Table Of ContentPsychological Management of Stroke
Psychological Management
of Stroke
Nadina B. Lincoln, Ian I. Kneebone,
Jamie A.B. Macniven and Reg C. Morris
Thiseditionfirstpublished2012
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Psychologicalmanagementofstroke/NadinaB.Lincoln...[etal.].
p. cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-68427-6(cloth)–ISBN978-0-470-68426-9(pbk.)
1. Cerebrovasculardisease–Psychologicalaspects. 2. Cerebrovasculardisease–
Treatment. I. Lincoln,NadinaB.
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616.80106–dc23 2011024712
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1 2012
Contents
About the Authors vii
Foreword by The Stroke Association ix
Preface xi
Acknowledgements xiii
Section 1 Background to Stroke and Stroke Services 1
Chapter 1 Experiences and Effects of Stroke and Its Aftermath 3
Chapter 2 Clinical Stroke Services 28
Chapter 3 Neurological Basis of Stroke and Related Vascular
Disorders 60
Section 2 Cognitive Effects of Stroke 85
Chapter 4 Neuropsychological Symptoms of Stroke 87
Chapter 5 Screening for Cognitive Problems after Stroke 109
Chapter 6 Neuropsychological Assessment after Stroke 130
Chapter 7 Communication Problems after Stroke 160
Chapter 8 Driving after Stroke 181
Chapter 9 Decision Making and Mental Capacity 203
Chapter 10 Neuropsychological Aspects of Rehabilitation 232
Chapter 11 Cognitive Rehabilitation 248
Chapter 12 Challenging Behaviour after Stroke 266
Section 3 Emotional Effects of Stroke 281
Chapter 13 Emotional Problems after Stroke 283
vi Contents
Chapter 14 Screening and Evaluation of Emotional Problems
After Stroke 299
Chapter 15 Managing Emotional Problems after Stroke 329
Chapter 16 Behavioural and Cognitive-Behavioural Therapy for
Depression after Stroke 336
Chapter 17 Stroke and Fear of Falling 349
Chapter 18 Prevention of Psychological Distress after Stroke 362
Chapter 19 Pain and Fatigue 378
Section 4 Social Dimensions of Stroke 391
Chapter 20 Carers of Stroke Survivors 393
Chapter 21 Strokes in Young People: Families and Children, Carers,
Employment and Long-Term Survival 425
Chapter 22 Prevention of Stroke 455
Chapter 23 Conclusions and Future Directions 486
Appendix 1 491
References 493
Index 589
About the Authors
Nadina Lincoln is Professor of Clinical Psychology at the University of
NottinghamandhonoraryconsultantclinicalneuropsychologistatNottingham
UniversityHospitalsNHSTrust.Shehasconductedanextensiveprogrammeof
research to evaluate clinical stroke services.
IanKneeboneisaConsultantClinicalPsychologistandavisitingreaderatthe
UniversityofSurrey.Hehaspublishedonscreeningmeasurestodetectpsycho-
logicalproblemsafterstrokeandonpsychologicalinterventionstomanagethem.
JamieMacnivenwasuntilrecentlyaConsultantClinicalNeuropsychologistfor
Nottingham University Hospitals NHS Trust and course director of the MSc
programme in clinical neuropsychology at the University of Nottingham. He
hasnowtakenupthe postofconsultant clinicalneuropsychologist atWaikato
Hospital, Hamilton, New Zealand.
RegMorrisisProgrammeDirectoroftheSouthWalesDoctorateProgramme
in Clinical Psychology, honorary professor at the Cardiff University and con-
sultant clinical psychologist in Wiltshire NHS Trust and has published widely
about facets of stroke care.
Ken Walters: The Cover Artist
Ken Walters was 30 years old, happily settled with a successful career in engi-
neering.Atthattimehehadnoideathathewasabouttoentera19-year-periodof
viii About the Authors
unhappinessandbadluck.Hebrokehisbackwhileworkingbrieflyonafarm,and
was so badlyinjuredhe didn’t get upfora year and had severepersistent pain.
Financialstressestriggeredtwoheartattacksandwhenhewastakenintohospital
in2005andtoldhe’dhadastroke,itwasyetanotherdisasterinhislife.Hewas
bedridden,paralyseddownoneside,withonlyapadandpentocommunicate.
Onhisfirstday,afterwritinganotetothenurse,hefoundhimselfdoodling.From
thenonhewasdrawingfromdawntoduskandcouldn’tstop.Hehadneverhad
theslightestinterestinartinhislife.Hewasa practicalperson, anengineerby
trade,andnow,suddenly,memoriesandthoughtsappearedasabstractimages.In
2007,heheardaboutSecondLife,anddecidedtoshowhisworkon-lineforthe
firsttime.Nowheisaprofessionalartist,sellingpicturesworldwide.Hecursed
the stroke at the time, but it has changed his life in ways he could never have
imagined. It has broughthiminterests and a new source ofself-respect.
