According to the National Stroke Association, stroke is the leading cause of disability in the United States. While only 10 percent of stroke survivors require nursing home care, the National Stroke Association's "Fact Sheet" notes that 40 percent are left with problems that require lengthy rehabilitation. Drs. Chemerinski and Robinson discuss mental health conditions that can occur after a stroke in "Psychosomatics," the journal of the Academy of Psychosomatic Medicine. Post-stroke depression is the most common of these conditions.
Post-Stroke Depression
Strokes occur when blood flow to part of the brain stops, either because of a clot or bleeding from a burst artery. The brain tissue dies without the oxygen and nutrients that the blood delivers. The brain injury can affect reasoning, emotion, physical function, and mental health. "Psychosomatics" reports that one third of stroke survivors develop post-stroke depression. This type of depression has the same features as depression found in the general population, but the location of the stroke seems to predict it. Post-stroke depression impedes rehabilitation success and quality of life gains.
Coping Strategies
People develop coping strategies to protect against the effects of stress. All coping strategies ease emotional pain. By using active strategies, the stroke survivor builds confidence in her ability to succeed, while passive strategies would limit her progress. The stroke survivor who employs passive coping strategies avoids dealing with her disabilities. She feels helpless and might deny the effect the stroke has on her life or isolate herself from family and friends. According to "Archives of Physical Medicine and Rehabilitation," active coping strategies are effective in overcoming post-stroke depression and play an important role in regaining function. The survivor who has an active coping strategy is confident in her ability to regain independent self-care skills. She accepts her disability and works toward regaining physical function and learning new ways to continue living her life.
Activities of Daily Living and Quality of Life
Rehabilitation teams are composed of the patient, his family; physical, occupational, and speech therapists; social workers, nurses, and physicians. Activities of daily living and quality of life indicators are methods they use to communicate with each other about goals and progress. Bathing, ambulating, eating, dressing and toileting are activities of daily living and contribute to independent self-care. The survivor judges her level of satisfaction with her life using quality of life indicators. For example, she might state that her life is good because she can share Sunday dinner with her family and rock her grandchild to sleep. Drs. Chemerinski and Robinson found more post-stroke depression in survivors with lower activity of daily living ability. The survivor with post-stroke depression is less satisfied with her quality of life than survivors without depression.
Rehabilitation
Active coping strategies help resolve post-stroke depression. Fortunately, active coping skills can be taught. "Archives of Physical Medicine and Rehabilitation" reports on ways to teach and support active coping skills. Group rehabilitation activities give the survivor the opportunity to see others succeed. This gives her hope and confidence that she will also succeed. Self-talk helps her strengthen her self-esteem. Individual and group therapy for depression and stroke support are invaluable. She learns to use active coping strategies from others and stays socially connected. The stroke survivor who views her life positively is less depressed and can make physical gains even beyond what rehabilitation teams expect.
Summary
The "Journal of Applied Gerontology" reports that the survivor who participates in a rehabilitation program that targets activities that are important to her will also have a more positive outlook on life. The survivor that learns to use active coping strategies has less post-stroke depression and makes more progress toward independence. The survivor that is able to participate in pre-stroke activities, even if modified, will retain independent function longer. By focusing on positive coping strategies, quality of life, activities of daily living, and physical functioning will increase and post-stroke depression will decrease.
