Deficits After a Stroke and The Suggested Solutions

Genevieve Green
Salt Lake Community College
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Abstract

The individual in question suffered a stroke in November of 2017 and has since exhibited

cognitive, physical, and emotional deficits that have created many issues with the family

involved. The family is looking for ways to cope with these new issues and potentially improve

the quality of life for the individual and decrease caregiver burnout with the members of the

family involved. Suggestions of psychological therapy or assisted living homes are references as

well as a general description of the effects of a stroke on social interaction and its potential side

effects.
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Main Body

The individual is eighty-two years old, was in generally good health and on medication to

assist with his B-Fib. What caused the stroke was a lapse in this medication and others that

allowed a clot to form and break apart causing two simultaneous strokes. This stroke affected the

right part of his brain in two places and he is now exhibiting signs of left neglect, depression,

apathy, child-like behaviors, and serious lapses in judgment. This has created an issue for the

family of this individual because he currently lives alone and refuses to participate in any kind of

therapy that could assist him. The family has tried to have him live with his daughter or have a

close relative living with him but he was unkind to his daughter and her family and the family

member that lived with him took advantage of his financial security and was removed by the

family. They are now on a rotation basis of who goes to check on him, take him to events and

any other travel he may require. Due to the left neglect the individual has had his license taken

away and this was a sore issue for him due to his past career as an ameteur racecar driver and

motorcross racer. The family has requested that I assist in providing some potential solutions to

his emotional and cognitive deficits.

Research has shown that a stroke in the right side of the brain specifically in the

prefrontal cortex area is more likely to create lack of empathy in the individual. This may result

in the rejection of the individual because of his rude and often harsh comments toward friends

and family members. “​The caregiver (usually a spouse or grown child) may feel saddened and

rejected by the inconsiderateness of a stroke survivor who lacks empathy. The caregivers and

loved ones may struggle to cope with the confusing behavior without understanding why the
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stroke survivor is being so mean.​”1 This causes burnout for the loved ones involved and often

isolates the individual from social interaction further, creating the perfect atmosphere for the

development of depression and anxiety. Such is the case in this particular individual’s situation.

In most instances the creation of a rotation system through family members would work well;

however, in this case many of the family members are unable to take time off from work to

attend to the individuals needs to it falls on the few that are retired or available during the day to

assist him. This is creating the burnout for the family members because of the behavior of the

individual and he is slowly losing people that are willing to be around him.

The strongest suggestions made for this family is to place the individual in some form of

psychological therapy, specifically Cognitive Behavioral Therapy, Mindfulness Therapy or

Interpersonal Therapy. “​IT focuses on interpersonal relationships by improving the way the

depressed person communicates and relates. Techniques help the person identify emotions and

their sources, express emotions in a healthy way and deal with emotional baggage from past

relationships… MT (also called Mindfulness-Based Cognitive Therapy)  helps those who suffer

repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy

with meditative practices and attitudes based on cultivating mindfulness. The goal is to become

acquainted with the mental states that often characterize mood disorders while learning to

develop a new relationship to them.”2 Interpersonal Therapy in particular would help the

individual focus on his interactions and others and the way that they affect other people, as well

as assist him in coming to terms with the loss of his wife in 2016. However, as mentioned earlier

the individual is not open to any sort of therapy and therefore is unwilling to cooperate with the

1
Heidi Moawad M.D., ​Loss of Empathy After a Stroke
2
American Stroke Association, ​Post Stroke Mood Disorders
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family’s suggestion. If asked, the individual denies any social or physical deficits and does not

need to seek further treatment than what he had when he had the stroke.

The importance of these cognitive and social abilities is illustrated in the research

conducted by Maria Arioli, Chiara Crespi and Nicola Canessa in the article ​Social Cognition

Through The Lens of Cognitive and Clinical Neuroscience​. They note the importance of the

developmental deficits and traumatic brain injuries in the causes and symptoms of cognitive

function, “Social cognitive impairments are a prominent concern, or even a core facet, of several

neurodegenerative (e.g., behavioral variant of frontotemporal dementia), neuropsychiatric (e.g.,

schizophrenia, major depressive disorder, and bipolar disorder), and neurodevelopmental (e.g.,

autism spectrum disorder and attention deficit hyperactivity disorder) conditions, and often occur

after acute brain damage (e.g., traumatic brain injury and stroke) [​9​]. Moreover, such deficits are

critical predictors of functional outcomes because they affect the ability to create and maintain

interpersonal relationships, thereby removing their benefits in everyday life [​7​]. In this respect,

the rewarding and healthy value of social interaction [​10​] is shown by growing evidence on the

negative consequences of isolation in terms of morbidity and mortality [​11​–​13​]. Interestingly,

perceived social isolation (i.e., loneliness) is a major risk factor for several diseases, including

dementia, independent of objective social isolation [​14​].” In this particular individual’s case

social isolation due to his lack of empathy and understanding in social situations increases his

risks of morbidity. It is then suggested that the individual’s family encourages placement in an

assisted living home where the individual is able to have acceptable social interaction, and the

burn out of the family can decrease, and indirectly improving the relationship between the

individual and his family.

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Ultimately the best recommendation would be to take steps to place the individual in an

assisted living home or find a home health provider that is willing to take on the role of care that

the family is currently providing. The individuals deficits both physically and cognitively are

creating issues not only for the family but for himself because he is refusing to acknowledge that

there is a problem with his behavior and physical state.

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References

Arioli, M., Crespi, C., & Canessa, N. (2018). Social Cognition through the Lens of Cognitive and
Clinical Neuroscience. BioMed Research International, 2018, 1–18.
https://www.hindawi.com/journals/bmri/2018/4283427/

American Stroke Association. (n.d.). Retrieved from

https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-
stroke/post-stroke-mood-disorders

Moawad, Heidi M.D. (August 19, 2019). Loss of Empathy After a Stroke. Retrieved from
https://www.verywellhealth.com/loss-of-empathy-after-a-stroke-3961831