Stroke Recovery: Can You Retain Function?

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. It can be caused by blocked arteries or bleeding in the brain, resulting in brain cells dying due to a lack of oxygen. The effects of a stroke depend on the location and severity of the damage, but they often include physical, emotional, and cognitive changes. While a stroke can cause permanent loss of function, early treatment and rehabilitation can improve recovery, and many people regain significant function.

Physical changes after a stroke

The physical changes that occur after a stroke depend on which part of the brain was affected and how extensively. A stroke occurs when there is a change in blood flow to the brain, resulting in oxygen deprivation and the death of brain cells. The brain is highly complex, and each part has a specific function or ability. Thus, the effects of a stroke vary from person to person.

• Weakness, paralysis, and trouble with balance or coordination, typically affecting one side of the body.
• Pain, numbness, or burning and tingling sensations.
• Fatigue, which may persist even after returning home.
• Inattention or neglect of one side of the body. In extreme cases, the person may not be aware of their arm or leg.
• Urinary or bowel incontinence.
• Difficulty with swallowing, chewing, or speaking.
• Vision problems, including partial or total loss of vision in one or both eyes, blurred vision, or double vision.
• Loss of muscle control on one side of the face.
• Loss of coordination or clumsiness (ataxia).
• Dizziness or vertigo.
• Nausea and vomiting.
• Headaches, often sudden and severe.
• Fainting or loss of consciousness.
• Difficulty with gripping or holding objects.
• Restricted ability to perform physical activities or exercises.

The effects of a stroke on the left and right sides of the cerebrum (the cerebrum is divided into left and right hemispheres) also differ. A right-side stroke may result in left-sided weakness and sensory loss, vision problems, and behavioural changes such as impulsivity. On the other hand, a left-side stroke may lead to right-sided weakness, speech and language problems, and difficulties with math and organisation.

The severity and duration of these physical changes vary, and early treatment and rehabilitation are crucial for improving recovery.

Emotional and personality changes after a stroke

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. The effects of a stroke vary from person to person, depending on the type, severity, location, and number of strokes. However, emotional and personality changes are common after a stroke and can be challenging to adjust to.

Emotional Changes

Emotional lability, or pseudobulbar affect (PBA), is a common emotional change after a stroke. PBA is characterised by a mismatch or exaggeration of feelings and expressions, such as laughing at a funeral or crying at a joke. People with PBA may also cry or laugh uncontrollably, appearing out of character or out of context. PBA is more common in women and can be worsened by fatigue, excessive noise, or crowded environments.

Other emotional changes that may occur after a stroke include:

• Increased irritability and anger
• Anxiety and excessive worry
• Depression and feelings of sadness
• Lack of motivation and apathy

Personality Changes

Personality changes can also occur after a stroke, and these can be surprising for those closest to the survivor. Existing personality traits may become exaggerated, or people may behave in ways that are out of character. For example, a stroke affecting the frontal lobe may cause a previously cautious person to become impulsive and disorganised. Alternatively, damage to the temporal lobe may result in a formerly outgoing person becoming more introverted and struggling with communication and memory.

Other personality changes that may occur include:

• Disinhibition, leading to inappropriate behaviour or comments
• Aggression
• Loss of interest in previously enjoyed activities
• Changes in social behaviour, such as becoming more introverted or extroverted

Strategies for Coping with Emotional and Personality Changes

The emotional and personality changes following a stroke can be challenging, but there are strategies and treatments that can help:

• Identify triggers: Recognise the situations or environments that may trigger emotional responses, such as fatigue, stress, anxiety, or crowded spaces.
• Ignore or address the emotional response: Choose to either ignore the emotional response and continue the conversation or task, or address it directly by explaining the situation to those around you.
• Take a break: Remove yourself from stressful situations and practice relaxation and breathing exercises.
• Seek professional help: Consider seeing a psychologist or therapist for cognitive and behavioural strategies, such as cognitive behavioural therapy.
• Medication: Antidepressants or anti-anxiety medication may be helpful in managing depression, anxiety, or aggression.
• Support and social groups: Join support groups or seek guidance from a trusted friend, family member, or faith leader.
• Brain-training techniques: Practice memory games, puzzles, or word searches to improve cognitive issues or memory loss.
• Develop coping strategies and routines: Establish structured routines to promote a sense of control and stability, such as setting specific goals, using reminder apps, or breaking tasks into simpler steps.

Changes to thinking, memory and perception after a stroke

A stroke can affect the way your brain understands, organises and stores information. This is known as cognition, which includes thinking, memory, and judgement. After a stroke, you might experience difficulties with orientation, short-term memory, attention, planning and sequencing, problem-solving, and insight.

Orientation

You may not know what the day or date is, where you are, or who the people around you are.

