Regaining Sensation Post-Stroke: Is It Possible?

Strokes can have a wide range of physical and cognitive effects on the human body, and recovery can take anywhere from days to years. One of the most common effects of a stroke is numbness in the limbs, which can significantly impact a person's quality of movement and safety. This numbness is caused by damage to brain cells due to a lack of oxygen-rich blood during a stroke. To recover from numbness, stroke survivors must retrain their brains by building new connections and pathways using the principle of neuroplasticity. This can be achieved through various rehabilitation techniques, including sensory reeducation, mirror therapy, and electrical stimulation therapy. While some people may recover feeling spontaneously within the first few months, others may need to pursue more intensive rehabilitation to regain sensation and function.

Numbness in the limbs

The feeling of numbness in the limbs after a stroke can be similar to the pins and needles sensation when a hand or leg falls asleep. This can make it challenging for stroke survivors to perform daily tasks and can also impact their safety. For instance, they may not realise if their clothes are too tight, or they may burn themselves in the kitchen.

To overcome numbness, stroke survivors need to retrain their brains by building new pathways through repetitive exercises. This process is known as neuroplasticity. It is important to work with therapists, such as occupational therapists and physical therapists, to address numbness and improve sensory function.

• Sensory reeducation: These exercises help to rewire the brain and retrain the sensory pathways. For example, a caregiver may tap the affected arm and ask the patient to identify where they felt the tap with their eyes closed. Another exercise involves placing different objects, such as a marble or a pen, in a bucket of uncooked rice and trying to identify them by touch.
• Electrical stimulation therapy: Tools like the SaeboStim Micro use low-level electrical impulses to improve sensory function.
• Mirror box therapy: This technique involves placing a mirror in front of the affected limb. The patient then performs repetitive movements with their unaffected limb while watching their reflection, giving their brain the impression that they are moving their affected limb.
• Thermal sensation exercises: Alternating between hot and cold cloths on the affected limb can help stroke survivors to distinguish between different temperatures.
• Sensory training exercises: Collecting objects with different textures, such as sandpaper or cotton wool, and feeling them without looking can help retrain the brain through sensory stimulation.

It is important to note that recovery from a stroke is different for everyone, and the intensity of rehabilitation plays a crucial role. While some people may recover within the first few months, others may need to continue rehabilitation for a longer period to maximise their recovery.

Rehabilitation methods

Rehabilitation after a stroke is a crucial part of recovery and can take weeks, months, or even years. The rehabilitation methods will depend on the individual's specific needs and the severity of the stroke. Here are some common rehabilitation techniques:

Physiotherapy and Exercises

Physical rehabilitation is often necessary to help individuals regain movement, physical function, and coordination skills. Physiotherapy can help with muscle weakness, balance issues, and movement, including walking. Exercises should be done regularly to help individuals reach their recovery goals.

Speech Therapy

Speech therapy is important for those who experience speech, language, and communication problems after a stroke. Speech-language pathologists work with individuals to assess and treat speech, language, and swallowing disorders. They may also work with other members of the stroke rehab team to develop a diet plan until swallowing improves.

Cognitive Rehabilitation

This type of rehabilitation focuses on improving memory, concentration, thinking, and mood. It can include cognitive behavioural therapy (CBT) to address issues such as anxiety, depression, and tiredness.

Occupational Therapy

Occupational therapy helps individuals regain skills needed for daily living, such as eating, drinking, dressing, bathing, reading, and writing. It can also include adaptations to the home to make it easier to move around.

Recreational Therapy

Recreational therapy helps individuals regain social skills and reconnect with their community.

Psychotherapy

Post-stroke depression is common, and psychotherapy can help address mental health challenges. Antidepressant medications and support groups can also help improve mood and provide emotional support.

Speech and language problems

Communication problems are very common after a stroke, with around one-third of stroke survivors experiencing issues with speaking, reading, writing, and understanding others. These issues can affect a survivor's ability to express their needs, connect with family members, and return to work.

