Distribution of participants according to need (
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5370",leadTitle:null,fullTitle:"Vortex Dynamics and Optical Vortices",title:"Vortex Dynamics and Optical Vortices",subtitle:null,reviewType:"peer-reviewed",abstract:"The contents of the book cover a wide variety of topics related to the analysis of the dynamics of vortices and describe the results of experiments, computational modeling and their interpretation. The book contains 13 chapters reaching areas of physics in vortex dynamics and optical vortices including vortices in superfluid atomic gases, vortex laser beams, vortex-antivortex in ferromagnetic hybrids, and optical vortices illumination in chiral nanostructures. Also, discussions are presented on particle motion in vortex flows, on the simulation of vortex-dominated flows, on vortices in saturable media, on achromatic vortices, and on ultraviolet vortices. Fractal light vortices, coherent vortex beams, together with vortices in electric dipole radiation, and spin wave dynamics in magnetic vortices are examined as well.",isbn:"978-953-51-2930-1",printIsbn:"978-953-51-2929-5",pdfIsbn:"978-953-51-4104-4",doi:"10.5772/62608",price:139,priceEur:155,priceUsd:179,slug:"vortex-dynamics-and-optical-vortices",numberOfPages:344,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"bf45ea3936725da5f92207f7709d24ab",bookSignature:"Hector Perez-de-Tejada",publishedDate:"March 1st 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5370.jpg",numberOfDownloads:22166,numberOfWosCitations:37,numberOfCrossrefCitations:19,numberOfCrossrefCitationsByBook:4,numberOfDimensionsCitations:33,numberOfDimensionsCitationsByBook:4,hasAltmetrics:1,numberOfTotalCitations:89,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 9th 2016",dateEndSecondStepPublish:"March 30th 2016",dateEndThirdStepPublish:"July 4th 2016",dateEndFourthStepPublish:"October 2nd 2016",dateEndFifthStepPublish:"November 1st 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"79235",title:"Dr.",name:"Hector",middleName:null,surname:"Perez-De-Tejada",slug:"hector-perez-de-tejada",fullName:"Hector Perez-De-Tejada",profilePictureURL:"https://mts.intechopen.com/storage/users/79235/images/5115_n.jpg",biography:"Professor Héctor Pérez-de-Tejada obtained a bachelor’s degree in science from the National Autonomous University of Mexico (UNAM) and later received his PhD degree from the University of Colorado (Boulder, Colorado). He has been a full researcher at the Institute of Geophysics of UNAM and participated in various academic functions first at the Ensenada (Baja California) campus and later at the Mexico City campus of that Institution. He was president of the Mexican Geophysical Union and has been a fellow of the National Research System in Mexico (level 3). Currently, he is the head of the Space Science Department of the Institute of Geophysics of UNAM, has participated in numerous research projects including as a guest investigator of the Pioneer Venus Orbiter mission of NASA at Venus, and has been involved in the analysis of plasma data of the Mars and Venus Express spacecraft of ESA. His academic activities have been related to studies of the interaction of the solar wind with planetary ionospheres and he has participated in many scientific publications where he has been the main author in most of them. He has been responsible for activities in the ionospheric sounder station near Mexico City and has been the supervisor of many graduate students at the Ensenada and at the Mexico City campuses of UNAM.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"National Autonomous University of Mexico",institutionURL:null,country:{name:"Mexico"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1217",title:"Hydrostatics",slug:"hydrostatics"}],chapters:[{id:"53924",title:"Vortex Structures in Ultra-Cold Atomic Gases",doi:"10.5772/67121",slug:"vortex-structures-in-ultra-cold-atomic-gases",totalDownloads:1735,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"In this chapter a basic introduction to the theory of vortices in ultra-cold (superfluid) atomic gases is given. The main focus will be on bosonic atomic gases, since these contain the same basic physics, but with simpler formulas. Towards the end of the chapter, the difference between bosonic and fermionic atomic gases is discussed. This discussion will allow the reader to make the conceptual step from bosonic to fermionic gases, while pinpointing the main differences and difficulties when working with fermionic gases rather than bosonic gases. The goal of this chapter is to provide a good and general starting point for researchers, or other interested parties, who wish to start exploring the physics of ultra-cold gases.",signatures:"Nick Verhelst and Jacques Tempere",downloadPdfUrl:"/chapter/pdf-download/53924",previewPdfUrl:"/chapter/pdf-preview/53924",authors:[{id:"144306",title:"Prof.",name:"Jacques",surname:"Tempere",slug:"jacques-tempere",fullName:"Jacques Tempere"}],corrections:null},{id:"53200",title:"Direct Generation of Vortex Laser Beams and Their Non-Linear Wavelength Conversion",doi:"10.5772/66425",slug:"direct-generation-of-vortex-laser-beams-and-their-non-linear-wavelength-conversion",totalDownloads:1853,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Vortex laser beams are a technology that has revolutionised applications in micro- and nano-manipulation, micro-fabrication and super-resolution microscopy, and is now heralding advances in quantum communication. In order to service these, and emergent applications, the ability to generate powerful vortex laser beams with user-controlled spatial and wavefront properties, and importantly wavelength, is required. In this chapter, we discuss methods of generating vortex laser beams using both external beam conversion methods, and directly from a laser resonator. We then examine the wavelength conversion of vortex laser beams through non-linear processes of stimulated Raman scattering (SRS), sum-frequency generation (SFG), second harmonic generation (SHG) and optical parametric oscillation. We reveal that under different types of non-linear wavelength conversion, the spatial and wavefront properties of the vortex modes change, and in some cases, the spatial profile also evolve under propagation. We present a theoretical model which explains these dynamics, through decomposition of the vortex mode into constituent Hermite-Gaussian modes of the laser resonator.",signatures:"Andrew James Lee and Takashige Omatsu",downloadPdfUrl:"/chapter/pdf-download/53200",previewPdfUrl:"/chapter/pdf-preview/53200",authors:[{id:"186944",title:"Prof.",name:"Takashige",surname:"Omatsu",slug:"takashige-omatsu",fullName:"Takashige Omatsu"},{id:"187036",title:"Dr.",name:"Andrew",surname:"Lee",slug:"andrew-lee",fullName:"Andrew Lee"}],corrections:null},{id:"53042",title:"Superconducting Vortex‐Antivortex Pairs: Nucleation and Confinement in Magnetically Coupled Superconductor‐Ferromagnet Hybrids",doi:"10.5772/65954",slug:"superconducting-vortex-antivortex-pairs-nucleation-and-confinement-in-magnetically-coupled-supercond",totalDownloads:1411,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Superconducting vortices are a well known class of vortices, each of them carrying a single magnetic flux quantum. In this chapter the authors present the results of low temperature Magnetic Force Microscopy experiments to investigate the nucleation and dynamics of superconducting vortices in magnetically coupled Superconductor/Ferromagnet (S/F) heterostructures made by Nb/Py. It is here shown that by controlling the thicknesses of both S and F layer, the formation of spontaneous vortex-antivortex pairs (V-AV) can be favored and their confinement and mobility can be tuned. The experimental results are compared with two theoretical models dealing with the spontaneous nucleation of V/AV pairs in the limits of S thickness respectively greater and smaller than the London penetration depth. It is shown that vortex nucleation and confinement is regulated by the intensity of the out-of-plane component of the magnetization with respect to a critical magnetization set by the thickness of both S and F layers. Additionally, external field cooling processes were used to probe in-field vortex nucleation and V-AV unbalancing, whereas the sweeping of an external magnetic field when below the superconducting critical temperature was used to force the vortex into motion, probing the vortex mobility/rigidity and the vortex avalanche events.",signatures:"Cinzia Di Giorgio, Domenico D'Agostino, Anna Maria Cucolo, Maria\nIavarone, Alessandro Scarfato, Goran Karapetrov, Steven Alan\nMoore, Massimiliano Polichetti, Davide Mancusi, Sandro Pace,\nValentyn Novosad, Volodymir Yefremenko and Fabrizio Bobba",downloadPdfUrl:"/chapter/pdf-download/53042",previewPdfUrl:"/chapter/pdf-preview/53042",authors:[{id:"13493",title:"Dr.",name:"Valentyn",surname:"Novosad",slug:"valentyn-novosad",fullName:"Valentyn Novosad"},{id:"186338",title:"Prof.",name:"Fabrizio",surname:"Bobba",slug:"fabrizio-bobba",fullName:"Fabrizio Bobba"},{id:"194213",title:"Dr.",name:"Cinzia",surname:"Di Giorgio",slug:"cinzia-di-giorgio",fullName:"Cinzia Di Giorgio"},{id:"194215",title:"Mr.",name:"Domenico",surname:"D'Agostino",slug:"domenico-d'agostino",fullName:"Domenico D'Agostino"},{id:"194216",title:"Prof.",name:"Maria",surname:"Iavarone",slug:"maria-iavarone",fullName:"Maria Iavarone"},{id:"194217",title:"Prof.",name:"Goran",surname:"Karapetrov",slug:"goran-karapetrov",fullName:"Goran Karapetrov"},{id:"194218",title:"Dr.",name:"Steven Alan",surname:"Moore",slug:"steven-alan-moore",fullName:"Steven Alan Moore"},{id:"194219",title:"Prof.",name:"Massimiliano",surname:"Polichetti",slug:"massimiliano-polichetti",fullName:"Massimiliano Polichetti"},{id:"194220",title:"Dr.",name:"Davide",surname:"Mancusi",slug:"davide-mancusi",fullName:"Davide Mancusi"},{id:"194221",title:"Dr.",name:"Volodymyr",surname:"Yefremenko",slug:"volodymyr-yefremenko",fullName:"Volodymyr Yefremenko"},{id:"194222",title:"Prof.",name:"Anna Maria",surname:"Cucolo",slug:"anna-maria-cucolo",fullName:"Anna Maria Cucolo"},{id:"194223",title:"Dr.",name:"Alessandro",surname:"Scarfato",slug:"alessandro-scarfato",fullName:"Alessandro Scarfato"}],corrections:null},{id:"53678",title:"Optical Vortices Illumination Enables the Creation of Chiral