Assessment and psychologic factors in stroke rehabilitation.

With improved survival after stroke, it is important to identify those patients whose quality of life can be enhanced through rehabilitation. The decision for rehabilitation is based on several factors: type and severity of neurologic deficits, cognitive status, physical endurance, and preferences of patient and family. Implementation requires identification of learning patterns, sensitivity to the patient's responses, and establishment of realistic goals. Systematic assessment of impairments and disability is valuable for describing the impact of the stroke, monitoring recovery, evaluating response to specific interventions, and determining their long-term benefits. Because of the range of potential impairments, it is important to use a battery of assessment measures and to incorporate specific measures during each stage of recovery. In addition to assessments for neurologic disabilities, assessments for psychosocial conditions are necessary, as depression and dysphoria occur commonly and affect the rehabilitation and recovery of stroke patients. Their influence on physical function is currently being debated in the medical literature. The social context in which a stroke patient recovers also has profound effects on the success of the recovery process. Such factors as the amount of social support, income level, race, and life satisfaction affect the patient's rehabilitation process and adjustment. Standardization of assessment measures and a better understanding of the psychosocial factors that influence rehabilitation are necessary for helping stroke patients achieve an optimum functional quality of life.