, and access to, health and disability services had been noted, little appears to have been accomplished. A descriptive qualitative research study was undertaken in the Taranaki region with support of the eight Taranaki iwi. Seven whanau focus groups interviews and three key informant interviews were undertaken. From analysis of the data a descriptive account of the whanau experience of onset of the stroke event, hospitalisation and service delivery following discharge of their whanau member is provided. The impact on the whanau of their ongoing provision of care with limited service provision from health and disability services is explored. On the basis of this analysis a number of recommendations are made. The key recommendation is that there needs to be a review of current rehabilitation service provision in Taranaki. From such a review it is hoped that changes will be implemented that will enable service provision to be more beneficial, accessible and acceptable to Taranaki Maori.
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    The understanding and experience of anxiety in older adults caring for partners with stroke : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology, Massey University
    (Massey University, 2007) Cotton, Elizabeth Helen
    Anxiety has been increasingly recognized as a serious health concern in older adults and is reported by many caregivers. However, still relatively little is known about the experience or presentation of anxiety in later life or about how that anxiety relates to caregiving. Much of the research into late-life anxiety has focused on anxiety disorders and has been carried out with reference to younger age groups, using diagnostic and psychometric measures developed, in the main, for younger people. There appear to be few studies in the literature that explore late-life anxiety as an independent phenomenon or that examine the effects of contextual factors on that anxiety. No studies could be found that investigate non-clinical experiences of anxiety in later life, starting from the perspectives of older adults themselves; neither could any studies be found that specifically investigate anxiety-related experiences of elderly people caring for partners with stroke. The present study explores how older adults, caring for partners with stroke, understand and experience anxiety. Semi-structured interviews were conducted with nine older adults, aged from 65 to 80 years, who were living in the community and were caregivers for partners with stroke. Interpretative Phenomenological Analysis (IPA) was used to identify themes within their accounts. Three master themes were identified: the phenomenon of anxiety, views that influence anxiety, and the experience of anxiety. Emergent themes describe participants' shared, main sources of anxiety, the signs and symptoms by which they recognized anxiety and the strategies that they had developed to cope with anxiety. A range of views about self, caregiving and ageing was identified that appeared to shape the anxiety that participants experienced. Findings highlight the chronic nature of the anxiety experienced by older spousal caregivers and suggest ways in which older caregivers can successfully deal with that anxiety. They provide a useful foundation for further research that seeks to determine which older adults are likely to experience anxiety problems in caregiving and also for programmes that seek to support elderly people who are caring for partners with stroke.
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    Does whole-body vibration training affect arterial stiffness, cognitive ability, and quality of life in chronic stroke? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Sport and Exercise in Exercise Prescription and Training at Massey University, Manawatū, New Zealand
    (Massey University, 2015) Yule, Christie Emily
    Background: Stroke is a type of cardiovascular disease, which has the third highest mortality rate in New Zealand. Risk factors of stroke have major consequences on the structure and function of blood vessels and their interaction with circulating blood; altering vascular structure through encouraging atherosclerosis and stiffening of arteries and by inducing thickening, narrowing, and tortuosity of capillaries and arterioles. Additionally, research has reported that the most significant effect of a stroke for a survivor is a decline in health-related quality of life (HRQOL). Studies state that stroke is associated with increased arterial stiffness, and even once established, arterial stiffness can be diminished by a programme of physical activity. Whole-body vibration (WBV) is a safe, easy to use, and time effective exercise intervention that has demonstrated significant improvements in arterial stiffness in healthy men and older sedentary adults. Therefore, it is worthwhile to explore the possibility of WBV as a valuable intervention in chronic stroke. Purpose: To investigate whether 4 weeks of WBV would significantly reduce indices of arterial stiffness, and improve cognition and quality of life in chronic stroke. Methods: Six participants with chronic stroke volunteered for this study. This was a cross-over design, where participants were exposed to WBV training for 4 weeks (3 times a week) on a commercialised Galileo vibration machine with an oscillating platform. WBV parameters were progressed throughout the 4 week intervention (5-7 sets of 60 sec bouts with 60 sec rest, 22-26 Hz, 2.1-6.5 mm, static squatting), and a 2 week washout period was prescribed between WBV and control (usual day-to-day living for four weeks) interventions. Arterial stiffness measurements (carotid arterial stiffness, PWV, PWA), cognition (ACE-III), and quality of life (SF-36), were conducted prior to each intervention and after the completion of each intervention. Additionally, rate of perceived exertion (Borg 15-point scale) was also recorded following every WBV session. Results: No significant improvements were shown for central BPs, HR, or central AIx@75. Additionally, no significant improvements were seen in PWV between WBV and control. There was not significant interaction, or main effects for carotid arterial stiffness (ß), DC or CC. However, carotid arterial stiffness did display a decrease over time for WBV, where arterial stiffness increased for control over time, but these measurements and their interaction effect were not found to be significant (p=0.166). No significant interaction or main effects were found for quality of life (SF-36) or cognitive ability (ACE-III). Finally, there was no significance of RPE over the 4 weeks. Conclusions: Limited studies have investigated the effects of multiple sessions of WBV (short-term training) in stroke, with no study examining the effects of WBV on arterial stiffness, QOL or cognition. The present study found no significant improvements in indices of arterial stiffness, cognitive ability, or QOL. However, this was the first study to investigate the effects of WBV on these variables in chronic stroke; therefore further research with larger sample sizes are needed to investigate the aims of this study further.
