Recovering From A Left-Sided Stroke: What's Possible?

A left-sided stroke can be life-altering, but recovery is possible. The recovery journey is unique to each individual, and the effects depend on the stroke's severity and the area of the brain affected. The left side of the brain controls a wide range of motor, sensory, and cognitive functions, so a stroke on this side can result in a variety of deficits. These may include physical impairments on the right side of the body, language impairments such as aphasia, intellectual impairment, behavioural changes, and visual impairment. Rehabilitation is crucial to optimising recovery, and it's important to start as soon as possible. This includes physical therapy, speech and cognitive therapy, occupational therapy, vision therapy, and psychotherapy. While recovery may be slow and uncertain, the brain's ability to adjust and reconnect neurological pathways through neuroplasticity offers hope for improvement.

Physical therapy can help with movement, balance and coordination skills

Physical therapy is an essential part of stroke recovery. It can help patients improve their strength, coordination, and balance, with the goal of helping them regain the ability to perform everyday activities such as walking, dressing, and bathing.

Physical therapy can begin as soon as 24 hours after a stroke. The intensity of the therapy will depend on the patient's condition, with more intensive services provided in inpatient rehabilitation units, and less intensive services provided in transitional care units.

• Gait training: Practicing various types of walking, such as walking forward and backward, side walking, and walking in a scissor state.
• Task-specific overground locomotor training: Improving walking endurance by practicing functional, virtual, cognitive, and task-specific skills.
• Treadmill training: Walking on a treadmill to improve gait and balance. This can be combined with electromyographic biofeedback, which provides visual and audio feedback to help improve motor function.
• Bodyweight-supported treadmill training: Walking on a treadmill while wearing a harness to support the patient's body weight and prevent falls.
• Robot-assisted gait training: Using robotic devices to assist with walking and improve gait.
• Balance training: Performing exercises to improve balance and reduce the risk of falling. This can include sitting and leaning forward, unsupported sitting with an extended hemiparetic knee, and standing balance exercises.
• Strength training: Using free weights, sandbags, Swiss balls, and elastic resistance bands to improve muscle strength.
• Range of motion activities: Performing exercises to improve the range of motion in the affected joints.
• Mirror therapy: Using mirrors to improve motor deficits and emotional well-being.
• Virtual reality training: Using virtual reality technology to provide engaging and motivating activities for patients, as well as to offer virtual environments that closely resemble the real world.

It is important to note that the specific exercises included in physical therapy will depend on the patient's individual needs and capabilities. Additionally, physical therapy should be combined with other forms of rehabilitation, such as occupational therapy and speech therapy, to address the various effects of a stroke.

Speech therapy can help with communication, speech and swallowing

A left-sided stroke can cause a wide range of effects, including physical, cognitive, and behavioural changes. The left side of the brain is responsible for a variety of motor, sensory, and cognitive functions, so damage to this area can result in a number of impairments.

One of the most common effects of a left-sided stroke is language impairment, known as aphasia. Aphasia can affect both speech production and interpretation of word-based information, impacting an individual's ability to communicate and connect with others. Other conditions that can arise after a left-sided stroke include dysarthria, or muscle weakness that results in slurred speech, and apraxia of speech, where the brain struggles to tell the muscles how to move when speaking.

Speech therapy can be an effective treatment for these conditions and can help with communication, speech, and swallowing. Speech therapy can help to improve oral motor movements and cognitive comprehension and formulation of responses. This can include tongue and lip exercises to improve strength and coordination, naming therapy, and singing therapy.

Additionally, speech therapy can address swallowing difficulties, known as dysphagia, which is a common side effect of left-sided strokes, affecting around 50% of stroke survivors. Dysphagia can be caused by muscle weakness or disrupted communication between the brain and the muscles involved in swallowing. Speech therapists can assess an individual's ability to swallow and recommend dietary adjustments to prevent further complications such as choking or aspiration pneumonia.

The key to successful recovery from a left-sided stroke is early intervention and consistent, repetitive practice. The brain has an incredible ability to adjust and rewire itself through neuroplasticity, and this process can be enhanced by working with a speech therapist to develop a customised treatment plan.

Occupational therapy can help with daily tasks like eating, drinking and dressing

A left-sided stroke can cause a range of physical and cognitive impairments, and recovery will look different for everyone. However, rehabilitation can help to restore lost functions and improve independence.

Occupational therapy is a crucial part of the recovery process, helping stroke survivors regain their ability to perform daily tasks such as eating, drinking, and dressing. Occupational therapists work with patients to improve motor control and hand function in the affected upper limb, as well as teaching strategies to manage the cognitive, perceptual, and behavioural changes that can occur after a stroke.