Short-term memory

You may not remember things that happened recently or people you met recently.

Attention

You may find it hard to concentrate or be easily distracted.

Planning and sequencing

You may not know how to start something or do things in the wrong order.

Problem-solving

It may be difficult to understand and fix a problem.

Judgement

You may make choices that don't make sense or do things that make you unsafe or uncomfortable.

Insight

You may find it hard to understand your difficulties and how they impact your life.

Additionally, a stroke can affect your brain's ability to process messages from your senses, including sensation, recognition, and vision. You might experience neglect, where you don't see or feel things on your affected side. This can be dangerous and impact your ability to drive safely.

These difficulties vary from person to person, and rehabilitation with a dedicated team can help improve these functions over time. Regular activities and exercises that challenge you in these areas can aid in your recovery. It is important to rest and relax, as stress and tiredness may worsen these difficulties.

Communication after a stroke

Communication problems are common after a stroke, with around one in three survivors experiencing difficulties. These difficulties can affect a person's ability to speak, read, write, or understand others when they speak or gesture. A person's ability to think and communicate after a stroke depends on the part of the brain affected.

Types of communication difficulties

• Aphasia/Dysphasia: Difficulty talking, reading, writing or understanding others when they speak.
• Apraxia/Dyspraxia: Difficulty coordinating the muscles for speech.
• Dysarthria: Weakness or paralysis in the muscles used for speaking, which may result in slurred speech.
• Dysphonia: Weakness or paralysis in the muscles in and around the vocal cords, resulting in a whispered, hoarse or rough voice.
• Cognitive difficulties: Problems with memory, thinking and judgement.

Strategies to improve communication

• Speech therapy: A speech pathologist can work with the patient to develop a rehabilitation program to improve their communication skills.
• Communication aids: Using gestures, writing, pictures or symbols to aid communication.
• Communication technology: Voice simulation and other technologies can be used to improve communication.
• Tips for family and friends: Speaking face-to-face in a quiet place, slowly and clearly, using short sentences, and minimising background noise can help improve communication with stroke survivors.

Everyday life after a stroke

A stroke is a life-altering event that can leave survivors with physical and emotional challenges. The road to recovery can be long and challenging, requiring extensive rehabilitation and lifestyle changes. However, with time and dedication, it is possible to regain strength, independence and a sense of normalcy in everyday life. Here are some key considerations for navigating daily life after a stroke:

Adjusting to New Realities

The effects of a stroke vary from person to person, depending on factors such as the type, severity, location, and number of strokes. It is important to understand that every stroke is unique, and so is the recovery journey. Some common challenges that stroke survivors may face include:

• Limb weakness, numbness or paralysis
• Communication difficulties, including aphasia (loss of speaking ability) and dysarthria (slurred speech)
• Vision problems
• Loss of coordination or balance
• Cognitive impairments, such as memory loss or difficulties with judgement and reasoning
• Emotional and personality changes, including depression and anxiety

Regaining Independence

Rehabilitation plays a crucial role in helping stroke survivors regain their independence and rebuild their lives. This often involves a combination of physical therapy, occupational therapy, and speech therapy:

• Physical therapy focuses on improving motor functions, such as walking, sitting, standing, and transitioning between different movements.
• Occupational therapy helps survivors relearn everyday activities, such as eating, drinking, dressing, cooking, and personal care.
• Speech therapy assists in regaining language and speaking skills, as well as improving breathing and swallowing abilities.

Managing Daily Activities

Simple everyday tasks may need to be relearned, and survivors may require more frequent rest breaks. Here are some tips for managing common daily activities:

• Bathing: Videos and step-by-step guides can offer helpful tips for adapting to new bathing routines.
• Dressing: Stroke survivors may need assistance with tasks like putting on clothes or doing their hair.
• Driving: Adjustments may be necessary to ensure safety, and alternative transportation options may need to be considered.
• Shopping: Planning and simplifying grocery shopping trips can make the task less overwhelming.
• Laundry: This task can be physically demanding, so finding ways to simplify it or seek assistance can be beneficial.

Support and Resources

Recovery from a stroke is a challenging process, and it is crucial to have the right emotional support. Support groups, online communities, and caregiver networks can provide valuable assistance and connection during this difficult time. Additionally, resources such as cookbooks, guides, and technology can aid in adapting to new routines and managing daily life.

Preventing Recurrent Strokes

Stroke prevention is of utmost importance for survivors. Active lifestyle changes can significantly reduce the risk of experiencing another stroke. This includes managing physical health conditions, such as high blood pressure, diabetes, and high cholesterol, as well as adopting healthier habits like regular exercise, a nutritious diet, and quitting smoking.

Frequently asked questions