Why is stroke considered to be a chronic condition?
The American Heart Association (AHA) and the American Stroke Association (ASA) want providers to take a different look at the way we treat stroke patients. Stroke, fundamentally, is a chronic condition in that we are not just treating that new onset for a short period of time. Formal rehabilitation, in general, ends about three to four months after the stroke. Of course, the duration of treatment depends on type, severity and location of the stroke.
Prior treatment approaches have managed stroke medically as a temporary or transient condition, looking more at the acute event. But currently we know that there are unmet needs that persist in many areas. When looking at these chronic outcomes and what they are impacted by, there is a significant link to communication and cognition.
Oftentimes, care providers want to get someone to the point where they are physically able to return home or to their environment. However, we cannot forget about the communication and cognitive piece that is so important. The research shows that those unmet needs are related to social reintegration, health-related quality of life, the ability to maintain an activity and self-efficacy (i.e., the belief that someone has the ability to carry out a behavior). There is a high incidence of depression, reduced drive and reduced belief that they can still do things the way they did before. Apathy is manifested in greater than 50% of stroke survivors at one year after stroke. Fatigue is a common condition. Daily physical activity is low and depression is high.
By four years after the stroke, greater than 30% of stroke survivors report persistent participation restrictions (e.g., difficulty with autonomy, engagement, or fulfilling societal roles). Oftentimes that ties back into communication and cognition.
The AHA and ASA clinical findings recommend SLPs assess certain areas for cognition and communication abilities. The focus areas that should be assessed for cognition and communication include:
- Simple attention and complex attention
- Receptive, expressive, and repetition language abilities
- Perceptual and constructional visual-spatial abilities
- Memory, including language-based memory and visual-spatial memory. When thinking about language and cognition across a continuum in relation to memory, it is important to remember the language-based aspects that are tied to memory. This is not just short-term, long-term memory and immediate recall. It also includes sematic memory and word finding. Memory is multifactorial in nature. Therefore, if there is a lower-level language impairment, then there is also an impact on higher-level memory abilities.
- Executive functioning abilities, including awareness of strength and weaknesses, organization and prioritization of tasks, task maintenance and switching, reasoning and problem solving.
Please refer to the SpeechPathology.com course, Assessment of Patients with Low-Level Cognitive Function, for more in-depth information on the evaluation of patients with low-level cognitive function, including methods for collecting baseline data and creation of functional, measurable, and timely goal targets based on analysis of clinical findings.