PHYSICAL CONDITIONS AFTER STROKE
WHAT IS DYSPHAGIA?
Dysphagia is the medical term for difficulty swallowing or paralysis of the throat muscles. This condition can make eating, drinking, taking medicine and breathing difficult. Many stroke survivors experience
dysphagia or trouble swallowing at some point after a stroke. Difficulty swallowing is most common immediately after a stroke, but usually declines over time.
Symptoms you might experience include:
Difficulty starting to swallow
Choking when food gets stuck
Coughing or gagging while swallowing
Liquid coming out of the nose after trying to swallow
Food getting caught in the lungs
Poor tongue control
Loss of gag reflex
Dysphagia should not be confused with painful swallowing or the constant feeling of a lump in the throat.
CAN DIFFICULTY SWALLOWING BE TREATED?
The most common treatment for difficulty swallowing is swallow therapy done with the help of a speech language, occupational, or physical therapist. Some stroke survivors may be candidates for Neuromuscular
Electrical Stimulation (NMES). If you show signs of aspiration or have difficulty managing your diet, you may be a candidate for this type of dysphagia therapy.
Exercising the tongue, lips, throat, and mouth can help relax and strengthen the muscles as well as increase their flexibility (examples include tucking the chin or rotating the head).
A speech language therapist can teach special exercises to stimulate the nerves involved in swallowing. These can include changing posture and sitting position, reducing distractions at mealtime, eating slower
with smaller amounts of food, and changing food texture.
Some medications, such as muscle relaxers, can help open the throat and make swallowing easier.
TIPS TO LIVING WITH DYSPHAGIA
Dietary changes or changes to the texture or thickness of foods may help with swallowing difficulties. For example, you may be able to chew and swallow smaller pieces so chopping, mincing or puréeing food may
make it easier for you to eat. Food should be prepared and consumed correctly to avoid inhaling into the lungs.
Dehydration or not drinking enough is always a risk. Thin fluids, such as water, are harder to swallow changing the thickness with liquid thickeners can be helpful. Ask your healthcare professional for the best
plan for your individual needs.
Everyone feels tired sometimes but usually it can be explained by a busy day or lack of sleep. Post-stroke fatigue for stroke survivors is different and is one of the most common effects of stroke. Post-stroke
fatigue is not necessarily related to activity level or quality of sleep and does not always improve with rest.
WHAT IS POST-STROKE FATIGUE?
Post-stroke fatigue, the invisible symptom, affects between 40 and 70 percent of stroke survivors. It can make you feel unwell and like you are not in control of your recovery. The lack of energy and the need
for frequent rest breaks can make it difficult for you to participate in rehabilitation and other everyday activities.
Post-stroke fatigue is often confused with “being tired.” It is not necessarily the same as tiredness, because it arrives without warning and rest does not always make it better. It occurs differently in every
individual. It may feel like you are hitting the wall, physically, emotionally, and/or mentally.
Many factors can influence your level of fatigue following a stroke, including:
Depression. You may feel tired because of depression which is very common after a stroke
Sleep. Irregular sleep cycles and disrupted sleep is also common after stroke
Medications. Some medications may make you more tired than usual
Post-stroke affects. Physical post-stroke symptoms such as upper limb weakness, paralysis make movement and activities of daily living require more energy
Pain. If you are experiencing pain following your stroke it requires energy to cope
CAN POST-STROKE FATIGUE BE TREATED?
There is no specific treatment or medication to treat post-stroke fatigue. Talk to your healthcare professional to get an accurate diagnosis for the cause of your fatigue. If fatigue is a side effect of
medications you are taking perhaps doses, time of day, or an alternative medication might help. If depression seems to be the root cause of your fatigue it can be treated in a number of ways. An accurate
picture of the cause of the post-stroke fatigue is necessary for proper treatment.
TIPS TO LIVE WITH POST-STROKE FATIGUE
Most stroke survivors start feeling less tired after a few months. Making changes to some of your activities can help reduce the grinding burden of fatigue and promote recovery. Being tired is very common after
a stroke, so remember it is not your fault. Here are some ideas to incorporate into your daily life that can help as you move forward with recovery:
Communicate. Your fatigue may not be obvious to others so talk to your friends, family and employer about what you are experiencing.
Rest. Give yourself plenty of time to rest, including naps or scheduled rest periods during the day.
Moderation. Don’t push yourself too hard, especially not if you are having a good day, it will leave you exhausted the next day.
Journal. Keep a diary of how much you are doing every day. Celebrate your successes as you look back and see how far you have come.
Take your time. Give yourself plenty of time. It may take you longer to get ready to go places. Rushing is exhausting.
Start small. Build up stamina and strength slowly. Maintain some level of regular exercise and gradually increase it.
Watch what you eat. Eat a healthy diet. Include plenty of fruits, vegetables and whole grains. Consult your healthcare professional if you have questions about what diet is best for you.
Listen to your body. You are the expert on how you feel.
Foot drop, sometimes called "drop foot," is the inability to lift the front part of the foot. While walking, if you have foot drop, you drag your toes along the ground, or bend your knees to lift your foot
higher than usual to avoid the dragging. Foot drop may be temporary or permanent, and it can occur in one or both feet.
WHAT IS FOOT DROP?
Foot drop is common after a stroke. It is a weakness or paralysis that limits your ability to raise the front part of your foot. The foot or ankle drops down when the leg is lifted to take a step. If you have
foot drop you may trip and fall if your foot and ankle are not supported by a brace at all times.
Foot drop can result when nerves are damaged during a stroke. The muscles are rarely damaged, but become weak because of lack of use following a stroke. Partial or complete recovery is possible with the help of
rehabilitative therapy. Physical therapy is central in strengthening muscles and joints.
CAN FOOT DROP BE TREATED?
Treatment varies as does the severity of drop foot after a stroke. A lot depends on your activity level and willingness to engage in long-term physical therapy to strengthen the affected muscles. Active
movement and exercise helps to strengthen the connections between the muscle and the brain.
The assistance of a plastic brace, also known as an ankle-foot orthosis (AFO), is very helpful. These braces support the foot and ankle to help minimize tripping and reduce fall risks.
