Experiencing a stroke can be a life-altering event, and it is crucial to understand that the recovery process is often complex and non-linear. While some individuals may make steady progress, it is not uncommon for stroke survivors to encounter setbacks and worsening of symptoms. This regression can be a normal part of the healing process, but it may also indicate additional medical complications.
In the initial days and weeks following a stroke, individuals typically undergo intensive care and rehabilitation to stabilise their condition and address the immediate effects of the stroke. This early intervention is critical to maximising the chances of recovery. However, the recovery journey is often long and challenging, and setbacks are not unusual.
Post-stroke symptoms can fluctuate and sometimes worsen over time. This can be influenced by various factors, including the type of stroke, the presence of other health problems, and the severity of the stroke. In some cases, new medical complications may arise, contributing to a decline in the patient's condition.
It is important to closely monitor any changes in symptoms and seek medical attention if there is a rapid or sudden worsening of stroke-related effects. Additionally, the support of a dedicated rehabilitation team is vital to help manage and improve symptoms. This team may include physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and psychologists.
While stroke recovery can be a challenging journey, it is important to remember that setbacks are a normal part of the process for many individuals. Working closely with a medical team and adhering to a tailored rehabilitation plan can help maximise the chances of recovery and improve long-term outcomes.
What You'll Learn
- Regression after a stroke is common and can be caused by changes in routine, activity levels, and new medication
- Post-stroke depression is a secondary effect that impacts 18-33% of stroke survivors
- A stroke can cause problems with thinking and memory
- A stroke can lead to sleep disturbances and excessive sleepiness
- A stroke can cause physical symptoms such as weakness, paralysis, and difficulty swallowing
Regression after a stroke is common and can be caused by changes in routine, activity levels, and new medication
Regression after a stroke is a normal part of the recovery process, but it can also indicate additional medical complications. It's important to monitor your condition and seek medical advice if you have any concerns. The stroke recovery process is not linear, and most patients experience ups and downs. However, it's crucial to ensure that overall, you're making progress and taking more steps forward than backward.
- Changes in routine or activity levels: Making significant changes to your daily routine, such as increasing physical activity or becoming more sedentary, can affect your body and impact your recovery.
- New medication: While medication is important for managing stroke-related complications and preventing another stroke, it can sometimes have negative side effects. For example, some stroke survivors report regression after taking antidepressants.
- Overworking yourself: Following a stroke, it's crucial to commit to a dedicated rehabilitation plan. However, overtraining can lead to regression. It's important to work closely with your therapy team to progress at a safe and steady pace.
- Post-stroke fatigue: Stroke recovery is exhausting, both mentally and physically. Post-stroke fatigue can impact your ability to participate in daily activities and rehabilitation.
- Emotional changes: It's normal to experience a range of emotions after a stroke, such as grief or anger. However, extreme emotional swings could be a sign of pseudobulbar affect, which should be discussed with your doctor.
- Stopping rehabilitation: Discontinuing rehabilitation can lead to a deterioration in functional abilities and worsening symptoms. It's important to stay consistent with your rehabilitation plan to avoid regression.
To manage and improve post-stroke symptoms, consider the following:
- Don't rush your recovery: Stroke recovery is a marathon, not a sprint. Aim for a slow and steady pace to avoid burnout.
- Get plenty of rest: Sleep is crucial for stroke recovery, as it gives your brain a chance to heal and recharge. Increased sleep requirements are normal after a stroke.
- Be consistent: Consistency is key in stroke recovery. Stick to your rehabilitation plan and make gradual progress to rewire your brain effectively.
- Practice with high repetition: Repeating therapeutic exercises helps activate neuroplasticity and strengthen the connections in your brain.
While small setbacks are normal during stroke recovery, sudden and rapid worsening of symptoms can be a medical emergency. If you experience any new or worsening stroke symptoms, such as drooping of the face, weakness on one side of the body, or slurred speech, seek immediate medical attention.
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Post-stroke depression is a secondary effect that impacts 18-33% of stroke survivors
Post-stroke depression is a common secondary effect of stroke, impacting 18-33% of survivors. It is often caused by biochemical changes in the brain, and can be accompanied by anxiety. Symptoms of post-stroke depression may include:
- Persistent sad, anxious or "empty" mood
- Restlessness and irritability
- Feelings of hopelessness, pessimism, guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies and activities, including sex
- Decreased energy and fatigue, and feeling "slowed down"
- Difficulty concentrating, remembering and making decisions
- Insomnia, early-morning awakening or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
Post-stroke depression can make the rehabilitation process more challenging for survivors, but treatments and strategies are available. A good psychologist or psychiatrist can help, and social support is also crucial.
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A stroke can cause problems with thinking and memory
A stroke can affect the way your brain understands, organises and stores information. This is also known as cognition. Different parts of your brain work together to produce cognitive skills like thinking and memory. If one of those parts of your brain is damaged by a stroke, this can lead to cognitive problems.
