TREATMENT OF AFFECTIVE DEFICITS IN STROKE REHABILITATION

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Post stroke affective disturbances are pervasive, i.e. they affect anywhere from 40-65% of stroke patients. The diagnosis and treatment of these disturbances in stroke patients is a major untreated problem facing the medical rehabilitation community. Traditional approaches to diagnosis which have relied exclusively on verbal self-report or nonverbal expressions of depression have not adequately addressed either the communication difficulties of aphasics or some of the other cognitive disturbances, i.e., aprosodia, minimization, concrete thinking, which limit the cognitive capacities of stroke patients. Furthermore, the effectiveness of various approaches to treatment has not been systematically studied in this population. The aims of this proposed study are twofold: first, to validate a comprehensive diagnostic battery which permits an accurate examination of the affective disorders following stroke; and secondly, to evaluate the effectiveness of two approaches to treatment: anti-depressants and cognitive therapy, when administered singly or in combination. It is expected that greater accuracy in diagnosis and more aggressive treatment will significantly improve the quality of life of this subgroup of older Americans.