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Is There Fun After Stroke?

By Wendy Wright

It is difficult to describe the changes that occur in the psyche of a stroke victim and even more difficult to understand the range of emotions this individual is going through while processing a sudden and drastic life course change.

The loss of independence and the potential for feelings of stigma can lead to social isolation, lack of leisure time activity, anxiety and depression.

Active leisure participation declines in the majority of people suffering from a stroke (Drummond, 1990). A Swedish study investigating the relationship between leisure activities (and the enjoyment derived from them) with feelings of depression in stroke victims, found that perceptions of social stigma were very common within the first year of a stroke and that leisure time activity (number of and frequency) decreased. This inactivity bred a reactive despondency that led to depression in 65% of the cases studied (Sjogren, 1982). Studies have shown that leisure time activities, especially leisure time physical activity can improve mood and assist in the management of mental health disorders (Penedo and Dahn, 2005).

Some of the barriers to leisure time physical activity include loss of physical ability to do a favorite activity, lack of social support, and a tendency towards poor self-efficacy.

Physical rehabilitation post-stroke tends to focus on mobility and self-care. Goals are generally directed toward resuming instrumental activities of daily living (IADLs) and less care is given to broader areas such as resuming leisure activities. Leisure activity has been linked with greater life satisfaction and therefore should be an important component of rehabilitation for a stroke victim (Hartman-Maeir, 2007). Leisure is meant to be an enjoyable part of life but the problem that generally arises is the physical inability of stroke victims suffering from contralateral hemiparesis or hemiplegia to return to their more active previous leisure pursuits.

In order to continue enjoying leisure time post-stroke, attention should be given to trying new leisure activities that are physically feasible for a person with hemiplegia and finding activities the individual will get pleasure from as much as pre-stroke leisure activity. With support and adaptive devices, these pursuits could include bowling, swimming (with floatation device), walking, kayaking, playing pool, in addition to pottery, painting, and woodwork. Many of these activities require little skill to begin with and can be easily improved upon with practice. The key is to try different activities until an activity is found that is pleasurable for the individual.

Social support is essential for individuals recovering from a stroke (or any other physical or mental health issue). Studies have shown that patients who have suffered from a mild/severe stroke but who have very good social support achieved a better functional status than those with little support (Tsouna-Hadjis et al., 2000). A high level of both instrumental and emotional social support improves recovery while also playing a role in an individual’s psychosocial status (Tsouna-Hadjis et al., 2000).

How can family help? There are many options: organizing leisure time outings and actively participating with the stroke patient in these activities, setting regular time aside to ensure that the loved one has opportunities for different leisure activities, and including the individual in group-type activities in order to engage them in social contact (very important following a stroke.) It is crucial to understand the value of social support and the role it plays in a stroke victim’s recovery, personal growth and lessening the feelings of stigma associated with stroke.

Self-efficacy is the belief in your own personal ability to succeed in a particular situation (Bandura, 1989). Self-efficacy is often built on past experiences. This sense of self-efficacy can affect how we approach new activities, challenges or tasks as well as the goals we construct for ourselves surrounding these tasks. This is important for a person suffering from paraplegia because they are suddenly thrown into a new paradigm where once they could predict their success or failure in most activities but now they are faced with uncertainty. Poor self-efficacy ensues when an individual no longer feels they have the ability to succeed in a situation, which in turn may affect their approach to trying new leisure pursuits. Once again, social support is critical as it can help support the stroke victim through this time of uncertainty by giving the emotional support needed to overcome the anxiety associated with attempting something new.

Leisure time pursuits, in particular physical leisure time activities, are an important part of post-stroke rehabilitation improving both physical and mental health profiles. Leisure activities can decrease feelings of stigma, isolation, anxiety and depression, but they require a strong social network of support to complete.

References:

Hartman-Maeir, A., Soroker, N., Ring, H., Avni, N. and Katz, N. (2007) Activities, participation and satisfaction one-year post stroke. Journal of Disability and Rehabilitation, 29(7): 559-566

Bandura, A. (1989) Social Cognitive Theory. Annals of Child Development, 6:1-60

Drummond, A. (1990) Leisure Activity After Stroke. Journal of Disability and Rehabilitation,12(4):157-160

Penedo, F. and Dahn, J. (2005) Exercise and Well-being: A Review of Mental and Physical Health Benefits Associated With Physical Activity. Current Opinions in Psychiatry, 18(2): 189-193

Sjogren, K. (1982) Leisure After Stroke. Journal of Disability and Rehabilitation, 4(2): 80-87

Tsouna-Hadjis et al., (2000) First Stroke Recovery Process: The Role of Family and Social Support. Archives of Physical Medicine and Rehabilitation, 81(7): 881-887

Wendy Wright was a practicum student and currently volunteers at CONNECT Lake Country.