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    Expectations of Individuals with Neurological Conditions from Rehabilitation: A Mixed-Method Study of Needs
    (South African Society of Physiotherapy, 2021) Olaleye, O. A.; Zaki, D. A.; Hamzat, T. K.
    Background: Knowledge of the specific expectations of patients with neurological conditions (NCs) from rehabilitation helps in setting attainable goals. Such expectations may vary from situation to situation. There are no studies investigating rehabilitation expectations amongst individuals with NCs in Nigeria. Objectives: The aim of our study was to explore the rehabilitation expectations of individuals with NCs. Method: This convergent mixed-methods study comprised a cross-sectional survey of 105 individuals with NCs and two sessions of Focus Group Discussions (FGDS) amongst eight individuals with NCs. The modified Needs Assessment Questionnaire was used to assess rehabilitation needs as a proxy for rehabilitation expectations, whilst disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Quantitative data were summarised using descriptive statistics and analysed using inferential statistics at p < 0.05. Thematic analysis was conducted on the qualitative data. Results: Sixty-one (58.1%) stroke survivors, 33 (31.4%) individuals with spinal cord injury (SCI) and 11 (10.5%) with traumatic brain injury (TBI) aged 46.48 ± 15.91 were surveyed. The need for social/recreational activity was the most expressed need (100%) amongst the participants. Mobility was reported as an important need constituting a barrier to enjoying life by 93 (88.6%) participants. Individuals with SCI expressed the greatest needs compared with the other two groups. Needs were significantly correlated with severity of disability (p < 0.05). Four overarching themes (physical health, financial, healthcare services/rehabilitation and emotional/social) representing major areas of needs emerged from the FGD data. Conclusion: Individuals with NCs in Nigeria have specified expectations of rehabilitation. Disability was a major driver of these expectations, irrespective of NC subtype. Clinical implications: Rehabilitation programmes for individuals with NCs should target expressed needs or expectations of each patient cohort and minimise disabilities associated with these conditions.
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    Effect of Aerobic Exercise on Post-Stroke Cognitive Function: A Systematic Review
    (MA Healthcare Ltd, 2020) Abba, M. A.; Olaleye, O. A.; Hamzat, T. K.
    Background/Aims: Literature suggests that aerobic exercise improves cognitive impairments post stroke. This systematic review was conducted to analyse evidence on the effectiveness of aerobic exercise in improving post-stroke cognitive impairments. Methods: Online databases (PubMed, EMBASE and Web of Science) were systematically searched from inception until 13 July 2017 using the keywords stroke/exercise/cognition. Clinical trials that met the inclusion criteria were assessed for methodological quality using the PEDro scale. Extracted data were synthesised for evidence. Results: A total of seven studies met the inclusion criteria. Participants in most of the studies were aged over 60 years and the majority had ischaemic stroke. The most commonly used measure for assessing cognition was the Mini Mental State Examination. The majority of studies included moderate to high intensity exercise (50–70% of VO2max) for 30–60 minutes three to five times per week. There is moderate evidence that aerobic exercise enhances global cognitive function, attention and working memory. Evidence that aerobic exercise improves memory, levels of brain-derived neurotrophic factor and executive function is conflicting and limited. Conclusions: Aerobic exercise is moderately effective in improving post-stroke cognitive impairments. More clinical trials are needed in view of the methodological limitations and paucity of existing studies.
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    Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol
    (Taylor & Francis, 2020) Abba, M. A.; Olaleye, O. A.; Hamzat, T. K.
    Background: Cognitive rehabilitation (CR) is an important component of stroke rehabilitation. Most of the strategies used for this purpose are not readily affordable. This is the protocol of a trial to investigate the effects of over-ground walking (OGW) exercise and CR on cognitive function among stroke survivors. Methods: This is a three-centre, single blind, randomised controlled trial (RCT). Fifty-seven stroke survivors with mild to moderate cognitive impairments will be recruited from three healthcare facilities and randomly assigned into three groups. Group A will receive moderate intensity OGW exercise. Group B will receive CR using an adapted cognitive intervention comprising an attention and a memory tasks. Group C will receive combine OGW and CR exercise. All interventions will be thrice weekly for 8 weeks. Outcomes to be assessed at baseline, 4th and 8th week of interventions are cognition, brain-derived neurotrophic factor (BDNF), quality of life and participation using Mini-Mental State Examination, Melsin brand ELISA kit, stroke-specific quality of life and London Handicap Scale, respectively. Friedman and Kruskal–Wallis tests will be used for within-group and between-group comparison of data. Discussion: This trial is the first to examine the effect of OGW exercise on cognition and BDNF among stroke survivors.
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    Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review
    (Frontiers Media S.A., 2020) Ekechukwu, E. N. D.; Olowoyo, P.; Nwankwo, K. O.; Olaleye, O. A.; Ogbodo V. E.; Hamzat, T. K.; Owolabi, M. O.
    Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task-oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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    Drivers of Cost of Treatment for Traumatic Spinal Cord Injury in Ibadan, Nigeria
    (Pan African Association of Neurological Sciences (PAANS), 2020) Olaleye, O. A.; Ojomo, O. A.; Hamzat, T. K.
    Background: Traumatic Spinal Cord Injury (TSCI) is a costly condition in human and economic terms. Yet, studies on direct cost of treatment for TSCI in resource-constraint countries are sparse. Objective: To estimate the direct cost of treatment for patients with TSCI at the University College Hospital (UCH), Ibadan, Nigeria using an incidence-based costing approach. Methods: All new cases of TSCI admitted in the hospital from January, 2009 to December, 2013 were identified and reviewed. Direct costs of in-patient and out-patient treatments over the first year of injury were estimated. Results: 114 individuals with TSCI (73 males; 41 females) were admitted and discharged home alive from the hospital. The largest cost driver to the patients and the National Health Insurance Scheme was cost of consultations by neurosurgeons which constituted about a third (34.4%) of the total costs of treatment. Less than a fourth (24.2%) of the total cost of in-patient treatment was spent on therapeutic interventions (surgery, drugs and physiotherapy). There was a significant relationship between the direct cost of treatment and each of the severity of traumatic spinal cord injury and length of hospital stay (p = 0.01). Level of injury was not significantly associated with direct cost of treatment (p=0.89). Conclusion: Direct cost of treatment for individuals with TSCI in Ibadan, Nigeria is substantial. This high cost underscores the need for novel service models with potential for minimizing cost for patients with TSCI in Nigeria.
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    Knowledge and Beliefs of Informal Caregivers of Children with Cerebral Palsy in Nigeria Concerning Cerebral palsy
    (Zambia Medical Association, 2019) Adegbemigun, O. D.; Hamzat, T. K.; Olaleye, O. A.
    Background: Caregivers of children with Cerebral Palsy (CP) play an important role in the habilitation of their wards. Their knowledge and beliefs about CP may affect their disposition to habilitation and the quality of care and habilitation their wards would receive. Knowledge and beliefs of informal caregivers of children with CP in Southwest, Nigeria were investigated in this study. 3 six(71%) respondents reported good knowledge while 9(9.7%) reported poor knowledge about cerebral palsy. Most of the caregivers responded correctly in expressing their belief, causes and management of cerebral palsy Methods: Ninety-three informal caregivers (relatives or friends) of children with CP who routinely provide an average of 3-5hours of care per week without pay were surveyed. A 56-item questionnaire was used to collect information on socio-demographics, knowledge and beliefs of the informal caregivers about CP. Data were summarized using descriptive statistics of mean, percentages and standard deviation. Results: Participants were aged 36.6 ±8.6 years and their age ranged from 16-66 years. Majority of the respondents (n = 85; 91.4%) were female. Most of the participants (n = 87; 93.5%) were married and (62.4%) had completed tertiary education. Sixty six (71%) respondents reported good knowledge while 9(9.7%) reported poor knowledge about cerebral palsy. Most of the caregivers responded correctly in expressing their belief, causes and management of cerebral palsy Conclusions: Informal caregivers of children with cerebral palsy in southwestern Nigeria had good knowledge and positive beliefs about cerebral palsy hence the need to ensure that they seek appropriate intervention to this condition.
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    Motor function, community reintegration and quality of life in stroke survivors with pre-stroke driving history
    (College of Medicine, University of Ibadan, and the University College Hospital, Ibadan, Nigeria., 2018) Olaleye, O. A.; Nwankwo, O. K.; Hamzat, T. K.
    Background: Driving is an important activity of daily living associated with improved community reintegration and better quality of life. It is however unclear if there is a definite difference in the motor function, community reintegration and quality of life of stroke survivors who returned to driving and those who did not. Methods: Stroke survivors with pre-stroke driving history participated in this cross sectional survey. Socio-demographics, clinical characteristics and driving history were documented. Motor function, community reintegration and quality of life were assessed using the Modified Motor Assessment Scale (MMAS), Reintegration to Normal Living Index (RNLI) and Health-Related Quality of Life in Stroke Patients (HRQOLISP-40) respectively. Returners and non-returners were compared using Mann Whitney U test at á0.05 . Results: Fifteen out of the 44 stroke survivors (34.1%) who participated in this study had returned to driving after their stroke. There was no significant difference in age, time since stroke onset and years of driving experience prior to stroke onset (p >0.05) between returners and non-returners. There was however a significant difference in the motor function, community reintegration and quality of life between the two groups (p<0.01) Conclusion: Stroke survivors with pre-stroke driving who returned to driving after stroke had better motor function, community reintegration and quality of life compared to their counterparts who had not returned to driving.
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    Relationships between Community Reintegration and Clinical and Psychosocial Attributes in Individuals with Spinal Cord Injury in a Nigerian City
    (American Spinal Injury Association, 2018) Atobatele, K. O.; Olaleye, O. A.; Fatoye, F. A.; Hamzat, T. K.
