Rehabilitation psychology and neuropsychology with stroke survivors.

Abstract

Stroke constitutes the third leading cause of death in Western countries, and with more than two thirds of stroke patients having major functional limitations (Baum, 1982), stroke is the primary cause of adult disability in the United States (Centers for Disease Control, 2003;Dobkin, 2005;Kelly, Pangilinan, & Rodriguez, 2007). As "stroke is more disabling than lethal" (de Freitas, Bezerra, Maulaz, & Bogousslavsky, 2005, p. 1), stroke survivors represent the largest diagnostic category of referrals to rehabilitation hospitals (Granger, Hamilton, & Gresham, 1988). With the accelerated "graying" of the U.S. population, stroke will remain a public health problem with major personal, societal, and economic implications. Even the "oldest old" may be reasonable candidates for rehabilitation after stroke (Lieberman & Lieberman, 2005). Furthermore, advances in thrombolytic and neuroprotective treatments after stroke

Assessment in Acute Stroke Rehabilitation

“…Location-speci fi c syndromes can result from lacunar infarcts. These include pure motor or sensory stroke, dysarthric stroke, and hemiparesis with ataxia [ 2 ] .…”

“…These deposits produce a thrombus that over time gradually narrows the arterial passage until the blood vessel becomes suf fi ciently occluded to produce a stroke. Permanent damage generally ensues with complete deprivation of blood fl ow beyond several minutes [ 2 ] . The likelihood of a stroke is largely affected by several factors including age, family history, systolic blood pressure, smoking, alcohol use/abuse, diet, myocardial disease, diabetes, and atrial fi brillation.…”

“…This type of stroke mechanism causes rapid focal onset symptoms with little opportunity for compensation by collateral blood supply routes [ 2,16 ] .…”

“…The blood rarely reaches the surface of the cortex but enters the cerebrospinal fl uid in about 90% of the cases. Signi fi cant compression of the brain stem structures can be fatal [ 2,16 ] .…”

“…As a consequence of the accelerated aging of the US population, stroke will remain a public health problem with adverse personal, societal, and economic implications. According to Caplan, rehabilitation services for stroke patients are typically provided to those in the middle range of impairment [ 2 ] . While those with milder strokes are frequently discharged directly to home with outpatient therapy or home care, those with more severe strokes who cannot tolerate inpatient rehabilitation are discharged to a long-term care facility with limited rehabilitation therapy services.…”