Physical therapy and ankle-foot orthotics are two of the three main treatments for foot drop; electrical stimulation is the third. With neuromuscular electrical stimulation (NMES), your leg muscle is directly
stimulated. This helps your nerves fire, making your muscles contract. Over time, the idea is that your leg muscles will be retrained.
While the same approach may not work for each stroke survivor, trial and error can help doctors and physical therapists figure out the best possible therapies for you.
Hemiparesis is weakness on one side of the body. You can still move the affected side of your body, but with reduced muscular strength. Health care professionals such as physical therapists and occupational
therapists play a large role in assisting you in your recovery from hemiparesis. Treatment is focused on improving feeling and motor skills, allowing you to better manage your daily living.
WHAT IS HEMIPARESIS?
Hemiparesis or one-sided (“hemi”) weakness (“paresis) affects about 8 out of 10 stroke survivors, causing weakness or the inability to move one side of the body. One-sided weakness can affect your arms, hands,
legs and facial muscles. If you have one-sided weakness you may have trouble performing everyday activities such as eating, dressing, and using the bathroom. Rehabilitation treatments, exercises at home, and
assistive devices can help with your mobility and recovery.
One-sided weakness in your arms, hands, face, chest, legs or feet can cause:
Loss of balance
Impaired ability to grasp objects
Decrease in movement precision
Lack of coordination
The location in the brain where your stroke occurred will determine where in the body you experience weakness. Injury to the left side of the brain, which controls language and speaking, can result in right-
sided weakness. Left-sided weakness results from injury to the right side of the brain, which controls our nonverbal communication and certain types of behavior.
CAN HEMIPARESIS BE TREATED?
It is possible for you to increase or regain strength and movement on the affected side with rehabilitation. Working with a physiatrist, physical therapist and/or occupational therapist has proven to have a
favorable impact on hemiparesis and mobility.
A variety of treatments are used to help improve the use and movement in your affected arms and legs. These include the following:
Modified constraint-induced therapy (mCIT). This therapy restricts use of a less affected part of your body, which forces you to use the weakened part of your body. Regular practice can improve nerve function.
Electrical stimulation. Used in the treatment of one-sided weakness to enhance sensory awareness, strengthen a weakened body part (such as the arm, leg, hand, or foot) and improve range of motion.
This procedure consists of placing small electrical pads on the weakened muscles of your affected body part. An electrical charge helps your muscles contract as you work to make it move. Many of these
electrical stimulation devices are covered by insurance and can be used at home.
Cortical stimulation. An electrical stimulation of the part of your brain called the cortex. A tiny electrode is placed on the dura, the tough membrane that covers your brain. The electrode sends an electrical
current to your brain while you undergo rehabilitation exercises.
Imagery. Mental imagery or the process of imagining the movement of the affected part of the body activates areas of the brain and muscles as if you are actually doing an activity. The nerves in the brain
involved in visualization and physical movement overlap, making this an effective activity when paired with other therapies in treating one-sided weakness.
Assistive Devices. Braces, canes, walkers and wheelchairs can lead to increased strength and movement. An ankle-foot orthosis (AFO) brace can help control your ankle and foot. A physical therapist can recommend
the appropriate device. Training in safety procedures and the proper use of orthotics, including proper fit and maintenance, is essential.
TIPS TO LIVE WITH HEMIPARESIS
In addition to rehabilitation treatment, exercise at home and assistive aids can help increase mobility. Repeated practice and regular activity will help increase control and flexibility and re-establish nerve
circuitry. You can learn specific activities to do at home that will help continue recovery after inpatient therapy. Always consult a healthcare professional before starting these exercises.
Making home modifications such as the following can improve your safety:
Raised toilet seats
Hand-held shower head
Plastic adhesive strips on the bottom of the bathtub
Long-handled brushes, washing mitts with pockets for soap
Electric toothbrushes and razors
Making simple lifestyle changes can help prevent falls and promote a healthier recovery. Some examples include:
Strengthening leg muscles and balance through exercises
Wearing flat, wide-toed shoes
Using a prescribed assistive device and not relying on furniture for support while walking
Taking precautions when taking medications that cause drowsiness
Paying close attention while walking
After a stroke, a condition called incontinence may develop for some people. This happens when the muscles that help you control urine and stool are weakened, thus making it more likely to have an accident.
Unconscious leaking is the most common but there are many different types of bladder and bowel control problems.
WHAT IS INCONTINENCE?
Incontinence will either be called urinary incontinence, referring to bladder control, or fecal incontinence, referring to bowel control. Urinary incontinence is more common than fecal incontinence among stroke
CAN INCONTINENCE BE TREATED?
In many cases incontinence is overcome in a relatively short period after a stroke. This can happen as a natural part of the recovery process or as a result of treatment or therapy. Treatment options include:
Bladder and bowel training
Use of a catheter
Behavioral and physical therapies
Individualized strategies for overcoming incontinence can be determined by a healthcare professional conducting an evaluation. Early diagnosis and treatment are important to prevent possible complications such
as urinary tract infections or skin breakdown.
Some people, particularly the elderly, live with chronic incontinence. In some cases, especially with fecal incontinence, modifying bowel habits, diet, and fluid intake can minimize the number of bowel movement
Bladder and bowel training can permanently improve incontinence and help manage chronic symptoms. Bladder and bowel training programs are usually customized to individual needs.
EXERCISES FOR BLADDER AND BOWEL CONTROL
The following are common training techniques and exercises for bladder and bowel retraining:
Timed Voiding. Also known as prompted voiding, it involves scheduling bathroom breaks at specific times to avoid the sudden and uncontrollable need to go. The goal is to increase the length of time between
scheduled bathroom breaks.
Urgency Control. Uses a combination of deep breathing and complex mental tasks to ignore the need to go. One example of a complex mental task is counting down from 100.
Pelvic Floor Muscle Training. Also known as Kegel exercises, build strength in the pelvic floor muscles leading to better muscle and bladder control.
Medication. The use of stool softeners or laxatives can be helpful for bowel incontinence. There are also medications that can help with urinary incontinence.
