Post-Stroke Challenges

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After experiencing a stroke, many people are unsure of how their day-to-day life will look. On top of financial burdens, doctor visits, and therapy sessions, patients often face emotional, physical, and cognitive changes. Learning how to address these sudden life changes is pivotal to gaining both physical and mental independence.

What to Expect

While each scenario differs, it is common to see physical, cognitive, and behavioral differences post-stroke. Some common physical changes involve weakness, stiffness, and numbness. Emotional challenges also arise due to physical changes to the brain. Cognitive thinking and memory difficulties are common due to brain damage as well.

Physical Conditions

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Having a stroke can result in varying levels of physical disabilities. It is possible to regain mobility and independence through therapy and other treatment options.
Some of the most prevalent physical effects of stroke include:

  • Fatigue

  • Foot Drop

    • What is Foot Drop: The inability to lift the front of the foot is a condition known as Foot Drop. Following a stroke, it is common for some patients to experience changes in the muscle tone in their legs or feet. This can cause a decrease in coordination or strength which results in the inability to flex the ankle or lift the forefoot.

    • This causes the person to drag their toes when walking or to lift the knee higher to compensate for the foot. This condition can occur in one or both feet. Through rehabilitation, patients can often make partial or full recoveries.

    • Treatment Options: If a stroke survivor is experiencing foot drop, they should begin rehabilitation immediately. If the condition remains untreated, it can lead to permanent gait abnormalities, postural deformities, increased fall risk, and further injury to the foot or leg.

      If a patient has foot drop, it is critical for them to wear a foot drop brace at all times. Without a brace, the risk of falling is much greater. A foot brace will help to maintain foot dorsiflexion and prevent the foot from inverting while walking. Physical therapy can help to strengthen the weakened muscles over time. Electrical stimulation is also an option for treating foot drop. Consulting with your medical professional can help you explore different treatment options to learn which combinations will work best for you.

    • You can read more about the benefits of a foot drop brace here - What does a Foot Drop Brace do?

    • You can read more about foot drop here: What is Foot Drop?

  • Hemiparesis
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    • What is Hemiparesis: One of the most common physical conditions, impacting 8 out of 10 stroke survivors, is hemiparesis. Hemiparesis is one-sided, “hemi” muscle weakness, “paresis”. The condition varies greatly in severity and location. Hemiparesis frequently limits patients’ ability to complete everyday tasks like dressing themselves, eating, and using the bathroom since the one-sided weakness greatly impacts an individual’s ability to balance, walk, and grasp objects. It also reduces your coordination capabilities and fine motor skills and leads to frequent muscle fatigue.

    • The location of the stroke in the brain will indicate which side of the body is affected. Because of the contralateral relationship between the brain and the body, if a patient has a stroke in the right side of their brain, they will often experience hemiparesis on the left side of the body and vice versa.

  • A condition known as hemiplegia also occurs as a result of spinal cord injuries or traumatic brain injuries. Hemiplegia, however, results in complete paralysis on one side of the body. Overtime, patients may regain sensation. Stroke is the leading cause of both hemiplegia and hemiparesis. Learn more about hemiplegia and hemiparesis.

    • Hemiparesis Rehabilitation Options: With hemiparesis, there is the potential to regain strength, mobility, and independence through rehabilitation. Through therapy sessions with an occupational therapist or physical therapist, many patients have made significant recoveries following their stroke. Your therapist may implement several different types of therapy to aid in your recovery.
      Some of the most common treatment options include:

      • Modified constraint-induced therapy (mCIT) - mCIT restrengthens the weaker side of the body by constraining, and therefore reducing, the use of the unaffected side of the body. This forces the patient to use their weaker side instead of constantly allowing the other side to take over.
      • Cortical stimulation - During cortical stimulation, a small electrode is placed on the membrane covering the brain, and electrical stimulation is applied during rehabilitation exercises.
      • Imagery - When a patient imagines the affected body part moving while completing exercises, it triggers the brain and muscles to think the affected body part is moving, even if it isn’t. Mirror Therapy is a commonly practiced application of imagery.
      • Electrical stimulation - Electrical stimulation can be used directly on the affected body part to improve range of motion and help target the muscle to improve strength.
      • Assistive Devices - Your physician or therapist may also recommend a device such as a brace, walker, cane, or wheelchair to assist with safe mobility. The devices can also help promote strength and movement. The fit and maintenance of these devices should be monitored by your medical professional in order to ensure safe use.
      • Home rehab - Home rehabilitation is commonly requested by therapists in the case of children with hemiparesis. To learn more about devices, exercises, and useful tips for home rehab for children with hemiparesis, read these helpful posts from our occupational therapists.
  • Paralysis

