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The Psychosocial Stressors of A Stroke (PSS)

By: Dr. Ron Sheppard, OTD, OTR/L, C/NDT, FABDA


There are approximately 795,000 individuals having a stroke each year just in the United States alone, and it is classified as the fifth leading cause of death in the country as well.


As an Occupational Therapist with a certification in Neuro Developmental Treatment (C/NDT), I don’t only address the physical effects caused by stroke, but also the psychological. I would like to provide you with a noted, universal characteristic that is very important to address before the survivor can gain maximum improvement: Psychosocial Stressors, (PSS for short).


What are Psychosocial Stressors? They are the psychological reactions experienced when a stroke survivor experiences stressful situations and demands that extend beyond their coping skills.

Here are some examples:

  • Financial difficulties due to medical bills from their stroke.

  • Caregiver issues, or the lack thereof.

  • Managing responsibilities, such as: Jobs, Children/grandchildren., Aging parents

Stroke survivors, and possibly their caregivers, are now unable to continue these responsibilities. The result is: additional stress being added to the debilitating effects of the stroke. Thus, your rehabilitation suffers.


As a new therapist 30 years ago, most of my clients with a diagnosis of stroke were retired, on fixed incomes with their homes paid off, no car payments, and their children out of the home etc.


Today it is much different. Survivors are much younger. Every decade after age 55 the number doubles. In simple terms, that translates to the trend that 25%, or 198,750, of the 795,000 is now 65 and younger.


Younger patients with late effects of stroke, their PSS are different than my older patients.

My younger clients are concerned about paying for:

  • Children’s college tuition(s)

  • Cars

  • Children’s marriages

  • Returning to work

  • Mortgage, etc.

They don’t care what kind of wheelchair or walker you get them, or if they can use another assistive device. They are worried about paying bills and family responsibilities, which are factors of PSS.


I learned early-on that if I didn’t address their PSS during my treatments, I noticed they weren’t progressing to their fullest potential. PSS take our patients’ focus from their successful rehabilitation, and inhibits them from being motivated to do Home Exercise Programs (HEP’s) and having enhanced feelings of giving up, depression etc.


Therefore, along with providing strengthening and range of motion exercises to their extremities; and mobility and assistive device training (i.e. tub chairs, wheelchairs and walkers), I had to address the PSS issues that were preventing the patient from directing their total focus on recovery.


Regardless of your discipline or setting, all therapists involved in recovery can learn how to address PSS following stroke and keep them motivated and focusing on their rehabilitation.


Some ways I address them, (which may help you in your recovery) are the following:

  • I asked if they went to church, If they did, I contact the church. Many church families will assist a stroke survivor free of charge. Some members can become sitters, provide meals, do light housework, and even drive patients to doctors’ appointments. Also, some churches have a medical staff, such as nurses, who can visit you and assist with medications, take blood pressure readings, etc.

  • I would also find and identify a list of social workers in the area, as they are a great resource to assist with financial issues and educate those without insurance. Social workers have many connections with local and state agencies that can and will assist with those in distressed financial situations.

  • People are also learning about creating GoFundMe accounts to assist with the pressure of mounting medical bills. I have had many past patients with long-term disabilities create these accounts and have been successful with assistance.

  • Also, just social media accounts such as Facebook and Instagram following a message of letting people know. If your friends and extended family aren’t aware of your needs, how can they assist?

As a stroke survivor, you have more to worry about than paying medical bills. You need less PSS so you can focus on your recovery.


Thank you.


Dr. Sheppard is an Occupational Therapist with 30 years of experience and developed two outpatient OT clinics specializing is adult/pediatric neurological disorders and orthopedic conditions. Dr. Sheppard has a certification in NeuroDevelopmental Treatment (C/NDT) and teaches a Stroke Recovery Continuing Education Course all over the country for other allied health professionals to attain required hours toward their licensure to practice. He just recently took a full time faculty position as a Clinical Associate Professor at Emory & Henry College of Health Sciences.

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