Tips To Live With Incontinence
The following tips may help better manage your incontinence:
Changes in diet. Some foods and liquids may affect bladder and bowel incontinence. For example many people have greater need to urinate after drinking coffee or alcohol. Spicy foods may affect your bladder as
Monitor your intake. Changing the timing, amounts, and types of liquids can help in control of urinary incontinence. For example limiting the amount you drink before bedtime may help. Similarly, some foods
affect individual’s bowel control.
Clothing selection. Wearing clothing that is easier to get off quickly can help.
Home modifications. If you have mobility issues having a urinal or commode easily accessible will help.
Talk to your healthcare professional about the best treatment solutions to treat your incontinence.
You may be asking yourself all sorts of questions when you feel pain somewhere in your body. Because each one of us feels pain differently it is important to know what could be causing us pain. Post-stroke pain
can occur immediately, weeks, or sometimes even months after a stroke. Research shows that more than half of stroke survivors have some form of post-stroke pain. In some cases, the pain is constant (chronic)
and in others, it comes and goes.
There are several areas where you can experience pain after a stroke. Local pain will be in the joints and central pain will be something like a burning or "pins-and-needles" sensation.
WHAT IS POST-STROKE PAIN?
While there are lots of different symptoms of pain, they are generallyc ategorized into two types: local and central.
Local (mechanical)pain is usually felt in the joints. Shoulder pain is especially common among stroke survivors.
Central post-stroke pain (CPSP) is described as constant, moderate, or severe pain caused by damage to the brain. This means that after a stroke, your brain does not understand normal messages sent from the
body in response to touch, warmth, cold, and other stimuli. Instead, the brain may register even slight sensations on your skin as painful.
The symptoms of post-stroke pain may be:
Come and go
Felt on part or all of the side of your body affected by the stroke
Felt on your face, arm, leg or torso (trunk)
Aching, burning, sharp, stabbing or itching
If you have central pain symptoms, you may:
Feel nothing when a sharp pin, warmth or cold is being applied to your skin.
Experience normal touching as unpleasant and painful.
Feel more pain with emotional stress, cold or movement.
Stop using your body parts that constantly feel pain.
Allow your muscles to weaken.
Misuse drugs, suffer from depression and increase your dependency on family members.
CAN POST-STROKE PAIN BE TREATED?
There are treatment options available for post-stroke pain including medication and physical therapy. Some stroke survivors are hesitant to discuss post-stroke pain with their doctor because they think it is
normal or are afraid of seeming weak. It is important to let your healthcare provider know what you are experiencing to find the right treatment plan for you , experts recommend that you
Keep a pain diary. Record where the pain comes from and how long the pain lasts.
Be Specific. Note whether pain is coming from something or someone touching you.
The following is a list of common types of medications your healthcare profession make recommend to treat post-stroke pain:
Analgesic pain killers
Anti-spasticity muscle relaxants
Non-steroidal anti-inflammatory drugs (NSAIDs)
Injections of cortisone (steroid shots)
Heat and stretching exercises (for shoulder pain)
Electrical nerve stimulation, or the application of electrical currents to the skin, may stimulate nerves and muscle fibers and improve muscle tone and strength to reduce pain
TIPS TO LIVE WITH POST-STROKE PAIN
Here are some tips you can practice at home:
Avoid things that can cause pain, such as hot baths, tight or easily bunched clothing, and pressure on the side of your body affected by the stroke.
Position paralyzed arms or legs to reduce discomfort.
Use heat packs or simple exercises prescribed by your physical therapist.
While sitting or lying down, support your paralyzed arm on an armrest or pillow to relieve shoulder pain.
Use a shoulder support while walking.
Try relaxation, meditation or hypnosis.
Remain active, to avoid possible muscle spasms or loss of muscle.
Depression is common among those who suffer from chronic pain. Seek help through your doctor or caregiver if you feel depressed.
Speak honestly with caregivers and healthcare professionals about your pain.
Paralysis or the inability of a muscle to move is one of the most common disabilities resulting from stroke. As many as 9 out of 10 stroke survivors have some degree of paralysis immediately following a stroke.
Continued rehabilitation and therapy can help stroke survivors regain voluntary movement even years following their stroke.
WHAT IS PARALYSIS?
Paralysis is the inability of a muscle or group of muscles to move voluntarily. Muscles are controlled by messages sent from the brain that trigger movement. When part of the brain is damaged after a stroke,
messaging between the brain and muscles may not work properly.
Paralysis is usually on the side of the body opposite the side of the brain damaged by stroke, and may affect any part of the body. You may experience one-sided paralysis, known as hemiplegia, or one-sided
weakness, known as hemiparesis. Locked-in syndrome is an example of severe paralysis that leaves the stroke survivor unable to move any muscles except those that control the eyes.
Post-stroke paralysis symptoms may include but are not limited to:
Dysphagia: trouble swallowing
SEIZURES AND EPILEPSY
In the first few weeks following a stroke some stroke survivors will experience a seizure. Seizures are a sign of brain injury and are caused by sudden disorganized electrical activity in the brain. Seizures
can be characterized by spasms or convulsions. Stroke is the most common cause of seizures in older people.
WHAT ARE SEIZURES AFTER A STROKE?
Around 5% of people who have a stroke will have a seizure within a few weeks of having a stroke. It is difficult to predict which stroke survivors will have a seizure. Acute or onset seizures normally happen
within 24 hours of the stroke. You are more likely to have one if you have had a severe stroke, a stroke caused by bleeding in the brain (a hemorrhagic stroke), or a stroke involving the part of the brain
called the cerebral cortex.
If you have an onset seizure, it does not necessarily mean you have or will develop epilepsy. Your risk of having a seizure lessens with time following your stroke. A small number of people will have more than
one seizure and will develop epilepsy. If you have recovered and have not yet had a seizure, you are at very low risk of developing epilepsy.
There are over 40 different types of seizures ranging from tingling sensations or ‘going blank’ for a few seconds, to shaking and losing consciousness. Generalized seizures are the most common and dramatic type
of seizure and are caused by electrical pulses on both sides of the brain. Partial seizures or focal seizures occur in only one part of the brain. These are common to individuals with epilepsy.