Nanostructures",doi:"10.5772/67073",slug:"optical-vortices-illumination-enables-the-creation-of-chiral-nanostructures",totalDownloads:1807,totalCrossrefCites:3,totalDimensionsCites:6,hasAltmetrics:0,abstract:"We discovered that optical vortices with an annular spatial form and an orbital angular momentum owing to a helical wave front enable us to twist materials, such as metal, silicon and azo-polymer, to form various structured matters including microneedles, chiral nanostructures and chiral surface reliefs. Such structured matters will potentially open the door to advanced devices, for instance, silicon photonic device, biomedical micro-electro-mechanical systems, ultrasensitive detector for chiral chemical composites and plasmonic metasurfaces for chiral chemical reactions.",signatures:"Takashige Omatsu, Katsuhiko Miyamoto and Ryuji Morita",downloadPdfUrl:"/chapter/pdf-download/53678",previewPdfUrl:"/chapter/pdf-preview/53678",authors:[{id:"186944",title:"Prof.",name:"Takashige",surname:"Omatsu",slug:"takashige-omatsu",fullName:"Takashige Omatsu"},{id:"194394",title:"Dr.",name:"Katsuhiko",surname:"Miyamoto",slug:"katsuhiko-miyamoto",fullName:"Katsuhiko Miyamoto"},{id:"194395",title:"Prof.",name:"Ryuji",surname:"Morita",slug:"ryuji-morita",fullName:"Ryuji Morita"}],corrections:null},{id:"53106",title:"Dynamical Particle Motions in Vortex Flows",doi:"10.5772/66315",slug:"dynamical-particle-motions-in-vortex-flows",totalDownloads:2252,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Circular vortex flows generate interesting self-organizing phenomena of particle motions, that is, particle clustering and classification phenomena. These phenomena result from interaction between vortex dynamics and relaxation of particle velocity due to drag. This chapter introduces particle clustering in stirred vessels and particle classification in Taylor vortex flow based on our previous research works. The first part of this chapter demonstrates and explains a third category of solid-liquid separation physics whereby particles spontaneously localize or cluster into small regions of fluids by taking the clustering phenomena in stirred vessels as an example. The second part of this chapter discusses particle classification phenomena due to shear-induced migration. Finally, this chapter discusses about process intensification utilizing these self-organizing phenomena of particle motions in vortex flows.",signatures:"Steven Wang and Naoto Ohmura",downloadPdfUrl:"/chapter/pdf-download/53106",previewPdfUrl:"/chapter/pdf-preview/53106",authors:[{id:"186403",title:"Prof.",name:"Naoto",surname:"Ohmura",slug:"naoto-ohmura",fullName:"Naoto Ohmura"},{id:"187311",title:"Dr.",name:"Steven",surname:"Wang",slug:"steven-wang",fullName:"Steven Wang"}],corrections:null},{id:"52536",title:"Numerical Simulation of Vortex-Dominated Flows Using the Penalized VIC Method",doi:"10.5772/65371",slug:"numerical-simulation-of-vortex-dominated-flows-using-the-penalized-vic-method",totalDownloads:1604,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Vorticity plays a key role in determining fluid flow dynamics, especially in vortex-dominated flows. Vortex methods, which are based on the vorticity-based formulation of the Navier-Stokes equations, have provided deeper insight into physical reality in a variety of flows using vorticity as a primary variable. The penalized vortex-in-cell (VIC) method is a state-of-the-art variant of vortex methods. In the penalized VIC method, Lagrangian fluid particles are traced by continuously updating their position and strength from solutions at an Eulerian grid. This hybrid method retains beneficial features of pure Lagrangian and Eulerian methods. It offers an efficient and effective way to simulate unsteady viscous flows, thereby enabling application to a wider range of problems in flows. This article presents the fundamentals of the penalized VIC method and its implementations.",signatures:"Seung-Jae Lee",downloadPdfUrl:"/chapter/pdf-download/52536",previewPdfUrl:"/chapter/pdf-preview/52536",authors:[{id:"186267",title:"Ph.D.",name:"Seung-Jae",surname:"Lee",slug:"seung-jae-lee",fullName:"Seung-Jae Lee"}],corrections:null},{id:"53733",title:"Vortex Structures in Saturable Media",doi:"10.5772/67074",slug:"vortex-structures-in-saturable-media",totalDownloads:1452,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this chapter, dipole and vortex solitons are computed using spectral renormalization method in the focusing two-dimensional saturable nonlinear Schrödinger (SNLS) equation with periodic and quasicrystal lattice potentials. The nonlinear stability of these multi-humped solitons is investigated using direct simulations of the SNLS equation. It is shown that multiple vortex structures on quasicrystal lattices can be nonlinearly stable as the saturation and the external lattice may prevent the collapse. These results may have applications to investigations of localized structures in nonlinear optics and Bose-Einstein condensates.",signatures:"İlkay Bakırtaş",downloadPdfUrl:"/chapter/pdf-download/53733",previewPdfUrl:"/chapter/pdf-preview/53733",authors:[{id:"186388",title:"Prof.",name:"İlkay",surname:"Bakırtaş",slug:"ilkay-bakirtas",fullName:"İlkay Bakırtaş"}],corrections:null},{id:"53994",title:"Holographic Optical Elements to Generate Achromatic Vortices with Ultra-Short and Ultra-Intense Laser Pulses",doi:"10.5772/66314",slug:"holographic-optical-elements-to-generate-achromatic-vortices-with-ultra-short-and-ultra-intense-lase",totalDownloads:1480,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"The requirements for the generation of optical vortices with ultra-short and ultra-intense laser pulses are considered. Several optical vortice generation procedures are analysed, specifically those based on diffractive elements, such as computer generated holograms (CGH). Optical vortices achromatization techniques are studied. Volume phase holographic (VPH) elements are considered for highly efficient, broad spectrum, high damage-threshold generation of vortices. VPH compound systems, including a compact one, for achromatic vortex generation are presented. Experimental results of vortice generation with ultra-short and ultra-intense pulses are shown.",signatures:"María-Victoria Collados, Íñigo J. Sola, Julia Marín-Sáez, Warein\nHolgado and Jesús Atencia",downloadPdfUrl:"/chapter/pdf-download/53994",previewPdfUrl:"/chapter/pdf-preview/53994",authors:[{id:"186587",title:"Dr.",name:"Jesús",surname:"Atencia",slug:"jesus-atencia",fullName:"Jesús Atencia"},{id:"186862",title:"Dr.",name:"María Victoria",surname:"Collados",slug:"maria-victoria-collados",fullName:"María Victoria Collados"},{id:"186863",title:"Dr.",name:"Iñigo",surname:"Sola",slug:"inigo-sola",fullName:"Iñigo Sola"},{id:"186864",title:"MSc.",name:"Julia",surname:"Marín-Sáez",slug:"julia-marin-saez",fullName:"Julia Marín-Sáez"},{id:"194462",title:"Dr.",name:"Warein",surname:"Holgado",slug:"warein-holgado",fullName:"Warein Holgado"}],corrections:null},{id:"52478",title:"Ultrashort Extreme Ultraviolet Vortices",doi:"10.5772/64908",slug:"ultrashort-extreme-ultraviolet-vortices",totalDownloads:1774,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Optical vortices are very attractive because they transport a well-defined orbital angular momentum (OAM) associated with the singularity of the beam. These singular beams, commonly generated in the optical regime, are used in a wide range of applications: communication, micromanipulation, microscopy, among others. The production of OAM beams in the extreme ultraviolet (XUV) and X-ray regimes is of great interest as it allows to extend the applications of optical vortices down to the nanometric scale. Several proposals have been explored in order to generate XUV vortices in synchrotrons and FEL facilities. Here, we study the generation of XUV vortices through high-order harmonic generation (HHG). HHG is a unique source of coherent radiation extending from the XUV to the soft X-ray regime, emitted in the form of attosecond pulses. When driving HHG by OAM beams, highly charged XUV vortices with unprecedented spatiotemporal properties are emitted in the form of helical attosecond beams. In this chapter, we revise our theoretical work in the generation of XUV vortices by HHG. In particular, we illustrate in detail the role of macroscopic phase matching of high-order harmonics when driven by OAM beams, which allows to control the production of attosecond beams carrying OAM.",signatures:"Laura Rego, Julio San Román, Luis Plaja, Antonio Picón and Carlos\nHernández-García",downloadPdfUrl:"/chapter/pdf-download/52478",previewPdfUrl:"/chapter/pdf-preview/52478",authors:[{id:"186282",title:"Dr.",name:"Carlos",surname:"Hernandez-Garcia",slug:"carlos-hernandez-garcia",fullName:"Carlos Hernandez-Garcia"},{id:"194247",title:"Ms.",name:"Laura",surname:"Rego",slug:"laura-rego",fullName:"Laura Rego"},{id:"194248",title:"Dr.",name:"Julio",surname:"San Román",slug:"julio-san-roman",fullName:"Julio San Román"},{id:"194249",title:"Dr.",name:"Antonio",surname:"Picón",slug:"antonio-picon",fullName:"Antonio Picón"},{id:"194250",title:"Dr.",name:"Luis",surname:"Plaja",slug:"luis-plaja",fullName:"Luis Plaja"}],corrections:null},{id:"53153",title:"Fractal Light Vortices",doi:"10.5772/66343",slug:"fractal-light-vortices",totalDownloads:1777,totalCrossrefCites:5,totalDimensionsCites:8,hasAltmetrics:0,abstract:"Vortex lenses produce special wavefronts with zero-axial intensity, and helical phase structure. The variations of the phase and amplitude of the vortex produce a circular flow of energy that allows transmitting orbital angular momentum. This property is especially in optical trapping, because due to the orbital angular momentum of light, they have the ability to set the trapped particles into rotation. Vortex lenses engraved in diffractive optical elements have been proposed in the last few years. These lenses can be described mathematically as a two-dimensional (2D) function, which expressed in polar coordinates are the product of two different separable one-dimensional (1D) functions: One, depends only on the square of radial coordinate, and the other one depends linearly on the azimuthal coordinate and includes the topological charge. The 1D function that depends on the radial coordinate is known as a zone plate. Here, vortex lenses, constructed