الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Stroke is the most common neurological disorder in adults which causes death and disability worldwide (1). An estimated 5.7 million people died as a result of stroke and 87% of these deaths were in low-income and middle income countries due to high fatality rates and overwhelming resource incurred by the health systems (1, 2). In the United States (2012)(3), the incidence and prevalence of stroke is the first leading cause of adult disability and the third leading cause of death, there are over 700,000 new strokes per year and over 4 million stroke survivors are expected to increase due to the rising average age of the population and improved management of cardiovascular disease approximately, 25% of stroke survivors die within 1 year, and about 50% die within 8 years, 50–70% of stroke survivors obtain functional independence, 15–30% of stroke survivors remain permanently disabled and about 20% of stroke survivors require institutional care ( 4).
In Egypt 2014, the number of new strokes per year might be around 150 000 to 210 000 the incidence rate was 1.8/1000. Stroke death reached 52,166 or 14.37 % of total deaths (5, 6). In Alexandria Main University Hospital where the study was done, revealed that, the incidence of acute stroke was highly significant in males compared to females (7). El Tallawy et al (2010) (8) reported that the incidence of stroke in the desert governorate of the New Valley is 2•5/1000 with a prevalence of 5•6/1000.
Stroke refers to a pathologic process involving the blood vessels of the brain or brain attack that occurs when a blood clot blocks an artery or a blood vessel breaks, interrupting blood flow to an area of the brain, brain cells begin to die (7, 8). Stroke is a form of cardiovascular disease affecting the blood supply to the brain also referred to as cerebrovascular disease or suddenly disrupted and unexpected damage to brain cells causing symptoms that last for more than 24 hours in the parts of the body controlled by those cells (9, 10).
Stroke is the most important cause of long-term disability and 40% of patients with stroke need active rehabilitation services (11). Regaining mobility is a primary goal of patients with stroke during rehabilitation, since it is a key factor in becoming independent in daily functioning predicting mobility (11, 12). Two major types of disorders ischemic and hemorrhagic each of which can produce either temporary or permanent deficit in neurological functioning(12). Ischemic stroke accounts for 80%–85% of all strokes, it occurs when there is a reduction or blockage of blood supply to the brain, primarily because of occlusive disease of the blood vessels and the hemorrhagic vascular disease accounts for 15%–20% of strokes and occurs when a blood vessel ruptures (12, 13).
Nursing care has a significant impact on the patient’s recovery, often many body systems are impaired as a result of the stroke and conscientious care and timely interventions can prevent debilitating complications during and after the acute phase, nursing interventions focus on the whole person in addition to providing physical care, nurses can encourage and foster recovery by listening to patients and asking questions to elicit the meaning of the stroke experience (14, 15).
Most stroke patients experience some level of fear and anxiety of the unknown in a therapeutic exercise program, such emotions can block the patient ability to push him or her to meet the challenges of the exercise program such as, fear of increased pain, discomfort, during an exercise may limit the patient motivation to exert full effort, constant positive feedback from the nurse can help overcome many of these obstacles (16).
Nurses play an important role in enhancing stroke patient’s recovery and their families’ understanding about the course of the disease, possibilities for improvement and recovery, limitations, besides providing information about the disease, treatment, rehabilitation and expectations for the future (17). In addition to the emotional support is another nursing intervention provided by nurses as multi professional members, focusing on the establishment of a trust relation with patients and their relatives with a view to enhancing the development of coping and adaptation strategies (16, 17) .
Phases of a therapeutic exercise program are presented, including criteria used to determine when an individual is ready to progress in the program, and ultimately to return to sport activity, practical application of the material for the various body segments (18). The ultimate goal of therapeutic exercise is to return the stroke participant to pain-free and fully functional activity, for this to be accomplished, attention must focus on modulating pain and restoring normal joint range of motion (ROM) kinematics, flexibility, muscular strength, endurance, coordination, and power (17, 18) .
Furthermore, cardiovascular endurance and strength must be maintained in the unaffected limbs, psychological influences can inhibit or enhance the progress of the therapeutic exercise program, as such, an awareness of the physical, psychological, emotional, social, and performance factors that may affect the patient during therapeutic exercise is essential. Only then can each component be addressed within a well-organized, individualized exercise program.’ Moreover, teach the patient and their family how to protect body structures in order to minimize future complications that could prevent potential functional recovery (19).
Goal setting is a common practice used to motivate patients in the program, this practice directs the individual’s effort, provides a sense of control that may enhance motivation, persistence, and commitment, and facilitates the development of new strategies to improve performance (20) . It has been found that patients who set specific personal goals in each training session exhibit an increase in self-efficacy, or the sense of having the power to produce intended outcomes, and have greater satisfaction with their performance