Strokes become prevalent in societies that begin to ignore the symptoms that cause them. Specific treatments and counteractions can be performed directly after a stroke that will enable an individual who has suffered a stroke to recover more efficiently. Although the brain is a complex organ it is becoming more understood with each study. In stroke victims parts of the brain are killed due to loss of blood flow to those areas. However there are research studies being performed which are discovering that although many central parts of the brain have been damaged to the point of uselessness there are other peripheral areas of the brain, outside of the initial damage, which revert to a latent state before completely dying. The behaviors of stroke victims changes often because of the damage to the brain. With the new physical improvements in treatments available the stroke victim may be able to more fully function as they did before the stroke. Learning to cope with the effects that are both physical and mental involved in stroke victims is the primary way that a patient can become positive in their own recovery. When institutional and familial inspiration, rehabilitation and understanding are perceived by the stroke victim then their recovery outlook, both physical and cognitive, is improved.
Waking Up: Stroke Affect on Behavior
In the 1970's, a popular television show addressed the very real affects of stroke. "The Waltons" actress, Ellen Corby, suffered a real stroke and her condition was integrated into the story line (IMDB, 2010). Grandma Walton came back after recovery a different and more frail woman however she maintained the same stern resilience of her former stroke character. Her television family was able to make the audience realize the very true and prevalent conditions that come with recovering and coping with stroke (IMDB, 2010). How does a stroke occur? How can one recover after a stroke? Strokes are not only a condition of the elderly. People of all ages can experience a stroke. Strokes occur when an aneurism or blood vessel bursts in the brain and causes damage to internal and external regions of the brain. There are some who fully recover from the damages of stroke and then others who are unable to function in the manner that they were accustomed to. Ellen Corby, Grandma Walton, wrote a book "The Pebble of Gibraltar" after she experienced a stroke, even with the control in half of her body being compromised from brain damage (IMDB, 2010). She went back to some acting on the show "The Waltons" after her stroke as well. She was welcomed by her television family, nurtured and loved as though she was truly a stroke surviving family member who would be received with all the accolades of a real family (IMDB, 2010). Behaviors also change based on the areas of the brain that are affected by stroke. The causes, effects, and recovery efforts involved in a stroke will be addressed in order to fully discuss how a stroke victim and their families can begin the difficult but important task of improving the quality of life and viability of the stroke victim. Scientific advancements as well as new discoveries have been brought to light which can help with the physiological recovery from stroke. Physical and mental therapies can assist the stroke victim with functional and communicational abilities so that there is less frustration and depression (Seale, Berges, Ottenbacher, Ostir, 2010).
What Causes Strokes
Circulatory problems and damages to the brain can cause a stroke. Strokes are not only a condition of the elderly, however. Children and young adults can also suffer from the debilitating effects of a stroke. Studies infer that if a child is very young, from fetal development through six months, they will be less likely to develop into a reasonably cognitive adult. They will suffer from developmental and educational problems that will not allow them intellectual advancement (Max, Keatley, & Delis, 2010). Michael Paul was born with cerebral palsy due to stroke during gestation. His life was extremely limited, including severe mental retardation, and physical problems that were so severe that he lived his entire life incontinent and in an infant state of existence. He managed basic motor skills, including rolling over and sitting on his own but he did not develop any finite skills such as feeding himself, walking, or speaking. He had a voice but was never able to use it, to the constant despair of his mother, for his sixteen and a half years of life before pneumonia took his life in 1988 (Perez, 2010). As children get older their chances of recovery improve but because their development is still in transition there is not as much improvement as in someone who has already learned many of the skills they would need to function, as an adult would (Max, Keatley, & Delis, 2010).
Physiological studies are incredibly necessary in studying the stroke victim because the damage is physical. There are new studies that have been developed and researched using MRIs and PET scanning technologies to discover that although brain tissue and cells do indeed die there are some that can be recovered because the cells have just gone into a stasis state instead of a total death state (Felger, et al., 2010). A dead brain cell cannot be recovered but a brain cell that is in stasis is able to be recovered by proper infusion of blood into the region by improved or increased blood pressure (Kaushal, & Schlichter, 2008). The science is still in the initial stages even after thirty years of research and there are many different contingencies that need to be met in the proper infusion of blood to the brain (Kaushal, & Schlichter, 2008). Timing appears to be the primary concern. If the recovery process is not done soon it will not work, but if it is done too quickly it can actually damage and kill those brain cells that are meant to be recovered (Kaushal, & Schlichter, 2008). Hopefully in the next few years the measurements of brain activity during and after strokes will be understood so that any potential recovery of damaged, latent brain cells will be understood, making the functioning of the stroke victim, both physical and cognitive, more positive. The quality of life of the stroke victim will be improved with this research and implementation, and in relationship to quality of life, the mental stability of the stroke victim would also be improved.
