Stroke Aftermath: Understanding The Lingering Effects And Challenges

A stroke is a brain injury that occurs when the blood supply to the brain is cut off. The effects of a stroke depend on the location and extent of the damage to the brain tissue. The brain is divided into three main areas: the cerebrum (right and left sides), the cerebellum (back of the brain), and the brainstem (base of the brain). Each part of the brain controls specific functions, and if a stroke occurs in one of these areas, the corresponding functions may be impaired. For example, a stroke on the left side of the brain affects the right side of the body and can lead to paralysis, sensory changes, and speech or language problems. The impact of a stroke can vary from person to person, with some people experiencing minor and short-term effects, while others may have more severe and long-lasting consequences. Early treatment and rehabilitation are crucial for improving recovery, and most people will need some form of rehabilitation to regain their physical and cognitive abilities.

Physical effects: paralysis, pain, fatigue, incontinence, restricted physical abilities

The physical effects of a stroke depend on which part of the brain was damaged and the severity of the damage. Here are some of the possible physical effects:

Paralysis

Paralysis, or weakness, on one side of the body is a common physical effect of a stroke. This can cause difficulty with gripping or holding things and performing certain movements.

Pain

Post-stroke pain, also known as central pain or thalamic pain, is experienced by about 10% of people who have had a stroke. It can arise days or years after the stroke and can be described as burning, aching, and prickling. The pain is typically constant but also has an intermittent stabbing component. It can be aggravated by temperature changes or movement and tends to get worse over time. Treatment options include medication and surgery, with surgical treatment often resulting in a 50% or greater reduction in pain.

Fatigue

Fatigue or tiredness is a common physical effect of a stroke and can be caused by physical changes, medication, mood changes, depression, anxiety, or difficulty sleeping.

Incontinence

Incontinence is a frequent issue after a stroke, with approximately half of stroke survivors admitted to medical facilities experiencing temporary bladder incontinence and one-third experiencing bowel incontinence. There are many types of incontinence that can occur, including urge incontinence, functional incontinence, and urinary retention. Incontinence may be caused by damaged brain tissue, muscle weakness, cognitive difficulties, or motor impairments that make it difficult to reach the bathroom in time.

Restricted Physical Abilities

A stroke can result in restricted physical abilities, impacting an individual's ability to perform physical activities or exercises. Motor impairments are common and can affect mobility, making it challenging to perform daily tasks and increasing the risk of accidents.

Emotional and behavioural changes: depression, anxiety, irritability, aggressiveness, apathy

Experiencing a stroke can lead to a variety of emotional and behavioural changes, including depression, anxiety, irritability, aggressiveness, and apathy. These changes are common and can be attributed to the impact of the stroke on the brain, which controls our behaviour and emotions. The specific effects depend on which area of the brain was affected and the extent of the damage.

Depression

Depression is a common occurrence in the first year after a stroke, particularly in those who struggle with communication and understanding. Symptoms of depression include a persistent feeling of sadness, difficulty concentrating, loss of interest in activities once enjoyed, changes in appetite and weight, and difficulty sleeping. It is important to recognise and address depression, as it can significantly impact one's quality of life and recovery process.

Anxiety

Anxiety is another emotion that may arise after a stroke, either on its own or alongside depression. People experiencing anxiety may feel constantly worried or anxious, have difficulty calming down, and experience challenges with decision-making, concentration, and sleep. Like depression, anxiety can hinder the recovery process, so seeking support and treatment is crucial.

Irritability and Aggressiveness

Stroke survivors may exhibit irritability and aggressiveness, which can manifest as physical or verbal behaviours. These behaviours can be distressing for both the survivor and their caregivers. Aggressive behaviours may include hitting, kicking, biting, throwing objects, screaming, and refusing treatment. Understanding the triggers of these behaviours, such as overstimulation or confusion, can help manage them effectively.

Apathy

Apathy, or a lack of motivation, is another potential emotional change after a stroke. This can impact the survivor's engagement in their daily activities, hobbies, and relationships. It is important to encourage survivors to stay connected with their loved ones and seek support from professionals to help manage these emotional challenges.

While emotional and behavioural changes can be challenging, many disabilities and changes resulting from a stroke tend to improve over time. Early treatment and rehabilitation can significantly improve recovery, and it is important to remember that time is a crucial factor in healing.

Cognitive effects: problems with thinking, memory, perception, communication, reading, writing, and understanding

A stroke can have a significant impact on a person's cognitive abilities, affecting their thinking, memory, perception, communication, reading, and writing.

Thinking and Memory

Cognitive problems are common after a stroke, with up to 60% of survivors experiencing some form of impairment in the first year. A stroke can affect the brain's ability to understand, organise, and store information, leading to issues with memory and thinking. This includes problems with concentration, attention, and information processing. Stroke survivors may also struggle with answering questions, planning, following conversations, and making judgements.

Perception

Perception refers to how an individual sees, hears, and feels the world around them. A stroke can cause changes in perception, such as altered sensations on the side of the body affected by the stroke. It can also lead to difficulties in recognising shapes and objects, or even one's own body. Some individuals may experience issues with their vision, such as losing half their vision in each eye (hemianopia).

Communication, Reading, and Writing

Communication problems are common after a stroke, as language is controlled by multiple areas of the brain working together. A stroke can impair an individual's ability to understand or process language (aphasia) and may result in decreased attention, distractibility, and inappropriate behaviour. Reading and writing may become challenging due to weak hand strength or issues with thinking or seeing.

Treatment and Rehabilitation

While there is no quick fix for cognitive problems after a stroke, treatments can help individuals cope with their challenges. Occupational therapists can assess individuals and teach them coping strategies, such as using diaries, labels, and reminders. Clinical neuropsychologists and clinical psychologists can also provide specialised support for more specific or severe cognitive problems. Rehabilitation and support are crucial for improving cognitive function and helping individuals adjust to any permanent lifestyle changes.

Speech and language problems: aphasia, dysarthria, dyspraxia

Aphasia is a common language impairment observed in almost a third of all stroke patients. It involves difficulty in finding the right words or understanding what others are saying. Treatment for aphasia involves speech and language therapy, which remains the standard of care. However, such therapy is not effective for all patients.

Dysarthria is an acquired speech disorder that reduces the intelligibility of speech due to weak, imprecise, slow and/or uncoordinated muscle control. Dysarthria can be treated by a speech and language therapist or speech pathologist, who may advise strategies and exercises to increase the clarity of speech. Other treatments include acupuncture or brain stimulation.

Dyspraxia is a dysfunction of the nerve connection between the brain and mouth, making speech difficult.

Daily life changes: living arrangements, sexual function, ability to work, level of independence

Daily life changes after a stroke

Living arrangements

Living arrangements may need to be altered after a stroke, with some individuals requiring residential care or home modifications. The hospital staff can help prepare for these changes and determine the best plan, taking into account factors such as the ability to care for oneself, follow medical advice, and move around and communicate independently.

Sexual function and relationships

A stroke can impact sexual function and relationships.

Ability to work

Returning to work after a stroke is important for individuals' participation in society and sense of competence. Cognitive performance, motivation, perceived working ability, and self-perceived barriers all play a role in returning to work. The likelihood of returning to work is also influenced by factors such as stroke severity, age, and occupation.

Level of independence

A stroke can affect one's level of independence, and they may need to rely on carers at home. Rehabilitation can help improve independence by adding special equipment and making adjustments to the home environment to enhance safety and freedom of movement.

Frequently asked questions