Hello, mowerman-ga!
There are numerous articles highlighting the value that a determined
and positive attitude plays in recovery from stroke. “Determination”
can be defined as “firm resolution,” “settled purpose,” “the mental
habit of settling upon some line of action with a fixed purpose to
adhere to,”and “firm resoluteness” according to The New Webster's
Dictionary of the English Language. Determination to recover from a
stroke would also imply a positive attitude about getting better.
The determination to move forward in life after a stroke is
epitomized by visitors to the National Stroke Foundation, which is
located in a small suburb of Kansas City.
“When Kolleen Arnold had a stroke at age 31, a doctor gave her
husband little hope she would recover…. Today, Arnold shares her story
and determination with other stroke survivors at an innovative
experiment called the American Stroke Foundation…The one-story house
with a patio, spacious backyard and pool gives stroke survivors and
their caregivers a place to share the battle and to relearn the basic
skills their strokes have stolen from them.”
“Survivors get compassion, but not pity, from others at the house.”
"We constantly preach, 'Use it or lose it,"' said Christy Axford
Hall, executive director. "We offer shoulders to cry on. But when
someone wants a glass of water, we say, 'Get your own water.' They
can't recover if people keep waiting on them."
"Most people with strokes still have tremendous abilities; they can
still think and do," Simon said. "Those people run this program. What
greater impetus to push someone to do more for themselves than to say,
'That guy who helped me had a stroke too, and he can do it."'
Read “Home Atmosphere Aids Stroke Recovery.” The Associated Press.
(9/11/2000) at http://www.cnn.com/2000/HEALTH/aging/09/11/stroke.home.ap/
The Stroke Recovery Foundation had a strong advocate in John Rich,
who’s “lifelong determination to beat challenges” played a strong part
in allowing him a fulfilling life after suffering two strokes.
“He did not complain about his disabilities, never asked "why me?",
and did not let them hold him back. The stroke which he suffered
shortly after his 50th birthday required courage and spirit on the
road to recovery. Spending almost five months in a wheelchair in a
rehabilitation hospital, Rich learnt again how to walk. He never
regained use of his left arm and hand.”
“Even after his second, more debilitating stroke in December, 2000,
his family and friends never underestimated his will to remain
positive, to gain whatever recovery he could.”
“In 1996, in a series of radio talks on overcoming strokes, he said:
"Everyday life to a person affected by stroke is somewhat daunting,
but if you remain positive about your inconveniences, you will find a
satisfactory quality of living."
Read “Printer’s Ink in His Blood and Resilience in His Bones,” by
Johnathan Chancellor. The Sydney Morning Herald. (11/1/2002) at
http://www.smh.com.au/articles/2002/10/31/1036026977707.html
The determination to recover from the effects of stroke was the main
factor in awarding Maria DiTullio the 2002 Mercy Courage Award for
Personal Achievement. At the age of 30, Maria suffered a stroke after
several rounds of chemotherapy to treat Hodgekin’s Disease.
“As a physical therapist, Maria knew that she faced a long, hard road
to recovery and began a comeback routine that included physical,
occupational and speech therapy. But through her own determination and
with the love and support of her family, Maria would comeback.”
“As her physical therapist and nominator explains, "Maria has been
relentless in her pursuit of further recovery." Through determination
and hard work Maria has recovered movement and made significant
improvements in motor control in her leg that has greatly improved her
walking. She continues to seek out additional therapy as she
constantly challenges herself to extend her recovery. Her speech is
improved and she is now completely independent, living on her own and
driving again. She has even learned to ski using adaptive equipment.”
Read “Mercy Courage Award.” Mercy Rehab Associates (2002) at
http://www.mercyhealth.org/news/courage/2002/ditullio.php
The recovery of Kate Adamson also highlights the role of
determination in beating the effects of stroke.
“On June 29, 1995, a severe stroke at the base of her brain left her
paralyzed and unable to speak. During the first few days of the six
weeks she would spend in the intensive care unit at Torrance Memorial
Medical Center, doctors gave her a 1 percent chance of surviving, let
alone recovering to the miraculous extent that she has.”
** ”What Kate Adamson had was determination, a quality that is
considered key by rehabilitation therapists in determining the level
of activity and functioning that a stroke patient will eventually
attain.” **
Read “Profile in Determination,” by Laurie Blue Lunderberg at
http://www.katesjourney.com/profiles.html
Determination to recover also plays an important part in childhood
recovery from stroke. A mother’s account of her 10-year old son’s
recovery after a debilitating stroke tells of his determination to
continue watercolor painting, despite the inability to use his right
hand. Although she was against it for fear that he would experience
failure, “David, however, was determined.” “It was his determination
and attitude that made the biggest difference.”
In fact, focusing on a patient’s weakness and protecting them from
possible failure can be more harmful than helpful. “Instead, in
reality, we often rob them of their desire, independence and their
strengths….They may have the will, and we may find ourselves
squelching it…Keeping hope and motivation alive while helping
survivors focus on their strengths is key to optimal recovery.”
