Social, emotional support more helpful to stroke patients than rehab

Which just means your insurance company will stop actual rehab because of the cost. You'll have to scream at your insurance carrier. This way they don't have to tell you the bad news that their rehab dept. is so bad that only 10% get to full recovery.
http://www.business-standard.com/article/news-ani/social-emotional-support-more-helpful-to-stroke-patients-than-rehab-118030500463_1.html

According to a recent study, providing stroke patients with social and emotional support is more helpful than sending them to a rehab.

The CMAJ-study suggested that when caring for stroke patients, health care providers should focus on the social and emotional issues facing patients, rather than only physical rehabilitation.

Neurophysiologic Correlates of Post-stroke Mood and Emotional Control

My post-stroke mood gets worse and worse every time I find out how fucking incompetent our stroke medical world is. But I control it quite well except for a tiny bit of swearing on my blog. My mood on my recovery is great, life is great. I am definitely not emotionally disturbed, I tried analyzing my therapist to see where she was going with her questions.
http://journal.frontiersin.org/article/10.3389/fnhum.2016.00428/full?

Deniz Doruk^1†, Marcel Simis^1,2*†, Marta Imamura², André R. Brunoni³, Leon Morales-Quezada¹, Renato Anghinah², Felipe Fregni^1,2* and Linamara R. Battistella²

• ¹Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
• ²Physical and Rehabilitation Medicine Institute of the University of São Paulo, Medical School General Hospital, São Paulo, Brazil
• ³Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil

Objective: Emotional disturbance is a common complication of stroke significantly affecting functional recovery and quality of life. Identifying relevant neurophysiologic markers associated with post-stroke emotional disturbance may lead to a better understanding of this disabling condition, guiding the diagnosis, development of new interventions and the assessments of treatment response.

Methods: Thirty-five subjects with chronic stroke were enrolled in this study. The emotion sub-domain of Stroke Impact Scale (SIS-Emotion) was used to assess post-stroke mood and emotional control. The relation between SIS-Emotion and neurophysiologic measures was assessed by using covariance mapping and univariate linear regression. Multivariate analyses were conducted to identify and adjust for potential confounders. Neurophysiologic measures included power asymmetry and coherence assessed by electroencephalography (EEG); and motor threshold, intracortical inhibition (ICI) and intracortical facilitation (ICF) measured by transcranial magnetic stimulation (TMS).

Results: Lower scores on SIS-Emotion was associated with (1) frontal EEG power asymmetry in alpha and beta bands, (2) central EEG power asymmetry in alpha and theta bands, and (3) lower inter-hemispheric coherence over frontal and central areas in alpha band. SIS-Emotion also correlated with higher ICF and MT in the unlesioned hemisphere as measured by TMS.

Conclusions: To our knowledge, this is the first study using EEG and TMS to index neurophysiologic changes associated with post-stroke mood and emotional control. Our results suggest that inter-hemispheric imbalance measured by EEG power and coherence, as well as an increased ICF in the unlesioned hemisphere measured by TMS might be relevant markers associated with post-stroke mood and emotional control which can guide future studies investigating new diagnostic and treatment modalities in stroke rehabilitation.

Introduction

Emotional disturbance is a common complication of stroke (Annoni et al., 2006). About 30% of stroke survivors develop anxiety and depressive symptoms critically affecting functional recovery (Parikh et al., 1990; Hackett and Anderson, 2005) and quality of life (Robinson, 1997; Jonsson et al., 2005). Moreover, a significant number of patients remain undetected and therefore untreated due to difficulties in diagnosis (Dafer et al., 2008; El Husseini et al., 2012; Ayerbe et al., 2013). Investigation of neurophysiological markers associated with post-stroke mood and emotional control could have important implications in the development of new interventions as well as the assessment of current diagnostic and therapeutic modalities in stroke rehabilitation. For example, neurophysiologically guided interventions, such as EEG biofeedback entrainment, has already been shown to be effective in stroke patients with physical and cognitive impairments (Nelson, 2007). Similarly in depression, qEEG has been used to detect inter-hemispheric imbalance in cortical activity that has lead to the application of new therapeutic approaches such as TMS (transcranial magnetic stimulation) and tDCS (transcranial direct current stimulation; Rosenfeld et al., 1996; Linden, 2014).

The exact causes of post-stroke emotional disturbance (PS-ED) are still unknown. Different mechanisms including direct effects of ischemia to mood regulating neural networks (Starkstein et al., 1988; Beblo et al., 1999) and a psychosocial (Gainotti et al., 1999) model have been proposed to explain PS-ED (Whyte and Mulsant, 2002). Additionally, several factors involving the severity of injury, cognitive impairment, pre-morbid depression, disability and localization of the stroke have been identified as predictors of PS-ED (Robinson, 1986; Hackett and Anderson, 2005; Ayerbe et al., 2013). However, some of these factors were inconsistent across studies. For example, earlier studies showed that left sided lesions that are close to the frontal lobe have been associated with depression (Robinson, 1986) whereas more recent studies showed no relation between the localization of stroke and depression after stroke (Carson et al., 2000).

