Norhayati Hussein - Academia.edu (original) (raw)

Papers by Norhayati Hussein

Braddom's Rehabilitation Care: A Clinical Handbook, 2018

Medical rehabilitation must encompass the needs of patients with cardiopulmonary disorders, renal... more Medical rehabilitation must encompass the needs of patients with cardiopulmonary disorders, renal dysfunction, and debility. With the aging population, there are even greater numbers of patients who are now presenting with these issues. These conditions may present as primary or secondary reasons for rehabilitation, in addition to other primary disabilities. Many patients with other disabilities will have cardiac, pulmonary, and renal disabilities. A degree of frailty is a common feature found in these underlying conditions. Rehabilitation specialists must be adept in providing rehabilitation for people with both primary and secondary disabilities.

The primary goals of stroke rehabilitation are to encourage and foster functional improvement and... more The primary goals of stroke rehabilitation are to encourage and foster functional improvement and neurological recovery. Organised stroke care, processes of care, early timing of rehabilitation and high intensity of rehabilitation therapies are important factors which have been identified as promoting better overall outcomes for individuals with stroke. This chapter examines the evidence for those elements which have been proven to be important in the effectiveness of stroke rehabilitation.

• Depression is a common complication of stroke. • Prevalence (major and minor) reported to affec... more • Depression is a common complication of stroke. • Prevalence (major and minor) reported to affect 23-40% of stroke patients. • White (2002) – major depression 9-37% in 1 6 months; 5-16% next year; 19-21% thereafter in >1725 patients studied. • Most cases of PSD evident within 1 two years. • Episodes last 7-8 months or more. • Depression often observed in severe physical illnesses. • Less emphasis on feelings of low self-esteem, guilt and self-blame in post-stroke depression. • More emphasis on hypochondriac concerns, lethargy and behavioural disturbances; diminished energy, weight loss, insomnia, poor concentration and psychomotor alterations all of which can be associated with the stroke itself. • Often patients unable to communicate feelings due to aphasia.

Motor deficits post-stroke are the most obvious impairment (Langhorne et al. 2012) and have a dis... more Motor deficits post-stroke are the most obvious impairment (Langhorne et al. 2012) and have a disabling impact on valued activities and independence. Motor deficits are defined as “a loss or limitation of function in muscle control or movement or a limitation of movement” (Langhorne et al. 2012; Wade 1992). Given its importance, a large proportion of stroke rehabilitation efforts are directed towards the recovery of movement disorders. Langhorne et al. (2012) notes that motor recovery after stroke is complex with many treatments designed to promote recovery of motor impairment and function.

• Neurological deficits resulting from a stroke are often referred to as impairments. These are d... more • Neurological deficits resulting from a stroke are often referred to as impairments. These are determined primarily by the site and extent of the stroke. • As a general rule, the severity of the initial deficit is inversely proportional to the prognosis for recovery. • Most spontaneous recovery occurs during the first 3-6 months after the stroke. • The course of recovery is a predictable phenomenon; it is initially very rapid and then negatively accelerates as a function of time (Skilbeck et al. 1983). Skilbeck et al. (1983) studied 92 stroke survivors with a mean age of 67.5 years (range= 36-89) at final assessment, either 2 or 3 years after stroke. The majority of recovery was reported within the first 6 months, with continued but non-statistically significant recovery after 6 months. • This type of recovery has, until recently, been regarded as largely inaccessible to medical intervention or manipulation.

ed from medical records. The PoCs reflected aspects of care received within 24 hours of admission... more ed from medical records. The PoCs reflected aspects of care received within 24 hours of admission, documentation and general management, and included CT scan, swallowing assessment, allied health assessment, documentation of premorbid functioning and discharge needs, measures to avoid aspiration, deep vein thrombosis and use of antiplatelet Adherence to key PoC was higher in SUs than in other models. For all patients, adherence to PoC was associated with improved mortality at discharge and trends found with independence at home.468 of 1701 eligible patients participated. (28%) Overall PoC adherence rates for individual care models were SU 75%, mobile service 65%, and conventional care 52% (P<0.001). The adjusted odds of participants being alive at discharge if adhering to all or all but 1 PoC was significant (OR 3.63; 95% CI: 1.04 to 12.66; P=0.043). Important trends at 28 weeks were found for being at home (aOR 3.09; 95% CI: 0.96 to 9.87;