“David insisted that he was going to fight this every step of the
way. He would fight everything and anyone who wanted to get in his
way. He was bound and determined that he was going to recover to the
best of his ability.”
David’s success and determination has paid off with a freelance
career and the publication of a book titled “Brain Attack at Ten.”
Read “Family Involvement Optimal for Stroke Recovery,” by Carol
Dow-Richards. Topics in Stroke Rehabilitation. Summer 2000 at
http://www.thomasland.com/_nonsearch/tsr07205.pdf
“Level of motivation or determination” is an important “predictor of
outcome” in patient recovery highlighted in the article “Motor
Recovery in Stroke,” by Auri A Bruno, MD. Emedicine (1/29/2002) at
http://www.emedicine.com/pmr/topic234.htm
According to David Tong, MD, at the Stanford University Stroke
Center, “Successful stroke rehabilitation is dependent on many
factors, including the severity of brain damage and the cooperation of
family and friends. Not surprisingly, the attitude of the patient is a
key factor in speed and degree of recovery. A positive outlook and
high level of determination may facilitate recovery.”
Read “A King's Recovery From Stroke Can Be Faster in His Own Castle,”
by Mike Fillon. WebMD Medical News. (5/5/2000) at
http://content.health.msn.com/content/article/23/1728_57262?
For stroke patient Patrick Hourihan, “the whole idea is you never
give up.” “After intense rehabilitation he walks and talks like he did
before the stroke, and it appears it was his determination that got
him to where he is now.
Read “Stroke Prevention,” OnAir Story (3/27/2002) at
http://www.wggb.com/health/strokeprev1.htm
Additional Reading
“Fighting Back After a Stroke,” by Jamie Leggatt.
http://www3.telus.net/leggatt/stroke_recovery.pdf
A series of links with information about all aspects of strokes and
recovery can be found at
http://dmoz.org/Health/Conditions_and_Diseases/Neurological_Disorders/Stroke/
I hope these articles provide valuable evidence that determination,
rather than sheer luck, is definitely a key factor in successful
recovery after stroke!
Best wishes!
umiat-ga
Google Search Strategy
+stroke recovery and +determination |
Clarification of Answer by
umiat-ga
on
18 Dec 2002 17:59 PST
Hello, again!
I would be happy to clarify my answer for you. I centered on
“real-life” accounts of determination and survival because your
original question mentioned nothing about wanting scientific studies
concerning both sides of the issue. However, the two articles I
included by medical doctors did, in fact, mention a variety of other
contributing factors that must also be taken into account when
considering survival from stroke. Certainly, determination and
positive attitude are important factors in patient outcome, but they
are not the only factors in stroke survival.
My original answer pointed to an article called “Motor Recovery in
Stroke,” by Auri A. Bruno, MD at
http://www.emedicine.com/pmr/topic234.htm While I highlighted Dr.
Bruno’s mention of determination being a key to stroke recovery, it is
evident from reading the article that other factors are at play. For
instance, he mentions the role of age, coimpairments and reduced
therapy as factors which effect survival rate.
“The effect of age on outcome may be related in part to more frequent
coimpairments. If elderly patients have lost function before
sustaining a stroke, less favorable outcomes following a stroke would
be expected. Furthermore, elderly patients often do not receive
therapy that is as intensive as therapy provided for younger patients,
perhaps due to their greater intolerance to activity. Older patients
may be discharged sooner from the rehabilitation program.”
Dr. Bruno also mentions that survival rate is hard to predict and is
often associated with the initial length of survival after the stroke.
(see chart in article)
“Individuals who survive the initial insult have good life
expectancy.”
“Fifty percent remain alive after 5 years, and those surviving longer
than 18 months lived comparable to general age-matched and sex-matched
populations.”
“Average life expectancy is 7 years following rehabilitation; 30%
survive 11 years.”
Other factors mentioned in the article which can effect stroke
survival are excerpted below:
“Early death following a stroke usually is related to the underlying
pathology and to the severity of the lesion. The 30-day survival rate
for patients with cerebral infarction is 85%, but for patients with
intracerebral hemorrhage, survival is reported to be only 20-52%.”
“Better management of cardiac and respiratory disorders has reduced
early mortality. However, hypertension, heart disease, and DM remain
risk factors for recurrence of stroke.”
“Coma following stroke onset indicates an unfavorable prognosis,
presumably because coma occurs frequently in cerebral hemorrhage. When
coma occurs in association with cerebral infarction, it reflects a
large lesion with cerebral edema.”
(Certainly, these medical conditions are beyond the scope of simple
determination in predicting patient survival!)
Another reference from my original answer, copied below, is also
quite clear in pointing out that determination is only one of many
contributing factors to survival. In fact, the doctor uses the words
“may facilitate.” Yes, determination does help, but it does not
automatically predict survival.
