DISABILITY AFTER STROKE AND ITS IMPACT ON SECONDARY PREVENTION

All aspects of stroke management are best considered within the World Health Organisation's framework of illness, which acknowledges four le vels: pathology; impairment; disability, and handicap. Prevention ulti mately aims to prevent death and minimise handicap. It may be targette d at pathology, preventing cerebral infarction; impairment, preventing symptoms and signs; disability, minimising dependence, or handicap, m aximising freedom within society. The risk of recurrence of symptomati c stroke is relatively low (10%/year) and the reduction in risk achiev able is only modest (20% reduction). Consequently, it is always necess ary to balance the risks of intervention, and the costs (e.g. in terms of reduced pleasure or increased anxiety) against the potential benef it. In severely dependent people, it is unlikely that intervention is warranted.