using different aperiodic zone plates, are reviewed. Their optical properties are studied numerically by computing the intensity distribution along the optical axis and the transverse diffraction patterns along the propagation direction. It is shown that these elements are able to create a chain of optical traps with a tunable separation, strength and transverse section.",signatures:"Federico J. Machado, Juan A. Monsoriu and Walter D. Furlan",downloadPdfUrl:"/chapter/pdf-download/53153",previewPdfUrl:"/chapter/pdf-preview/53153",authors:[{id:"186344",title:"Prof.",name:"Walter",surname:"Furlan",slug:"walter-furlan",fullName:"Walter Furlan"}],corrections:null},{id:"53041",title:"Partially Coherent Vortex Beam: From Theory to Experiment",doi:"10.5772/66323",slug:"partially-coherent-vortex-beam-from-theory-to-experiment",totalDownloads:2036,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Partially coherent vortex beam exhibits some unique and interesting properties, for example, correlation singularities (i.e., ring dislocations) exist in its correlation function, and one can determine the magnitude of the topological charge of the vortex phase from the number of the ring dislocations. Modulating the coherence of a vortex beam provides a convenient way for shaping its focused beam spot, which is useful for material processing and optical trapping. Furthermore, a partially coherent vortex beam has an advantage over a partially coherent beam without vortex phase for reducing turbulence‐induced scintillation, which will be useful in free‐space optical communications. We introduce recent theoretical and experimental developments on partially coherent vortex beams.",signatures:"Xianlong Liu, Lin Liu, Yahong Chen and Yangjian Cai",downloadPdfUrl:"/chapter/pdf-download/53041",previewPdfUrl:"/chapter/pdf-preview/53041",authors:[{id:"186341",title:"Prof.",name:"Yangjian",surname:"Cai",slug:"yangjian-cai",fullName:"Yangjian Cai"},{id:"194234",title:"Dr.",name:"Xianlong",surname:"Liu",slug:"xianlong-liu",fullName:"Xianlong Liu"},{id:"194235",title:"Dr.",name:"Lin",surname:"Liu",slug:"lin-liu",fullName:"Lin Liu"},{id:"194236",title:"Dr.",name:"Yahong",surname:"Chen",slug:"yahong-chen",fullName:"Yahong Chen"}],corrections:null},{id:"53151",title:"Vortices and Singularities in Electric Dipole Radiation near an Interface",doi:"10.5772/66459",slug:"vortices-and-singularities-in-electric-dipole-radiation-near-an-interface",totalDownloads:1366,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"An oscillating electric dipole in free space emits its energy along straight lines. We have considered the effect of a nearby interface with a material medium. Interference between the directly emitted radiation and the reflected radiation leads to intricate flow line patterns. When the interface is a plane mirror, numerous interference vortices appear, and when the distance between the dipole and the mirror is not too small, these vortices lie on four strings. At the center of each vortex is a singularity, and these singularities are due to the fact that the magnetic field vanishes at these locations. When the interface is a boundary between dielectric media, reflection leads again to interference. The pattern for the transmitted radiation depends on whether the medium is thicker or thinner than the material in which the dipole is embedded. For thicker dielectrics, the field lines bend toward the normal, reminiscent of, but not the same as, the behavior of optical rays. For thinner media, oscillation of energy across the interface appears, and above a crossing point, there is a tiny vortex. We have also considered the case of a dipole in between two parallel mirrors.",signatures:"Xin Li, Henk F. Arnoldus and Zhangjin Xu",downloadPdfUrl:"/chapter/pdf-download/53151",previewPdfUrl:"/chapter/pdf-preview/53151",authors:[{id:"100987",title:"Dr.",name:"Henk",surname:"Arnoldus",slug:"henk-arnoldus",fullName:"Henk Arnoldus"},{id:"186475",title:"Dr.",name:"Xin",surname:"Li",slug:"xin-li",fullName:"Xin Li"},{id:"187293",title:"Mrs.",name:"Zhangjin",surname:"Xu",slug:"zhangjin-xu",fullName:"Zhangjin Xu"}],corrections:null},{id:"53064",title:"Spin-Wave Dynamics in the Presence of Magnetic Vortices",doi:"10.5772/66099",slug:"spin-wave-dynamics-in-the-presence-of-magnetic-vortices",totalDownloads:1626,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"This chapter describes spin-wave excitations in nanosized dots and rings in the presence of the vortex state. 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The monte Carlo method is a method of the family of algorithmic methods, it makes it possible to solve statistical problems and contribute to the analysis of data based on stochastic processes, thus it allows to evaluate the maturity risk and these probabilities thus the appointment of this method refers to the random side used at the casino of Monte Carlo located in MONACO.
The scope of the Monte Carlo method is very broad and covers all fields of nuclear medicine and particle transport, namely applications in radiotherapy-brachytherapy, scintigraphic imaging, shielding, dosimetry, PET, gamma camera, etc.
This choice of use of this method is not due to chance, but on the one hand because it allows to simulate the behavior of different particles and to deduce the average behavior of all particles according to the law of large numbers and the central limit theorem, so it can handle coupled and 3D problems with complex geometry and it can answer specific questions (average flow in a volume, Absorbed dose, Kerma, Hp(10), etc.), and its major advantages and determining the sources of errors, on the other hand, this method makes it possible to comply with the laws of ALARA (As Low As Reasonably Achievable) radiation protection which are:
Justification of the practice
Limitation of exposure
Optimization of radiation protection
All this through simulation and modeling of the experience by the Monte Carlo method before practicing it in order to be able to determine the limits of the doses absorbed by the staff and the patient, as well as to develop and determine the correction methods to improve the quantification images and results, as well as the design of radiation detection equipment.
Monte Carlo uses software and calculation codes requiring a better knowledge of the input data of the problem (source, energy, angle and distribution, spatial and temporal dependence), and of the geometry which must represent the real situation, as well. The materials constituting the system to be studied, type of calculation envisaged, criteria for stopping the simulation, these parameters are defined and entered by the operator, and the basic nuclear data will be taken directly from data libraries (effective diffusion section, adsorption, fission, etc.).
Among these codes we cite GEANT4, GAMOS, GATE, FLUKA, PENELOPE… generally written in the C ++ language. So, Monte Carlo is a reliable method and offers complete and very close to reality solutions, which cover all the needs in nuclear medicine.
Most visualization techniques exploit radiation, photonic or otherwise, the intensity of which can be measured in total flux, while gamma radiation used in nuclear medicine is exploited at the level of its smallest indivisible component, the “photon”, and to detect this gamma radiation, a scintillation detector is generally used, the sensitive cell of which is a crystal which has the property of producing a small burst of light when it is touched by a photon, a photomultiplier tube associated with this crystal transforms this spark into an electrical pulse whose amplitude is proportional to the energy of the radiation. The total number of photons detected during a given time interval, or count rate, is the measurement of the radioactivity present in the field of the detector. It’s this ability to count the number of individual photons that make medicine nuclear energy provides quantitative results [1].
So, photons (mphoton = 0, qphoton = 0), are electromagnetic radiations characterized by their energy and their origin, they can be produced by the following phenomena:
de-excitation of the nucleus following a modification of its structure;
de-excitation of the electronic procession;
bremsstrahlung production;
dematerialization or positron annihilation
There are two types of photons:
X-rays:
Products during the rearrangements of the electronic procession, usually caused by the collision of electrons on atoms, [10 keV; 100 keV].
Produced by linear accelerators used in radiotherapy external, [6 MeV; 25 MeV].
Ray γ:
Gamma radiation generally accompany α and β decays, their energy ranges from 60 keV at 3 MeV.
Whatever the origin of the photon, its behavior in matter will be identical.
The photons interact directly with the electrons of matter, and then regenerate various effects depending on the disappearance or not of this one, we find the photoelectric effect, creation of pairs which are due to a disappearance of the photon, the coherent and incoherent diffusion due to the non-disappearance of the photon.
The method to generate histories is to query the probability distributions that describe the problem. This concept is called sampling. The method chosen for Sampling these probability distributions depends on the nature of the distribution [2].
Flowchart of photon transport in Monte Carlo.
The analogous simulation of particle transport using the Monte Carlo method allows the particle to be followed in its actual path, and the particle is sampled by following the following steps (Figure 1):
Sampling of the “random distance” collision distance (average free path).
transport of the particle to the point of interaction taking into account the constraints of geometry.
Selection of the collided nucleus (heterogeneous environment).
selection of the type of interaction.
This is the distance the particle traveled before it interacted. Or a particle that will undergo an interaction at a point x, at a distance l in a given volume.
The probability of interaction in dl:
The cumulative function is calculated by:
We draw a random number ε, and we look for L such that:
So,
where
Which nuclide is subject to collision in the case of a mixture environment?
We must just generate a random number ε between 0 and 1 and compare it to the cumulative probabilities (Figures 2 and 3).
Density of probability.