WHAT IS EPILEPSY AFTER A STROKE?
Occasionally, a stroke survivor may suffer from chronic and recurring seizures as a result of stroke and may be diagnosed with epilepsy. Many stroke survivors who experience seizures do not develop epilepsy. If
you have seizures a month or more after your stroke, you are more at risk for epilepsy.
Epilepsy is a neurological disorder in which recurrent seizures occur that cannot be associated with other specific causes. Seizures, as well as the onset of epilepsy, can occur after a stroke. Having one
seizure after a stroke does not necessarily mean a person has epilepsy; however, if chronic and recurring seizures are a result of a stroke, then a stroke survivor may be diagnosed with epilepsy.
When stroke warning signs are not clearly present, a seizure may indicate that a person had a stroke, especially in children and infants.
CAN SEIZURES AND EPILEPSY BE TREATED?
Luckily, stroke-related epilepsy can typically be fully controlled with anti-seizure medicines. Taking medications regularly as prescribed is very important in post-stroke seizure management.
A device called a vagus nerve stimulator (VNS), also known as “a pacemaker for the brain,” is a battery-powered device that can be surgically attached to your vagus nerve in your lower neck. The VNS simulates
your nerve with pulses of electrical energy and can help prevent future seizures. You usually continue to take medication while using the device. If medications do not effectively control your
seizures/epilepsy, surgery may be an option.
Consult with a healthcare professional to find the treatment that works best for you.
TIPS TO LIVE WITH SEIZURES/EPILEPSY
If you seek treatment for seizures you should have a long, enjoyable life with a few adaptations. Seizures and epilepsy can restrict your independence by limiting your ability to drive a car. Staying active
with regular exercise has been shown to help with seizure control as long as appropriate safety precautions are taken. Avoid dehydration, overexertion and hypoglycemia as this can help you stay active without
raising the risk of seizures. Some activities such as cooking or swimming may require supervision. Consult with a healthcare professional on specific management tips that meet your needs.
It is important to let people know if you experience seizures or epilepsy. Educating friends, family, caregivers, and co-workers on what to do if you have a seizure is the first step to avoiding injury during a
The National Institutes of Health has established guidelines for what to do if someone is having a seizure:
Roll the person on his or her side to prevent choking or vomiting.
Cushion the person’s head.
Loosen any tight clothing around the neck.
Keep the person’s airway open. If necessary, grip the person’s jaw gently and tilt his or her head back.
Do not restrict the person from moving unless he or she is in danger.
Do not put anything in the person’s mouth, not even medicine or liquid.
Remove any sharp or solid objects that the person might hit during the seizure.
Note how long the seizure lasts and what symptoms occurred in order to inform a doctor or emergency personnel if necessary.
Stay with the person until the seizure ends.
Sleep problems are common after a stroke. More than half of all stroke survivors have some type of sleep problem. Poor sleep can slow your recovery and lead to depression, memory problems, and night-time falls.
Sleep plays an important part in not only helping the brain to heal, but in physical healing as well. The good news is there are ways to improve your sleep.
WHAT ARE COMMON SLEEP PROBLEMS AFTER STROKE?
You may experience changes in your sleep following a stroke. More than half of stroke survivors have one of the following sleep problems:
Insomnia describes not being able to fall or stay asleep. Although some people may have problems with getting too much sleep, the usual sleep disorder is trouble sleeping at night followed by feeling drowsy
during the day. Failing to get enough sleep can cause setbacks in post-stroke recovery.
Sleep-Related Breathing Disorders
The most common sleep disorder is obstructive sleep apnea. This is a serious condition. Sleep apnea increases the risk of having a second stroke. It is caused by abnormal breathing patterns. Loud snoring,
choking, and gasping sounds during sleep may mean that you have sleep apnea.
Sleep-Wake Cycle Disorders
After a stroke, some survivors do not get sleepy at night. It may be difficult to wake the stroke survivor in the morning. This happens when the sleep-wake schedule is no longer affected by sunlight and the
darkness of night.
CAN SLEEP PROBLEMS BE TREATED?
Your healthcare team can help you with your sleep problems.
Treatments of insomnia can include prescription sedatives or changes in your bedroom or night time activities.
Continuous positive airway pressure (CPAP) is one of the most common and effective treatments of sleep-related breathing disorders like sleep apnea. CPAP uses a machine to deliver short bursts of compressed air
that prevent obstruction in the airway. CPAP can help you get an uninterrupted night of sleep.
If CPAP doesn’t work well for you, there are other ways to control sleep-related breathing disorders. A special mouthpiece can be made to help minimize your symptoms. The most common purposes for mouthpieces
are to prevent teeth-clenching or to prevent the tongue from interfering with breathing. In some cases, upper airway surgery can result in a wider airway and relieve sleep problems. There are also some
medications that can help.
Sleep-wake cycle disorders can be treated in a variety of ways. Talk with your healthcare team. Bright light therapy may help. The treatment is typically administered in the morning and may last about 30
Melatonin is a hormone that can be prescribed to be taken at night. It acts like a sedative and can help induce sleep at night, and in time help correct the sleep-wake cycle. Sleep-wake cycle disorders are not
usually permanent and a combination of time and treatment will it in most cases.
TIPS TO MANAGE SLEEP PROBLEMS AT HOME
Here is a list of common sleep-friendly adjustments you can make at home:
Keep the bedroom dark and at a comfortable temperature
Prevent and avoid noises that can be heard at night
Increase movement and exercise
Expose yourself to light during the day
Follow a regular sleep schedule. Go to bed and wake up the same time every day.
Have a bedtime routine. For example, take a warm bath before bedtime. Listen to calm music or read a book.
Use the bedroom only for sleep or sex. Do not eat food or watch TV in bed.
Certain foods and drinks can lead to sleep problems:
Consume food and drinks that are caffeine-free. Avoid coffee, tea, certain soft drinks and chocolate after the late afternoon.
Plan to eat dinner meal three hours before you go to bed.
Make sure you are full or not hungry before bedtime. But, avoid heavy meals that can cause poor sleep.
