Seeking Stroke Re-Evaluation: A Guide To Getting Started

If you're caring for someone who has had a stroke, it's important to know that their recovery journey will be unique to them. Their recovery will depend on the extent of physical and mental impact, as well as their rehabilitation plan. After a stroke, a person might have trouble with movement, speech, memory, concentration, thinking, mood, and emotions. They may also experience paralysis or weakness, usually on one side of the body. As a caregiver, you can help your loved one by familiarising yourself with their medications and their side effects, modifying your home to meet their needs, and providing emotional support. You should also be aware of the signs of post-stroke depression and seek help from a healthcare provider if you notice any changes in their behaviour or emotions.

Monitor changes in behaviour and emotions

After a stroke, it is important to monitor changes in the behaviour and emotions of the survivor. This is because strokes can affect people in different ways, and the impact can range from little effect on their life to having to make significant life changes.

Behavioural Changes

A stroke survivor may experience a change in their ability to perform daily activities. They may have problems with movement, such as numbness down one side of the body, or difficulty walking or moving around. They may also experience dizziness or imbalance, which can lead to falls. It is important to monitor these physical changes and seek appropriate assistance, such as physical or occupational therapy, if needed.

Emotional Changes

Emotional changes are also common after a stroke. The survivor may experience anxiety, depression, or tiredness. Post-stroke depression is particularly common, affecting 30-50% of survivors. It is important to consult a healthcare provider if you notice any changes in the survivor's emotions, as these can significantly impact their recovery and rehabilitation.

Support

It is crucial to provide support to the stroke survivor and their caregivers during this time. This may include involving family and friends in their recovery, seeking support from community resources, or joining support groups specifically for stroke survivors and caregivers. Additionally, it is important for caregivers to take care of themselves by taking breaks, eating healthy, and getting adequate rest.

Physiotherapy and exercises to improve movement

Physiotherapy and exercises can help stroke survivors improve their movement and relearn lost functions. The human brain is capable of reorganising its undamaged cells and making up for what has been lost through neuroplasticity. This process can be guided by rehabilitation, and physiotherapy can provide expert guidance on how to relearn movement and regain function.

Types of Movement Problems Treated by Physiotherapy

A stroke can affect your movement in a number of ways, including:

• Weakness or paralysis down one side of the body.
• Changes in sensation, such as heavy limbs, numbness, and pins and needles.
• Joint pain and partial dislocation.
• Muscle stiffness or spasms, known as spasticity.

Physiotherapy can begin as early as 24 hours after a stroke. In the early stages, it focuses on preventing complications and aiding recovery. Later, it can help find ways to enable stroke survivors to do things that are important to them, such as getting in and out of bed or doing sports. Physiotherapy can also help adapt activities so they can be done independently.

Where Will It Take Place?

Physiotherapy can begin in the hospital on the stroke ward and then progress to more active sessions in a rehabilitation area or physiotherapy gym. In some cases, a specialist community rehabilitation team will support recovery at home.

Physiotherapy Exercises

Exercises will depend on the specific needs of the patient. They may include:

• Strengthening weak muscles and building stamina.
• Stretching exercises to reduce muscle and joint stiffness.
• Balance exercises, such as standing up a lot if you are having difficulty keeping your balance.
• Walking as much as possible if you are having difficulty walking.
• Practising lifting and using your arm if you are having difficulty with this.

Frequency and Intensity of Stroke Exercises

Stroke exercises are most beneficial when done consistently and repetitively. Resistance exercises should be done 3-5 times a week, with 2-3 sets of 12-15 repetitions of each exercise. It is important to consult with a medical professional to determine the optimal type and frequency of exercises for your unique situation and to avoid causing any new or lasting damage.

Cognitive behavioural therapy to aid mental health

Cognitive behavioural therapy (CBT) is a recommended treatment for anxiety and depression after a stroke. It can help with tiredness, too. CBT is based on the principle of recognising, registering, and altering negative thoughts and cognitions so that mood and emotional symptoms are improved. CBT can be augmented with direct in-vivo activation offered by occupational or movement therapists.