    Background: The bio-psychosocial model for comprehensive understanding of community reintegration among individuals with spinal cord injury (SCI) varies across communities. Yet, information about community reintegration in Nigeria is not available. Objective: To investigate the association between community reintegration and clinical and psychosocial attributes among Nigerians with SCI. Methods: Fifty individuals (31 females; 19 males) with SCI aged 38.6 ± 11.1 years participated in this longitudinal survey. Pain, functional ability, and severity of injury were assessed at discharge and at 1, 2, and 3 months post discharge from inpatient care using the Visual Analogue Scale (VAS), FIM®, and American Spinal Injury Association Impairment Scale (AIS), respectively. Self-esteem (SE), social support (SS), and depression were also assessed using the Self-Esteem Questionnaire, Social Support Questionnaire, and Beck Depression Inventory, respectively. CR was assessed at 1, 2, and 3 months post-discharge using the Reintegration to Normal Living Index (RNLI). Data were analyzed using Spearman’s rho correlation and Friedman test. Results: The psychosocial and clinical attributes were significantly different from baseline and across the 3 months post-discharge (p < .0001), except for SS. CR significantly correlated with level of injury, function ability, SE, and depression across the 3 months post-discharge (p < .01). CR was significantly correlated with SS only at 1 month post-discharge (p = .027). Conclusion: Individuals with SCI had significant improvement in clinical and psychosocial attributes from discharge to 3 months post-discharge. Improvements in these variables were associated with better reintegration into the community.
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    Disability and Quality of Life among People Living With HIV/AIDS in Ibadan, Nigeria
    (Zambia Medical Association, 2017) Olaleye, O. A.; Adetoye, A. A.; Hamzat, T. K.
    Background: Improvements in medical and pharmacologic management of HIV/AIDS has led to increased life expectancy for the afflicted individuals. Hence, the focus of management for People Living With HIV/AIDS (PLWHA) has shifted to issues relating to function and Quality of Life (QoL). Information is scarce on disability issues and quality of life among people living with HIIV/AIDS in Nigeria. This was the premise of this study that assessed the level of disability and how it related to quality of life among people living with HIV/AIDS in Ibadan, the largest city in Nigeria. Methods: 360 PLWHA (274 females; 86 males) aged 37.79±9.37 years participated in this study. They were recruited from the anti-retroviral clinics of one secondary and one tertiary healthcare facilities in Ibadan, Nigeria. Disability and QoL were assessed using the 12-item WHO Disability Assessment Schedule (WHODAS 2.0) and the WHOQOL_HIV Bref respectively. Data were analysed using Chi square and Kruskal Wallis test at p = 0.05. Results: Almost a quarter (23.6%) reported being currently ill, with HIV/AIDS-related symptoms accounting for the highest perceived illness (42.5%). Majority of these participants (71.1%) had mild to extreme disabilities. There were no significant associations (p > 0.05) between disability and each of age, sex and employment status. Disability was however, significantly associated with level of education, alcohol use, CD4 count, history of tuberculosis and QoL (p<0.005) between disability and each of age, sex and employment status. Disability was however, significantly associated with level of education, alcohol use, CD4 count, history of tuberculosis and QoL (p<0.001) Conclusion: Disability was relatively high among people living with HIV/AIDS in Ibadan, Nigeria. Although mostly rated mild, disability was associated with poor QoL. This underscores the need for early identification of disability in people living with HIV/AIDS to minimise its impact on their QoL.
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    Knowledge and Perception of Nigerian University Undergraduates about the Risks Associated with using Commercial Motorcycle for Transportation
    (Zambia Medical Association, 2017) Ajayi, O. O.; Fatudimu, M. B.; Olaleye, O. A.; Hamzat, T. K.
    Background and Purpose of Study: Commercial motorcycle is a popular mode of mass transportation in Nigeria, which despite its acknowledged benefits has been associated with health and social problems. It is embraced largely by young Nigerians, including university undergraduates who have not been well studied with respect to this mode of transportation. We determined the proportion of undergraduates of a Nigerian university regularly using commercial motorcycle. Level of knowledge and perception of risks associated with usage and some factors that may influence choice of commercial motorcycle were also investigated. Methods: This cross-sectional survey was conducted among Nigeria premier University of Ibadan undergraduates, recruited from their halls of residence using consecutive sampling technique. A self-administered questionnaire was hand distributed to obtain information on the respondents' socio-demographic variables, knowledge and perception of risks associated with using commercial motorcycle for transportation. Descriptive statistics were calculated and Chi- square test was used as inferential statistics at á = 0.05. Results: Among the 1000 respondents, 75% regularly used commercial motorcycle for transportation. A statistically significant association was found between gender and the knowledge of risks (p? 0.001) and also between age and the perception of risks associated with using this mode of transportation. However, there was no significant difference in the knowledge (p=0.03 and perception of risks (p=0.97) associated with using commercial motorcycle for transport between users and non- users. Conclusions: Respondents had limited knowledge and low perception of the risks associated with using commercial motorcycle for transport. Strategies should be put in place to educate these youths on the risks associated with using commercial motorcycle for transport.