Limit drinks two hours before bedtime. Drinking fluids at night can lead to frequent trips to the bathroom.
Avoiding alcoholic drinks at night. Alcohol helps you fall asleep, but your sleep is often restless.
Sleep is important for good health. Everyone should expect to get a good night’s sleep.
Spasticity Awareness Week is June 13-19, 2016. Please join us in raising awareness about this condition that affects over 12 million people worldwide.
To recognize Spasticity Awareness Week 2016, National Stroke Association has partnered with five advocacy organizations to form The Spasticity Alliance. This week we are launching the website
www.spasticityalliance.org as a resource for individuals living with spasticity, family and caregivers who want to learn more about spasticity.
The resources below contain information about the symptoms of spasticity, management techniques and treatments that help to ease the symptoms of spasticity. While there is no cure for this condition, there are
many tactics that can help individuals living with spasticity resume their normal daily activities.
WHAT IS SPASTICITY?
After a stroke, damage to the brain can block messages between muscles and the brain causing arm and leg muscles to cramp or spasm (spasticity), kind of like a bad charley horse. This will limit your
coordination and muscle movement. This post-stroke condition makes daily activities such as bathing, eating and dressing more difficult.
Spasticity can cause long periods of strong contractions in major muscle groups, causing painful muscle spasms. These spasms can produce:
A tight fist
Arm pressed against the chest
Stiffness in the arms, fingers or legs
CAN SPASTICITY BE TREATED?
There are many strategies and treatments for spasticity to help you recover, return to work and regain function. In order to achieve the best results possible, a mixture of therapies and medications are often
used to treat spasticity. Ask a healthcare professional about the best treatment plan for you. Some of the options include:
Braces. Putting a brace on an affected limb
Exercises. Range-of-motion exercises
Stretching. Gentle stretching of tighter muscles
Movement. Frequent repositioning of body parts
Medications. Medications are available to treat the effects of spasticity
ITB Therapy. A programmable, battery-powered medical device that stores and delivers medication to treat some of the symptoms of severe spasticity
Injections. Injections block the chemicals that make muscles tight
Surgery. Surgery on the muscles or tendons and joints may block pain and restore movement
TIPS TO LIVE WITH SPASTICITY
Managing spasticity with assistive devices, aids and home adaptations can help ensure your safety and reduce the risk of spasticity-related falls. Physical and occupational therapists will recommend the
appropriate aid(s) as well as safety procedures, maintenance and proper fit. Some modifications in your home to improve safety include:
Raised toilet seats
Shower or tub bench
Plastic adhesive strips on the bottom of the bathtub
Braces, canes, walkers and wheelchairs may help you move about freely as you gain strength.
Always follow rehabilitation therapists’ recommendations regarding limitations and safety needs.
Following a stroke, you might experience problems with your vision, but you are not alone. Up to two thirds of people experience some changes to their vision after a stroke. Having trouble with your vision can
be distressing and it can affect the rest of your recovery. For example, you may not be able to walk confidently if you cannot fully see where you are going. Like other effects of stroke, visual problems do
often improve in time as the brain recovers.
WHAT ARE SOME PROBLEMS AFTER STROKE?
A stroke can cause a number of vision problems—also called visual disturbances. There are many types of vision problems and possible treatments for them. How you are affected depends on exactly where the stroke
occurred in your brain. Post-stroke vision problems can fall into one of two general categories, vision loss or perception problems.
Vision loss also known as visual field loss, is common after stroke. Frequently it is experienced as blind spots in the field of vision. Specific visual field loss conditions are named based on the location and
size of the visual loss. Different types of visual field loss include:
Hemianopia means blindness in one half of the visual field. A stroke that occurs in the left hemisphere of your brain can inhibit the ability to see the right visual field of each eye, while right hemisphere
stroke can impair the left visual field of each eye. The most common form of this is homonymous hemianopia, which means that your vision loss is on the same side of each eye. Research shows that eight to ten
percent of stroke survivors have homonymous hemianopia.
Quadrantanopia means blindness in a quarter of your visual field.
Scotoma refers to an island-like area of blindness, typically smaller than hemianopia or quadrantanopia.
Tunnel vision means that your peripheral vision is lost. Medically, this is known as bitemporal hemianopia. The outside half of the visual field in each eye is blind.
Vision Perception Problems
Damage to your brainstem and/or cerebellum makes it difficult to process what the eye sees, also known as vision perception problems. You may find it difficult to coordinate movement and focus your eyes
resulting in double vision. It may affect your ability to blink, resulting in dry eyes. You may experience a variety of vision perception problems, depending on where the stroke occurs in your brain.
Common perception problems include:
Double vision or seeing two of one thing.
Visual midline shift where the center point in your line of sight is perceived as having shifted either left, right, above or below where it really is. As a result, you may become dizzy and may tilt your body
to the right or left in order to compensate.
Visual neglect, also called inattention, is when you ignore objects in a certain area. Visual neglect can cause you to eat food from only one half of your plate or shave only half your face. Stroke survivors
with visual neglect often recover completely.
Other visual perception problems include depth and distance perception, color detection problems, dizziness, hallucinations, and failure to recognize common objects, which is called agnosia.
The brain stem houses three pairs of nerves that control your eye movement. If they are damaged and do not allow one or both eyes to move together, you may experience double vision and visual midline shift.
Perception problems that result from brain stem damage are called ocular motility (or movement) impairments. For example, double vision results when your eyes are not able to work together to move into the
correct position. Damage to the cerebellum can impair your ability to coordinate looking in the same direction with both eyes.
Both the brain stem and cerebellum play a role in sensation. Damage to these areas can lead to loss of feeling, which makes blinking difficult and causes blurry vision or visual neglect.
CAN VISION PROBLEMS BE TREATED?
There are many treatments for visual disturbances. Consult with an optometrist, ophthalmologist or primary care provider for suggestions about specific vision problems, symptoms and treatment. Treatment plans
will be customized to fit your vision problems and needs.
The goal in developing a treatment strategy for vision loss is to expand the visual field. Treatment can be broken down into three different categories:
Optical therapy is also known as vision field relocation. Mirrors or prisms are used to move images from the blind area to the seeing side.
