Stroke Recovery: Regaining Mobility After Paralysis

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain, often due to blocked arteries or bleeding. It can result in paralysis or weakness on one side of the body, making it difficult for the patient to move, sit, stand, or walk. This can lead to a stroke patient being bedridden, which can cause further complications such as muscle atrophy, learned nonuse, contractures, pressure sores, respiratory problems, and poor circulation or blood clots. However, with the help of a healthcare provider, there are treatments and rehabilitation options available to improve the patient's condition and prevent further complications.

Loss of muscle control: Paralysis or hemiplegia can occur on one side of the body, making it difficult to move

Hemiplegia or hemiparesis is a common effect of a stroke, resulting from tissue damage within the brain that interrupts communication with the muscles. Hemiplegia refers to paralysis on one side of the body, while hemiparesis refers to weakness on one side of the body.

When a stroke impacts the areas of the brain that control muscle movement, the signals between the brain and the muscles can become weakened or lost. As a result, the muscles are not able to respond as well to the brain's directions, and paralysis or weakness can set in. This is not because of damage to the muscles themselves, but rather the interruption of the neural signals from the brain to those muscles.

When these neural signals are completely severed, this results in paralysis or hemiplegia. However, if the connection is damaged but not lost entirely, some neural signals can still pass to the muscles, resulting in significantly weaker muscle activation, or hemiparesis.

Hemiplegia and hemiparesis can make it difficult for stroke patients to get out of bed without assistance. The affected individual may need to be pulled up from a lying down position to a sitting position.

To help restore muscle function after a stroke, passive range-of-motion exercises can be performed by a therapist or caregiver, who moves the affected individual's limbs through their full range of motion. These exercises can also be performed independently, with the unaffected limbs being used to move the affected ones. Passive exercises help to activate neuroplasticity, the brain's ability to form new neural pathways, allowing for the restoration of communication between the brain and muscles.

As the affected individual's muscle function improves, they can begin to incorporate active exercises, which require their own muscle contraction to perform the motion. Transitioning from passive to active exercises will help to strengthen the neural pathways and improve muscle function.

To summarise, hemiplegia and hemiparesis are common effects of a stroke, resulting from disrupted communication between the brain and muscles. Passive range-of-motion exercises can help restore muscle function by activating neuroplasticity, while active exercises further strengthen neural pathways and improve muscle function over time.

Difficulty with speech: A stroke can cause aphasia, or difficulty speaking and understanding speech

A stroke is a major neurological injury, and survivors may experience a range of difficulties, including being bedridden. The secondary effects of a stroke depend on the area of the brain affected and the severity of the stroke. While being bedridden, a stroke survivor can experience several complications, including muscle atrophy, learned nonuse, contractures, pressure sores, respiratory problems, poor circulation, and blood clots. Prioritizing exercise and frequent movement are crucial for recovery and preventing these complications.

Now, addressing the issue of difficulty with speech, a stroke can cause aphasia, which is characterised by difficulties in verbalizing thoughts or understanding others' speech. Aphasia is a common problem, affecting around one-third of stroke survivors. It occurs when there is an impairment in the cognitive skill of language processing, leading to challenges in producing and/or comprehending speech. Individuals with aphasia may also experience difficulties with reading and writing.

There are several types of aphasia:

• Broca's aphasia (expressive aphasia): difficulty with spoken and written expression.
• Anomic aphasia: difficulty with word retrieval, often with slow or halting speech.
• Wernicke's aphasia (receptive aphasia): trouble understanding speech and producing meaningful speech; sentences may be fluent but lack coherent meaning.
• Conduction aphasia: difficulty with repeating words or phrases.
• Global aphasia: severe impairments in both speech production and comprehension.

Additionally, stroke survivors may experience dysarthria, which is a motor speech disorder characterised by weakness or incoordination of the muscles involved in speech. This can result in slurred or mumbled speech, unnatural tone, or abnormal volume and pace of speech.

Apraxia of speech is another condition that can occur after a stroke, where individuals know what they want to say but have difficulty producing the desired sounds due to inaccurate voluntary control of the muscles related to speech, such as the lips and tongue.

To address these speech difficulties, working with a speech-language pathologist or speech therapist is highly recommended. They can evaluate speech, language, and communication skills and develop a personalized treatment plan, which may include tongue and lip exercises, naming therapy, singing therapy, and non-verbal communication techniques. Consistent practice is crucial for improvements, and it's important to remember that communication problems tend to get better with time and treatment.

Vision problems: Blurred or double vision, as well as partial or total loss of vision, can occur after a stroke

Why Stroke Patients Can't Get Out of Bed

Being bedridden after a stroke can have a significant impact on a survivor's health, independence, and quality of life. Remaining in bed for an extended period can lead to muscle atrophy, learned nonuse, contractures, pressure sores, respiratory problems, poor circulation, and blood clots.

Vision Problems After a Stroke

Vision problems are very common after a stroke, with about 60%-65% of stroke survivors experiencing some form of visual impairment. The type of vision problem depends on the location of the stroke. If the stroke affects the occipital lobe or the brainstem, the person is more likely to experience vision issues.