The challenge of constructing an exemplary stroke rehabilitation system is balancing the attempt ... more The challenge of constructing an exemplary stroke rehabilitation system is balancing the attempt to maximize patient outcomes while controlling costs. This review, using findings from Chapters 3, 5, 7, 21, and 22 and from evidence-based consensus opinions, presents research on the stroke rehabilitation triage process. Evidence on patient screening, establishing assessment criteria, stroke severity, and unit location is reported. As well, a potential stroke rehabilitation triage system is proposed.

Cerebrovascular disorders represent the third leading cause of mortality and the second major cau... more Cerebrovascular disorders represent the third leading cause of mortality and the second major cause of long-term disability in North America (Delaney and Potter 1993). The impairments associated with a stroke exhibit a wide diversity of clinical signs and symptoms. Disability, which is multifactorial in its determination, varies according to the degree of neurological recovery, the site of the lesion, the patient’s premorbid status and the environmental support system.

Recovery after a stroke is associated with cortical reorganization. Motor recovery is a complex p... more Recovery after a stroke is associated with cortical reorganization. Motor recovery is a complex process combining: 1. Neurological or Spontaneous Recovery. Recovery of impairment or normal way of moving as measured by Fugl-Meyer score or 3D Kinematics (restoration of normal movement patterns). 2. Functional Recovery. Recovery of tasks or activities often through learned compensatory movements (new movement patterns) as measured by the ARAT, Barthel Index or even the FIM. Both involve changes to the motor cortex and this relationship is not fully understood.

Journal of Clinical Nursing, 2018

Aims and objectives: To investigate oral health knowledge for stroke care and the clinical practi... more Aims and objectives: To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia Background: Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia. Design: A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided. Methods: All (16) hospitals were invited to participate and site visits were conducted. A standardized questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined. Results: Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n=513) reported that some form of 'mouth cleaning' was performed for stroke patients routinely. However, only a third (38.3%, n=309) reported to Accepted Article This article is protected by copyright. All rights reserved. perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (P<0.001). Conclusions: The clinical practice of providing oral hygiene care is less than ideal and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.

Spinal Cord Series and Cases, 2017

INTRODUCTION: Spinal cord injury (SCI) has increased over the years, and so has the survival. Wom... more INTRODUCTION: Spinal cord injury (SCI) has increased over the years, and so has the survival. Women with SCI remain fertile and have equal chance of pregnancy. CASE PRESENTATION: We described a case of a 29-year-old lady with traumatic spinal cord injury (SCI) resultant with paraplegia in 2008, who conceived naturally 2 years after the injury. She only had her antenatal checkup at a low-risk antenatal center throughout her pregnancy and was not referred to specialized obstetric care. She did not appreciate active labor, and unexpectedly had a precipituous labor and gave birth in the bathroom. DISCUSSION: Pregnancy is relatively safe in women with spinal cord injury (SCI). However, disability-related issues can be exaggerated during pregnancy, delivery and post-partum periods. Thus, understanding common issues related to pregnancy in this population is important. Specialized obstetric care with rehabilitation input throughout antenatal and postnatal care is crucial for a good overall outcome of a pregnant woman with SCI.