Quality of Life
The quality of life after a stroke in any individual depends on many situations and conditions. The post-stroke physiological conditions need to be improved and damaged brain tissue needs to be re-calibrated to work properly. Physical therapy and cognitive therapy are also important in the process of recovery after a stroke (Ostwald, 2004). There has been a great deal of research in the brain's ability to recover. Although research exists, and has been studied for the past three decades, there is still much research to do (Kaushal, & Schlichter, 2008). The brain is a finite organ that has specific functions that lie close together. If stimulation to the damaged brain regions is not conducted at the very right moment in time in the very right regions of the brain then the increased blood flow to those areas might cause additional damage instead of improving the life (Kaushal, & Schlichter, 2008). All brain tissue is not dead after a stroke. Much of the brain is in a dormant state, trying to recover itself. Once circulation is regained in those areas then motor skills and cognition will also improve. However, as mentioned before, if the circulation is not increased in the right time at the correct flow then the tissues that are damaged become permanently dead, unable to recover. Additionally some functions of the brain can transfer to living tissue (Kaushal, & Schlichter, 2008). While in a coma state, functions that existed in what is now damaged need to be re-wired into the parts of the brain that are not damaged.
Studies on Recovery
Stroke, being a leading cause of function and independency loss in the United States, has been studied quite a bit. In one study of research conducted by Seale, et al. (2010) there is distinct information stating that those stroke victims who are given attention and rehabilitation in an institutionalized setting are more likely to find functionality and a positive personal outlook of their potential for a high quality of life even after experiencing the stroke. The emotional outlook of these same patients was also more positive than those who were released after a few brief weeks of hospitalization and rehabilitation efforts. A hypothesis that has been proposed by Seale, et al., (2010) named "broaden and build hypothesis" brings forward the idea that if a stroke victim feels more positive emotional feelings during their institutionalization then their risk of becoming depressed decreases and their ability to try harder to improve their motor skills and physical functionality increases. This positive emotional outlook comes after an extended (over twenty days) stay in the hospital, experiencing positive input from staff, family, and from physical therapy and rehabilitation therapy (Seale, et al., 2010).
In a report by Carod-Artal and Egido (2009) it is brought to attention that 46% of those who suffer from stroke do not recover completely and a third need help with at least one daily routine. Also noted in this research is that when stroke research is conducted it is usually considered that there will be mortality in those who suffer from a stroke within a year, or they have a recurrence within a year. Those who will recover usually do so within a year, also (Carod-Artal, & Egido 2009). Within those researched in the study by Carod-Artal and Egido (2009) between 50 and 70% recover to the point of being independently functional. Conversely, the two also discuss that between 15 â 30% are permanently disabled, with twenty per cent of these victims being kept in an institutional setting for at least three months after having a stroke. The quality of life of those who suffer a stroke is not only perceived by their ability to function in society and in life after the onset of the stroke, but also by the mental perception of the person who has suffered a stroke. If the patient is an artist or a musician and can no longer create their art then the perception is that their quality of life has not been restored. If the person has lost the use of their hands, or if they are not strong enough to carry a guitar, or to hold a microphone then they may begin to feel as though their life no longer has the worth that it did before. Coping with a stroke involves more than physical therapy and psychological counseling. The person should also be given a new lease on life as well. If a stroke victim cannot find a reason to live, a new skill or talent, or an external force, family and friends who support him or her, then there is a potential for depression.
Compensating for Cognitive Loss
Much like Grandma Walton, many who suffer a severe stroke find ways in which to re-assimilate themselves into society. Grandma Walton wrote stories and continued acting after she recovered from her stroke (IMDB, 2010). Others find that painting, taking walks, caring for children and other tasks that are not strenuous help them to find ways to compensate for their mental disabilities. Others may find that the nonresponsive parts of their bodies seem to have a mind of their own. In one case, Betty Paul named her left arm Henry (Betty Paul, personal communication, April, 1997). When I asked her why she did tell me it was because he was stubborn and only did what he wanted to. Her left arm was limp to her side and she was unable to use it. Betty was less capable of assimilating back into society because she developed depression after becoming incapable of walking and using her left arm (Betty Paul, personal communication, April, 1997). Her son, Verle Spears (personal communication, May, 2005), addressed this with the author, as well, recounting that she was ready to just lie down and relieve her husband of having the burden of caring for her. Depression is a common outcome in disabled individuals after a stroke, especially when they were active before they experienced the stroke if not addressed as soon as the stroke victim regains cognition (Seale, et al., 2010).
