Article: Sharon - The Quality And Quantity Of Social Support

The Quality And Quantity Of Social Support: Stroke Recovery As Psycho-Social Transition

Thomas A. Glass and George L. Maddox
Social Science & Medicine, 1992, vol. 34, issue 11, pages 1249-1261

Abstract: The impact of various types and amounts of social support is examined in the context of recovery from first stroke. We conceptualize the rehabilitation process as a psychosocial transition. In a longitudinal design, 44 patients were followed for 6 months following first stroke. Growth-curve analysis (repeated measures MANOVA) was utilized to examine the impact of three types of social support on changes in functional status during recovery. While all three types of support (emotional, instrumental and informational) were shown to be significantly related to recovery of functional capacity, substantial differences were found in the nature of those effects. The impact of social support does not appear during the first month of rehabilitation, indicating the importance of longitudinal designs and longer observation. Patients reporting high level of emotional support showed dramatic improvement despite having the lowest baseline functional status. Instrumental support is most closely related to positive outcomes when provided in moderate amounts. Unlike the other two types, the effect of informational support is mediated by disease severity.

Translation:  What does moderate instrumental support and high emotional support mean?

Emotional support relates to affirming and reassuring the person they are important, loved, wanted, and that you value what they are doing.

Instrumental or practical support relates to doing things for the person—for example,  giving them money, putting on their socks, cutting their meat.

So if the family does many of the tasks for the stroke survivor, even the things that they can do —essentially provide more support than they need, the survivor does not use their skills or learn what they can do.

 It may seem unfair and even mean to let someone with one hand struggle to put on their socks when you can do it quickly for them with your two hands, but this is not unlike the old parody of, “Give a man a fish and you will feed him for a day; teach a man to fish and he will have food for a lifetime.”

Striking a balance between supporting and over-supporting and ensuring the risk of stroke survivor falling/hurting themselves is not too great is difficult!   Let me give you an example from our situation.

About a month after John came home from rehabilitation, he asked me to get money for him.  I easily could have driven to the bank and gotten it.  At that time, I really didn’t know if he could handle money, but I said “Why don’t you get money yourself? You can go on your scooter.”  At the physiotherapist’s suggestion, we had purchased a very sturdy scooter and he was able to ride around the neighborhood. The bank was less than a mile from us by a bike path with only 2 main road crossings. 

John was furious. He stormed off on his scooter. I was really uncertain. My heart was in my throat and my stomach was sore, so I followed in the car at a distance.  Seemingly he didn’t have any trouble as he pulled up to the drive-through machines and got the cash.  I drove home. 

Later, he told me that he was angry because he was scared. When he go to the bank machine, he couldn’t remember his PIN and had to try a couple of times, but got it.  This particular experience was a turning point in many ways. I really saw the benefits of letting him take risks and figure out how to solve problems, rather than me just doing everything for him.  For him, it was a stepping stone to more confidence.  He recognized that he wasn’t dependent on me to do everything for him.

References:

• Hollander, M., Lui, G., Chappelle, N. (2009) Who Cares and How Much?  The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly.  Healthcare Quarterly, 12(2) 2009: 42-49.
• Ji, J., Zoller, B., Sundqusit, K., Sudqusit, J., (2012). Increasted risks of coronary heart disease and stroke among spousal caregivers for cancer patients. Circulation. 125, 1742-1747. 
• LeGoff, P. (2002). Home care sector in Canada: Economic problems.
• Palmer, S., Glass, T.A., Palmer, J.B., Loo, S, Wegener, S.T. (2004). Crisis intervention with individuals and their families following stroke: A model for psychosocial service during in-patient rehabilitation. Rehabilitation Psychology. 49 (4),  338-343. 
• Pellerin, C., Rochette, A., & Racine, E. (2011). Social participation of relatives post stroke: the role of rehabilitation and related ethical issues. Disability and Rehabiliation, 33(13-14), 1055-1064. 
• Romanow, R. (2002). Building on values: The future of healthcare in Canada.