According to David Tong, MD, at the Stanford University Stroke
Center, “Successful stroke rehabilitation is dependent on many
factors, including the severity of brain damage and the cooperation of
family and friends. Not surprisingly, the attitude of the patient is a
key factor in speed and degree of recovery. A positive outlook and
high level of determination may facilitate recovery.”
Read “A King's Recovery From Stroke Can Be Faster in His Own Castle,”
by Mike Fillon. WebMD Medical News. (5/5/2000) at
http://content.health.msn.com/content/article/23/1728_57262?
The study referred to by jennerina-ga appeared in the July 2001 issue
of Stroke: Journal of the American Heart Association. The full text of
the study, titled “Negative Attitudes Among Short-Term Stroke
Survivors Predict Worse Long-Term Survival,” by S.C. Lewis, PhD; M.S.
Dennis, MD; S.J. O’Rourke, PhD; M. Sharpe, MRCPsych. Stroke.
2001;32:1640. can be found at
http://stroke.ahajournals.org/cgi/content/full/32/7/1640?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Lewis%2C+S.C&fulltext=attitude&searchid=1040255230449_2717&stored_search=&FIRSTINDEX=0&search_url=http%3A%2F%2Fstroke.ahajournals.org%2Fcgi%2Fsearch&journalcode=strokeaha
The abstract is posted below, but the full study is quite
fascinating.
Background and Purpose—Patients respond to serious illness in
different ways. We wished to determine whether different attitudes
toward illness are associated with survival after stroke.
Methods—Three hundred seventy-two stroke patients were identified and
medically assessed as part of a randomized trial to evaluate a stroke
family care worker. They had all survived 6 months from randomization.
A research psychologist visited each patient and administered the
Mental Adjustment to Stroke Scale (a self-rated attitude scale based
on the Mental Adjustment to Cancer Scale). Disability and dependence
(Barthel Index, modified Rankin Scale) and mood (Hospital Anxiety and
Depression Scale, General Health Questionnaire 30) were also assessed.
Patients were followed up in 1998 (3 to 5 years after the initial
stroke) to establish their survival. We modeled the relationship
between Mental Adjustment to Stroke scores and survival, adjusting for
other factors associated with stroke survival.
Results—Eighty-two patients (22%) died within 3 years. After
adjustment for other significant factors, fatalism and
helplessness/hopelessness were both associated with decreased survival
(P=0.03 and 0.04, respectively), but fighting spirit, anxious
preoccupation, and denial/avoidance were not. Mood was not associated
with survival.
Conclusions—Patients’ attitudes toward their illness seem to be
associated with survival after stroke. Patients who feel that there is
nothing they can do to help themselves 6 months after a stroke have a
shorter survival. These findings need to be confirmed and any causal
relationship between attitude and survival further explored in a
randomized controlled trial to "improve" the attitude of stroke
patients toward their illness.
The article “Psychological, Behavioral and Environmental Influences
on Post-Stroke Recovery,” by Jan Remor-Osborn, PhD. at
http://www.thomasland.com/_nonsearch/tsr05205.pdf also highlights
other factors that influence stroke survival.
“Research has demonstrated that recovery from stroke is influenced by
several factors including premorbid personality, degree of physical
loss, amount of social support, and severity of cognitive change.
Psychological disturbances and behaviors, including depression,
adjustment disorders, anxiety, personality changes, aggression, and
non-compliance may significantly impact outcome. Environmental and
extra-therapeutic circumstances provide an often-overlooked framework
for the recovery process. Selected issues drawn from
clinical experience and recent literature addressing these variables
are examined to further understanding and to provide a practical
approach in optimizing recovery.”
For an interesting perspective on attitude and recovery, read
“Healthy Attitude: 101,” by Barry Bittman at
http://www.mind-body.org/Barry%20Bittman%20-%20stroke-survival.htm
While Dr. Bittman highlights the importance of research studies that
correlate healthy, positive attitudes with recovery from diseases,
including stroke, he also points out that many positive-thinking
people succumb to their illness. “While these combined research
findings are impressive, one should realize that attitude is not the
only determining factor in survival. This is an important perspective
to consider based upon the fact that some people tend to blame
themselves unnecessarily for their disease or outcome. It’s a fact
that despite positive and unyielding attitudes, people still succumb
to illnesses like cancer and strokes everyday. Heaven is filled with
positive thinkers who adhered to healthy exercise and nutritional
regimens throughout their lives.”
Thus, your point is well-taken, and an important one at that.
Patients should never feel inadequate in the way that they handle
debilitating illnesses. While positive outlook is important, it is not
the only determining factor between a successful outcome after stroke.
umiat-ga
Additional Reading
For a good overview of factors that affect quality of life after
stroke, and a number of interesting references, read “An Exploration
of Outcomes and Quality of Life Factors in an Educationally-based
Rehabilitation Program,” by Caroline Bliss Isberg, PhD. Cabrillo
College Stroke Center at http://www.strokecenter.com/qol.html
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