    • 9 out of 10 stroke survivors will experience some form of paralysis immediately following the event. Through therapy, patients often regain varying degrees of movement. After the brain is damaged from the stroke, the signals sent to your muscles are often not received. Paralysis can occur anywhere in the body. Hemiplegia is paralysis occurring on one side of the body. On rare occasions, a stroke results in “locked-in” paralysis for the survivor. In this case, the survivor's body is completely paralyzed with the exception of their eyes.
  • Spasticity

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  • Spasticity results from post-stroke brain damage preventing proper signal translation from the brain to your muscles. This results in muscle cramps and spasms. This leads to difficulties in everyday activities.

    • Treatment Options: There are a variety of options available for treating spasticity. As always, check with your healthcare professional before initiating any treatments.

      • Movement - Any form of movement often helps with spasticity. The degree and strenuousness often depends on an individual’s case.

      • Exercises - Certain exercises are often prescribed as a form of treatment for spasticity. Spasticity usually decreases a person’s range of motion, and exercising is a great way to combat that.

      • Stretching - Stretching, much like exercising, helps with mobility in the affected muscles.
        Equipment like the NEOFECT Hand Extender assists with stretching and minimizing spasticity.

      • Braces - To control spasms in the affected limb, a brace may sometimes be used.

      • Surgery - Performing surgery on the afflicted muscles or tendons and joints can help people regain mobility and decrease pain.

      • Medications - Ask your doctor about available medications to treat spasticity.

      • Injections - Injections like botulinum toxin (Botox) work by blocking the chemicals that cause tight muscles.
        Learn more about Spasticity.

Emotional Changes

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Not all changes after a stroke or TBI are visible. Some hidden effects come in the form of emotional changes. Some people may experience varying emotions such as frustration, sadness, anger, sense of loss, anxiety, and fear. Many people even experience post-stroke depression. All of these changes are normal to experience after such a traumatic, unexpected event. These changes occur not only as a result of how the patient feels about the stroke itself but also due to damage to the brain. If anything feels abnormal, always be sure to address your concerns with your healthcare professional.

Depression in varying degrees is common post-stroke with more than 1/3 of survivors experiencing some form of depression. Depression post-stroke is also underdiagnosed, meaning its highly likely that this percentage is even greater.

Common symptoms of depression include anger, anxiety, frustration, sadness, hopelessness, and fear. Depression can also lead to suicidal thoughts.

  • Symptoms: Symptoms of depression vary in intensity and prominence.
    • Persistent sad, hopeless, anxious feelings
    • Disrupted sleep
    • Change in eating patterns
    • Social withdrawal
    • Fatigue
    • Irritability
    • Feelings of hopelessness or worthlessness
    • Difficulty concentrating
    • Suicidal thoughts

Depression can occur any time and some survivors experience it weeks, months, or even years post-stroke. Not only can depression impact your quality of life, it can slow down or even halt your recovery progress. Depression can also worsen other post-stroke conditions if not treated.

  • Treatment Options: Always consult your healthcare provider to discuss your options.
    • Medication - Antidepressants are a common treatment option for people with depression. Antidepressants react with the chemicals in your brain to help improve mood.
    • Mental health therapy - Therapy provided by a psychiatrist is often coupled with antidepressants to help improve mental health.

Pseudobulbar affect (PBA) is an extremely common emotional change following a stroke. It is reported that up to half of all stroke survivors experience PBA at some point following the event. PBA is characterized by an outburst of uncontrollable laughter or crying. These outbursts are sudden and occur unexpectedly, even in inappropriate social situations, making the event very embarrassing for the survivor.