Types of Vision Problems

• Homonymous hemianopia: Vision loss in either the right or left half of the visual field in each eye.
• Homonymous quadrantanopia: Vision loss in either the upper or lower quarters of the visual field.
• Scotoma: A blind spot anywhere in the visual field.
• Spatial inattention: The brain doesn't process visual information on the side affected by the stroke.
• Eye movement disorders: Impaired eye function due to nerve and muscle damage around the eyes.
• Dry eyes and light sensitivity: Issues with blinking or closing the eyes can lead to dry eyes, irritation, burning, and blurry vision.

Treatment for Vision Problems

• Vision therapy: Various exercises to help with different vision issues and compensate for changes.
• Glasses and corrective lenses: Special types of lenses, such as prisms, can be used to bend light and improve vision.
• Physical and occupational therapy: Therapies to improve balance, coordination, and spatial awareness.
• Relaxation techniques: Techniques like deep breathing to cope with stress, depression, or anxiety caused by vision changes.

Emotional instability: Depression, anxiety, and emotional instability are common after a stroke

Emotional instability after a stroke

Depression, anxiety, and emotional instability are common after a stroke, with one in two survivors experiencing depression and one in four experiencing anxiety. These emotional changes can affect both sleep and quality of life.

Depression

Depression after a stroke is often caused by biochemical changes in the brain. When the brain is injured, survivors may not be able to feel positive emotions. Depression can make the rehabilitation process more challenging for survivors as they attempt to do the hard work required.

Symptoms of depression can include:

• A persistent sad, anxious, or "empty" mood
• Restlessness and irritability
• Feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities, including sex
• Decreased energy and fatigue
• Feeling "slowed down"
• Difficulty concentrating, remembering, and making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts

Anxiety

Anxiety often accompanies depression in stroke survivors. Worry and fear can range from uncomfortable to disabling. Generalized anxiety disorder, combined with clinical depression, can further disrupt recovery.

Symptoms of anxiety can include:

• Feeling very worried or anxious most of the time
• Finding it hard to calm down
• Finding it hard to make decisions
• Feeling tired all the time
• Having trouble concentrating
• Finding it hard to get to sleep or stay asleep

Treatment and support

If you are experiencing depression or anxiety after a stroke, it is important to seek treatment and support. Talk to your doctor about how you are feeling, and they will work with you to find the best treatment for you. Treatment options may include therapy, medication, exercise, and lifestyle changes. It is also important to have social support from family, friends, or a stroke support group.

Fatigue and drowsiness: Excessive daytime sleepiness can be a symptom of a stroke, impacting a patient's recovery

Why Stroke Patients May Struggle with Fatigue and Drowsiness

Excessive daytime sleepiness (EDS)

Following a stroke, it is common for survivors to experience fatigue and drowsiness. This may be a symptom of excessive daytime sleepiness (EDS), where patients feel a constant need for sleep during the day, even after a full night's rest. EDS can impact a patient's recovery, affecting their mood, relationships, and daily activities.

Causes of EDS

EDS can be a primary disorder or a secondary effect of other conditions. It may develop as a complication of a stroke or be caused by medications, behaviours, or other sleep disorders. Here are some factors associated with EDS:

• Sleep-related breathing disorders, such as obstructive sleep apnea, which is the most common type of sleep disorder affecting breathing.
• Reversed Robin Hood Syndrome: This occurs when the brain redirects blood flow from damaged areas to healthy ones, potentially leading to excessive sleeping.
• Depression: Mental health disorders like depression are common after a stroke, and severe depression may cause fatigue and drowsiness, resulting in excessive daytime sleep.

Impact on Recovery

EDS can interfere with stroke rehabilitation and recovery. The brain normally uses 20% of the body's energy, but during the initial recovery phase after a stroke, its energy consumption increases as it requires extra energy to heal. Therefore, patients may experience decreased alertness and excessive sleepiness.

Additionally, sleep promotes neuroplasticity, which is crucial for recovery. Neuroplasticity allows the brain to adapt and rewire itself, enabling healthy areas to take over functions impacted by damage. Sleep also improves learning and memory, which are often essential components of stroke recovery, depending on the affected brain areas.

Managing EDS

It is important to identify and address the factors contributing to EDS. Here are some recommended approaches:

• Address underlying conditions: For example, using a C-PAP machine to treat sleep apnea can improve sleep quality and reduce daytime drowsiness.
• Psychological care: Considering therapy or medication for emotional changes, depression, or other mental health conditions that may be contributing to EDS.
• Pharmacological treatments: Reviewing medications with a doctor to determine if they are causing drowsiness or if stimulant medications are needed to increase alertness.
• Improve sleep hygiene: Establishing good sleep habits, such as a consistent sleep schedule, limiting technology use before bedtime, and creating a peaceful sleeping environment.
• Healthy lifestyle changes: Consuming a healthy diet, exercising regularly, and making other lifestyle changes can increase daytime energy and boost recovery.

Frequently asked questions