Inversion of the CDF for selection of the collided nucleus.
Example (H2O):
The choice of the interaction type is done in the same way of choosing of the collided nucleus.
with σphotoelecric: cross section of photoelectric effect
σcoh: cross section of coherent scattering effect
σincoh: cross section of incoherent scattering effect
In the case of photoelectric effect, the history of the photon ends, and the program begins with another sample, except if there is emission of a fluorescence X-ray in this case The direction of the emitted photon in the laboratory system is given by.
(θ and Φ, are polar and azimuthal angles, respectively), with the azimuthal angle sampled from,
and the polar angle sampled from,
with θmax = π
When the scattering is incoherent the energy hν’ of the scattered photon is taken as the Compton energy:
where
mec2: the energy equivalence of the electron rest mass (511 keV);
θ: scattering angle.
It is common to neglect sampling coherent scattering angles [3], this may be justified in many situations. However, in diagnostic radiology the neglect of coherent scattering is a poor approximation [4].
Sampling of scattering angles can be done with the rejection method, from the total (incoherent more coherent) scattering cross-section [5], or separately, through method of Klein-Nishina cross-section and the classical Thompson scattering cross-section and corrected for the use of incorrect scattering cross-sections by applying a weight factor to the photon [6], or with and the distribution function techniques.
Ideally, every real particle in a physical problem should be simulated by a fictitious particle in monte Carlo, in fact, to limit the duration of the simulations and improve computational efficiency [7], a monte Carlo particle does not exactly simulate a physical particle but rather represents a number w of particles physical. The number w is the weight, this weight represents the importance that is assigned to a particle. By default, the weight of each particle is 1 and the energy deposited by a particle equals the product of its energy by its weight.
The benefit of giving weight to a particle is to favor certain physical processes over others. It is necessary to simulate more particle with a low weight to decrease the uncertainty, if we have a sample N of σ (uncertainty) and we want to decrease σ to
There are several Monte Carlo calculation codes in the field of nuclear medicine, among these codes there is the famous GEANT4 code which is a very powerful and flexible toolkit, for medical applications, but the use of this code does not is not easy, it requires strong knowledge of C ++ language, and details of GEANT4, Most GEANT4 users are researchers who always want to know what is going on in simulation.
The thing that drove Pedro Acre to develop an easy-to-use framework based on the GEANT4 code, allowing to deal with medical physics problems with minimal knowledge of GEANT4 and no need for C ++, thus it provides all the necessary functionalities. to deal with a subject of medical physics while avoiding complicated coding, it is the GAMOS code (Geant4-Based Architecture for Medicine-Oriented Simulation).
The minimum set necessary to compile a project is to select a geometry, a physics list and a generator, to run N events to do this, the geometry will be written in a (.geom) extension file, the name of the geometry, the choice of the physics list, the generators, and the other functionality will be written in an input file of .in extension, therefore output items will be displayed in a file with an .out extension and errors in a file with the gamos_error.log extension.
Tap on terminal:
mkdir gamos-6.2.0
cd gamos-6.2.0
run: wget http://fismed.ciemat.es/GAMOS/download/GAMOS.6.2.0/download_scripts.sh
run: sh download_scripts.sh
cd scripts
run: sh installGamos.sh home/your home directory/gamos-6.2.0
to make sure that Gamos has been installed correctly, you need to compile the tutorials
to compile the tutorials tape:
cd ∼/gamos-6.0.0/GAMOS.6.0.0
source ∼/gamos-6.2.0/GAMOS.6.2.0/config/confgamos.sh
cd Tutorials
. /runAll
There are 3 ways to describe your geometry:
Using a text file.
Using one of the geometry examples provided by Gamos.
Using C ++.
In this case we will be concerned with the use of a geometry from a text file, the extension of this file must be (.geom), the 1st step is to create a mother volume that will generate all the other volumes, so that the particles do not escape from the mother volume, and to finish the history of the particles that will come out of this volume, then build the other volumes from the following tags:
Materials
Examples
:ISOT Cs137(Name) 55(Z) 137(A) 136,907(atomic mass)
:ELEM Hydrogen(Name) H(Symbol) 1.( Z) 1.0078 (A).
:ELEM Water(Name) 1. (density) 2(Number of components).
Hydrogen 2*1.0078/ (2*1.0078 + 15.999)
Oxygene 1.0078/(2*1.0078 + 15.999)
Geant4 provides a list of predefined materials, whose compositions correspond to the definition of NIST. Among them you can find all the simple elements, you can use these materials when building a volume in GAMOS without needing to redefine them on your geometry file.
The elements can be found in
Materials consisting of a mixture of elements or materials can be found in
Other materials common in medical physics are also predefined in the files
Volume
For more details on List of solid parameters see the manual [8].
Rotation matrix
3 rotation angles around X,Y,Z
6 theta and phi angles of X,Y,Z axis
9 matrix values (XX, XY, XZ, YX, YY, YZ, ZX, ZY, ZZ)
Example
:
:
:
:
There are other features offered by Gamos such as Visibility, Color and transparency, Check overlaps…. For more details return to manual.
The first lines of this file are to appeal to the geometry file using the following commands:
Then, determine one of the lists found on physical Gamos and functions adabpted to your problem, such as:
….
Then, you have to determine your generator by writing the following command.
The generator allows you to choose the type of particle and combine any number of single particles or isotopes decaying into e +, e-, g, as well as choosing which distributions of time, energy, position and direction by the following commands:
For a single source particle:
For an isotope source:
…
There are 3 choices, Constant time, Time changing at constant interval, Decay time:
…
It can be, Constant, BetaDecay, Gaussian, RandomFlat…
/gamos/generator/energyDist SOURCE_NAME GmGenerDistEnergyConstant ENERGY.
/ gamos / generator / energyDist SOURCE_NAME GmGenerDistEnergyBetaDecay.
/ gamos / generator / energyDist SOURCE_NAME GmGenerDistEnergyGaussian MEAN SIGMA.
/ gamos / generator / energyDist SOURCE_NAME GmGenerDistEnergyRandomFlat MIN_ENERGY MAX_ENERGY.
…
It can be, at point, in a Geant4 volume, in a user defined volume, in steps along a line,in square, in a disc, in the voxels of a phantom(materials, structure…)….
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionPoint POS_X POS_Y POS_Z.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionInG4Volumes LV_NAME1 LV_NAME2.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionInUserVolumes POS_X POS_Y POS_Z ANG_X ANG_Y ANG_Z SOLID_TYPE SOLID_DIMENSIONS.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionLineSteps POS_X POS_Y POS_Z DIR_X DIR_Y DIR_Z STEP.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionSquare HALF_WIDTH POS_X POS_Y POS_Z DIR_X DIR_Y DIR_Z.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionDisc RADIUS POS_X POS_Y POS_Z DIR_X DIR_Y DIR_Z.
/gamos/generator/positionDist SOURCE_NAME GmGenerDistPositionPhantomVoxels.
It is also possible to create distributions where several of the four variables, are generated at the same time, so that they are related.
By using this minimum of commands described above we can run an example and also visualize the geometry by VRML, OpenGL and ASCII with this command:
/control/execute PATH_TO_MY_GAMOS_DIRECTORY/examples/visVRML2FILE.in
The main way to extract information of what is happening and modify the running conditions is
/gamos/userAction MyUserAction
This user action feature allows you to add filters, and classifier in order to follow and focus on the particles as well as the processes you are interested in with this command:
For filters
/gamos/filter FILTER_NAME FILTER_CLASS PARAMETER_1 PARAMETER_2
For classifiers
/gamos/userAction USER_ACTION CLASSIFIER_NAME
/gamos/scoring/assignClassifier2Scorer CLASSIFIER_NAME SCORER_NAME
Next step consiste of attaching a sensitive detector to a volume, which used to creating hits (deposits of energy) each time a track traverses a sensitive volume and loses some energy.
Finally you can creat a score to calculate many quantities with or without error, in one or several volumes, for each scored quantity one of several filters can be used, only particles in a given volumen, and results can be displayed in a file or as a histogram.
To strengthen radiation protection, nuclear activities must be carried out in accordance with the fundamental principles to ensure the protection of man and the environment against the harmful effects of exposure to ionizing radiation, and since we are talking about medical nuclear medicine, The use of ionizing radiation for medical purposes contributes significantly to the exposure of the population. After natural exposure, this practice presents the first source of exposure of artificial origin, it is therefore recommended to control the doses, and to minimize the time, it is suggested to simulate the experiment before the practice.
We will be interested in the photon, in a midst, the fluence of photons decreases exponentially with the thickness of the material crossed. So, we have:
As the Kerma is at any point proportional to the fluence of photons:
For against, the absorbed dose is proportional to the photon fluence that when the electronic equilibruim is achieved in the material medium. In this case:
Therefore the dose rate decreases exponentially with the thickness of the material traversed, so to protect ourselves from external exposure we must move far from the source and protect ourselves with shielding, where the role of simulation comes in determining the thickness necessary to attenuate these photons.
The attenuation study of a parallel beam of photons of diffetent energy which moves away from a distance of 1 m from the plate of material with Gamos is made by this user action: /gamos/userAction SHNthValueLayerUA, and we must stopped secondary particle, so that they will not be counted as particles coming out of the shield layers by this command /gamos/userAction GmKillAtStackingActionUA GmSecondaryFilter. This commands, allows us to studying penetration, and to establish the role of the shielding.
Attenuation of E = 150 Kev photons by Pb.
Attenuation of E = 150 Kev photons by Cu.
Attenuation of E = 511 Kev photons by Pb.
Attenuation of E = 511 Kev photons by Cu.
Attenuation of E = 2Mev photons by Pb.
Attenuation of E = 2Mev photons by Cu.
