For stroke survivors embarking upon a challenging rehabilitation regimen, achieving the very best outcomes and quality of life depends as much upon the level of care and assistance provided by family members as clinical caregivers.
A pilot program developed within the Emory Center for Rehabilitation Medicine places as much of an emphasis on caring for the at-home caregiver as it does the patient.
According to Sarah Blanton, therapy program coordinator, stroke survivors in the U.S. over the past decade have steadily experienced decreased lengths of stay in acute care and rehabilitation centers. This shifts a larger responsibility for rehabilitation to the family, which often is unprepared to manage the additional responsibility.
"While family members' management of a stroke survivor's care has been associated with faster and more extensive recovery after stroke, family caregivers often experience negative outcomes from this role, which can be due to inadequate caregiver knowledge, skills and family support, as well as certain behaviors of the stroke survivor," says Blanton.
"Studies of outcomes of stroke family caregivers have shown significant amounts of depression and fatigue at levels equivalent to caregivers of patients with Alzheimer's disease and at rates far greater than the general population," says Blanton. "Learning about depression and ways to strengthen aspects of family functioning may help reduce negative outcomes for caregivers and stroke survivors.
"Finding new approaches to facilitate caregivers in their roles is essential to ultimately improving quality of life of both caregivers and stroke survivors," explains Blanton.
The pilot program at Emory develops an educational intervention to standardize the education component in the clinical setting. The data will be obtained to explore the impact of the family-focused interventional education program on caregiver and patient outcomes. The long-term goal is to develop and test family-based interventions to improve caregiver outcomes and positively affect stroke survivor recovery.
According to Steven L. Wolf, PhD, professor of rehabilitation medicine at Emory University School of Medicine, the main goal of this project is to enhance patient and family-centered care, by promoting self-efficacy through educational and training programs to collectively improve outcomes of the stroke survivor family unit as a whole.
"The effects of the intervention will be examined on caregiver and patient outcomes like depression, fatigue and health related quality of life," says Dr. Wolf. "Finding ways to address the needs of the patient and family will enhance clinical care and may improve long-term outcomes for patients and families.
"Use of our data involving caregivers and stroke survivors' quality of life collected through an Emory-based national randomized clinical trial (EXCITE) for initial development of the caregiver intervention programs reflects the interdisciplinary merging of research and clinical programs," notes Dr. Wolf.
"Ongoing evaluation of stroke survivor and caregiver outcomes will provide feedback that can be used for process improvement as well as data available for analysis in support of future research opportunities," says Dr. Wolf.
Emory recently established a new Constraint-Induced Therapy Clinic offering rehabilitation programs for patients who have suffered from a stroke and have experienced weakness or immobility in a hand and/or arm.
The Clinic is designed to help patients recovering from a stroke improve the use of an arm and/or hand by restraining the less-impaired hand and/or arm with an immobilizing mitt during waking hours in an effort to encourage use of the weaker arm. Patients engage in daily rehabilitative therapy sessions, which include intensive training in functional tasks such as opening a lock, turning a doorknob or pouring a drink. The program uses evidenced-based, innovative therapeutic approaches such as constraint-induced therapy to facilitate upper extremity recover after stroke.
"Among the distinct aspects of this clinic are the application of the patient-centered care approach specifically designed to promote self-efficacy within the context of an upper extremity rehabilitation program," says Dr. Wolf. "In addition, an active and ongoing screening of stroke survivors for quality of life concerns such as depression or post-stroke fatigue and the use of techniques to facilitate family involvement in the care and administration of constraint-induced therapy in the home environment are equally important."
Recently, Dr. Wolf, Blanton and colleagues finalized a study in which more than 220 patients suffering predominantly from ischemic stroke (the most common for of stroke in which a blood vessel becomes clogged) participated in the Extremity Constraint-Induced Therapy Evaluation Trial (EXCITE).
The study results say that patients who received constraint-induced movement therapy within three to nine months after suffering from a stroke showed significant improvement in arm and hand. The findings appeared in the Nov. 1, 2006 Journal of the American Medical Association.
Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The annual health care costs for stroke care is approximately $35 billion.
Individuals interested in information about the rehabilitation programs may contact Sarah Blanton at 404-712-2222.