Constructing the stroke: sudden-onset narratives of stroke survivors

In this article, the authors explore the narrative production of stroke from the perspectives of survivors, that is, the stroke itself, not its implications for the individual poststroke. In the vast amount of literature on both sudden onset and chronic illness, the narrative construction of the onset of the illness, for the most part, has been ignored by social scientists, most notably in qualitative research. This is certainly true of stroke. Drawing on existing literature in both chronic illness and the body, the authors extend this to explore the phenomenological construction of stroke onset. Using data gathered from in-depth interviews with 111 stroke survivors postdischarge, they suggest three narrative mechanisms are used in the construct of the sudden-onset event itself: the use of typifications to construct the body during stroke, stroke as an internal communicative act, and stroke as a physical sensation and the mechanisms used to minimize bodily concerns.     

Cardiovascular risk in survivors of stroke

BACKGROUND: Stroke survivors are at significant risk for recurrent stroke and cardiovascular disease. Inadequately managed modifiable risk factors increase the threat of recurrent stroke, development of new comorbidities, and double the risk of premature mortality. The purpose of this study was to determine the prevalence of modifiable cardiovascular risk factors in stroke survivors who completed a research screening evaluation for entry into exercise rehabilitation studies. The sample collected between January 2001 and June 2005 evaluated 364 community-dwelling men and women aged 34 to 88 years living in Baltimore, Maryland. METHODS: Each participant's risk profile was evaluated from data obtained during a medical history and physical examination and from laboratory analysis of a fasting blood sample. Current practice guidelines were used to define risk categories. RESULTS: Ninety-nine percent of participants had at least one suboptimally controlled risk factor. Ninety-one percent had two or more concurrent risk factors inadequately treated. Eighty percent of the participants had prehypertension or hypertension, 67% were overweight or obese, 60% had suboptimal low-density lipoprotein, 45% had impaired fasting glucose, 34% had low high-density lipoprotein, and 14% were current smokers, while reportedly receiving routine medical care. CONCLUSIONS: These findings confirm that cardiovascular risk factors remain inadequately managed in stroke survivors, increasing the chance for repeat stroke and cardiovascular event. Systematic assessment of this vulnerable population is imperative at every healthcare encounter.     

The Framingham Disability Study: physical disability among community-dwelling survivors of stroke

The relationship between stroke and physical disability was examined in a cohort of adult, Framingham, Massachusetts, residents who, between 1948 and 1951, were assembled for a longitudinal examination of cardiovascular disease. Multivariate analyses examined the amount of residual disability attributable to stroke among 2540 community-dwelling survivors, 27 years after their initial examination, after controlling for age, cardiovascular risk factors, other cardiovascular diseases, and eight general health conditions related to physical disability. Among men living in the community, a history of stroke explained 12% of the variance in physical disability. Suffering a stroke, however, was not as strongly related to physical disability among women living in the community, accounting for only 3% of the variance. Results suggest that although older men and women die from the same major causes, they may not be disabled by the same conditions.     

The lived experience of stroke survivors with early depressive symptoms: A longitudinal perspective

Purpose

The aim of the study was to describe the lived experience as it develops over time in stroke survivors suffering from early depressive symptoms.

Method

This paper presents a phenomenological hermeneutical interview-study of nine participants at 6, 12, and 18 months after stroke.

Findings

The participants related the depressive symptoms to the consequences of the stroke, and the experience of loss was crucial. Depressive symptoms was not meaningful on its own, but formed the backdrop of the experience of stroke. Our findings revealed three patterns of experience: (1) finding a restored self; (2) trapped in a different life; and (3) fighting to regain self.Two groups of stroke survivors are particularly vulnerable and should receive special attention: (a) old adults living alone; and (b) adults experiencing serious threats to their commitments such as to work, family, and children.

Conclusion

Depressive symptoms have a severe impact on life after stroke. Life circumstances, degree of residual impairment from a stroke, and social context were found to influence people to move along different paths. Older adults living alone and adults experiencing serious threat to their commitments should receive special attention, in terms of further research and in terms of follow-up in clinical practice.More studies investigating the experience of post-stroke depression (PSD) over time and the association between depressive symptoms and loss/grieving are needed. There is also a need for continued empirical research on the identification of effective interventions aimed at prevention or improved coping with PSD.     

A description of physical activity behaviors,barriers, and motivators in stroke survivors in Quebec

BackgroundStroke survivors do not meet physical activity (PA) recommendations to accrue the associated health benefits. Perceived barriers and motivators to PA can be influenced by geographic and cultural nuances that are important to consider when developing stroke-specific PA interventions.ObjectiveThe objectives of this study were to describe PA duration and frequency, barriers and motivators to PA, and to explore sex and ages differences in PA among stroke survivors in Quebec.MethodsA cross-sectional online survey was used to recruit Quebecers through special interest groups and word-of-mouth that experienced a stroke (≥ 18 y, ≥ 1 y post-stroke). Twenty-one survey items were related to demographic information, PA behavior, barriers and motivators to PA, and physical inactivity. Summary statistics were calculated using SPSS.ResultsThirty individuals who were 7.6 ± 8.3 years post-stroke completed the survey. Light intensity aerobic PA was reported by 97% of participants, moderate intensity PA by 70%, high intensity by 30%, and 37% reported doing strength training. Barriers to PA were fear of falling (47%), not feeling comfortable participating in PA at a gym (33%) and lack of energy (30%), while motivators included, improving physical condition (87%), feeling good (67%) and reducing risk of subsequent stroke (70%).ConclusionOur findings show that 30 stroke survivors from Quebec did not achieve the minimal PA recommendations. Alternative approaches to PA should consider accessibility, safety, and enhancing fitness to optimize PA participation for stroke survivors living in Quebec.     

