Post-Stroke Apathy

Shannon Compton, PT, DPT, NCS, CBIS

July 14, 2020

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Question

What is post-stroke apathy and the clinical features of post-stroke apathy?

Answer

Recently, research has moved towards redefining apathy as a loss of goal-directed behavior, since behavior is something external, which we can both observe and measure. I just wanted to take a moment to recognize how we, as physical therapists frequently describe our patients. So this loss of goal-directed behavior, what does that mean, and how do we typically document it? Think about how many times you have seen or documented yourself that someone has, "poor task initiation", or "poor task persistence" or my favorite, that "they exhibit self-limiting behavior". These phrases describe aspects of apathy, but we're sort of talking around the issue with these phrases. We're not saying that this person has post-stroke apathy or apathetic affect.  I would like to propose to you today is that perhaps we should be documenting things specifically as this patient has an apathetic affect or they have apathy so that we can make sure that not only do they have access to the correct resources or the correct interdisciplinary care team after their stroke but also that we're using that to document why further skilled intervention is necessary or making sure that they make it to the appropriate level of care after their discharge.

Post-stroke apathy occurs in about one-third of patients after a stroke. Clinical features include low motivation, reduced initiation, loss of self-activation, or emotional indifference. There does not seem to be any stronger association between apathy and either ischemic or hemorrhagic stroke. And as we know as therapists, optimal stroke recovery involves participating in a high volume of repetition of tasks. So these are the patients with low self-activation, low motivation, and reduced initiation. These are the patients who are going to require extra attention in facilities, whether it be inpatient rehab, skilled nursing, or long term care to ensure that they're being prompted by family, by nursing, by rehab throughout the day to engage in meaningful activities and get the number of repetitions that they need to be able to see optimal recovery. So what factors might indicate to you that someone might have apathy as a co-presentation? Apathy is associated with impaired cognition, typically measured by the MOCA. It's associated with aphasia, lower FIM scores, lower Fugl-Meyer scores, and the presence of neglect. There is no association between apathy and gender, age, chronicity of stroke, or years of education. 
 

What tends to happen to these individuals with apathy? Well, it does not tend to change very much throughout the more acute phases of the stroke, or even over the first year of stroke recovery, it tends to be fairly persistent. And these patients are more likely to be discharged from the acute care hospital to either skilled nursing rather than inpatient or more likely to be discharged to a skilled nursing facility rather than home. And they do tend to require more support From caregivers, whether institutional caregivers or family caregivers because they do have those lower levels of initiation. These individuals also tend to see lower levels of functional recovery irrespective of neurologic recovery.

For more information on post-stroke apathy, check out the course: Post-Stroke Apathy and Depression: Addressing Psychosocial Barriers to Patient Success 


shannon compton

Shannon Compton, PT, DPT, NCS, CBIS

Shannon Compton is a physical therapist with extensive experience in rehabilitation across the continuum of care for individuals with stroke and traumatic brain injury.  She received her Doctor of Physical Therapy degree from the University of Oklahoma Health Sciences Center. She is an ABPTS Board Certified Clinical Specialist in Neurologic Physical Therapy and a Certified Brain Injury Specialist. She currently practices in outpatient at the Healthy Aging and Neurology clinic of Northwest Rehabilitation Associates in Salem, OR.


Related Courses

Post-Stroke Apathy and Depression: Addressing Psychosocial Barriers to Patient Success
Presented by Shannon Compton, PT, DPT, NCS, CBIS
Recorded Webinar

Presenter

Shannon Compton, PT, DPT, NCS, CBIS
Course: #3694Level: Intermediate2 Hours
  'I personally liked the personal experience used for examples'   Read Reviews
Apathy and depression are two common complications of stroke which can negatively impact a person’s recovery. This course will review possible contributions of psychosocial and neuroanatomical factors to the development of post-stroke apathy and depression, and use case examples to illustrate how physical therapists can overcome these complications to improve patient outcomes. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Innovative Treatments for Patients Post-Stroke Across the Continuum of Care – Evidence-Based Strategies to Improve Outcomes
Presented by Shannon Compton, PT, DPT, NCS, CBIS
Recorded Webinar

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Course: #3697Level: Intermediate2 Hours
  'Love to see videos while going over case studies'   Read Reviews
This course uses case studies to explore how a program of high-quality, evidence-based, intensive physical therapy can help patients post-stroke achieve their true full potential through applied motor learning and motivational principles. Participants will gain ideas for fostering patient motivation and increasing independence in self-care across a variety of practice settings, with specific ideas for how to modify activities based on equipment and personnel availability – including telehealth applications. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.