Ischemic Stroke Therapeutics, 2016

Stroke rehabilitation is critical to dealing with a growing burden of stroke-related disability. ... more Stroke rehabilitation is critical to dealing with a growing burden of stroke-related disability. The most important prognostic factors predicting stroke recovery are stroke severity, age of the stroke survivor, and access to rehabilitation. Neuroplasticity with associated neurological recovery is an important concept which emphasizes the importance of stroke rehabilitation. Optimal rehabilitation outcomes are reported when rehabilitation takes place in specialized interdisciplinary stroke rehabilitation units, when rehab is initiated early and when therapy is of sufficient intensity. Outpatient rehabilitation therapy has been shown to further improve outcomes. In the future, stroke rehabilitation outcomes will improve even further through better adherence to clinical practice guidelines and the increasing use of new technologies. There is a developing evidence base supporting long-term rehabilitation management of stroke, a concept which in the past has received little in the way of resources or attention.

Medical issues post stroke are those which are within the domain of the doctor and the nurses, bu... more Medical issues post stroke are those which are within the domain of the doctor and the nurses, but are unrelated to secondary stroke prevention. Not only do these complications occur relatively frequently, but they have also been shown to contribute to poor outcome. As such, an understanding of these disorders is critically important to stroke care and management. Although the number of potential medical complications is extensive, this review will focus on six of the most common and clinically relevant: urinary and fecal incontinence, venous thromboembolism, seizures, osteoporosis, central pain states, and post-stroke fatigue. Both short-term and long-term complications will be evaluated. 17. Medical Complications Post Stroke pg. 2 of 98 www.ebrsr.com Key Points Urinary Incontinence  The treatment of urinary/fecal incontinence post stroke has not been well studied.  Indwelling urinary catheters should only be used for cases of intractable urinary retention, continuous wetness or the need for monitoring.  Prompted voiding and biofeedback-assisted pelvic training plus behavioral therapy and weekly in-home visits reduce incontinent episodes. Treatment with a functionally oriented rehabilitation approach vs. a Bobath approach for urinary incontinence post stroke has not been well studied. Deep Vein Thrombosis  The incidence of DVT is less than 10% in the rehabilitation phase.  Anticoagulation reduces the incidence of DVT. Low molecular-weight heparin is more effective than unfractionated heparin. The use of physical methods does not appear to be effective in preventing DVT. Seizures  The prevelance/incidence of seizures varies, on average approximately 10% of stroke patients experience seizures.  The treatment of seizures post stroke has not been well studied. There is no significant difference in the efficacy of any antiepileptic in the management of post stroke seizure. Osteoporosis  Ipiflavone, vitamin D along with calcium supplementation, sunlight therapy, a combination of vitamin B12 and folate, and bisphosphonates can all be used to reduce the risk of osteoporosis post stroke. Central Pain State  Central pain states post stroke are uncommon, but not rare.  The majority of pain states do not respond well to treatment, although a broad range of drug treatments are available. Post-stroke Fatigue  Post-stroke fatigue is relatively common. A limited number of treatments have been evaluated. Cognitive therapy, especially when augmented with graded activity training has proven to be useful.  At present there is no evidence to support the effectiveness of pharmacological treatment for post-stroke fatigue.

Journal of paediatrics and child health, 2009

Expert Review of Neurotherapeutics, 2014

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the... more Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.

Topics in Stroke Rehabilitation, 2009

International Journal of Stroke, 2014

Background In the interest of prioritizing resources and providing future direction for researche... more Background In the interest of prioritizing resources and providing future direction for researchers, a complete overview of the landscape of stroke rehabilitation literature was conducted. Aim We aimed to examine the evolution of stroke rehabilitation randomized controlled trials, with respect to number, sample size, and methodological quality between 1970 and September 2012. Methods Using the Evidence-Based Review of Stroke Rehabilitation ( http://www.ebrsr.com ), all randomized controlled trials related to stroke rehabilitation interventions were eligible for inclusion and were divided into five groups based on the primary outcome (i.e., motor, cognitive, medical complications, psychosocial, and ‘other’). Results One thousand sixty-three randomized controlled trials met inclusion criteria, with motor studies accounting for 58·8% of the total. The total number of randomized controlled trials grew between 1970 and 2012, with 35·2% of all the studies published in the last five-years....