Aphasia

Aphasia affects your ability to speak and understand what others are saying. It can also impact your ability to read and write. Aphasia occurs when you are no longer able to understand or use language. It is often the result of a left-hemisphere stroke, as the two primary language centres of the brain typically reside in this hemisphere. There are many types of aphasia, including:

• Broca's aphasia (expressive aphasia): difficulty with spoken and written expression
• Anomic aphasia: difficulty with word retrieval, may be demonstrated by slow, halting speech
• Wernicke's aphasia (receptive aphasia or fluent aphasia): difficulty understanding speech and producing meaningful speech; the person may speak long, fluent sentences that don't make sense
• Conduction aphasia: difficulty with repeating words or phrases
• Global aphasia: difficulties with both speech production and comprehension

Dysarthria

Dysarthria occurs when there is weakness or incoordination of the muscles involved in speech. This can cause slurred speech, mumbling, and unnatural speech patterns. It may be caused by damage to the pons, corona radiata, cerebellum, or areas within or surrounding the motor cortex.

Apraxia of Speech

Apraxia of speech is when a person knows what they want to say but has difficulty producing the desired sounds. Their brain struggles to send the right messages to the muscles involved in speech. It is often caused by damage to Broca's area, a specific portion of the left insula, and/or the premotor cortex.

Treatment

Communication problems after a stroke can be treated with speech and language therapy. Speech-language pathologists can evaluate an individual's speech, language, and communication skills to develop a customized treatment plan. This may include tongue and lip exercises, naming therapy, singing therapy, and learning non-verbal communication techniques.

Rehabilitation should start as soon as possible after a stroke, and consistent practice is key to improving communication skills. While communication problems tend to improve naturally over time, some people may have lasting issues and need to learn new ways to connect with their loved ones.

Mental health challenges

Experiencing a stroke can have a significant impact on one's mental health and well-being. Here are some of the mental health challenges that stroke survivors may face:

• Depression and Anxiety: Post-stroke depression (PSD) is one of the most common emotional issues following a stroke. It can significantly impact a person's quality of life, functional outcomes, and increase the risk of mortality. Anxiety is also prevalent among stroke survivors, with feelings of worry, nervousness, and unease. Both conditions can be effectively treated with counseling or therapy and, in some cases, medication.
• Post-Traumatic Stress Disorder (PTSD): Experiencing a stroke can be a traumatic event, and it is not uncommon for survivors to develop PTSD. Symptoms can include intrusive thoughts or memories, avoidance of reminders of the stroke, negative changes in thoughts and mood, and alterations in physical and emotional reactions.
• Pseudobulbar Affect (PBA): PBA is characterized by a mismatch between feelings and expressions, such as laughing at a funeral or crying at a joke. It can be managed through medication and cognitive-behavioral therapy.
• Apathy: Some stroke survivors may exhibit a lack of interest or motivation, appearing indifferent or uncaring. It is essential to encourage them to engage in activities and make choices to promote a more active lifestyle.
• Delirium: Delirium is a common but underrecognized complication following a stroke. It involves an altered level of consciousness, with fluctuations in orientation, memory, thought, or behavior.
• Changes in Personality: A stroke can also lead to changes in personality traits, such as impulsiveness, anger, or frustration. These changes can affect the survivor's relationships and quality of life.
• Fatigue: Post-stroke fatigue is a common symptom, with survivors experiencing physical and mental exhaustion. It can be influenced by physical impairment, sleep disorders, and depression.
• Sleep Disturbances: Stroke survivors may experience sleep-disordered breathing, such as snoring or sleep apnea, and sleep-wake disorders, including insomnia or excessive daytime sleepiness. These disturbances can impact rehabilitation and quality of life.

Physical therapy

The first step in stroke recovery is an assessment to determine the patient's difficulties and the rehabilitation and support they need. This should begin in the hospital and continue after the patient has been discharged. The patient and their therapist should agree on clear goals for the rehabilitation. The patient may be given activities or exercises to practice in their own time to aid their recovery.

Some exercises that can be done as part of physical therapy include:

• Practising with objects of different textures, such as soft scarves, rough sandpaper, fluffy cotton balls, rough Velcro, and cool silverware. Without looking at the objects, the patient can pick them up and try to identify them by touch alone.
• Burying different textured objects in a bowl of rice, such as marbles, coins, paper clips, and cotton balls. The patient then reaches into the bowl and tries to find and identify the objects without looking.
• Placing a cold washcloth on the patient's affected limb, then replacing it with a warm washcloth after 30 seconds. The patient should try to identify the difference in temperature.
• Mirror box therapy: placing a mirror in front of the affected limb and performing repetitive movements with the unaffected limb while watching the reflection. This gives the brain the impression that the affected limb is moving and helps to rewire it.

Frequently asked questions