• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文学位 >The influence of self-efficacy on recovery of spontaneous arm use in hemiparetic stroke.
【24h】

The influence of self-efficacy on recovery of spontaneous arm use in hemiparetic stroke.

机译：自我效能对偏瘫脑卒中自发手臂恢复的影响。

获取原文
获取原文并翻译 | 示例
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

The overall purpose of this dissertation is to determine the influence of self-efficacy on the recovery process of spontaneous arm use in people with hemiparetic stroke. Given that post-stroke arm use is a meaningful outcome within the context of the International Classification of Functioning, Disability, and Health (ICF) model, we first identified the critical predictors of arm recovery through a systematic review in order to have a better appreciation of upper limb stroke rehabilitation techniques (Chapter 2). According to this systematic review, there was a 317% increase in the frequency of articles on predictors of arm recovery over a nearly 30-year period. Early neurophysiologic and motor-behavior measures were the best predictors at follow-up of arm-specific outcomes. However, we found far fewer studies of social-cognitive factors than of neurophysiological or motor-behavior factors in predicting arm recovery after a stroke. Further, there was no outcome measure classified at the ICF participation level.;Before developing a new measure, we examined two commonly used performance-based measures of spontaneous arm use (the Actual Amount of Use Test (AAUT) and the Motor Activity Log (MAL)) with respect to an important psychometric property---the minimal detectable change (MDC) (Chapter 3). The MDC is used to determine the threshold for whether a pre-post change is due to actual change and not measurement noise from a measurement perspective. Another important finding was that significant training-induced spontaneous arm use was observed in the MAL but not in the AAUT when comparing their MDC values. This discrepancy was the case both immediately after the intervention and at 1-year follow-up. This may be influenced by the nature of the instruments. Specifically, the AAUT has scoring systems with low sensitivity.;In Chapter 4, fifteen participants with hemiparetic stroke and ten non-disabled adults were recruited. All participants were asked to complete the self-efficacy measure. Reaching is a task used to evaluate the participants' self-efficacy, they needed to consider which target to reach for and which hand to reach with, forming a hand-target combination. Then, participants were asked to compare two hand-target combinations and identify which combination they had higher confidence in reaching, but without actually moving their arm. In the stroke group, we found significant correlations between self-efficacy and target distance (r=-0.603, p0.001) and self-efficacy and target location effects (r=-0.378, p0.001). In addition, participants with stroke rated their self-efficacy to be lower when they had to reach with the paretic hand when compared to the non-paretic hand (p0.001). The results support the validation of the self-efficacy measure for those with hemiparetic stroke.;The same population was recruited to test the relationship of self-efficacy and arm selection after hemiparetic stroke (Chapter 5). All participants completed the self-efficacy measure (Chapter 4) and the arm reaching test. We found that hand-specific self-efficacy was significantly correlated with the probability of paretic hand selection for the stroke group (r=0.767; p0.001), but not the non-dominant hand for the control group (r=0.055; p=0.88). More importantly, self-efficacy alone explained 84.2% of the variance in hand selection. The strong relationship between hand-specific self-efficacy and paretic hand selection supports the contention that perceived confidence in task-specific motor capability likely plays an important role in determining hand use after hemiparetic stroke.;Given the identification of a strong relationship between self-efficacy and arm selection in the stroke group, we further examined how changes in self-efficacy would influence paretic limb choice in people with hemiparetic stroke (Chapter 6). An additional sample (n=8) was recruited and randomly assigned to two groups: self-efficacy manipulation (SE) group (n=4) and stroke-related information (SI) group (n=4). We found that the pre-morbid hand dominance may act as confounders to this result. In addition, the effective dosage and proper timing of the self-efficacy manipulation will need further investigations with a larger sample. (Abstract shortened by UMI.)
机译：本文的总体目的是确定自我效能对偏瘫患者自发手臂恢复过程的影响。在国际功能，残疾与健康分类（ICF）模型的背景下，考虑到卒中后手臂的使用是有意义的结果，我们首先通过系统的评估确定了手臂恢复的关键预测因素，以便更好地理解上肢中风康复技术（第二章）。根据这项系统评价，在将近30年的时间里，有关手臂恢复预测指标的文章的频率增加了317％。早期的神经生理和运动行为措施是对手臂特定结局进行随访的最佳预测指标。但是，我们发现预测脑卒中后手臂恢复的社会认知因素研究要少于神经生理或运动行为因素研究。此外，没有将结果度量归类为ICF参与级别。;在制定新度量之前，我们研究了两种基于性能的自发手臂使用的绩效度量（实际使用量测试（AAUT）和运动活动日志（ MAL））来衡量重要的心理测量特性-最小可检测变化（MDC）（第3章）。 MDC用于确定阈值，该阈值用于确定前后变化是否是由于实际变化而不是从测量角度来看的测量噪声。另一个重要发现是，在比较其MDC值时，在MAL中观察到了明显的训练诱发的自发手臂使用，而在AAUT中未观察到。干预后和随访1年时均出现这种差异。这可能会受到仪器性质的影响。具体来说，AAUT的评分系统敏感性较低。在第4章中，招募了15名偏瘫性卒中参与者和10名非残障成年人。要求所有参与者完成自我效能测量。到达是一项用于评估参与者的自我效能的任务，他们需要考虑要达到的目标和要伸出的手，从而形成一个手目标组合。然后，要求参与者比较两个手部目标组合，并确定他们对伸手可及的距离有较高的信心，但实际上并未动手。在卒中组中，我们发现自我效能和目标距离（r = -0.603，p <0.001）与自我效能和目标位置效应（r = -0.378，p <0.001）之间存在显着相关性。此外，中风的参与者将他们必须要用手握住的手的自我效能评价为，与非用手抚摸的相比，其自我效能较低（p <0.001）。结果支持了偏瘫患者的自我效能测量方法的验证。招募了同一人群以测试偏瘫患者中自我效能与手臂选择的关系（第5章）。所有参与者均完成了自我效能测量（第4章）和手臂伸直测试。我们发现，对于中风组，特定于手的自我效能感与选择性手选择的概率显着相关（r = 0.767； p <0.001），而对于对照组而言，非优势手则与之无关（r = 0.055; p = 0.88）。更重要的是，仅自我效能就可以解释84.2％的手选择差异。特定于手的自我效能感与paretic手选择之间的密切关系支持以下论点：对特定任务的运动能力的感知信心可能在决定偏瘫患者卒中后的手部使用中起重要作用。卒中组的有效性和手臂选择，我们进一步研究了自我效能的变化将如何影响偏瘫性卒中患者的四肢选择（第6章）。招募了另外一个样本（n = 8），并随机分为两组：自我效能操纵（SE）组（n = 4）和中风相关信息（SI）组（n = 4）。我们发现病态前的手支配地位可能与此结果混淆。另外，自我效能控制的有效剂量和适当时机需要对更大的样本进行进一步研究。 （摘要由UMI缩短。）

著录项

  • 作者

    Chen, Shu-Ya.;

  • 作者单位

    University of Southern California.;

  • 授予单位 University of Southern California.;
  • 学科 Health Sciences Rehabilitation and Therapy.;Psychology Social.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 198 p.
  • 总页数 198
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号