Eye movement therapy trains the eye muscles to compensate by only moving within the viewable visual field, resulting in improved reading ability and speeding up the ability to take in all surroundings.
Visual restoration therapy (VRT) is a restoration therapy designed to improve visual sensitivity in the previously blind zones by using light to stimulate the border between the “seeing” and “blind” visual
fields. Flashing lights on a computer screen stimulate partially functioning neural cells at the edge of the blinded area within the visual field.
There are several treatments designed to correct perception problems. Here are some common treatments for perception problems:
Prisms. Prisms can correct many perception issues, including double vision, depth perception, visual neglect and visual midline shift. The type and positioning of the prism differs depending on your symptoms.
Therapy and training. Because many perception problems are caused by lack of muscle control, various exercises geared toward building up muscle control can be effective.
Eye muscle surgery. In some cases, surgery can be used to correct double vision.
Eye patches. Eye patches can be effective and cost-efficient, but do not alleviate double vision permanently. Nevertheless, if therapy and treatment have proven unsuccessful, wearing an eye patch can be a
EMOTIONAL CONDITIONS AFTER STROKE
Stroke can have all sorts of different effects. Many effects are physical and easy to see, but there can also be hidden effects, like emotional changes. After a stroke you may experience fear, anxiety,
frustration, anger, sadness, and a sense of loss for the changes you have experienced. These feelings are a natural response to stroke.
Some emotional and personality changes are caused by the physical effects of brain damage, other changes are because of your feelings and thoughts about stroke. A stroke takes time to adjust to, but if you are
experiencing depression or other personality and emotional changes you should talk to your healthcare professional. There are treatment options to help you deal with the emotional fallout from your stroke.
Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear, and hopelessness in varying degrees. These emotions are common with post-stroke depression, which affects more than a
third of stroke survivors. According to the National Institutes of Health, post-stroke depression is underdiagnosed.
WHAT IS POST-STROKE DEPRESSION?
Your emotional health is just as important as your physical health and can promote or disrupt post-stroke recovery. Post-stroke depression is frequently described as a feeling of hopelessness that interferes
with functioning and quality of life. If not treated and managed appropriately, post-stroke depression can slow down your recovery.
Depression can set in weeks, months, or even years after your stroke and can stop your progress of recovery and rehabilitation, impacting your quality of life. A combination of factors can lead to post-stroke
depression. The sudden nature of stroke can have a life-changing impact. Also, the damage to your brain after a stroke, genetics, and social factors can also contribute to depression.
Symptoms of post-stroke depression vary in severity, frequency, and duration. Signs and symptoms of depression include:
Persistent sad, anxious or empty feelings
Increase or decrease in appetite and eating patterns
Feelings of helplessness, hopelessness, and/or worthlessness
Loss of interest in activities or hobbies
Difficulty concentrating or remembering details
Aches, pains, headaches and digestive problems that do not ease with treatment
Caregivers, family members, friends, and co-workers can be very helpful in recognizing post-stroke depression symptoms and encouraging you to consult with a healthcare professional.
CAN POST-STROKE DEPRESSION BE TREATED?
If your depression is left untreated and unmanaged, it can worsen a number of other common post-stroke conditions such as malnutrition, incontinence, pain, fatigue, and sleep issues. Depressive emotions can
increase when you are frustrated about not making progress in recovery. There are a variety of treatment options for post-stroke depression. Consult with your healthcare professional to determine the best
course of action. Common treatments include:
Medication. Medications known as antidepressants are common treatments for post-stroke depression and may be prescribed by your psychiatrist, primary care doctor, or other physician. Antidepressant medications
interact with chemicals in the brain called neurotransmitters to improve mood.
Mental Health Therapy. Medication is often combined with mental health therapy provided by a psychologist, psychiatrist, social worker, or counselor.
Cognitive behavioral therapy focuses on helping you identify thoughts and feelings that lead to undesirable behavior.
Other Therapy. Sometimes post-stroke depression is fueled by other after effects of stroke, such as spasticity or aphasia. Physical or speech therapy can improve those conditions, and in turn help you with
TIPS TO LIVE WITH POST-STROKE DEPRESSION
Treatment alone is not always enough to fight depression. A variety of practical management strategies can help you fight depression and other difficult emotions. Some tips to manage depression include:
Communicate. Talk about your feelings, post-stroke issues, and concerns with your caregivers, family, and friends. Relationships may change after a stroke and it may take time to adjust to new roles.
Improve nutrition. Foods rich in omega-3 fatty acids, folic acid, vitamin B, and complex carbohydrates can help improve mood and fight depression.
Omega-3 fatty acids (fish, flaxseed, walnuts) promote brain health.
Complex carbohydrates (brown rice, oatmeal and whole wheat) boost neurotransmitter chemicals in the brain that affect mood.
Dark chocolate helps fight fatigue and reduce stress.
A deficiency in folic acid (found in beans, oranges, and broccoli) is linked to depression; folic acid boosts neurotransmitters and promotes cognition.
Vitamin B12 (eggs, milk, liver) increases energy and alertness.
Attend a stroke support group. National Stroke Association’s Stroke Support Group Registry lists hundreds of support groups throughout the U.S.
Set realistic goals and prioritize. Break up larger tasks or projects into smaller ones.
Practice stress and anxiety management techniques. Deep breathing, squeezing a stress ball, guided imagery, aromatherapy, meditation, and taking a walk or journaling can be very helpful.
Be patient with yourself and loved ones. Stroke can be traumatic and recovery takes time.
Stay as active as possible. Adaptive equipment and aids such as canes, braces and walkers can help stroke survivors improve physical fitness. Walking, yoga, and swimming, are low-impact and promote recovery.
Get out into the community. Volunteering for a cause you believe in, returning to work, taking cooking classes, or joining a club can be exciting.
Minimize or eliminate alcohol consumption and smoking.
PSEUDOBULBAR AFFECT - PBA
Pseudobulbar affect (PBA) is one of the most frequently reported post-stroke behavior conditions, with up to half of all stroke survivors experiencing it at some time. PBA can be extremely embarrassing and can
negatively impact a survivor’s social life and relationships.
