Stroke And Disability: Understanding The Link

Stroke is a disease that occurs when the brain's blood supply is interrupted, often as a result of a blood clot or ruptured blood vessel. It is the leading cause of permanent disability in adults, with 15 million people worldwide affected by stroke each year and an estimated 50% of those individuals living with permanent or chronic disability. The physical and mental effects of stroke can significantly impact a survivor's recovery, mental well-being, and future plans. The disabilities caused by stroke can be both visible and invisible, and the specific effects depend on which part of the brain was damaged and by how much.

Paralysis or weakness on one side of the body

Hemiplegia and hemiparesis are symptoms of a stroke, which occurs when brain cells are damaged due to insufficient blood and oxygen supply. About 80% of stroke survivors experience hemiparesis. The conditions can also be caused by other medical issues, such as traumatic brain injury, arthritis-related changes or trauma affecting the spinal cord, a brain or spinal cord tumour, autoimmune disorders, cerebral palsy, infection of the brain or spinal cord, postictal paralysis, and psychological and psychiatric conditions.

Hemiplegia and hemiparesis can lead to several consequences, including an inability to maintain balance, grasp objects, decreased precision in movement, lack of coordination, leaning to one side, and loss of bowel or bladder control. These issues can make it difficult to maintain a normal level of independence in daily activities, and hemiparesis is one of the leading causes of disability.

If you experience sudden hemiparesis, you should seek immediate medical attention as it can be a sign of a stroke or other serious medical condition. Treatment for hemiparesis and hemiplegia focuses on strengthening motor skills and coordination and improving the ability to manage everyday activities. Physical and occupational therapy play an important role in the recovery process and can help with strength and mobility improvements over time.

Aphasia or dysphagia (difficulty with language or swallowing)

Aphasia and dysphagia are two of the most common disabilities caused by a stroke. Aphasia is a complex language and communication disorder resulting from damage to the language centres of the brain. Dysphagia is difficulty in swallowing.

Aphasia

Aphasia can affect people in different ways, but it typically impairs a person's ability to speak or understand speech. It does not affect intelligence, but it can be difficult for others to understand that a person with aphasia is still thinking in the same way but is unable to communicate their thoughts easily. Aphasia is one of the three main communication problems caused by a stroke, and around a third of people who have a stroke will experience it.

Dysphagia

Dysphagia affects more than 50% of stroke survivors. It can increase morbidity and mortality after a stroke and significantly impact a person's quality of life, as it can be dangerous and isolating to share meals with others. Dysphagia can lead to aspiration pneumonia, dehydration, malnutrition, and weight loss.

Treatment

Speech therapists work with patients to address aphasia and dysphagia. Depending on the severity of the stroke, patients may regain their ability to speak relatively soon or may need more therapy after leaving the hospital. Prompt evaluation and treatment of swallowing disorders can help mitigate the development of secondary complications and foster reintegration into society.

Sensory problems

If a stroke occurs toward the back of the brain, it is likely that some disability involving vision will result. In addition, a stroke on the right side of the brain can cause spatial thinking or imagery problems, while a stroke on the left side can lead to language and speech issues.

The long-term effects of a stroke depend on which part of the brain was damaged and by how much. Early treatment and rehabilitation can improve recovery, and many people regain a lot of their abilities.

Physical and/or mental fatigue

Post-stroke fatigue is very common. It can manifest as physical or mental fatigue, or both.

Physical Fatigue

Stroke survivors often feel permanently tired or low on energy, and this fatigue is not relieved by rest. Physical fatigue can make simple tasks like climbing stairs or walking from one room to another challenging.

Mental Fatigue

Mental fatigue can include short-term memory loss, mental fog, or forgetfulness.

Impact on Daily Life

For some stroke survivors, fatigue can be so severe that it has a debilitating effect on their daily lives.

Treatment

The sooner post-stroke issues are addressed, the better the chances of avoiding permanent disability. Physical rehabilitation immediately after a stroke can help improve the chances of re-activating muscles and regaining mobility.

Anxiety and depression

Experiencing a stroke can be a sudden and shocking event that affects every part of your life. It is normal to have a lot of different feelings after a stroke, and it is common for survivors to experience anxiety and depression.

Anxiety

Around one in four stroke survivors will experience anxiety within the first five years. It is natural to have many worries after a stroke, such as worrying about having another stroke, getting around on your own, or financial concerns. If anxiety is stopping you from doing the things you want to do or causing you distress, it is important to seek help. Living with anxiety can lead to sleeping problems, tiredness, and muscle tension. It can also make you feel more irritable and cause you to avoid certain activities.

Depression

Depression is the leading cause of disability worldwide and is common among stroke survivors, with one in two survivors experiencing depression. It is often caused by biochemical changes in the brain, and when the brain is injured, positive emotions may be more difficult to feel. Depression can make the rehabilitation process more challenging, but treatments and strategies are available to improve these changes. It is important to seek help if you are experiencing symptoms of depression, as it can have a significant impact on your wellbeing and recovery.

Treatment and Support

If you are experiencing anxiety or depression after a stroke, it is crucial to talk to your doctor, family, and friends about how you are feeling. Effective treatments include cognitive behavioural therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). Additionally, engaging in physical activity, eating well, and avoiding alcohol can also help improve your mental health. Social support is crucial, and it is beneficial to stay connected with family and friends or join a support group.

Frequently asked questions