• Improving awareness of the impact of left neglect on daily tasks and providing practical strategies for completion: Occupational therapists can help patients become more aware of how left neglect impacts their daily lives and provide strategies to overcome these challenges. This may include systematic visual scanning training to improve insight and awareness of deficits, facilitating the achievement of "over learning" of visual scanning skills.
• Teaching compensatory techniques and adapting tasks or the environment: Occupational therapists can teach compensatory techniques, such as using the unaffected upper limb for tasks requiring precision (e.g. shaving). They may also adapt tasks or the environment to improve the patient's level of independence. For example, recommending assistive equipment or home modifications, such as grab rails near steps or a raised chair height, can make daily tasks easier and safer.
• Retraining and facilitating sensorimotor return: Occupational therapists use active therapy and graded task selection to encourage sensorimotor return. This may include muscle facilitation and strengthening exercises, as well as everyday activities to develop reach, grasp, and object manipulation skills. Specific techniques such as functional electrical stimulation, constraint-induced movement therapy, and progressive resistive exercise can also be employed.
• Improving upper limb function: Occupational therapists conduct detailed assessments of motor and sensory changes, particularly in the upper limb and hand function. Interventions may include techniques to reduce spasticity, such as stretching, static or dynamic splinting, and the use of botulinum toxin therapy. Upper limb positioning, bandaging, compression garments, and electrical stimulation may also be used to prevent or reduce hand edema.
• Facilitating independence in self-care tasks: Occupational therapists work with patients to improve their ability to perform personal self-care tasks, such as showering, dressing, toileting, grooming, and eating. This may involve cueing, physical assistance, and prompting to locate and identify necessary items.
• Educating patients and caregivers: Occupational therapists provide education and support to both patients and their caregivers throughout the rehabilitation process. This includes teaching safe positioning for eating tasks and visual scanning strategies for reading. They also train caregivers to use assistive equipment and modifications safely and effectively.

Recreational therapy can help with social skills

A left-sided stroke is a life-altering event, but recovery is possible. The recovery journey is different for everyone, but rehabilitation methods can help restore function and address the secondary effects of a stroke.

Recreational therapy is one such method that can help stroke survivors regain their social skills. This form of therapy combines fun activities with therapeutic benefits, stimulating the brain and promoting recovery. Here are some ways in which recreational therapy can help with social skills:

• Gardening: Stroke patients can benefit from being outdoors and physically active. Gardening can be adapted to their mobility needs, and even the sense of smell from flowers can stimulate the nervous system, promoting brain function.
• Wii Gaming: Occupational therapists often use Wii games as a fun form of rehab, as they help with rehabilitation while being enjoyable.
• Singing along to music: Music therapy is beneficial for the brain during stroke recovery. Singing along requires more attention and brain activity, which promotes brain recovery.
• Making music: Learning a new instrument can be challenging, but even simple drums or a music glove can provide a fun activity with therapeutic benefits.
• Needlecraft: Activities like knitting or crochet require fine motor movement in the hands, as well as sustained attention and planning, all of which enhance brain function.
• Aquarium making: The sensation of rocks and water provides additional input to the affected hand and arm, stimulating the brain.
• Leaf collecting and pressing: Being outdoors in nature is stimulating for the brain, and collecting leaves can be a fun activity that promotes recovery.
• Socializing with other stroke survivors: Interacting with others who have had strokes can help improve mood and provide a sense of community and understanding.

These recreational activities provide an enjoyable way to stimulate the brain and body, aiding in the recovery of social skills and overall brain function. They can be adapted to meet the specific needs and abilities of the individual, ensuring a tailored approach to rehabilitation.

Psychotherapy can help with post-stroke depression and other mental health challenges

A left-sided stroke is a life-altering event that can result in a wide range of physical, cognitive, and behavioural changes. While the recovery journey is unique to each individual, rehabilitation plays a crucial role in restoring lost functions and improving quality of life.

Psychotherapy is one of the recommended treatments for post-stroke depression, which affects around one-third of stroke patients. It can help patients cope with the emotional and mental challenges that arise after a stroke. This includes dealing with the loss of independence and major changes to their daily lives, which can lead to depression and grief.

One form of psychotherapy that has been used for post-stroke depression is cognitive behavioural therapy (CBT). While findings have been inconsistent, a meta-analysis of randomised controlled trials (RCTs) showed that CBT had positive effects on depressive symptoms compared to control groups. CBT was found to improve symptoms of depression, anxiety, and neurological functional deficits, as well as activities of daily living. However, more high-quality RCTs are needed to confirm the benefits of CBT in this context.

Interpersonal psychotherapy is another form of psychotherapy that has been explored in combination with pharmacotherapy for post-stroke depression. In a feasibility study, patients who received either interpersonal psychotherapy, pharmacotherapy, or a combination of both showed benefits in terms of mood, quality of life, and social support. This suggests that a combination of psychotherapy and medication can be as effective as either element alone in treating post-stroke depression.

In addition to psychotherapy, other therapeutic strategies for post-stroke depression include pharmacological approaches such as antidepressants, as well as non-pharmacological approaches like electroconvulsive therapy, acupuncture, music therapy, and natural products.

Overall, psychotherapy can be a valuable tool in the recovery process after a left-sided stroke, helping to address the mental health challenges that may arise and improve the patient's overall well-being.

Frequently asked questions