WHAT IS PSEUDOBULBAR AFFECT?
Have you experienced sudden outbursts of uncontrollable crying or laughing? If so, you may have Pseudobulbar affect (PBA). It is sometimes referred to as emotional lability, pathological crying and laughing or
emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations.
PBA is often mistaken for depression, causing it to be underdiagnosed, undertreated and sometimes inappropriately treated.
Only a healthcare provider can diagnose PBA. However, the Center for Neurologic Study-Lability Scale (CNS-LS), developed by healthcare professionals, can help you assess whether you have symptoms of PBA. Your
answers to this simple seven-question scale will help you determine whether to talk to your healthcare provider about PBA. A CNS-LS score of 13 or higher may suggest PBA.
This scale is not intended as a substitute for professional medical assessment and/or advice. Please consult your healthcare provider.
CAN PSEUDOBULBAR AFFECT BE TREATED?
PBA can be treated. The first step to treating PBA is to get an accurate diagnosis. Because people with PBA may cry a lot, their symptoms may be confused with depression. However, PBA is not depression. Ask
your healthcare professional about PBA treatment options. Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA.
TIPS TO LIVE WITH PBA
Be open about the problem so people are not surprised or confused when you have an episode.
When you feel an episode coming on, try to distract yourself by counting the number of objects on a shelf or by thinking about something unrelated.
Take slow deep breaths until you're in control.
Relax your forehead, shoulders and other muscle groups that tense up during an emotional episode.
Change your body position. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position.
These tips are general coping techniques and are not substitutes for medical advice. Talk with your doctor about additional ways to cope with your PBA episodes and whether a treatment plan may be appropriate.
RESEARCH ABOUT PBA
Results of a 2010 National Stroke Association survey about PBA after stroke showed that:
53 percent of stroke survivor respondents reported symptoms of PBA based on their answers to the Center for Neurologic Study-Lability Scale (CNS–LS). This percentage is higher than the 6 to 34 percent cited in
Fewer than one in five stroke survivor respondents were familiar with PBA.
About four in 10 respondents indicated that PBA episodes interfered with their social activities, including spending time with friends and family.
More than one-quarter of respondents suffering from PBA symptoms indicated that they experienced PBA outbursts frequently or often.
Only about one-third (38 percent) of respondents with PBA symptoms were treated for their episodes.
COGNITIVE CONDITIONS AFTER STROKE
Cognition is the process of thinking and knowing things. Damage to the brain after a stroke can cause many cognitive changes. Doing things that once were easy may now be hard. Changes in cognition are very
stressful. Cognitive challenges after stroke include dementia and memory problems, as well as many kinds of communication challenges. Learn more about cognitive changes after a stroke, treatment options, tips
and strategies to handle these new challenges.
After a stroke it is very common to have communication problems. This condition known as aphasia can affect your ability to find the right words, to understand what others are saying and/or reading and writing.
WHAT IS APHASIA?
If you have aphasia you may have difficulty in expressing yourself when speaking, trouble understanding speech, and difficulty with reading and writing. Aphasia is not a disease, but a symptom of brain damage.
It is most commonly seen in adults who have suffered a stroke.
No two people experience aphasia the same way. The exact type will depend on what part of the brain is injured by the stroke. Generally, aphasia can be divided into four broad categories:
Expressive aphasia. You know what you want to say, but cannot find the words you need.
Receptive aphasia. You hear someone talking or see the printed page but cannot make sense of the words
People with anomic or amnesia aphasia, the least severe form of aphasia, have difficulty in using the right names for objects, people, places, or events.
Global aphasia is the most severe, caused by widespread damage to the language areas of the brain. Stroke survivors with global aphasia cannot speak or understand speech, nor can they read or write.
CAN APHASIA BE TREATED?
A full recovery from aphasia is possible. Speech therapy is the most common treatment for aphasia. There are a variety of specific speech therapy exercises and techniques. Other types of therapy have also
proven effective for some stroke survivors, including:
Melodic intonation therapy which allows stroke survivors to sing words they cannot speak
Visual speech perception therapy focuses on associating pictures with words.
Constraint-induced language therapy involves creating a scenario in which spoken verbal communication is the only available option, and other types of communication, such as visual cues from body language, are
Group therapy and support groups
Some prescription medication can aid in the recovery of aphasia
Practice at home will support professional speech therapy. Some activities to support aphasia recovery include:
Play word-based games, such as board games, cards and crossword puzzles.
Cook a new recipe and read the ingredients.
Practice writing a shopping list or greeting cards to loved ones.
Read aloud or sing.
Go out to eat, order off a menu and calculate the tip.
TIPS FOR COMMUNICATING WITH APHASIA
If you have aphasia, here are some tips for communicating with others:
Use props to make conversation easier (photos, maps).
Draw or write things down on paper.
Stay calm. Take one idea at a time.
Show people what works best for you.
Take your time. Make phone calls or try talking only when you have plenty of time.
Create a communication book that includes words, pictures and symbols that are helpful.
Use the Internet to connect to people via email or to create a personal Web page.
Carry and show others a card or paper explaining what aphasia is and that you have it. Keep it in your purse or wallet.
TIPS FOR COMMUNICATING TO SURVIVORS WITH APHASIA
Use props to make conversation easier (photos, maps).
Draw or write things down on paper.
Be patient. Take one idea at a time.
Speak simply, clearly and slowly.
Be sure the person with aphasia understood you.
Treat the person with aphasia as an intelligent adult; aphasia does not typically affect thinking skills.
Try different ways to get your message across.
Memory loss is something that everyone experiences at times, often increasing with age, or following a stroke. It is estimated that approximately one third of stroke survivors will develop memory problems. The
memory problems can be so severe that they interfere with normal functioning and are then called dementia— more common in older stroke survivors.
WHAT IS MEMORY LOSS AFTER A STROKE?
You may experience memory problems after a stroke. You might experience the following types of memory loss:
Verbal: memory of names, stories and information having to do with language
Visual: memory of shapes, faces, routes and things seen
Informational: memory of information and skills or trouble learning new things
Vascular dementia: A common post-stroke condition involving loss of thinking abilities.
