ASSESSMENT AND PSYCHOLOGIC FACTORS IN STROKE REHABILITATION

With improved survival after stroke, it is important to identify those patients whose quality of life can be enhanced through rehabilitation . The decision for rehabilitation is based on several factors: type an d severity of neurologic deficits, cognitive status, physical enduranc e, and preferences of patient and family. Implementation requires iden tification of learning patterns, sensitivity to the patient's response s, and establishment of realistic goals. Systematic assessment of impa irments and disability is valuable for describing the impact of the st roke, monitoring recovery, evaluating response to specific interventio ns, and determining their long-term benefits. Because of the range of potential impairments, it is important to use a battery of assessment measures and to incorporate specific measures during each stage of rec overy. In addition to assessments for neurologic disabilities, assessm ents for psychosocial conditions are necessary, as depression and dysp horia occur commonly and affect the rehabilitation and recovery of str oke patients. Their influence on physical function is currently being debated in the medical literature. The social context in which a strok e patient recovers also has profound effects on the success of the rec overy process. Such factors as the amount of social support, income le vel, race, and life satisfaction affect the patient's rehabilitation p rocess and adjustment. Standardization of assessment measures and a be tter understanding of the psychosocial factors that influence rehabili tation are necessary for helping stroke patients achieve an optimum fu nctional quality of life.