The sociodemographic patterning of health in Estonia, Latvia, Lithuania and Finland

BACKGROUND: Public health problems in the Baltic countries are typical of Eastern European transition economies. A common assumption is that the economic transition has been particularly difficult for previously disadvantaged groups, and comparative research on the health differences between sociodemographic groups in the Baltic countries is therefore needed. This study compared associations of health with gender, age, education, level of urbanization and marital status in three Baltic countries and Finland. METHODS: The data were gathered from cross-sectional postal surveys conducted in 1994, 1996, 1998 and 2000 on adult populations (aged 20-64 years) in Estonia (n = 5052), Latvia (n = 4290), Lithuania (n = 7945) and Finland (n = 12796). Three self-reported health indicators were used: (i) perceived health, (ii) diagnosed diseases and (iii) symptoms. RESULTS: The prevalence of less-than-good perceived health (average, rather poor or poor) was higher in the Baltic countries (men 66-56%, women 68-64%) than in Finland (men 35%, women 31%). The odds ratios (with 95% confidence intervals) of less-than-good perceived health among the low educated compared to the highly educated in Estonia, Latvia, Lithuania and Finland were 2.03 (1.49-2.77), 2.00 (1.45-2.76), 2.27 (1.78-2.89) and 1.89 (1.61-2.20) among men, and 3.32 (2.43-4.55), 2.77 (2.04-3.77), 2.07 (1.61-2.66) and 1.89 (1.63-2.20) among women, respectively. Diseases and symptoms were also more common among the lower educated men and women in all four countries. However, urbanization and marital status were not consistently related to the health indicators. CONCLUSIONS: The Baltic countries share a similar sociodemographic patterning of health with most European countries, i.e. the lower educated have worse health. The methodological considerations of this study point out, however, that further research is needed to support public health policies aimed at the most vulnerable population groups.     

Determinants of health-related quality of life in Nigerian stroke survivors

Stroke is a leading cause of disability in developing countries. It is crucial to identify factors influencing health-related quality of life (HRQOL) in stroke survivors in this setting so that such factors can be efficiently manipulated in order to maximize HRQOL improvement. This is the first study of these determinants in Nigerian stroke patients. One hundred consecutive consenting stroke survivors were studied in Ibadan. The stroke levity scale (SLS) was used to assess stroke severity. HRQOL was assessed using the psychometrically robust HRQOL in stroke patients (HRQOLISP) questionnaire. HRQOL determinants were sought among variables such as age, gender, socio-economic class (SEC), post-stroke duration, side, type and number of strokes, SLS, modified Rankin scale (mRS), social support, and Likert-graded responses to laughter and negative feelings frequencies. Gender, aphasia, handedness, stroke side, type and frequency as well as SEC had no significant impact on HRQOL. The determinants of HRQOL were SLS, mRS, social support, laughter and negative feelings frequencies. Aside from stroke levity and disability, psychosocial factors such as emotional responses and social support determine HRQOL in stroke survivors. Both neuroscience and clinical management of stroke might benefit from a corresponding broader integrative conceptual framework for life after stroke.     

Patterns of informal care among Puerto Rican,African American,and white stroke survivors

Background. There has been an increase in the number of non-institutionalized stroke survivors over the past few decades leading to larger numbers of family caregivers. Less is known about the patterns of informal caregiving within racially and ethnically diverse families even though there is greater post-stroke morbidity and mortality for these groups.

Research aims. The purpose of our research is to examine the informal caregiving networks of white, African American, and Puerto Rican caregivers.

Methodology. We examine data collected from 118 stroke survivors and caregivers to explore the dynamics of caregiving. Data are drawn from a diverse group of whites, African Americans, and Puerto Ricans living on the US Mainland and Puerto Rico at three different time points over the course of 12 months.

Analysis. We examine the size, stability, change, and family dynamics of informal caregiving networks.

Findings and implications. We find that whites, African Americans, and Puerto Ricans each have differing caregiving structures highlighted by expansion and contraction across time, size of network, and relationship to the stroke survivor. Greater cultural awareness among health professionals can lead to improved coordination of information or formal care services. These findings may also be used as a baseline for understanding the caregiving patterns of other Spanish-speaking Caribbean nations.     

The role of social support in the family and community integration of right-hemisphere stroke survivors

The goal of this project was to understand better the communicative processes by which social support can assist right-hemisphere stroke survivors in the process of community integration. Open-ended interviews were conducted with 12 right-hemisphere stroke survivors and their family caregivers. The transcribed interviews revealed 7 challenges (physical, cognitive-perceptual, emotional, relationship, employment, financial, and challenges to activities of daily living) and three types of resources (formal external, informal external, and internal). Stroke survivors' internal resources were shown to be essential for facilitating community integration. Implications for researchers and health care providers are discussed within the framework of Hobfoll's (1988) conservation of resources theory.     

Life satisfaction and functional disabilities in long-term survivors after first stroke

Despite good recovery from a stroke, the quality of life (QOL) of most stroke patients living in the community is not always restored in their acute or recovery phase. Our aim of this study was to evaluate the relation between basic/social functional disabilities and life satisfaction (one of the indicators of QOL) in long-term survivors after a first stroke. Sixty three consecutive outpatients who had received comprehensive inpatient rehabilitation after their first stroke participated in this cross-sectional study. The profile, basic activities of daily living, life style and life satisfaction of these outpatients were evaluated based on their interview. More than half of the subjects had a decrease in life satisfaction. There was mostly weak positive correlation between functional/social disabilities and the life satisfaction, and both age and sex were not predictors of their QOL. Therefore, functional disabilities had a weak impact on QOL in the long-term survivors after the first stroke.