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    The effect of seated and supine exercise on executive function in TIA patients and healthy controls : a thesis presented in partial fulfilment of the requirements for the degree of Master of Health Science in Sport and Exercise at Massey University, Wellington
    (Massey University, 2014) Grigg, Rebecca Maureen
    Purpose: Exercise is suggested to improve executive function in healthy adults. However, there is limited research in this area on stroke populations. The purpose of this study was to examine the effects of an acute sub-maximal bout of seated and supine exercise on executive function in transient ischemic attack (TIA; minor stroke) patients and an age-matched healthy control group (HC). Methods: Nine TIA patients (7 males, 2 females; 65.1 ± 10.1 y; 85.8 ± 16.9 kg) and fifteen HC participants (13 males, 2 females; 61.5 ± 7.1 y; 84.9 ± 16.3 kg) performed two familiarisation sessions and four laboratory-based exercise protocols on a cycle ergometer. During the laboratory-based exercise tests participants performed two continuous, incremental maximal graded-exercise tests (GXT) to volitional exhaustion; one test was performed on a seated cycle ergometer, the other on a cycle ergometer in a supine position. The two remaining tests were 30-minute sub-maximal exercise tests (Seated and Supine). The Stroop task assessed executive function and was performed prior-to (Baseline), immediately after (Post) and 15-minutes (15-min Post) following the sub-maximal exercise tests. Near infrared spectroscopy (NIRS) was continuously recorded throughout the entire testing protocol to assess changes in total haemoglobin (tHb), oxy-haemoglobin (O2Hb), deoxy-haemoglobin (HHb), and tissue saturation index (TSI). Results: Regardless of exercise modality (Seated cf. Supine) or condition (TIA cf. HC) (P < 0.05), exercise elicited significant improvements in the time to complete the Stroop task (Baseline: 61.3 ± 10.0 s; Post: 58.1 ± 9.4 s; 15-min Post 54.8 ± 9.0 s). There were no changes in the number of correct Stroop answers reported for Seated exercise across each assessment time point (P > 0.05). However, a significant decrease in the number of correct answers was revealed immediately after (Post) Supine exercise which increased 15-minutes after exercise (P < 0.05). There was a significant increase in tHb (-0.6 ± 7.3 cf. 15.6 ± 8.1 %) and O2Hb (-2.3 ± 10.9 cf. 22.2 ± 11.1 %) after exercise (Baseline to Post) which remained significantly higher 15-minutes following exercise regardless of the exercise modality (Seated cf. Supine) or condition (TIA cf. HC) (both P < 0.001). Conclusion: This study showed 30-minutes of sub-maximal exercise in a seated and supine position led to improvements in executive function in TIA and HC participants. Cognitive improvements were observed immediately and 15-minutes after exercise. Possible mediators include increases in cerebral oxygenation and neurotransmitters. These findings may be important for improving executive function, a cognitive domain greatly impaired by stroke. Future research should further investigate the underlying mechanisms by which exercise affects executive function in stroke patients.