Perna Robert, Harik Lindsey
Pate Rehabilitation, Anna, Texas, USA.
TIRR Memorial Hermann, Houston, Texas, USA.
NeuroRehabilitation. 2020;46(2):195-204. doi: 10.3233/NRE-192970.
A stroke event, sometimes referred to as a cerebrovascular accident (CVA), is a sudden and often traumatic life event that results in life-changing consequences with which affected people must cope. There are nearly 800,000 instances of stroke annually in the U.S. (American Heart Association, 2018). Stroke is the leading cause of disability in adults, and more than one-third of people who survive a stroke will have severe disability in the U.S. (Mayo, 2005). Between 35% and 75% of stroke survivors will have significant cognitive impairment (Tatemichi et al., 1994; Nys et al., 2007). An estimated one-third of people suffer depression after stroke (Hackett et al., 2005), about one-fourth experience significant anxiety (Barker-Collo, 2007), and about one-fifth suffer from insomnia (Leppavuoria et al., 2002). These and other stroke-related psychological issues negatively influence rehabilitation and outcomes through a variety of mechanisms. For example, post-stroke depression has been shown to be related to more negative functional consequences (Kneebone et al., 2000; Matsuzaki et al., 2015). Psychological disturbances may affect rehabilitation outcomes through a reduction in adherence to home exercise programs, reduced energy level, increased fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future.
This manuscript aims to identify and describe the role of rehabilitation psychology in treating these common post-stroke complaints and, ultimately, optimizing post-stroke outcomes via two case examples.
This manuscript describes two cases of individuals in post-acute rehabilitation who had psychological issues which were negatively affecting outcomes.
Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients' emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes.
中风事件，有时也被称为脑血管意外（CVA），是一种突然且往往具有创伤性的生活事件，会导致改变生活的后果，患者必须应对。在美国，每年有近80万例中风病例（美国心脏协会，2018年）。中风是成年人残疾的主要原因，在美国，超过三分之一的中风幸存者会有严重残疾（梅奥诊所，2005年）。35%至75%的中风幸存者会有显著的认知障碍（立道美智等人，1994年；尼斯等人，2007年）。据估计，三分之一的人在中风后会患上抑郁症（哈克特等人，2005年），约四分之一的人会有明显的焦虑（巴克 - 科洛，2007年），约五分之一的人患有失眠症（莱帕沃里亚等人，2002年）。这些以及其他与中风相关的心理问题通过多种机制对康复和预后产生负面影响。例如，中风后抑郁症已被证明与更负面的功能后果有关（克内伯恩等人，2000年；松崎等人，2015年）。心理障碍可能通过减少对家庭锻炼计划 的依从性、降低能量水平、增加疲劳感、降低挫折耐受力以及可能减少对未来的动力和希望来影响康复结果。
本手稿旨在通过两个案例，识别并描述康复心理学在治疗这些常见的中风后问题中的作用，并最终优化中风后的预后。
本手稿描述了两例处于急性后期康复阶段且心理问题对预后产生负面影响的个体案例。
鉴于中风具有突然且显著改变生活的性质，通常有必要处理一系列往往无法仅通过精神药物简单管理的心理问题。此外，了解患者的情绪调整和问题可以帮助他们最大限度地实现康复、恢复以及融入社区。对于所讨论的案例，心理会诊在帮助优化其康复和功能结果方面发挥了核心作用。