Symptoms of memory loss after a stroke may include:
Confusion or problems with short-term memory
Wandering or getting lost in familiar places
Difficulty following instructions
Trouble making monetary transactions
Memory loss may be a direct result of stroke, but can also be caused or worsened by:
Alcohol, tobacco and drugs
Lack of sleep
Depression and stress
Poor nutrition or diet
CAN MEMORY LOSS AFTER A STROKE BE TREATED?
Memory can improve over time, either spontaneously or through rehabilitation, but symptoms can last for years. Most treatment for memory loss after a stroke is actually treatment to prevent further strokes.
Some stroke survivor’s memory loss may benefit from medications for related problems, such as anxiety, depression or sleeping problems.
There are brain retraining techniques designed to improve your thinking and memory following a stroke. The training can help you improve alertness and attention and adapt to your loss of memory function, but
there is no scientific proof that such therapy can improve your ability to carry out daily tasks. This training can be done in person as well as with computer programs and applications.
Brain Stimulation Training
Suggestions for stimulating the brain and improving memory and cognitive ability include:
Trying something new. Try new hobbies that involve both the mind and body.
Exercise. Physical fitness adds to overall physical and mental health.
TIPS FOR MANAGING MEMORY LOSS
Improve your daily activities with the following tips:
Have a place for everything. For example hang keys on a hook by the door. Put things away where they belong.
Have a routine. Set daily routines, such as bedtime tasks, in the same specific sequence every day. Post both daily activities and special events on a large calendar.
Write things down. Keep a notebook of important information handy. Organize it into sections, such as appointments, phone numbers and medications. Put notes in prominent places and leave written directions on
how to use common household items, such as phones and microwaves, next to those items.
Use Memory Cues. Memory cues help you remember certain tasks or information. To make a memory cue, connect a task or piece of information to something meaningful, such as an image, familiar name or song.
Keep it simple. Try not to tackle too many things at once. Break tasks down into easy steps.
Repetition. If you forget what someone said, ask them to repeat as often as necessary.
Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory, and other thought processes caused by brain damage from impaired blood flow to your brain. Vascular dementia
is common following a stroke.
WHAT IS VASCULAR DEMENTIA?
Vascular dementia is a common post-stroke problem which affects cognitive function or thinking abilities. Vascular dementia makes it difficult for you to process information. This can lead to memory loss,
confusion, decreased attention span and problems performing everyday activities.
Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular dementia also can result from other conditions that damage blood vessels and reduce circulation,
depriving your brain of vital oxygen and nutrients.
Factors that increase your risk of heart disease and stroke—including high blood pressure, high cholesterol and smoking — also raise your vascular dementia risk. Controlling these factors can help lower your
chances of developing vascular dementia. The risk for vascular dementia increases with every stroke.
Depending on the location and size of damaged brain area, the onset of dementia following a stroke differs from person to person. Left-hemisphere strokes are commonly associated with vascular dementia. Symptoms
of vascular dementia include:
Language problems (aphasia)
Difficulty paying attention or following a conversation
Difficulty planning and organizing tasks
Difficulty with calculations, making decisions, solving problems
Visual orientation problems, hallucinations
Impaired motor skills
CAN VASCULAR DEMENTIA BE TREATED?
Controlling conditions that affect the underlying health of your heart and blood vessels can sometimes slow the rate at which vascular dementia gets worse, and may also sometimes prevent further decline.
Depending on your individual situation, your healthcare professional may prescribe medications to:
Lower your blood pressure.
Reduce your cholesterol level.
Prevent your blood from clotting and keep your arteries clear.
Help control your blood sugar if you have diabetes.
Some Alzheimer's medications may help.
Consult a healthcare professional to determine if and what medications are appropriate.
TIPS FOR MANAGING VASCULAR DEMENTIA
If you have vascular dementia you may become more dependent on family members or caregivers for assistance with activities of daily living due to physical and behavioral changes. Here are some practical
strategies to manage the symptoms of vascular dementia:
For memory problems—create lists, take notes and establish a regular routine.
For cognitive (thinking) symptoms—work with a speech therapist, play card games and use puzzles and crosswords. There are also computer programs and applications to sharpen brain functions.
Manage stroke risk factors like hypertension, diabetes, high cholesterol by taking medications prescribed by your healthcare professional as well as making lifestyle changes.
Work or consult with a physical or occupational therapist to regain and maintain independence.
Improve social functioning and reduce isolation by attending a stroke support group to connect with others, practice social skills and seek advice. To find a support group in your area, visit the national
Stroke Support Group Registry.
To manage depression and other emotional issues, seek out a counselor or social worker.
If vascular dementia impacts your functioning at work, discuss your needs with your employer.
If you have severe vascular dementia may not be able to maintain financial responsibilities or make medical decisions. A Medical Power of Attorney is a legal document that designates a person to make healthcare
decisions for you if you are unable to. Living wills and advance directives are also legal documents that outline your preferences if you are unable to communicate them.
CARING FOR SOMEONE WITH DEMENTIA
Providing care for a person with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry and grief, as well as social isolation are common.
Learn as much about the vascular dementia as you can. Ask your primary care doctor or neurologist about good sources of information. Your local librarian also can help you find good resources.
Take a break every day. Take care of your health by seeing your own doctors on schedule, eating healthy meals and getting exercise.
Seek out support. Many people with dementia and their families benefit from counseling or local support services. Contact your local Alzheimer's Association affiliate to connect with support groups, resources
and referrals, home care agencies, residential care facilities, a telephone help line, and educational seminars.
Give encouragement. Caregivers can help a person cope with vascular dementia by being there to listen, reassuring the person that life can still be enjoyed, providing encouragement, and doing their best to help
the person retain dignity and self-respect.
Provide a calm environment. A calm and predictable environment can help reduce worry and agitation. Establish a daily routine that includes enjoyable activities well within the comfort zone of the person with
New situations, excess noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. As a person with dementia becomes upset, the ability to think
clearly declines even more.
Paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person in your care.
Article Source: stroke.org