  • Only your medical professional can diagnose PBA. Due to similar symptoms, PBA is often misdiagnosed as depression. Without proper diagnosis, it is hard to get help. Consult your physician about diagnosis and treatment.

It is important to know these that emotional and behavioral changes following a stroke are not permanent, as this can often be difficult for both the stroke survivor and their loved ones to remember. Learn more about Emotional and Behavioral Challenges needing Stroke Victim Support.

Cognitive Challenges

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In some patients, there is an affect on cognitive capabilities. Memory, retention, and recognition can all be impacted. Adjusting to these changes can be hard, but there are strategies, tips, and treatments that can help improve and restore cognitive capabilities.

Aphasia: A common symptom as a result of a stroke is communication difficulties. While aphasia appears in varying degrees, it is characterized by a difficulty understanding others, reading and writing, and finding proper words to express yourself. Aphasia is a result of the damage to the brain caused by the stroke and is more common in adults than younger survivors.

There are several different varieties of aphasia. While every individual has their own unique case, the different types of aphasia are typically divided into four categories: expressive aphasia, receptive aphasia, global aphasia, and anomic/amnesia aphasia. Each form can appear in mild or severe cases.

Expressive aphasia is when a person knows what they want to say but are having trouble finding the words to say it.

Receptive aphasia is when a person has difficulty understanding and comprehending speech or written text.

Global aphasia impacts all areas of speech and comprehension. The damage to the brain and communication centers is severe, leaving the survivor unable to speak, comprehend speech, read, or write. Global aphasia is the most severe form of aphasia.

Anomic/amnesia aphasia is when people have difficulties remembering the correct term for people, places, or items. This is the least severe form of aphasia.

  • How to treat aphasia: Fortunately, it is possible for patients to make a full recovery from aphasia. The most popular treatment option for aphasia is speech therapy. Different techniques and exercises can be implemented depending on each person’s case. Other treatment options like, art therapy, melodic intonation therapy, visual speech perception therapy, constraint-induced language therapy, group therapy, and support groups have also been successful forms of aphasia treatment. Prescription medication is occasionally used alongside other therapies as well.
  • Continuing to use therapy methods and incorporating your practices into your daily life can help reinforce progress from professional speech therapy. Some activities include: playing word games, solving crossword puzzles, reading or singing aloud, practicing writing for grocery lists or on cards to family members and friends.
  • Supporting survivors with aphasia: Finding creative ways to ease communication with survivors with aphasia is very important. Using props such as photos or maps can help facilitate conversation. Speaking clearly and slowly or drawing pictures or using written words can help as well. When communicating with someone with aphasia it is always important to remember to be patient. Aphasia usually does not affect thinking, only communicative skills. Therefore, it is important to always treat the person with aphasia as an intelligent person. Be creative and patient! Aphasia can greatly impact social interactions and can be frustrating, especially for the survivor.

Memory Loss: Around 1/3 of stroke patients will experience some degree of memory problems. In older patients, memory loss commonly appears in the form of dementia, which can be debilitating.
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  • Types of Memory Loss: There are four main types of memory loss: verbal, visual, informational, and vascular dementia. For people who experience verbal memory loss, they have trouble recalling names and stories. With visual memory loss, people experience difficulties remembering routes, things they’ve seen, shapes, and faces. Informational memory loss leads to difficulties recalling old and learning new skills or information. Vascular dementia impacts an individual’s thinking and cognitive abilities.

  • How to Manage Memory Loss: These simple tips can help make memory loss manageable.

    • Create a routine. Creating a specific sequence or timeline for your daily activities can be beneficial to memory loss. Post activities and special days on a calendar to keep track of upcoming events.
    • Keep it simple. Breaking down your to-do list into a step-by-step process can make big things more manageable.
    • Write things down. Use a notebook to keep yourself organized.
    • Leave yourself instructions around the house. Leaving instructions for common tasks such as cooking can be very helpful.
    • Have a home for everything. Designate a spot for all of your items and make sure to put them away when you finish using them.


Find more tools and resources for stroke management.

WRITTEN BY

  • June Lee
    Clinical Manager / Physical Therapist
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