From the curves we can see that the element suitable for attenuating and absorbing photons is lead (you can try other materials than Cu), because it is less expensive, and it allows to have an optimal thickness compared to other materials, as well as for the facility of its control of the parameters of aquatic chemistry.
We can also Make an histogram of the energy spectrum of photons of energy 1 Mev and other types of particles that traverse the plate by using Gamos filters, and classifiers, with
Energy spectrum of photons that traverse the plate.
Energy spectrum of electron.
Number and type of processes that occur when a number N = 10 4of photons passes through the material.
Geometry realized by GAMOS. Three-dimensional (3D) acquisition with block description, and 18F source.
So we can remove the number of interactions that occur along the path of the particle in the material with this command
Shielding calculations made by hand are often approximations, the most accurate are those performed by simulation, The thickness of the shielding needed depends on: Radiation Energy, the shield material, and Radiation intensity, So the lower the energy of the gamma rays, the easier it is to shield of them, and high energy gamma rays sometimes determine shielding requirements.
For gamma rays, the higher the atomic number of the shield material, the greater the attenuation of the radiation.
PET imaging combined with CT scanning allows two examinations to be performed simultaneously: the PET examination studies the biological activity of organs, while the CT examination studies the anatomy and morphology of organs. The objective of this examination is to detect anomalous organic activities, by injecting the patient with low-level radioactive glucose, the radiation dose is very low, and does not represent a risk for the patient and his entourage. The injected product is a weakly radioactive marker (derived from glucose marked by Fluorine 18), which will be fixed on the organs, with a preference for the organs that work more, the radioactive marker to highlight the biological activity. This examination is performed on a hybrid machine consisting of two devices:
PET scanner that records the radiation emissions of the injected product.
X-ray CT which allows to obtain anatomical images
Quantitative reconstruction of PET (Positron emission tomography) data with GAMOS (Monte Carlo) needs to have knowledge of the scanner geometry (Figure 13). Both typical clinical and preclinical scanners use a block-type geometry. Many rectangular blocks of crystals are arrayed in regular polygons. Some of these polygons are arranged along the axis of the scanner, and Monte Carlo simulation remains an essential tool to help design new medical imaging devices, and to know what is happening in the simulation.
With this user action we can obtain information about the physics process that occur in a PET scanner with all particle:
We will obtain results about track (Figure 14) and procces that occur for each particle in terminal and we can save them in file, for example
Information about track of the job in interactive running.
Final position X ,Y,Z obtain with GAMOS.
So we have 901 total number of events:
55.66% of ‘original’ gammas reaching one sensitive detector,
94.21% with photoelectric interaction in SD,
37.67%with photoelectric interaction and no Compton interactions,
38,51, with photoelectric interaction and one Compton interaction,
16.29% with photoelectric interaction and two Compton interaction,
6.7% with photoelectric interaction and more than two Compton interaction,
31,03% with no photoelectric interaction and no Compton interaction.
Also we can get more details from the histrograms for examples:
Figures 16–20 show the different parameters and details after reaction generated by Gamos based on random number generator (Section 2.2.4).
Accumulated Energy deposit.
Accumulated energy lost.
Accumulated energy lost.
Information about interaction of gammas in the sensitive detector.
Informations about Compton effect.
To conclude, Monte Carlo simulation facilitates the experiment and minimizes the time to process the phenomena, so we can go as far as studying the treatment using proton therapy because if we use a cancer treatment with photons, there will be the maximum amount of X-rays, so there will be a maximum dose delivered to the area to be treated (tumor volume), but also there will be a certain level of dose around this volume which are the organs at risk, and which are the tissues that should not be irradiated and which are, so the great advantage of protons is to have a delicate dose, almost zero once the target is reached, because the protons deposit their energy locally, so they generate less complication, and allows to decrease the risk of having a radiation-induced carcinogenesis. Proton therapy has an extremely important indication, which makes it possible to prevent proton therapy, and the Monte Carlo method remains a very powerful tool that makes it possible to improve research in this field by going as far as microdosimetry.
Stroke is an insult to the brain tissue caused by a sudden interruption to the blood supply to the brain [1]. Sacco et al. gave an elaborate definition of stroke as a neurological deficit attributed to an acute focal injury of the central nervous system (CNS) by a vascular cause, including cerebral infarction, intra-cerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH) [2]. Stroke is highly prevalent and a second major cause of death and disability worldwide [2, 3, 4]. Stroke is a leading cause of dementia and depression. It can be classified on the basis of its aetiology as either ischaemic (87%) or haemorrhagic (13%) [5]. Ischaemic stroke results from occlusion of a cerebral artery which can be thrombotic or atherosclerotic (50%), embolic (25%) and micro-artery occlusion (lacunar stroke or infarcts) (25%) [5]. Haemorrhagic stroke is caused mainly by spontaneous rupture of blood vessels or aneurysms or secondary to trauma [5]. Early definitions of stroke and transient ischemic attack (TIA) focused on the duration of symptoms and signs. However, Sacco et al. [2], noted that use of clinical observations and modern brain imaging showed that the duration and reversibility of brain ischemia is variable. Brain tissue that is deprived of needed nutrients can, in some patients, survive without permanent injury for a considerable period of time, that is, several hours or even, rarely, days, while in most other individuals, irreversible damage (infarction) occurs quickly [2].
There has been a rise in the prevalence of stroke related disability in many countries [6]. A rise in the incidence of stroke in Zimbabwe from 31/100,000 to 57/100,000 in a decade was reported with fatality rates ranging from 22 to 58% at one month following stroke reported in Zimbabwe and other African studies [7].
The risk factors for stroke are generally similar to those for coronary heart diseases and other vascular diseases [4]. High blood pressure is one of the leading primary and secondary modifiable risk factors [5]. The other risk factors for stroke include smoking, low physical activity levels, unhealthy diet, abdominal obesity, diabetes and excessive consumption of alcohol [4]. Effective prevention strategies should include targeting the key modifiable risk factors such as hypertension, elevated lipids and diabetes.
Clinical manifestations of each stroke differ based on the part and side of the brain affected, extent of the lesion and the person’s general health. Some of the effects of stroke include numbness, weakness or paralysis on one side of the body opposite the side of the brain affected, slurred speech, difficulty thinking of words or understanding other people, confusion, sudden blurred vision or sight loss, being unsteady on your feet and severe headache [8]. Concerning the stroke warning signs, numbness on one side was surprisingly identified as the commonest warning (44%) while unspecified pain was the least cited (11%) in one of the studies [9]. Stroke can also result in psychological problems such as depression, anxiety, feeling helpless and thoughts of death or suicide, trouble sleeping and feelings of worthlessness [10]. In general, a right cerebrovascular accident may result in left hemiplegia or hemiparesis, difficulties with visuo-spatial memory, neglect of the left side of the body, poor judgement, and impulsivity, while a left cerebrovascular accident may cause right hemiplegia or hemiparesis, apraxia, and aphasia due to the location of the Broccas’ and Wernicke’s areas [11].
Stroke was associated with 43.7 million disability-adjusted life years annually around the world [5]. It is one of the most common neurological diseases in the black African and the leading cause of adult neurological admissions in West African sub-region, constituting up to 65% of such admissions [9]. Globally, 70% of strokes and 87% of both stroke-related deaths and disability-adjusted life years occur in low- and middle-income countries [4]. Approximately 60% of stroke patients acquire permanent disabilities and experience limitations in terms of mobility, vision, voice, speech, swallowing (dysphagia) and sexual function globally [4]. Stroke can cause multiple impairments which might need a variety of rehabilitation interventions [12]. Motor impairment is the most common deficit after stroke and the motor deficits increase fall risks and fall-related injuries. This in turn significantly affects the patients’ mobility, participation in their activities of daily living, social events and other occupational performance areas [13].
Stroke is a leading cause of functional impairments; with 20% of survivors requiring institutional care after three months and 15–30% being permanently disabled [14]. Many stroke patients experience activity limitation, restricted social participation, and psychological issues such as anxiety and depression some years after having stroke [15]. Approximately 65% of stroke patients are dependent on others to help them with everyday activities and the quality of life 2–5 years after stroke has been reported by many stroke survivors as poor [15].
Several researchers have studied the stroke survivor’s physical, social, psychological and emotional needs [16, 17, 18, 19]. Although most stroke patients receive rehabilitation, the lifelong need for care of stroke patients with disabilities has not been fully explored [17]. Despite calls for comprehensive stroke services to address long-term needs of patients, there had been little investigation of the perceived needs of stroke survivors in the long term or what determines such needs [20]. This area lacked a systematic approach to problem identification, had a poor evidence base, and was not underpinned by sound theoretical concepts hence there was need for further research in the area [15]. Similarly, needs of caregivers for stroke patients need further exploration.
Stroke Rehabilitation is a progressive, dynamic and goal-orientated process aimed at enabling a person with impairment as a result of stroke to reach their optimal physical, cognitive, emotional, communicative, social and functional activity level [21]. Stroke rehabilitation begins in the acute care hospital after the person’s overall condition has been stabilised, often within 24–48 hours after the stroke [22]. Stroke rehabilitation plays a vital role in lessening the effects of impairments and activity limitations, and in facilitating the return to active participation in community life and economic self-sufficiency after the stroke [12]. Internationally recognised best practice in the early management and rehabilitation of individuals following stroke includes collaborative and multidisciplinary assessment and treatment by a coordinated team of health care professionals [23]. A collaborative approach improves quality of life in stroke patients [12].
In the first weeks and months of recovery, the goals of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life [21]. Although rehabilitation may not reverse the brain damage, it can substantially help people achieve the best possible long-term outcomes [22] through various ways that include facilitation of neuroplasticity of the brain. Rehabilitation is especially crucial during the early stages of recovery to regain independence when patients have little or no control over their affected muscles [22].
