**5. Rehabilitation and caregiving of stroke survivors**

The occurrence of stroke is devastating and overwhelming for both the survivor who becomes disabled suddenly and the family who are not prepared for the changes brought about in their lives when managing the multiple problems of a patient post stroke [7]. This is because they may face financial worries and are not prepared for the long care-giving hours and emotional stress which are predominant factors in increasing caregiver stress when one is caring for stroke survivors [93]. Caregivers should therefore be involved early on in the rehabilitation phase so that they understand and deal with the problems and prepare for after discharge life. The quality of rehabilitation, timing of treatment and amount of time spent in hospital have a bearing on the functional outcomes of the patients [6, 94–96]. Success of rehabilitation is also determined by emotional and physical challenges that the patient faces post stroke [97]. It is therefore important to identify barriers to an efficient rehabilitation service [6, 98, 99]. This is because availability of resources will affect the standard of stroke rehabilitation that patients receive [6, 100]. Effective rehabilitation initiated early after stroke can help enhance the recovery process and minimise functional disability which in turn improves quality of life of both the patient and the caregiver [42, 43, 97, 101–103]. Caregivers need to be well prepared for the emotional and physical challenges that the survivor faces as they may become barriers to care or even have a bearing on caregiver burden.

Moreover, organised respite care services that are available in developed countries may not be available in Zimbabwe to help with care of stroke survivors. This means that caregivers who have to look after survivors for long periods of time in most cases have no respite support. Disability benefits or allowances and voluntary support services to assist people living with disabilities and their caregivers may

not be available as is the case in Zimbabwe [104, 105]; yet the caregiver's role in the health delivery system and support of stroke survivors is important. The global prevailing economic meltdown may also affect development of community services in most developing countries. This is despite home-based rehabilitation being considered an important complementary component of health-care to address stroke related disability as advocated by WHO in the case of HIV/AIDS. In South Africa, Hale et al. noted that stroke care leaves the caregiver who has no knowledge of what is going on in a predicament of what to do as information provided may not meet all their needs [33]. This results in increased caregiver strain as they may be the only source of rehabilitation available to the survivors of stroke as most cannot afford formal services due to poverty [34, 98]. There is therefore a missing link between hospital rehabilitation and survivors of stroke and their caregivers post discharge within the community.

The large numbers of people affected by stroke may also mean that the caregiver burden will increase and quality of life among many people will be affected. It is therefore important that caregivers of stroke survivors receive adequate caregiver support. When caregivers do not receive support, they may become strained resulting in inadequate support to survivors that will affect their quality of life. It is hoped that equipping caregivers by training them to look after stroke survivors may hopefully improve their outcomes and those of stroke survivors they care for. This is because elsewhere it has also been previously reported that disability affects quality of life and functional independence among survivors of stroke and increases burden of care among the caregivers [7].
