We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.

The anterior operculum syndrome (AOS) is a well-defined clinical entity that has received little attention in the English literature. We report the clinical and CT findings in 3 cases of AOS; 2 were caused by bilateral cerebral infarctions secondary to bilateral internal carotid occlusion and 1 by the residual effects of viral encephalitis. Although there was variability in the range of deficits found in our cases, each of these patients presented with characteristic facio-pharyngo-glosso-masticatory diplegia with a dramatic automatic-voluntary movement dissociation. This syndrome deserves attention for its characteristic anatomic and prognostic implications.

This research assessed the psychosocial impact of a first stroke on the primary support person of the patient. Three waves of data were gathered at 6-month intervals, beginning on average 7 weeks poststroke (Time 1). A discriminant function approach was used to identify two groups of support persons from Time 1 data: those at risk for significant long-term depression and those whose depressive symptoms did not exceed age expectations. For 6-month and 1 -year follow-ups, group membership was predicted and validated with at least 74% accuracy. Support persons at risk for depression at the 6-month follow-up had higher Time 1 depression scores, were less optimistic, were more concerned about future care for the patient, had lower household incomes, and were more likely to be married to the patient. Additionally, they named fewer people in their social networks but had more face-toface contacts with those people prior to the stroke and were less satisfied with their social contacts after the stroke. Those at risk i year after the first interview again had higher initial depression scores, were less optimistic, were more likely to be married to the patient, and named fewer network members for the period preceding the stroke. In addition, their stroke-patient partners were younger and more impaired in the physical activities of daily living at Time 1.Stroke is the third leading cause of death and disability in the United States. Its sequelae may be physical, cognitive, or emotional, and its effects are often long-lasting. Because of its unpredictable, uncontrollable nature, stroke may leave its survivors particularly vulnerable to emotional adjustment difficulties. Clinicians and researchers concerned with recovery from stroke have frequently stressed the importance of a supportive family or network of friends.Recently, it has been recognized that people providing support to stroke survivors may face their own adjustment problems. For example, Duffy (1978, 1979) noted a high prevalence of depressive symptoms in a study of strokepatient spouses. Coughlan and Humphrey (1982) reported decreased life satisfaction in spouses of stroke patients more than 3 years after the event. Similarly, Holbrook (1982) found that one third of the family members in her study had not yet adjusted 2-5 years after the stroke.Literature in this area has also characterized specific psychosocial problems reported by significant others in the aftermath of stroke.

The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.

Thirty-four informal caregivers who support 26 persons with ALS reported on AAC technology use. Each caregiver completed the Communication Device Use Checklist, a survey tool developed for this study based on Light's (1988) classification of the purposes of social interaction (Augmentative and Alternative Communication, 4, 66-82). The checklist includes 17 purposes of communication and asks participants to judge importance, mode, and frequency of use for each purpose. Results show that the three communication purposes used most frequently and valued as important by caregivers involve regulating the behavior of others for basic needs and wants (getting needs met; giving instructions or directions to others; and clarifying needs). Consistent reports of use and frequency for the purposes of staying connected (social closeness) and discussing important issues (information transfer) indicate that AAC technology can assist the dyad in maintaining previous relationships. The face-to-face spontaneous conversation mode is used most frequently, despite the slow rate of production, the lack of permanence, and the demands on conversational partners during message generation. Clinical and research implications are discussed.