As part of stroke rehabilitation, occupational therapy (OT) involves the use of activities or training to improve or maintain the ability to live independently and cope with daily life for people with stroke [16]. The philosophy of occupational therapy is based on the concept that all humans have a need to become engaged in occupations [24], and that need is present even after stroke. Therefore, the role of the occupational therapist is to facilitate the patient’s continued participation in meaningful and purposeful daily activities and adaptation to the patient’s changed status. These occupations (all goal-directed engagement in self-care, work or leisure activities) can be termed as activities and participation areas in the International Classification of Functioning, Disability and Health (ICF) terminology [25]. According to the ICF framework, stroke results in activity limitation and participation restriction [26]. The ICF is a globally agreed framework and classification to define the spectrum of problems in the functioning of patients [27]. The ICF was also shown to be an essential tool for identifying and measuring efficacy and effectiveness of rehabilitation services [28]. Using the ICF takes a biopsychosocial approach which addresses the quality of life gap which is often left in favour of quantity of life.
Occupational Therapy in general, focuses on the assessment and treatment of individuals who are limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, or the ageing process through the use of purposeful activity and adaptive equipment and technology in order to maximise independence, prevent disability and maintain health [29]. Occupational therapists play a crucial role in the rehabilitation of stroke patients as they are experts at training patients to relearn complex bodily movements and avoid complications that could derail their progress later [30]. Occupational therapy is concerned with promoting health and wellbeing through participation in activities of everyday life and this is done by modifying the occupations and the environment in a therapeutic way to better support participation [23]. Occupational therapists also employ neurophysiologically based handling techniques meant to facilitate neuroplasticity of the brain. In some instances, occupational therapists can teach compensatory strategies when the old ways of functioning are no longer possible [30]. Therefore, occupational therapy for stroke includes interventions for physical, social, psychological and cognitive impairments [30]. The role of occupational therapists in stroke rehabilitation is particularly important because they focus on functional outcomes and getting clients back to doing everyday activities [11] which is usually unique to the profession. It is important that the interventions suit a patient’s needs [30].
The period of receiving services in stroke rehabilitation depends on the severity of disability and specific needs of the stroke survivor, although it has been proved that a great deal of stroke recovery occur within the first six months to a year following the onset of the stroke [31]. Occupational therapists work collaboratively with the patient to establish the impact of stroke on their performance of daily tasks, including personal care, domestic tasks, work and leisure activities; and in formulating a goal-focused program to develop the required skills for participation in daily life [23]. Given the variability in stroke complications, occupational therapists need to have a wide repertoire of techniques to help each client [11]. The treatment techniques in occupational therapy may include using occupational tasks to help improve cognitive abilities, teaching adaptations to meaningful activities to keep the client involved, and using task-specific movement to help with range of motion and motor control [11]. The occupational therapist can provide a patient with an assistive device or adjustments and adaptations in the environment, for example, in a patient’s home. This enables the patient to perform his/her ADLs independently and also dealing with other emotional or social issues that may result from stroke [30].
The occupational therapy process for stroke patients begins with an assessment of the patient’s roles, tasks and activities that are important for the patient [30]. An assessment is conducted to understand the impact of changes in motor function, sensation, coordination, visual perception, and cognition on the stroke patients and on the capacity to manage daily life tasks [23]. Assessment is also used to identify areas of individual and environmental difficulties and to enable patient-centred goal setting with the participation of both the patient and the caregiver [23]. The occupational therapist will then assess the ability to perform the roles, tasks and activities and if a limitation or restriction in some area is found, the occupational therapist will identify the performance components and craft the solution or intervention meant to restore, improve or maintain patient’s maximum level of performance [30]. Some of the performance components may include neuromuscular, cognitive and perceptual, language and psychosocial problems.
The occupational therapy interventions should therefore be able to address the patient’s needs and be provided in both the acute and rehabilitation phases [30]. For some stroke survivors, rehabilitation will be an on-going process to maintain and refine skills and could involve working with occupational therapists and other specialists in that field for months or even years after the stroke [22].
In order to adequately address challenges stroke patients face, there is need to identify the activities and areas of participation they consider important. This section is therefore based on a study done in Zimbabwe which sought to find out the activities and areas of participation considered important by stroke patients, the level of difficulty experienced in carrying out these activities and the reasons for attaching importance to these areas [32]. The study was cross sectional descriptive in nature and was done with 40 stroke patients consecutively selected as they came for their reviews at an outpatient stroke clinic at a central hospital in Zimbabwe [33] . An interview questionnaire adapted from the ICF checklist version 2.1a clinician form was administered by the researchers with consent after ethical approval (JREC….). Excluded were patients with significant cognitive and language impairments as it would have been difficult to communicate with them. In the study, 25 were female and 15 were male. Participants’ ages ranged from 34 to 81 years with the 50–59 years age group being the mode. These demographic characteristics are consistent with a study done by Mlambo et al. [34], which was done in South Africa and the participants’ ages ranged from 32 to 81 with a mean age of 52 years. The activities and areas of participation assessed during the study were obtained from the domains in the ICF checklist as alluded to earlier.
Half of the patients reported severe difficulty in lifting and carrying objects, while 43 and 38% of participants experienced complete and severe difficulties in fine hand use respectively [32]. About 20% had flexion contractures of the elbow and wrist joints of the affected side. These difficulties were due to the condition (stroke) which causes disturbances in muscle tone and loss of selective and isolated movements in the hand and arm [35] and this hinders execution of functional movements [36]. Thirty three percent of the participants had moderate difficulty in walking and used mobility aids while 20% had complete difficulty [32]. Half of the participants reported experiencing complete difficulty in using transportation like cars or buses. On driving, only 18 participants were drivers and 78% of them reported complete difficulty in the area [32].
On importance attached to these domains, all participants considered fine hand use and walking important, while 98% considered being able to use transportation important [32]. However, it was noted that none of the participants who were drivers had driving addressed by their therapist. Driving rehabilitation is an area that has not been fully explored by OTs in Zimbabwe. Driving is an important ADL and many stroke patients who were driving prior to their stroke wished to resume driving as noted by Kneebone and Lincoln [37]. A study by Duncan et al. [38] found that hand function and mobility were some of the key areas considered important by stroke patients.
Half of the participants in the study reported severe difficulties in dressing, 33% had moderate to severe difficulties in grooming while 65% had severe difficulty in bathing themselves [32]. About 73% had no difficulty in feeding and this can be explained by the exclusion of patients with speech and cognitive problems in the study. Speech and cognitive problems are often associated with feeding problems. Thirty three percent did not experience any difficulties in toileting while the remainder had mild to severe difficulties and used sanitary wear or were catheterised [32].
All aspects of self-care were considered as very important by all participants as they viewed these activities crucial for human survival [32]. This was also noted in a study by Aberg et al. [39] where the participants valued their independence in self-care activities.
In Chimusoro’s study [32], 78 and 75% of participants had complete difficulties in acquisition of goods and services, and preparing meals respectively. About half of the participants considered being able to prepare meals important, while 32% consisting mainly of male participants and elderly female participants did not view it as important since they had their meals prepared for them by caregivers. On doing housework, all male participants considered it as not applicable to them. This is common in the Zimbabwean and most African cultures where most if not all men, do not consider household chores as part of their ADLs. Therefore it would be irrelevant to engage a male patient in therapy sessions focusing on retraining household chores unless found necessary during the assessment process. The same notion applied to the elderly female patients who had long stopped doing those chores before suffering a stroke. These duties were done for them by children, grandchildren and/or caregivers [32]. This is where the aspect of interdependence is seen in the African culture. The elderly in Africa usually end up living with their children and grandchildren as compared to the Western culture where the elderly can be living alone and independence in home maintenance tasks becomes an important aspect of their lives.
All the participants did not have any difficulties in basic interpersonal interactions, formal and informal interactions [32]. Participants considered these areas important. However, 10 and 4% had mild and moderate difficulties in intimate relationships respectively. They attributed their problems in sexual function to their condition and felt it hindered maximum enjoyment of intimate relationships. They viewed their intimate relationships as important but were reluctant to share this with their therapist since they were not aware that the issue could be addressed in occupational therapy. Resumption of sexual activity for stroke patients is very important as cited by Edmans, although they may fail to articulate this to the therapist [40].
In this domain remunerative employment was not applicable to half of the participants as some were retired and some did not work prior to suffering the stroke. For the remaining half they reported complete difficulty and had not yet returned to their previous jobs. This is consistent with the findings by D’Alisa et al. [41] in which 40% had severe restrictions in employment issues. About 95% of patients to whom employment was applicable considered it as very important [41].
About 33% had moderate difficulties in economic self-sufficiency as they had financial problems due to their unemployment status. All the participants considered being self-sufficient important. In D’Alisa et al. [41], 15% had moderate to severe restrictions in economic self-sufficiency. This difference may be due to lack of a national social security system that cushions persons with disabilities in Zimbabwe as compared to more developed countries.
All participants considered it important to be reintegrated into the community. About 85% did not report any difficulty in participating in religious and spiritual activities and 95% considered them very important [32].
Fifty eight percent considered recreational activities as important. These recreational activities were mainly visiting friends and relatives, watching television, reading or listening to the radio [32]. There is a stark contrast in the type of recreational activities cited by the Zimbabwean sample as compared to other studies where participants reported restrictions in activities like golf, bowling, tennis and attending social clubs. The differences in the recreational activities can be explained by the differences in the socio-economic statuses of the samples. The culture of participating in recreational activities for leisure purposes need to be reinforced and further explored especially in low income groups where people mostly engage in productive activities whether paid or unpaid than they do in recreational activities.
