Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit.

Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts.

Results: The content analysis yielded four categories, each with 2-3 subcategories. The overall theme was "to be acknowledged or not": it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged.

Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.

BACKGROUND AND PURPOSE: Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine.

METHODS: A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients' degree of overall disability, measured by the modified Rankin Scale (mRS).

RESULTS: No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke.

CONCLUSIONS: The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit.

TRIAL REGISTRATION: Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

PURPOSE: The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation.

METHOD: 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01.

RESULTS: Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level.

CONCLUSION: Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.

Purpose: The study explored the direction of change (decline vs. improvement) after diffuse axonal injury (DAI) in the domains of the ICF: body structure, body function, and activity.

Methods: Thirteen patients with DAI were assessed by using diffusion tensor imaging (DTI) to measure body structure, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) to measure body function, and the Assessment of Motor and Process Skills (AMPS) to measure activity. The DTI, BNIS, and AMPS were applied at the acute phase (A1), and at 6 and 12 months post-injury (A2 and A3). Visual and statistical analyses were conducted to explore time-dependent changes in the ICF domains.

Results: Improvements were observed for most patients in all ICF domains from injury until six months. Thereafter, the results diverged, with half of the subjects showing a decline in DTI and BNIS scores between A2–A3, and all but one of the patients exhibiting identical or better A2–A3 AMPS process skill scores.

Conclusions: From 6 to 12 months post-injury, some patients underwent an ongoing degenerative process, causing a decline in cognitive function. The same decline was not observed in the activity measure, which might be explained by the use of compensatory strategies.

• Implications for rehabilitation

• In rehabilitation it is essential to be aware that in some cases with TBI, an ongoing degenerative process in the white matter can be expected, causing an adverse late effect on cognitive function.

• The cognitive decline, caused by DAI, does not necessarily mean a concurrent decrease in activity performance, possibly explained by the use of compensatory strategies. This suggests that, after the post-acute phase, rehabilitation offering strategy training may be beneficial to enhance every-day functioning.

• Strategy use requires awareness, which imply the need to assess level of awareness in order to guide rehabilitation.

Aim: To explore the feasibility to make on-road assessments routinely at 3 months follow-up for all patients with a 3 months verbal prohibition of driving after stroke, to support the physicians decision of fitness to drive.

Methods: From September 2007 to December 2009 there were 151 stroke patients from the stroke units at the hospital eligible for inclusion in the study. Fifty agreed to be assessed by the Nordic Stroke Driver Screening Assessment (NorSDSA) and on-road assessment. As base for discussion about the consequences on resource use relative to accuracy, calculations were made to explore and compare an expected yearly cost for two different assessment conditions, the NorSDSA followed by on-road assessment in uncertain cases and on-road assessment for all cases.

Findings: The yearly need for driving assessments was estimated to 500 patients. With less accuracy than only on-road assessments the NorSDSA with the stipulated cut-off produced a cost benefit of 1,700 €. The NorSDSA resulted in 32% uncertain cases and the certain cases were in 17% in disagreement with the on-road assessment, the gold standard.

Conclusion: It is conceivable and could be recommended to make on-road assessments for all patients with stroke at 3 months follow-up as accuracy is of importance both for patients and society and may save resources in the long run.

Background: Working memory (WM) problems influence most activities of daily living. The aim was to evaluate if computerized working memory training after brain injury has a significant effect on functioning in daily life. Method: Outpatients with WM deficits, aged 22-63 years, were randomized to either intervention group (IG, n = 20) or control group (CG, n = 18) and received 5 weeks standard rehabilitation. The IG also received WM training with the Cogmed QM training program. Assessments were made before (A1), immediately (A2) and 3 months (A3) after intervention. After follow-up, the CG was offered the computerized training and assessed after this (A4; n = 8). Assessments included the WAIS-III Digit span reversed, Fatigue Impact Scale (FIS), Assessment of Motor and Process Skills (AMPS), Rivermead Behavioural Memory Test-II (RBMT-II) and a WM questionnaire. Results: The IG improved on digit span and FIS, A1-A2, and significantly more than the CG on the WM questionnaire, A1-A3. Both groups improved in AMPS motor skill and the AMPS process skill score tended towards significant improvement in the IG, from A1-A3. After training (A3-A4), the CG improved in digit span and RBMT-II. Conclusion: The WM training seems to have a generalized effect on functional activity and lessens fatigue.

Objective: To study if computerized working memory (WM) training, in the sub-acute phase after acquired brain injury, in patients with impaired WM, improves WM, cognition and psychological health. Research design: A randomized study (n = 47) with an intervention group (IG) and a control group (CG), mean age 47.7 years. The WAIS-III NI, Digit span, Arithmetic, Letter-Number Sequences (Working Memory sub-scale), Spatial span, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the self-rating scales DEX and HADS were administered at baseline and at follow-ups at 6 and 18 weeks. Both groups underwent integrated rehabilitation. The IG also trained with the computerized WM training program, Cogmed QM, which was offered to the CG and followed up after the study completion. Results: Both groups improved after their WM training in Working Memory, BNIS and in Digit span, particularly the reversed section. Both the BNIS and the Digit span differed significantly between the IG and CG due to the greater improvement in the IG after their WM training. Psychological health improved as both groups reported less depressive symptoms and the CG also less anxiety, after the training. Conclusion: Results indicated that computerized WM training can improve working memory, cognition and psychological health.

OBJECTIVE: The aim of this work was to explore the extent to which social, cognitive, emotional and physical aspects influence participation after a traumatic brain injury (TBI).

DESIGN/SUBJECTS: An explorative study of the patient perspective of participation 4 years after TBI. The cohort consisted of all patients (age range 18-65 years), presenting in 1999-2000, admitted to the hospital (n = 129). Sixty-three patients responded; 46 males and 17 females, mean age 41 (range 19-60) years.

METHODS: Four years after the injury, the European Brain Injury Questionnaire (EBIQ), EuroQol-5D, Swedish Stroke Register Questionnaire and Impact on Participation and Autonomy (IPA) questionnaire were sent to the sample. Data were analysed with logistic regression.

RESULTS: On the EBIQ, 40% of the sample reported problems in most questions. According to IPA, between 20% and 40% did not perceive that they had a good participation. The analyses gave 5 predictors reflecting emotional and social aspects, which could explain up to 70% of the variation in participation.

CONCLUSION: It is not easy to find single predictors, as there seems to be a close interaction between several aspects. Motor deficits appear to have smaller significance for participation in this late state, while emotional and social factors play a major role.