Quantitative electroencephalography (qEEG) is a safe, cost-effective technique used to assess cortical activity and has been valuable in assessing emotion related networks. Among the qEEG parameters, frontal alpha power asymmetry has been especially of interest given its relation to emotional processes and pathological conditions such as major depressive disorder (MDD) and anxiety (Coan and Allen, 2004; Thibodeau et al., 2006; Harmon-Jones et al., 2010). Yet, it is unknown whether emotional disturbance secondary to other neurological conditions, such as stroke, is associated with similar EEG changes. In fact, qEEG has already been used in stroke as a predictive measurement for prognosis and clinical management in motor recovery (Finnigan and van Putten, 2013). However, use of qEEG in non-motor outcomes of stroke is limited (Schleiger et al., 2014) and to our knowledge there is no study assessing the qEEG correlates of post-stroke depression and anxiety.

Transcranial magnetic stimulation (TMS) is another technique that is useful in assessing cortical activity in both MDD and stroke. TMS studies assessing changes in cortical activity in patients with MDD have shown decreased excitability in the left hemisphere (Maeda et al., 2000; Fitzgerald et al., 2004), and decreased motor threshold in the right hemisphere (Bajbouj et al., 2006). In stroke, TMS studies demonstrated that inter-hemispheric asymmetry in cortical activity (Murase et al., 2004) is associated with functional recovery after stroke (Hendricks et al., 2002). Therefore, together with EEG, TMS could potentially help elucidate changes in cortical activity related to PS-ED.

In this cross-sectional preliminary analysis of 35 stroke subjects we investigated the associations between the emotion sub-domain of Stroke Impact Scale (SIS-Emotion) and several neurophysiologic measures obtained by EEG and TMS when adjusted for potential confounders such as age and time since stroke. Given that hemispheric asymmetry plays an important role in both stroke and mood disorders, we hypothesized that post-stroke changes in mood and emotional control is associated with inter-hemispheric imbalance that can be indexed by EEG and TMS.

50 Per Cent More Motivation With This Way of Thinking About Rewards

How is your doctor helping motivate you to recover/do your exercises? ANYTHING AT ALL?
Has your doctor even thought about your resilience, motivation or emotional needs for recovery?
http://www.spring.org.uk/2016/02/reward-versus-loss.php?
The research shows that exactly the same financial rewards can produce markedly different levels of motivation when framed in different ways.

Professor Kevin G. Volpp, one of the study’s authors, said:

“Our findings demonstrate that the potential of losing a reward is a more powerful motivator and adds important knowledge to our understanding of how to use financial incentives to encourage employee participation in wellness programs.”

The study compared workplace rewards for physical activity.
Some people in the program were given $42 and then had $1.40 taken away for each day they didn’t exercise.
Others were told they would simply receive $1.40 for each day they exercised.
Both of these were compared with a control group.
Financially, it amounted to exactly the same thing, but the first framing emphasises a loss of money and the second framing emphasises the reward.
Fascinatingly, the reward-framing had no effect over and above offering no reward for exercise.
However, the loss-framed incentive increased by 50% the amount of times people reached their exercising goals compared with the control group and the reward-framed incentive.
The study was published in the journal Annals of Internal Medicine (Patel et al., 2016).

More at link.

Post-traumatic growth in acquired brain injury: A preliminary small scale study

It's only 8 years old so I'm sure your doctor is using this to reinforce your mental  therapy.
http://informahealthcare.com/doi/abs/10.1080/02699050600664566

2006, Vol. 20, No. 7 , Pages 767-773 (doi:10.1080/02699050600664566)

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Joanna Collicutt McGrath^1†and P. Alex Linley²

¹Oxford Centre for Enablement, Oxford, UK

²University of Leicester, Leicester, UK

^†Correspondence: Joanna Collicutt McGrath, Wycliffe Hall, University of Oxford, 54, Banbury Road, Oxford OX2 6PW, UK, 01865 284961, 01865 274215jcollicutt@aol.co.uk

Primary objective: To examine the nature, degree and time course of positive psychological change in people with severe acquired brain injury.

Research design: This preliminary exploratory study employed a cross-sectional design, comparing two matched samples, one early post-brain injury (M = 7 months) and one late post-brain injury (M = 10 years).
Methods and procedures: The Posttraumatic Growth Inventory (PTGI), Sense of Coherence Scale-13 (SOC-13) and Hospital Anxiety and Depression Scale (HADS) were administered.
Main outcomes and results: The samples differed significantly with respect to reported post-traumatic growth, with the late sample reporting higher levels. HADS anxiety was significantly associated with post-traumatic growth. Both samples achieved high scores on the SOC-13.

Conclusions: The participants showed evidence of substantial positive psychological change, demonstrating that it is not precluded by severe brain injury. The results suggest that this develops slowly over time and requires a degree of emotional engagement.

Read More: http://informahealthcare.com/doi/abs/10.1080/02699050600664566