Out of the 40 participants, 53% wanted to return to their work. They considered it very important because some were breadwinners and wanted to be able to look after their families [32]. In a study in Singapore by Kong and Yang [42], 14 out of 54 participants continued to be gainfully employed [42]. Of these 14, 11 were able to go back to previous jobs while 3 had to change jobs due to their physical limitations [42].
Thirty four percent wanted to be able to do their instrumental ADLs again [32]. These were mainly female participants who valued being able to look after their children and homes. Only 10% did not wish to return to any activity in particular and these were mainly elderly patients who had not been engaging in any activities that they considered important enough to return to [32]. In such cases, it would be necessary for the therapist to try to look for areas of interest for the patient so as to build a passion for doing activities that are meaningful to them and can also be used during therapy.
In summary, these findings give insight into the areas stroke patients consider important in the Zimbabwean context. They are consistent with other studies, for example, one study by Sumathipala [20], where stroke patients considered ADLs, social participation, mobility aids, home adaptations, housing and financial support as important [20].
The ICF is an important framework in guiding management of stroke patients as it can be used to assess and address all aspects of a person’s life without just focusing on his/her diagnosis [43]. Occupational therapy has an important role of facilitating a patient’s optimal functioning and independence through participation in meaningful and purposeful daily activities. The strength of occupational therapy lies in the ability to analyse activities/occupations. The occupations in which a person engages and the amount of time one spends doing the occupations is very specific to the circumstances and the culture in which a person lives [44]. Therefore, the effectiveness of occupational therapy and the quality of care can improve when culturally relevant occupations are selected and interventions are important to a person with stroke.
This section is based on a cross sectional pilot study done in Harare, Zimbabwe in 2020 with 35 stroke patients attending rehabilitation [45]. Mean age of participants was 58 years (S.D 8.8) and the greater proportion were female (
About 49% were employed [45], consistent with another study done on stroke survivors in Zimbabwe where less than half were working and the rest had no source of income [46]. Left cerebral Vascular Accidents accounted for 74.3% of the strokes. Study participants had a median duration with stroke diagnosis of 104 days (inter-quartile range 44–270). This is mainly the situation in Zimbabwe where most of the patients who come for rehabilitation have stroke duration of less than two years. Those who had stroke for more than two years will have inadequate funds to continue treatment, hence will not come for rehabilitation services.
The needs of participants were grouped into physical, instrumental, social, informational and emotional needs. Highlighted in Table 1 are the needs according to the groupings and it consists of 28 statements to which participants were expected to answer “yes” or “no” on whether they consider it a need.
Item | Need | Considered as a need by stroke patients | |
---|---|---|---|
Yes | No | ||
1 | To ease my pain, since nothing seems to ease it. | 35 (100%) | 0 |
2 | Help on walking and general moving | 35 (100%) | 0 |
3 | Help on how to get job done in my home (ADLs) such as cleaning, cooking, ironing and laundry | 35 (100%) | 0 |
4 | Help on how to do things like cutting my toenails, washing myself | 35 (100%) | 0 |
5 | Help on how to deal with fatigue | 35 (100%) | 0 |
6 | Learning about exercise | 35 (100%) | 0 |
7 | Help on how to bath independently | 35 (100%) | 0 |
8 | Help on dealing with bladder/ bowel problems (accidents, constipation, diarrhoea) | 32 (91.43%) | 3 (8.57%) |
9 | Help on how to prevent pressure sores | 30 (85.71) | 5 (14.29%) |
10 | Help on sight problems. | 29 (82.86%) | 6 (17.14%) |
11 | Help on getting back to driving | 19 (54.29%) | 16 (45.71%) |
12 | Help on swallowing problems. | 14 (40%) | 21 (60%) |
13 | Help on speech and communication problems | 12 (34.29%) | 23 (65.71%) |
14 | Help on hearing problems. | 4 (11.43%) | 31 (88.57%) |
15 | Additional aids or adaptations (kitchen appliances, stair lift, grab rails) if other please specify | 35 (100%) | 0 |
16 | Adaptations outside the home (e.g., ramps, rail) if other please specify | 33 (94.29%) | 2 (5.71%) |
17 | Help on how to occupy my day better (e.g., social outings, hobbies, leisure activities) | 35 (100%) | 0 |
18 | Help and advocacy in accessing social services | 34 (97.14%) | 1 (2.86%) |
19 | Help on how to travel using public transport such as buses and commuter omnibuses | 32 (91.43%) | 3 (8.57%) |
20 | More information about my stroke (e.g., what is stroke, why has it happened to me, how to avoid having another one) | 35 (100%) | 0 |
21 | Advice on how to improve my diet | 35 (100%) | 0 |
22 | Advice on how to manage my money better. | 33 (94.29%) | (5.71%) |
23 | Help on how to do shopping. | 32 (91.43%) | 3 (8.57%) |
24 | Advice on employment after stroke | 25 (71.43%) | 10 (28.57%) |
25 | Help and information on how to manage my physical relationship with my partner | 13 (37.14%) | 22 (62.86%) |
26 | Help on improving self-esteem, anger issues and other emotional issues If other please specify | 35 (100%) | 0 |
27 | Help on improving my memory and concentration. | 33 (94.29%) | 2 (5.71%) |
28 | Help on how to deal with emotional and behavioural changes | 34 (97.06%) | 1 (2.94%) |
Distribution of participants according to need (
Fourteen statements related to physical needs. All the participants in the study considered pain management, walking and general mobility, performing basic and instrumental activities of daily living (ADLs), engaging in recreational activities, dealing with fatigue and exercising as their physical needs post stroke [45]. Specific self-care needs cited were independent bathing and cutting toenails. Only 40% and about 11% cited swallowing and hearing problems respectively. Thus physical needs were the most common needs of stroke patients. This is because stroke mainly affects the physical components resulting in pain, reduced mobility, poor muscle strength, reduced speech and communication, problems with swallowing and incontinence and many other deficits which might results in decreased functioning and inability to cope [12]. In a similar study done in Australia, patients mostly over the age of 65 years needed assistance with performing ADLs, such as self-care [15], and this shows that this is a major need among all stroke patients regardless of location.
Sight problems, prevention of pressure sores and dealing with bladder and bowel problems were cited by more than 80% of participants as needs indicating that they are also common needs in this group.
These two aspects had a combined five needs (Table 1). There were two items on instrumental needs, and all participants indicated the need for additional aids or adaptations in the house while 94% cited need for adaptations outside the home. Under social needs, there were three items and about 97 and 91% respectively indicated the need for help and advocacy in accessing social services and using public transport. All participants needed help on how to engage in social outings, hobbies and leisure activities. Stroke survivors in this study faced societal barriers that can affect engagement in activities of daily living namely problems in using public transportation, lack of adaptations inside and outside the home environment as well as lack of aids and appliances to facilitate independence. Due to the economic situation in Zimbabwe, most places are not specifically adapted for people with disabilities to engage fully in social and daily activities, for example, inadequate provision of rails and ramps in public buildings for those who have problems with mobility [47]. Assistive devices like wheelchairs and modifications to the home environment are not available to the survivor soon after discharge to promote maximum participation [48], hence participants citing them as needs they require occupational therapists to meet. In Zimbabwe, wheelchair service provision and services are fragmented and poorly integrated [49]. The use of mobility devices such as wheelchairs, crutches and canes improves mobility, health and quality of life, and it enables those with mobility issues to mobilise without any restrictions [48]. Another study showed that stroke survivors had more participation restrictions as a result of environmental barriers [50]. Physical/structural and services/assistance were considered the dominant barriers to participation in activities of daily life for stroke survivors in China, hence there were considered to be among the most common needs presented by stroke survivors [51]. In another study on “Identification of rehabilitation needs after a stroke”, some of the most expressed needs of the participants were needs relating to adapted means of transportation and home visits from healthcare personnel [52]. Home visits might also help in noting any home adaptations that need to be done [53]. Social support should be provided to stroke survivors, including barrier-free facilities and occupational therapists should advocate for those services in the community.
Six items related to informational needs. All the participants needed information on their condition (stroke) and advice on diet. Over 90% needed advice on or help on better money management and shopping. Twenty-five participants needed advice on employment after stroke. The least cited as informational need had to do with managing physical relationships with partner/spouse (about 37%) (Table 1). The need to give more information about the condition is consistent with findings by Williams et al., where only 38% professed to know stroke warning signs and only 25% correctly interpreted their symptoms [54]. Similarly, Mckevitt, et al., reported more than half of their participants wanting more information about their stroke (cause, prevention of recurrence) [55]. This shows that this is a major concern among most stroke patients regardless of the part of the world they live, hence the need for occupational therapy intervention. Knowledge about the condition will also help them to adhere to the home programs they will be given and to seek for early treatment before any complications or permanent disability arises. With more knowledge about stroke, they could identify the disease immediately, resulting in a decrease in the time from symptom onset to hospital arrival, and a subsequent increase in the number of patients who may receive appropriate interventions [56]. It might also help them to know how to prevent any future recurrence of the condition and the services that might be beneficial to them in order to minimise any complications that may arise as a result of the condition.
Three items related to emotional needs. All items were cited as needs by more than 94% (improving memory and concentration (94.29%), self-esteem, anger and other emotional issues (100%) plus dealing with the emotional and behavioural changes (97.06%) (Table 1). This high proportion of more than 90% of the participants having emotional needs after stroke is probably because stroke affects the person’s ability to engage in daily living activities, communicate well with others and that can lead to increased dependence, feelings of low self-worth, (e.g., if the patient is incontinent) resulting in many psychological and emotional issues like depression [57]. The findings in this Zimbabwean study are consistent with a study on “Self-Reported Long-Term Needs After Stroke” where over one third of respondents reported experiencing emotional problems (including depression, crying) after the stroke [55]. Since emotional and psychological needs are liable to be neglected, post-stroke depression is a common complication which seriously impairs quality of life [18]. Therefore, psychological expertise and psychological support is needed by stoke survivors [18].