There are several different types of cognitive problems, including:
- Problems with planning and problem-solving (executive function)
- Problems noticing things on one side (spatial neglect)
- Problems moving or controlling your body (apraxia)
- Controlling movement and finding your way around (visual perception)
- Confusion and denial (anosognosia)
- Problems recognising things (agnosia)
Cognitive problems are usually worst during the first few months after a stroke, but they can and do get better. Problems are likely to improve most quickly over the first three months, as this is when your brain is at its most active, trying to repair itself. It’s still possible for problems to improve after this, but you may find that it takes longer. Recovery can continue at a slower pace for months or years.
Treatments for cognitive problems focus on ways to cope with the issues, rather than ‘fix’ them. An occupational therapist can assess you and help you learn coping strategies. This may involve using aids such as writing in a diary or using labels and reminders. Or it may involve learning other techniques that can help you.
If your problems are quite specific or severe, you may be referred to a clinical neuropsychologist or clinical psychologist. These healthcare professionals specialise in the way the brain works.
- If you think you may be experiencing some of the problems described, the first thing to do is to speak to your GP. They will check if there is anything else that could be causing the problems, such as an infection or side effects of medication.
- Do not be too hard on yourself. Having cognitive problems after a stroke is not something you can control. Be patient with yourself. You’re not stupid, even though you may feel that way.
- Allow yourself more time to get things done and do not expect too much of yourself.
- Being as active as you can may help with cognitive problems. It can also help with emotional problems like low mood and anxiety.
- Plan your day so that you balance being busy with taking breaks and resting. You’re not going to be able to take life at the same pace as you did before, at least not to begin with.
- Look into aids and equipment that you may find helpful, especially for problems with memory. Your occupational therapist will be able to suggest some to you.
- Find ways to relax. Your mind needs to rest just as much as your body. Even small things like going for a short walk, listening to music or having a quiet moment to yourself in another room can help to calm your mind.
- Tell people what’s going on. Cognitive problems are nothing to be embarrassed about. Explaining how someone can help will make it easier for you both. This might include speaking slowly or writing things down.
- Talk to someone who understands. Cognitive problems can affect your confidence and how you feel about yourself. Talking about it can really help. Many people find support groups useful, because you can talk about problems with people who are going through the same thing.
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A stroke can lead to sleep disturbances and excessive sleepiness
A stroke is a brain injury that occurs when the blood supply to the brain stops. The recovery process is complex and often full of twists and turns. It is vital that stroke survivors get enough sleep as this gives the brain a chance to rest and recharge, facilitating neuroplasticity. However, sleep problems may follow a stroke, and these can slow recovery and lead to depression, memory problems, and night-time falls.
Two-thirds of stroke survivors experience sleep-disordered breathing, which is characterised by abnormal breathing patterns that interrupt sleep. Obstructive sleep apnea is the most common type of sleep-disordered breathing in stroke survivors. It causes the sufferer to stop breathing for ten or more seconds, many times during the night. Loud snoring, choking, and gasping sounds during sleep may indicate sleep apnea. Sleep apnea increases the risk of a second stroke.
Another common sleep disorder is insomnia, which causes sufferers to have trouble falling asleep or staying asleep throughout the night. Insomnia is more common than getting too much sleep, though excessive sleepiness after a stroke could be normal or a sign of other medical complications like sleep apnea.
There are ways to improve sleep after a stroke. Treatments for insomnia may include prescription sedatives or changes in the bedroom or nighttime activities. Continuous positive airway pressure (CPAP) is a common and effective treatment for sleep-related breathing disorders like sleep apnea. A CPAP machine delivers short bursts of compressed air to prevent airway obstruction and help the patient get a better night's sleep.
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A stroke can cause physical symptoms such as weakness, paralysis, and difficulty swallowing
A stroke is a brain injury that occurs when the blood supply to the brain stops. The signs and symptoms of a stroke can develop over hours or even days, and the type of symptoms depends on the type of stroke and the area of the brain that is affected.
Post-stroke, individuals often experience "ups and downs" during recovery, and regression can be a normal part of the process. However, if secondary effects worsen dramatically, it may be a sign of a medical emergency. Changes in routine or activity levels, new medications, and overworking oneself can all contribute to worsening symptoms.
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Frequently asked questions
Yes, a stroke can get worse. In some cases, the worsening of symptoms is a normal part of the recovery process, but it can also be a sign of additional medical complications.
It is important to communicate any changes in symptoms to your doctor and rehab team. They will be able to investigate the cause of the regression and help keep you on track with your recovery.
While every stroke is different, some common signs of a worsening stroke include increased weakness, impaired speech, drooping of the face, or confusion. If you experience any of these symptoms, seek immediate medical attention.