Neuropsychological And Social Predictors Of Recovery After Stroke

ABSTRACT

Stroke is a public health concern in sub-Saharan Africa due to the high and adverse consequences of mortality and morbidity and its effects on survivors, family and caregivers in general. It accounts for 10% of the world’s total mortality rate and it is the highest cause of disability in adults; and the highest bed occupancy. In sub-Saharan countries, there is a great burden of stroke because it occurs among young population and unavailability of well-structured rehabilitation strategies and facilities. Over the years, emphasis has been put on the biomedical or physical changes associated with stroke with little attention on the neuropsychological and social factors. The absence or unavailability of neuropsychological and social care impede rehabilitation and recovery after stroke. The study examined the neuropsychological and social factors that predict stroke recovery among survivors. An explanatory sequential mixed quantitative-qualitative method design was employed. The quantitative study purposively sampled ninety (90) stroke survivors from the Stroke Investigation Research and Education Network (SIREN) register and administered a structured questionnaire and neuropsychological battery of tests. It was observed that executive function, language and depression served as predictors of recovery after stroke. With age and education as covariates, there were significant differences between survivors with ischaemic vs. haemorrhagic, right vs. left, and anterior vs. posterior strokes on neuropsychological and social functioning. Moreover, cognitive/emotional debriefing, collective centered coping and africultural coping system inventory predicted executive function, language and visuospatial/visuoconstructional skills as well as anxiety.

On the other hand, the qualitative study purposively sampled eight (8) stroke survivors for an in-depth individual interview to explore their stroke experience and recovery process using a phenomenological approach. The qualitative data were analysed using the thematic analysis with the aid of Atlas.ti. Five (5) themes emerged from the qualitative study namely “Impact of stroke”, “Recovering from stroke” and “Perception of stroke”, Rehabilitation strategies”

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and “Strengthening of relationships”. Findings from both studies converged by revealing that stroke impact negatively on survivors’ neuropsychological functioning which were individual-specific dependent on several factors. Recovery of function were attributed to biomedical care, enhanced by religion. It further established that subjective religious experiences are associated with cognitive and affective processes which are controlled by the frontal, temporal and parietal lobes as well as the limbic system (amygdala, hippocampus). It can be speculated that these religious coping strategies which are related to cognitive and affective processes which play a role in brain functioning (activation and increased activities) during religious experiences, and hence brain recovery. Findings show that differences in survivors’ functioning may facilitate rehabilitation plans and strategies. Again, findings will also help develop and enhance measures that will reduce post-stroke disability which will ensure appropriate stroke management and rehabilitation goals as well as introducing or reinforcing religious practices into rehabilitation.