Psychological impact of a stroke and rehabilitation Flashcards Preview

Nervous system > Psychological impact of a stroke and rehabilitation > Flashcards

Flashcards in Psychological impact of a stroke and rehabilitation Deck (23)
Loading flashcards...
1
Q

Challenges of illness

A
  • Treatment and hospitalisation
  • Disruption to daily living
  • Uncertainty, threat to future
  • Burden of ongoing self-care, lifestyle changes
2
Q

Psychosocial challenges in a stroke

A
  • Cognitive impairment
  • Perceptual impairment (psychological process of taking in information and using that to make decisions about our actions)
  • Limitations to communication
  • Participation in activities
  • Psychological functioning
  • Leads to anxiety/depression/emotionalism
3
Q

Emotional and cognitive responses to stroke

A
  • Emotional impact is a key feature of some conditions and increasingly recognized in others
  • Common emotional responses include emotionalism/anxiety/depression, frustration and anger
  • Emotionalism: lessening of control over emotions, increased tendency to cry or laugh
  • Emotionalism can be embarrassing and may interfere with treatment, affects 20-25% of patients in first 6m of stroke
  • Symptoms of emotionalism generally get better with time
4
Q

Frustrated response to stroke

A
  • Frustration e.g. about not being able to do normal things is normal and understandble
  • Can escalate into anger and be directed at others
  • Can complicate relationships, focus concerns away from illness and lead to reactance
  • Common post-stroke and may affect longer term adherence to rehab
5
Q

Anxious responses to stroke

A
  • Re: consequences of illness/treatment, unavoidable
  • Re: procedures, can be reduced with good clinical care
  • Results in disturbing beliefs, increased attention to symptoms, alters perception, interpretation of information and memory recall
  • Initially can be positive as it motivates, helps patients overcome initial adjustment but problematic if prolonged/disproportionate and linked to depression
  • Affects 25-33% of stroke patients
6
Q

Depressed responses to stroke

A
  • Common reaction indicated by persistent low mood, loss of interest or pleasure in normal activities
  • Can have huge negative effects: suicide, poor adherence, lack of motivation, alienation of others
  • 1 in 3 stroke patients will experience
  • Largest effect on worsening health
7
Q

When will depressed responses be more common?

A
  • Life threatening or chronic illness, unpleasant or demanding treatment, low social support/adverse social circumstances, history of depression/alcohol or drug abuse
8
Q

Why is it important to address depressive responses to a stroke?

A
  • Reduced survival
  • Increased risk of further acute events and complications
  • Increased symptoms, disability and reduced quality of life
  • Prolonged recovery, poorer outcomes from treatment
  • Increased costs of care
9
Q

What are illness cognitions?

A

A patient’s own implicit common sense beliefs about their illness

  • Mental representation for recognising symptoms and responding to illness experience
  • Developed through own and others’ experiences, media, education etc
  • Qualitative and quantitative research to investigate
10
Q

Dimensions of illness cognitions

A
  • Identity: label, signs, symptoms
  • Cause: biological, psychological, multi-factorial
  • Timeline: duration, pattern
  • Consequences: short and long term effects on life
  • Curability/controllability: by themselves/others
  • Links to wider beliefs about body and medicine
11
Q

What are stressors?

A

Physical, psychological threat to well being, placing demands that require adaptation, leading to stress response

12
Q

What is a stress response?

A

Biological and psychological (behavioral, cognitive, emotional) response associated with internal state of strain/tension/arousal

13
Q

What is stress?

A

An interaction between stressor and response perceived as discrepancy between demands vs resources and ability to cope

14
Q

What does the self-regulatory model do?

A

Suggests how illness beliefs interact with emotional response to influence actions

15
Q

Aspects of self-regulatory model

A
  • Interpretation: understanding problem/stressor
  • Coping: address problem to re-establish normality
  • Appraisal: assessing success of coping
  • Re-interpretation: additional coping as necessary
16
Q

What does coping mean?

A

Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding resources

17
Q

Stages of adjustment

A
Major event 
Shock and denial 
Anger
Depression
Coming to terms
Acceptance
Moving on
18
Q

Social support

A
  • Positive social support provides emotional and practical assistance to enhance effective coping and adjustment
  • Presence of support alone not enough: carers may not be coping themselves, burdens associated with relationships (guilt, protection, expectations)
  • Clinicians have key role in forming supportive relationship by providing opportunities for disclosure, effective listening, ensuring continuity and follow up
  • Clinicians can facilitate support outside clinical context by involving carers and support groups
  • ‘Take into consideration the impact of the stroke on the person’s family, friends and/or carers and, if appropriate, identify sources of support’
19
Q

What is a stroke rehabilitation service?

A

Comprises a multidisciplinary team of people who work together towards goals for each patient, involve and educate the patient and family and have relevant knowledge and skills to help address most common problems faced by their patients

20
Q

Cycle of rehabilitation

A
  • Multi-disciplinary assessment to identify/measure patients’ difficulties and needs
  • Goal setting for long/medium/short term improvements
  • Interventions to support change and assist in achievement of goals
  • Evaluation of re-assessment to assess progress against agreed goals
21
Q

Stages of stroke rehabilitation

A
  • Inpatient stage: stroke unit with multi-disciplinary team (e.g. drs, nurses, physios, OTs, SLTs, psychologists, social worker etc) plus access to other services (e.g. continence, psychiatry) as needed. Focus on mobilization, education
  • Early post discharge: multi-disciplinary stroke team in community with links to GP and social care where necessary, plus ongoing training and support for carers with daily activities (OTs)
  • Ongoing: structures exercise training with educational and psychological support and advice based on goal setting with stroke patient and family/carers. Initially 45 min 5 days per week, later tailored to needs/ability
22
Q

Characteristics of goals in stroke rehabilitation

A
  • Meaningful and relevant to individual
  • Focus on activity and participation
  • Challenging but achievable
  • Both short and long term
  • Communicated, understood and supported
  • Reviewed regularly
  • Part of a broader, individual rehab plan
23
Q

Cognitive support for stroke victims

A
  • Visual neglect affecting functions such as mobility, dressing, eating
  • Memory (e.g. using associations, mnemonics, encoding, aids)
  • Attention (e.g. attention training)