A Good Quality of Life is Complicated

RebeccaDutton
Home After a Stroke

August 14, 2013

Rehabilitation for stroke survivors focuses on physical recovery and functional skills like dressing.  Yet physical and functional abilities can only partially predict a person's quality of life (1).  Clarke discovered underlying mechanisms that explain why some clients experience a sense of well-being after a stroke and others don't (2).  Physical and cognitive disabilities are less disruptive when they: (a) permit participation in self-defining activities that contribute to a positive self-identity and (b) are counterbalanced by adaptive strategies and social resources.

Self-defining activities.  Three of Clarke's subjects defined themselves as very physically active before their stroke (e.g. skiing, gardening, etc.).  One subject who used to be physically active said "What quality is there left?"  Five of Clarke's subjects did not define themselves by their physical activities so their sense of well-being was higher.  For example, they appreciated things like modifications that allowed them to drive again.  Teaching and helping others used to define me and they still do.  My experience as a teacher and an OT help me explain things when I present to stroke support groups and OT students.  For me participation in self-defining activities has been an important way to reclaim a feeling of self-worth.

Adaptive strategies.  Six of Clarke's subjects successfully adapted to their stroke.  Prior education helped them get the most out of their rehab.  A school principal felt being an educator helped him listen closely and "tap into" instructions he was given.  A systems analyst used her logical reasoning skills to create memory aids.  Being an OT helps me understand why my therapist is working on a particular skill.

Social resources.  Some of Clarke's subjects got support from family and friends.  One spouse helped his wife both physically and emotionally.  He was described as "being very gentle and humorous."  Other subjects felt a lack of social support.  One woman talked about being "dropped" by her neighborhood friends and feeling stigmatized because she could not drive.  No one walks in her neighborhood except cleaning ladies.  A second woman felt rejected because her husband would not walk down the street with her because she "cannot walk well enough."  A third woman's husband was critical of the memory aids she created and wanted them removed from the house.  My family lives far away so I am blessed to have many supportive friends.

Bottom Line: A good quality of life after a stroke is complicated.

1. Wilson, I Cleary, P Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes.  Journal of the American Medical Association. 1995;273:59-65.
2. Clarke, P. Towards a greater understanding of the stroke experience: integrating quantitative and qualitative methods.  Journal of Aging Studies. 2003;17:171-187.

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