The Hospital Anxiety and Depression Scale (HADS) is often used to assess anxiety and depression in stroke patients. CBT can be effective in reducing anxiety symptoms, as measured by the HADS Anxiety sub-scale. CBT can also help with post-stroke depression, as measured by the Post Stroke Depression Rating Scale (PSDRS).

CBT can be done in person or online (telerehabilitation).

Speech therapy to regain language and speaking skills

Speech therapy can be an effective way to improve language and communication skills after a stroke. Speech and language therapy can help speed up the recovery process, and it is recommended for patients showing signs of aphasia. Aphasia is a common disorder that affects language and communication skills, including speaking, listening, understanding, reading, and writing. It is estimated that around one-third of people who have a stroke develop aphasia.

The success of speech therapy depends on the individual, and it is often a slow and uncertain process. However, research has shown that "higher intensity" speech therapy, which involves more sessions and longer durations, can lead to greater and faster improvements.

• Tongue In-and-Outs: Sticking the tongue out and holding it for 2 seconds, then pulling it back in and holding again. This helps train the tongue for coordinated movement, improving speech production.
• Side-to-Side Tongue Movements: Moving the tongue to touch the right and left corners of the mouth, holding for 2 seconds each time.
• Up-and-Down Tongue Movements: Sticking the tongue out and reaching up toward the nose, then down toward the chin, holding for 2 seconds in each position.
• Smiling: Smiling is a simple exercise that can improve oral motor skills. It is important to practice a symmetrical smile, especially if the stroke has affected one side of the face.
• Puckering Lips: Puckering the lips together as if kissing, holding for 2 seconds, and relaxing.
• Consonant and Vowel Pairing Repetition: Writing down difficult consonants and pairing them with each of the vowels (a, e, i, o, u) for repetitive practice. For example, practicing "ra, re, ri, ro, ru" for the "r" sound.
• Sentence Production: Reading aloud is beneficial for those with apraxia of speech, a disorder that affects the coordination of lip and tongue movements. Starting with a sentence or two and gradually increasing the length or time spent practicing.
• Phonological Processing: Guessing the number of syllables in words stated by a family member or caregiver. This exercise provides feedback and helps with speech sound patterns.
• Word Games: Playing games such as Boggle, Scrabble, or Bananagrams can improve cognitive language skills like word finding and memory.
• Speech Therapy Apps: Using apps like the CT Speech and Cognitive Therapy App, which assesses problem areas and provides tailored exercises, can be a convenient way to continue therapy at home.

Additionally, singing therapy can be an effective approach for individuals who are unable to speak at all after a stroke, especially those with aphasia. Singing activates the right hemisphere of the brain, allowing individuals to produce words in different pitches and rhythms, even when they cannot speak normally.

It is important to work with a speech therapist to determine the most appropriate exercises for the individual's specific needs and to ensure a personalized and effective recovery plan.

Occupational therapy to relearn everyday activities

Occupational therapy is an important part of stroke recovery and rehabilitation. It involves relearning everyday activities to enable the patient to lead a full and independent life. It helps them regain the skills they need for day-to-day activities and other things they want to do.

Occupational therapy can help patients return to work, be independent in their own homes, and do leisure activities and hobbies. An occupational therapist can advise on equipment that can be used, and changes that may be needed to the patient's accommodation.

The overall goal of occupational therapy is to help patients relearn everyday activities that may have been lost due to brain changes from the stroke. After a stroke, a doctor may refer the patient to an occupational therapist. The exact treatment plan and how long the patient will need therapy ultimately depend on how severe the stroke was and how many brain cells were affected.

During occupational therapy, patients work one-on-one with an occupational therapist as they help guide them through everyday skills they need to work, be at home independently, and help take care of themselves. Some of these life skills include balance to help prevent falls, and therapeutic activities, such as lifting arms or using hands.

Occupational therapists may also recommend specific equipment for the patient's home to help make daily tasks easier. These include shower chairs, grabbers, and raised toilet seats. Occupational therapists can also teach caregivers and loved ones how to support the patient.

The benefits of early intervention have also been established. According to a 2021 study, receiving occupational therapy immediately upon hospital discharge after a stroke was found to increase the chances of regaining independence in as little as 3 months.

Frequently asked questions