The majority of the participants in the Zimbabwean study perceived most of the needs in all categories as important and requiring intervention [45]. Physical needs rated as very important in this study were independent mobility and dealing with bladder and bowel incontinence. These aspects enable participants to be independent and to perform daily activities without restrictions. Participants also perceived informational needs as important [45]. Information on dietary issues is important among stroke patients as this might enhance recovery and help in minimising the intake of unhealthy foods such as saturated fats and too much sodium chloride which might even increase the risk of having a recurrent stroke [58]. Knowledge about one’s condition will conscientise them on the importance of receiving rehabilitation and adhering to one’s treatment and medications. The knowledge can also minimise complications and prevent future recurrence of the condition, hence this information is important among stroke patients [59]. Furthermore, knowledge and information about the condition is important since there is often confusion and a lack of information about surviving after a stroke, prevention of subsequent strokes, treatment, services, benefits and adaptions to property [60, 61]. Stroke survivors had to adapt to changes in their bodies as a result of stroke and adjust their expectations, including roles within the home and community [60]. This was particularly so for those of working age and hence the importance of knowledge on the condition.
In one study, stroke survivors experienced a lack of information about what had happened to them and did not realise they had had a stroke [62]. Relevant information is required at different times after a stroke, for example, information about benefits and services most needed after discharge from hospital [61]. Some survivors and carers are unsure which profession offers which service, and there can be role confusion related to an Occupational Therapist, a Physiotherapist, a Home Carer and a social worker, hence this information is also important among stroke patients who should know which services can address their specific needs [60].
The majority of the patients in the Zimbabwean study indicated that adaptations in the home environment were important [45]. Without these, stroke survivors are restricted in performing their daily activities and social roles resulting in increased dependency [63]. Without assistive technology, stroke survivors and other people with disabilities are often excluded, isolated and locked into poverty, resulting in increased burden of morbidity and disability [63]. This is similar to a study done to identify the long-term needs of stroke survivors using the ICF where the participants reported that home adaptations (such as stair or grab rails) provided after discharge from hospital enabled them to adapt to their physical disabilities by facilitating independence in walking, climbing stairs and ADLs [20]. Stroke patients saw this as important since these factors might create a significant barrier to their physical functioning and independence.
Pfavai [45] also revealed that emotional issues such as dealing with depression and behavioural changes were rated as important by more than 80% of the participants. Most of these are not easily seen unlike physical needs hence their importance might be overlooked by occupational therapists. These issues might affect recovery and engagement in daily occupations hence they were perceived as important by the participants. Emotional problems such as depression might also be fatal, in worst cases leading to suicide and general increased mortality, hence their importance must not be overlooked [64]. A sudden attack and poor prognosis had an appreciable effect on the psychological and emotional wellbeing of stroke survivors [18], hence they are important and should be addressed. Interventions usually focus on treating the disease, rather than the emotional needs of the patients. These emotional and psychological needs are liable to be neglected and post-stroke depression is a common complication which seriously impairs quality of life [18; 63].
Participants in Zimbabwe also perceived the need to engage in recreational pursuits as important in their lives [45]. This is one of the areas which are mostly neglected during intervention by occupational therapists. However, engaging in leisure and recreational activities is of importance since it improves physical health, enhances mental wellness, social interaction with others and it enables the stroke survivors to engage in activities which are meaningful in their lives [65]. In a study done on coping with the challenges of recovering from stroke, participants reported the importance of recreational activities and the great distress which was associated with the loss of hobbies and activities that had previously been a source of pleasure and achievement [62]. This is also in line with Rhoda et al., [66] where the participants highlighted the importance of engaging in recreational activities. Participants experienced social isolation, restriction to their homes which they felt could result in sadness and depression due to inability to engage in those activities which were normally found interesting before [66]. However, these activities should be client centred so that their benefits to each individual can be realised.
Access to public transport which is conducive and specifically adapted for people with disabilities was perceived as important by participants in Pfavai study [45]. This is important since lack of suitable transport results in participation restriction in activities such as religious activities, shopping and other social gatherings participants might want to engage in [47]. In a study done in China, physical/structural and services/assistance which include inaccessible public transport for those with disabilities were considered the dominant barriers to participation in activities of daily life for stroke survivors in China hence these needs are important and should be addressed [18]. Social support should be provided to stroke survivors, including barrier-free facilities [47]. Furthermore, the social security system for stroke survivors and other disabling conditions needs to be improved in low-income and middle-income countries.
Findings from Pfavai study [45] indicated that most of the needs of stroke patients were not being fully met including those needs participants rated as very important. Perceived unmet needs may reflect expectations and knowledge but may also indicate where service provision should be developed [55]. The needs which were mostly being fulfilled were physical needs such as pain management, exercises to facilitate walking and mobility in general, and self-care including independent bathing [45]. This is because these needs can be easily identified and their physical limitations can be easily noted compared to other needs such as emotional, informational and societal. The later ones are therefore less likely to be addressed. These findings are consistent with McKevitt
The emotional needs highlighted included how to deal with depression, anger issues, low self-esteem and behavioural changes as a result of stroke [45]. Emotional needs might be overlooked during the assessment process especially if the patient does not mention any emotional issues they might be experiencing. This is in line with a study done on the unmet needs of stroke patients where cognitive and emotional health needs such as concentration, memory, cognition, fatigue, and emotions were less likely to be fully met than physical needs despite physical needs being more common [15]. This affirms the requirement to implement strategies to help stroke survivors address the range of emotional problems they may experience [55]. Stroke rehabilitation usually focuses on physical impairments and assisting stroke survivors to develop functional independence. This may mean that services aimed at addressing the cognitive and emotional needs of stroke survivors are not adequately resourced [15]. This supports the results obtained in Pfavai [45] study where emotional needs were not being fully met compared to most of the physical needs [45]. Therapists need to be intentional in ensuring that emotional problems experienced by stroke survivors are adequately addressed.
Instrumental needs which were perceived as being unmet by more than 70% of the participants included adaptations outside the home environment and aids and adaptions inside the home environment [45]. Without these aids, stroke survivors are less able to perform their daily activities without restrictions [49]. However, due to the economic situation in Zimbabwe there is lack of resources in hospitals and assistive devices are scarce for those with performance limitations [45, 47]. There is also lack of transport and financial resources for the occupational therapists to do home adaptations for the patients soon after discharge [53]. This need might also be more than the 70% which was obtained in Pfavai study [45] since the study was partly done at a rehabilitation centre where the patients are given assistive devices such as wheelchairs for them to use before discharge and at a nominal fee after discharge. Stroke survivors have also reported that health systems are not responsive to their changing needs and that there is a lack of long-term re-assessment of their needs, [15]; hence some of the needs which might arise later during intervention may not be met.
Training on getting back to driving and information on how to do shopping were rated by more than 90% of participants as unmet [45]. These are some of the needs which are over looked during intervention. This might be due to lack of expertise among the concerned occupational therapists on driving rehabilitation. At the time of writing this chapter, there was no comprehensive module on driving in the University of Zimbabwe curriculum on occupational therapy undergraduate training. This might result in lack of expertise and confidence in addressing that need. This is also in line with a study done on coping with the challenges of recovering from stroke where loss of ability to drive a car was seen as a major challenge which required intervention and the ability to resume driving was spoken with deep emotion [62]. Driving was seen as representative of independence, a way to regain self-esteem, a means to access social support and to facilitate participation in valued activities [62]. This aspect however needs special training to avoid causing harm to patient and society.
Skills on shopping independently were also perceived as unmet in Pfavai study [45], and this might be due to lack of resources to simulate the shopping environment or lack of funds to teach the patients in the actual environment. In a study that looked at the combined perceptions of people with stroke and their carers regarding rehabilitation needs one year after stroke [67], patients reported having to give up a task in advance and had limitations in more physically demanding activities such as going to buy groceries among other tasks, supporting the need to address shopping needs among stroke patients [67]. The importance of this need might be overlooked during interventions. Information and knowledge needs of stroke survivors should not be underestimated and should be considered when developing strategies to meet the rehabilitation needs of stroke survivors [68].
Another unmet need in the Zimbabwean study [45] was financial/money management after a stroke. Most stroke survivors lose their jobs after the incident of stroke, and cognitive components might also be affected resulting in inability to adequately manage their money. However, this need seemed to have been overlooked. Li et al. also noted that few studies have looked at the financial impact of stroke on the survivors and their families, indicating that this area’s importance might be underrated [18].
Early discharge of patients due to unavailability of beds might also result in some of the stroke patients’ needs not being adequately met. Although many individuals still have rehabilitation needs one year after stroke, rehabilitation is often concluded within the first three months, and follow up is not usually done hence some of the needs might not be adequately fulfilled [67].
The occupational therapist is the health professional who specifically addresses patients’ involvement in daily life situations, and as such, she/he should be well conversant with that particular aspect of patients’ lives. This in turn addresses one’s quality of life which is often neglected. Stroke patients’ perceived needs highlighted above provide patients’ perspectives which is critical in the development of patient-centred services by service providers. The commonly used functional outcome measures (e.g., the Barthel Index) may underestimate dependence leading to rehabilitation professionals and patients prioritising different needs. Not using meaningful occupations in treatment; lack of discharge planning, using interventions not perceived as driven by patient’s occupational goals, and use of interventions chosen by therapists without considering what the patient needs thereby placing the patient in a passive role were noted as major challenges [69]. The stroke patients’ perceptions help the therapists to tailor interventions to meet patients’ specific needs.
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