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Stroke Recovery: Can Emotional Support Trigger Mental Stimulation?

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Emotional support sounds like a good idea. I mean who does not think this is a good idea? Yet, when we think of this idea, we rarely think of it as having serious implications for physical health. Just the word "support" often suggests that it is not an active intervention but a make-do, and the very least that one can do if someone is facing a major life challenge. But is this really the case? The literature on stroke and emotional support suggests that emotional support is more than just good intentions. It has a real impact on outcome.

Maria Glymour, an assistant professor of Society, Human Development and Health at Harvard, and her colleagues reported their findings on emotional support in stroke in the journal Neuroepidemiology [1]. In this article, they reported that emotional support led to better thinking ability six months down the line and also greater improvement in thinking at the same time. This suggests that the mental stimulation offered by "emotional support" somehow affected the brain, such that even when there was significant damage to a brain region, the associated brain changes improve thinking.

In fact, emotional problems do limit function in stroke patients [2]. Sometimes, people feel that depressed stroke survivors are unreachable, but there is evidence to suggest that you can in fact make them feel better to the extent that they feel less distressed and interact more successfully with others [3]. The cyclical problem here is that it is often very difficult for caregivers to provide this kind of support because of how demanding the role of caregiving is, regardless of the best intentions of the caregiver [4]. In fact, caregivers themselves may suffer from emotional difficulties when having to care for their loved ones.

There is also evidence from brain science that the brain's emotional processor, the amygdala, is smaller in stroke patients, especially in those whose thinking has been affected. This smaller amygdala may lead to depression [5].

How then can we address this vicious cycle? Asking caregivers to provide emotional support to people who have suffered from a stroke creates two patients, so that it seems that somehow the following factors are true: 1. Emotional support is helpful to the thinking abilities of stroke survivors; 2. Caregivers can provide this support but must be protected from burnout. How can we solve this dilemma then?

A few suggestions would be: 1. Caregivers may benefit from having automatic tools available to help them take a break from providing emotional support. They may serve as a guide rather than a constant caregiver. The latter would then allow people to take a break from care to allow them to focus on their own lives and also replenish their care-giving energy; 2. Doctors could build emotional support into rehabilitation programs. Providing this as a professional service may be helpful. Adding a psychiatrist or any other appropriate mental health worker to the treatment regimen would be one practical way to do this, as would emphasizing positive emotions. If you think this is impossible in a stroke population, consider a recent study that showed that in fact, many people who have had a recent stroke do in fact have positive emotions [6].

The message of this highlight then is that we may be slowing down the rehabilitation of stroke patients by placing the majority of the emotional support burden on caregivers, and that since emotional support can help create people with more agency, it is in everyone's best interest to include this in the medical regimen. Emotional support is not a soft variable. It matters when it comes to physical health -- stroke being a key example of this phenomenon.

1. Glymour, M.M., et al., Social ties and cognitive recovery after stroke: does social integration promote cognitive resilience? Neuroepidemiology, 2008. 31(1): p. 10-20.
2. Shinohara, Y., Factors affecting health-related quality of life assessed with the SF-36v2 health survey in outpatients with chronic-stage ischemic stroke in Japan--cross-sectional analysis of the OASIS study. Cerebrovasc Dis. 29(4): p. 361-71.
3. Turner, M.A. and D.G. Andrewes, The relationship between mood state, interpersonal attitudes and psychological distress in stroke patients. Int J Rehabil Res. 33(1): p. 43-8.
4. Haley, W.E., et al., Problems and benefits reported by stroke family caregivers: results from a prospective epidemiological study. Stroke, 2009. 40(6): p. 2129-33.
5. Sachdev, P.S., et al., Amygdala in stroke/transient ischemic attack patients and its relationship to cognitive impairment and psychopathology: the Sydney Stroke Study. Am J Geriatr Psychiatry, 2007. 15(6): p. 487-96.
6. Ostir, G.V., et al., Positive emotion following a stroke. J Rehabil Med, 2008. 40(6): p. 477-81.

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