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Doctor's Thoughts

Life After Stroke by Dr. Rehan Rahim M.D. - Dr. Rehan Rahim M.D.

Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. This is because stroke can impact virtually all human functions and, unlike other disabling conditions, the onset of stroke is sudden, leaving the individual and the family ill prepared to deal with its sequelae. In developed countries, stroke is the third common cause of death after heart disease and cancer. Many advances have been made in stroke prevention and management; however, stroke continues to be a prevalent and burdensome condition, particularly among the older persons. As the population ages, more persons are having strokes and more are surviving the acute phase. Given the increases in both relative and absolute numbers of older individuals, the long-term consequences of stroke are a major public health concern. Consequently, the number of stroke patients returning to the community is growing. This will result in an increase in the number of persons who will seek community-based services to prevent deterioration and also to increase their functional capacities to facilitate their community reintegration, and to promote health related quality of life The rationale, planning, provision, and allocation of health services for patients with stroke require accurate information on outcome and the extent of continuing disability after stroke.

As stroke mortality rates decline, individuals are increasingly likely to live with their residual impairments, which can pose a considerable impact for survivors’ subsequent well-being. Stroke survivors felt that stroke was unique. Strokes happen suddenly, are often hugely incapacitating and recovery is often a long-term process, even for those people who consider their stroke to be mild. The time it takes to recover from a stroke varies—it can take weeks, months, or even years. Some people recover fully, while others have long-term or lifelong disabilities. Stroke survivors experience physical, psychological and social challenges that are interrelated and impact on each other. Survivors may experience psychological challenges such as increased anxiety, fear of having another stroke, loss of confidence and depression. These often are invisible to other people but are major disabling factors in regaining independence and may make people reluctant to go out alone or to go back to work. Survivors may also suffer from memory problems, which impact on the ability to perform daily living activities. Loss of control over emotion and feelings of frustration are also common features. The residual physical effects often leave survivors disabled, resulting in an altered body image and a far more restricted lifestyle. Speech, language and swallowing can also be severely affected. Social life and relationships, both within and outside the family are changed. Partners and children become careers, role reversal often occurs and the difficulties of getting out make social relations and activities hard to continue. Rehabilitation is a process of assisting individuals to reach an optimum level of independence. Professionals view the return to valued activities such as getting about independently; going back to work, return to social activities and hobbies as key aspects of rehabilitation and a return to normal life. The rehab team and stroke survivors set goals and developed strategies to achieve these. For some, these goals were expressed in general terms but others were very specific. Achievement of one goal could often fulfill others, such as getting to the toilet independently, reduced career stress and burden, reduced dependence, improved self-esteem.

It is clear that a stroke is a major life event or defining moment for individuals who have experienced them. They challenge and undermine their basic trust in the world and make them rethink who they are and what they want. Rehabilitation is a complex journey in which individuals set their own goals and explore, often slowly and painstakingly, ways and strategies for achieving them.