Psychosocial therapy should be started with family members at the time of the patient’s hospitalization and begin with the patient as soon as feasible. Family members should be given realistic, straightforward information and instructions to provide support for the patient and to develop a partnership for solutions to problems as early as possible. The family member who is closest to the patient should observe health personnel assisting the patient and practice under the supervision of a nurse or physical therapist. The physician should provide information and dispel myths regarding stroke to help provide the most positive yet realistic psychosocial environment for motivating, energizing, and inspiring the patient to move forward to return to a productive, useful life. Accurate and simply explained facts about the cause of the cerebrovascular event are essential for both the patient and the family, and both should understand that recovery from a stroke is often a slow process.

Family involvement becomes even more important when the patient is cared for at home after discharge from the hospital. Family members should provide encouragement, show confidence in improvement, and permit the recovering person to do as much as he or she can and to be as independent and vigorous as possible. It is important that the patient does not become overly discouraged by failures. Patients need to be reassured that they are wanted and needed and that they are still important to the family and part of the social picture. They need to understand that many others have recovered from strokes and have been able to return to normal activities or continue to do very useful work. Giving the recovering person certain reasonable tasks (such as encouraging him or her to assume some household duties) is often helpful. It may also be very useful to assist the patient to develop new outside interests within his or her given capacity, particularly if the person is unable to return to gainful employment. Family counseling and education in the form of individual sessions or through regional family support groups are important to help the family overcome the stresses associated with new responsibilities and, sometimes, the depression that may occur in family members.

The physician should also be familiar with local driving guidelines and share this information with the patient and family. When considering a return to driving following stroke, a patient should be assessed carefully in terms of physical, perceptual, motor, and cognitive issues which could impede the safety of their driving. In general, a formal road test should be completed after a patient has improved suggesting that it may be safe for them to drive.

A treatment program that reduces the likelihood of further morbidity or mortality of patients after acute cerebrovascular events depends on (1) the
pathophysiologic mechanism responsible for the event, (2) the degree of functional deficit (the degree of aggressiveness in the use of specific therapies varies inversely with the degree of residual functional deficit), and (3) the potential benefits and risks of the therapeutic method being considered. If specific therapy for the underlying mechanism is available, appropriate measures should be provided, as outlined in Chapters 16 and 17. Correction of associated cerebrovascular risk factors with appropriate monitoring may also help to reduce the risk for a subsequent cerebrovascular event (see Chapters 24, 25, 26, 27, 28, 29, 30, 31).