In Ken’s words: ‘In my art I try to bring together my experiences, skills and
emotions. I draw on my experiences, filtered through my emotions and
moods and use my skills to paint with light on my pc. I use my own software
to translate what I see and feel into still frame images, I’ve replaced the brush
and pencil with an electronic pen and tablet. Unlike with paint, I can vary the
intensityoflightintheimagestoreflectmythinkingandemotions.Ifinditfar
more liberating and intensive than paint, and I control powerful computing
abilitytorendermyimaginationintodigitalreality.Thisbringsauniqueaspect
tomy art, anaspect not knownor understoodbymany.Mychronicfatigue is
a major driver of my emotions; it can also bring them to a halt.’ Ken Walters
kindly donated the cover image for this book. More of his images can be
seen on http://kenwalters.deviantart.com/gallery
Foreword by The Stroke Association
The psychological consequences for people living with stroke are frequently
neglected or inadequately addressed, yet may have a major impact on quality
of life.
TheStrokeAssociationisgratefultotheauthorsforcollatingandpresenting
the evidence to facilitate improved stroke management in this important area.
Weurgehealthcareprofessionalstoreadthisbookandtakeactiontoimprovethe
quality of life for those affected by stroke.
Joanne Knight BSc DPhil MRSC
Director of Research & Development
The Stroke Association
TheStrokeAssociationistheonlycharitysolelyconcernedwithhelpingeveryone
affectedbystrokeacrosstheUnitedKingdom.Ourvisionistohaveaworldwhere
thereare fewer strokesand allthose touchedbystroke get the helpthey need.
www.stroke.org.uk
Stroke Helpline 0303 3033 100
Preface
This book came about in response to several requests for information from
professionalsworkinginstrokeservices.IntheUnitedKingdomandworldwide,
therehasbeenanincreasingrecognitionthatstrokehasimportantpsychological
dimensions.Themanagementofthesepresentsachallengetostaffworkingin
publichealth,voluntaryorganisations,primarycare,emergencyservicesaswell
asdedicatedstrokeservices.Therefore,clinicalpsychologistshavebeenincreas-
inglyrecruitedtoworkwithsurvivorsofstrokeandtoadviseotherprofessionals,
particularlymembersofmultidisciplinarystroketeams,onpsychologicalassess-
ment and interventions.
Theaimofthebookwastoprovideprofessionalsworkinginstrokeservices
withtheevidencebasetosupporttheirrole.Theaimwasalsotodemonstratethe
widerangeofpsychologicalskillswhicharerelevantinhelpingpeoplewhohave
hadstrokes,orwhoareatriskofstroke.Theinclusionofpracticalexamplesand
case histories is intended to illustrate the application of psychological skills
andknowledgeinareal-worldcontext.Itisalsohopedthatitwillgive‘life’and
relevance to the research literature.
The overall aim is to improve clinical services and outcomes for those who
havesufferedastrokeandfortheirfamilies.Increasingrecognitionofthepsycho-
logicalaspectsofstrokemanagementandthedevelopmentofpsychologicalskills
byall members ofthe multiprofessional teamwillhelp achieve these goals.
Acknowledgements
Manypeoplehaveassisteduswiththepreparationofthisbook,andourthanksto
them all for their help.
Inparticular,wewouldliketothankthefollowingforcommentingondraft
chapters: Emmanuel Akinwuntan, Jane Barton, Audrey Bowen, Vanessa Dale,
AvrilDrummond,VickiHacker,HelenaHarder,SamanthaHull,ValerieMor-
rison, Julie Wilcox, Paul Willner and Linda Worrall. Other people have con-
tributedillustrationsandunpublishedinformation.TheseincludeJaneBarton,
AudreyBowen,VanessaDale,RobertDineenandLukeWilliams.Inaddition,
we thank Caroline Watkins, who contributed some components of chapter 1.
The case studies in this book are based on real patients and carers. In some
casestheirdetailshavebeenchangedtopreserveanonymity,butrealnameshave
beenincludedforsome,attheirownrequest.Insomeinstances,informationhas
beenslightlymodifiedtoillustrateparticularpoints.Wewouldliketothankall
the patients and carers who provided information as well as the following
professionalsforcontributingmaterialforcasestudies:MalAuton,JaneBarton,
VanessaDale,VickiHacker,GemmaWall,RoshandasNairandLukeWilliams.
Thebookwaswrittenasacollaborationbetweenallfourauthors.However,
eachauthorwasresponsibleforthemajorityofmaterialprovidedinindividual
chapters. Ian Kneebone provided the major contribution to chapters on the
management of mood and related problems (15, 16, 17 and 19), Jamie
Macniven to chapters relating to neuropsychological aspects (3, 4, 6, 10 and
12), Reg Morris to chapters on lived experience, service delivery, decision
making,socialdimensionsandprevention(1,2,9,20,21and22)andNadina