With appropriate cognitive and physical therapy many stroke victims are able to fill their lives with positive futures (Carlsson, Moller, & Blomstrand, 2009). With the positive advances in science directly after a stroke there is less chance of a stroke victim finding that their life has now become a series of inconveniences to others. Stroke victims have a great deal of value and if they can find something with which to occupy their time and their minds then they will be able to cope strategically and mentally with the limitations the now must live with (Carlsson, et al., 2009). Friends, family, and physicians as well as the stroke victim him or herself needs to be diligent in helping the victim of stroke to come as close to a normal existence as possible.
Social interaction can also be decreased after the onset of symptoms caused by a stroke. If a person finds they are less capable they may choose to withdraw from public view. For instance if a person were likely to take daily walks or go dancing on Friday night, they will not wish to be seen in a more vulnerable state, incapable of these pleasurable events. However, those who were more likely to go into public settings after experiencing a stroke were the members of the study who had been hospitalized and cared for while being rehabilitated through cognitive and physical therapies. These individuals were ready to take on the new experiences that were to come before them (Seale, et al., 2010). The study found that about 27 per cent of the participants studied came home from their hospital stays of 20 days or more with a positive outlook for their own recovery (Ahlsio, Britton, Murray, & Theorell, 1984). These same participants maintained their positive outlook after follow up research as well. In addition to the initial therapy while hospitalized directly after the stroke, these same participants were involved in structured professional therapy sessions after they were discharged (Seale, et al., 2010). Functional independence measures (FIM) were researched as well, from the moment of discharge and three months later. Seale, et al., (2010) determined that the well being and positive outlook of the patients was in direct relationship to their functional independence. Those who were improving their physical acuity and were able to conduct many tasks on their own with progressive improvement were more likely to continue to have a positive outlook on their current health and their future physical abilities.
Subjective reporting of one's own wellbeing is an important part of the research study and surveys performed by Ahlsio, et al., (1984). The study determined that once a person believes that they are functioning well then their positive outlook improves. If a participant did not feel that they were able to conduct their lives with the same quality as they did before they suffered from a stroke then their outlook was less positive. The results were measured across males, females, married and single, all geriatric patients (Ahlsio, et al., 1984). This is important to research and remember when it comes to the assistance of others who may be suffering from strokes and the aftermath of physical and cognitive limitations. Memories will need to be recovered, and finite motor skills will need to be worked on in order to assist the patient in improving their positive outlook of quality of life.
What Can Be Done
Families, professionals, and the stroke victim need to work in conjunction to help the stroke victim to recover as much as possible. If any of these three groups fails in their actions toward recovery, if the family becomes frustrated, the professionals turn their attention toward others or displays indifference in the slow progress of the victim, or if the sufferer himself or herself becomes depressed because of the realization that they will never be able to do the things that they were used to doing, there will be less or even no recovery of those faculties and functions that were automatic before the stroke (Alexander, & Wilz, 2010). Medical professionals have the first run at helping the stroke victim to recover. If they do not implement strategies that are important in the initial redevelopment of motor skills and communication skills then the other two parts, the families and the stroke sufferer, will be ill equipped to continue the rehabilitation process once the patent has left the hospital (Jacobson, Mulick, Swartz, 1995). The adaptation from behaviors and abilities before the effects of a stroke to capabilities that are more limited occurs in nearly all stroke victims.
Another important part of rehabilitation is the family members who are caregivers for the stroke victim directly after they have come home, and even after years of helping. Frustration can cause depression in the caregiver. If this frustration is transferred to the stroke victim then they both will suffer from hopelessness and depression (Alexander & Wilz, 2010). Depending on the gender of the person who is the caregiver, there are different methods to try to counter the feelings of helplessness when love is not enough to help your family member to recall an important date, or even the name of their own children (Alexander & Wilz, 2010). Where men are less likely to suffer from psychological or physical wearing from caring for their infirm loved ones, females find the task physically exhausting and psychologically taxing (Alexander & Wilz, 2001). The studies that have been conducted by Graham, Banerjee, and Gill (2009) suggest that it is necessary to evaluate the potential care giver before they are put into a position to be caring for a stroke victim. In the report, it states that postal questionnaires are needed to ensure that the care giver will not fall into depression. If the patient is to be cared for, it is responsible for physicians and professional care givers to ensure that the family members who are taking on this daunting task are up for the responsibility (Graham, et al., 2009).
Mild Stroke Considerations
Unfortunately, when a person suffers from what is considered a "mild stroke" they are expected to fully recover without any side effects. The medical community and even more so the social and corporate community does not fully grasp the concept that a mild stroke is still a stroke and that some functions and memories may be lost forever in damaged areas of the brain (Carlsson, et al., 2009). These members of society, the stroke victim who is perceived to be just fine may suffer more trauma and mental instability based on the response of those around them. When treating and rehabilitating such a patient who suffers from a mild stroke, one should make the patient aware that the general public will not be able to fully acknowledge and understand that they may still have limitations (Carlsson, et al., 2009).
Understanding what causes a stroke, what happens when a stroke occurs, whether a major stroke, or a mild one, and how to cope with the rehabilitation and recovery process of a stroke victim, the quality of life of the patient will be improved. Mortality rates will decrease if the mental and emotional state of the patient is considered, especially if they have a positive outlook and a positive support base in their life. Friends and family members who are caregivers need to also maintain their own personal mental and physical health in order to help the stroke patient when they are in need of it. Dignity and support are very important in rehabilitation as is social interaction. Ensuring ample hospitalization and institutional rehabilitation services is important, also, when one is trying to recover as much functional actions as is possible once parts of the brain have been damaged. Physicians need to be proactive, as well, and keep up with science on procedures that are becoming available and are being studied in regards to improved brain rehabilitation based on circulatory advancements. When all factors are put together, the stroke sufferer has a greater chance of regaining a lot of their physical and cognitive abilities and become a viable member of society.
Ahlsio, B., Britton, M., Murray, V., & Theorell, T. (1984). Disablement and quality of life after stroke. Stroke, 15, 886 â 890, retrieved from http://stroke.ahajournals.org.
Alexander, T., & Wilz, G. (2010). Family caregivers: Gender differences in adjustment to stroke survivor's mental changes. Rehabilitation Psychology, 55(2), 159 â 169, doi: 10.1037/a0019253
Carlsson, G. E., Moller, A., & Blomstrand, C. (2009). Managing an everyday life of uncertainty â A qualitative study of coping in persons with mild stroke. Disability and Rehabilitation, 31(10), 773-782, doi:10.1080/09638280802638857
Carod-Artal, F. J., & Egido, J. A. (2009). Quality of life after stroke: The importance of a good recovery. Cerebrovascular Diseases, 27(1), 204-214, doi:10.1159/000200461
Corby, E. (1988). The pebble of Gibraltar. New York: Vantage Press, 1.
Graham, C. R., Banerjee, S., & Gill, R. S. (2009). Using postal questionnaires to identify carer depression prior to initial patient contact. Psychiatric Bulletin, 33, 169-171, doi: 10.1192/pb.bp.108.020982
Felger, J. C.; Abe, T., Kaunzner, U. W.; Gottfried-Blackmore, A., Gal-Toth, J. McEwen, B. S.; Iadecola, C., Bulloch, K.(2010). Brain dendritic cells in ischemic stroke: Time course, activation state, and origin. Brain, Behavior & Immunity, 24(5): 724-737. doi: 10.1016/j.bbi.2009.11.002
IMDB (2010). Biography for Ellen Corby. The Internet Movie Database, Amazon.com, retrieved from http://www.imdb.com/name/nm0179289/bio.
Jacobson, J. W., Mulick, J. A., & Schwarts, A. A. (1995). A history of facilitated communication: Science, pseudoscience and antiscience. American Psychologist 50(9), 750-765, doi:10.1037/0003-066X.50.9.750
Kaushal, V., Schlichter, L. C. (2008). Mechanisms of microglia=mediated neurotoxicity in a new model of the stroke penumbra. The Journal of Neuroscience, 28(9): 2221 â 2230. doi:10.1523/JNEUROSCI.5643-07.2008
Max, J. E., Bruce, M., Keatley, E., Delis, D. (2010). Pediatric stroke: Plasticity, vulnerability, and age of lesion onset. The Journal of Neuropsychiatry and Clinical Neurosciences, 22, 30 â 39, doi:10.1176appi.neuropsych.22.1.30
Ostwald, S. & Duggleby, W. (2004). Abstracts from the symposium on health care for the elderly 6-7 October, 2003. Nursing and Health Sciences, 6, 161 â 164, doi: 10.1111j.1442-2018.2004.187_3.x
Perez, K. (2010). My brother, Michael: Angel to our family. Xomba.com, retrieved from http://www.xomba.com/my_brother_michael_angel_our_family.
Redfern, J., McKevitt, C., Dundas, R., Rudd, A. G., Wolfe, C. D. A. (2000). Behavioral risk factor prevalence and lifestyle change after stroke: A prospective study. American Heart Association, 31, 1877 â 1881, doi:10.1161/STROKEAHA.110.580209
Seale, G. S., Berges, I. M., Ottenbacher, K. J., Ostir, G. V. (2010). Change in positive emotion and recovery of functional status following stroke. Rehabilitation Psychology, 55(1), 33-39, doi:10.1037/a0018744