The type and severity of the stroke, its location in the brain, the speed of diagnosis and early treatment, all impact the likely short-term and longer term effects of a stroke. Some people may recover quickly, but many may need longer-term support and rehabilitation/reablement for physical and/or psychological effects.
Individual support and care will start in the hospital, in a dedicated stroke unit, or a rehab ward, before continuing back at home or residential care.
What happens after a Stroke?
Fatigue is a common effect of a stroke. It is more than feeling tired now and again, but ongoing tiredness that does not improve with more rest or sleep. It can be such that even eating or drinking towards the end of the day become difficult because keeping hold of cutlery or glassware is a struggle.
Patients may also find that their stamina is much reduced making keeping active for a length of time difficult. For example, a trip to the shops may start out fine but become an increasing struggle with time.
Feeling pain and changes in feeling sensations
Damage to the nervous system following a stroke may affect sensations in a number of ways:
Less sensitive to temperature – both hot and cold
Numbness – general feeling less sensitive so that every day tasks such as eating or dressing can be an issue
Feeling more sensitive – conversely some people can feel more sensitive, particularly regarding taste, hearing or touch – so watching tv or being in crowded places can become difficult;
Altered sensations – for example tingling or pins and needles in affected limbs; at their worst these could be a sensation of burning or something crawling over your skin.
Altered limbs/unaware – Some people experience difficulties around position and movement of limbs which can leave them feeling that limbs don’t belong to them or that they have altered in size and shape.
Damage to the nervous system may result in tingling cold or burning hot sensations. Stroke survivors may also experience less sensitivity to touch and temperature, and more sensitivity to taste, hearing or touch.
Cognitive effects of a stroke
Cognitive is a term that refers to the many functions the brain uses to process information. One or more cognitive functions can be affected by a stroke, including:
- spatial awareness –having an awareness of where your body is in relation to your immediate environment
- executive function – the ability to plan, solve problems and reason about situations
- praxis – the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea
Assessments for each cognitive function will be carried out early after diagnosis, so that a treatment and stroke rehabilitation plan can be made. Rehab may include techniques to relearn communication skills through speech and language therapy. Most cognitive functions will return with time and help, but they may not return in the way that they were before.
Stroke rehabilitation to aid recovery from the physical effects
A stroke typically only affects one side of the brain. When a stroke damages the part of the brain that controls muscle movement, the signals between the brain and the muscles can be weakened, leading to muscle weakness or paralysis. Because each side of the brain controls movement on the opposite side of the body, paralysis/weakness also typically occurs on one side of the body, opposite to where the stroke occurred.
Weakness on one side of the body is often referred to as hemiparesis, and paralysis on one side of the body is called hemiplegia. The range can extend from mild weakness in one limb, such as an arm, which might impact the ability to use your fingers, to much more severe weakness with no movement in the limbs at all (paralysis). Another form of muscle weakness is called Drop Foot and occurs when muscle weakness in the foot means toes catch on the ground as the foot is lifted to step forwards.
Physiotherapy treatment for muscle weakness and paralysis may start within 24 hours of the diagnosis of a stroke. The early stages may focus on preventing complications and helping the stroke recovery process. With longer term effects, physiotherapy will help to find ways to do every day tasks for example such as getting in and out of bed.
An occupational therapist may be required to help identify adaptations to the home, or particular equipment to make everyday activities easier.
The more therapy and the more active someone is after a stroke, the better. Guidelines recommend at least 45 minutes of each type of therapy every day for as long as needed. Moving helps balance, aids breathing and skin care, and reduces the risk of blood clots in legs.
Post-stroke spacticity treament
After a stroke, muscles may become stiff, tighten up and resist stretching. This is called spasticity and it relates to muscle tone, the natural tension, or contraction, in a muscle that resists stretching. About 25 to 43% of survivors will have spasticity in the first year after their stroke. It’s more common in younger stroke survivors. It’s also more common when the stroke is caused by a bleed on the brain (haemorrhagic).
For some, spasticity may be mild muscle stiffness, for others it may be severe, resulting in pain or spasms. Spasticity may also lead to fixed joints, when muscle tone is abnormally tight, so muscles shrink and shorten. Joints can become stuck in one position and quite hard to move. For example, this may cause a wrist to curl in or an arm to stay in a folded position against the chest.
There is a mix of physiotherapy and medication to help treat spasticity. Physiotherapy should be regular to move your joints, and to help stretch the muscles.
A generic brand name for “Botulism Toxin” – may be used by injection directly into muscles. It acts as a nerve block, to help with spasticity and reduce muscle tightness. Other brand names used are Dysport and Xeomin.
Other types of medication to botox can help reduce the stiffness and pain that often comes with spasticity. The brand names for the most widely used medications are baclofen or tizanidine.
Speech therapy for Aphasia and communication problems after a stroke
Aphasia is a problem with speaking and understanding, as well as reading and writing, which can occur after a stroke. It happens if the parts of the brain responsible for language are damaged. Dysarthria is weakness in the muscles that are involved in speech which occurs as a result of brain damage.
A speech therapist should be seen for an assessment to start therapy which may involve exercises to improve control over speech muscles. It may also involve learning to use communication aids such as letter charts or using alternative methods such as gestures or writing.
Dysphagia – trouble swallowing after a stroke
Dysphagia is problems with swallowing. The damage caused by a stroke can interrupt the normal swallowing reflex, making it possible for small particles of food to enter the windpipe. Coughing or gagging and inability to swallow food or drink properly are the signs to look out for.
A speech therapist will provide help to learn to manage and overcome swallowing problems including giving tips to make swallowing easier and exercises to improve the muscles involved in swallowing.
Rehabilitation for the psychological effects of a stroke
Two of the most common psychological problems that can affect people after a stroke are depression and anxiety. Feelings of anger, frustration and bewilderment are also common. An assessment will help determine any course of treatment or support that might be needed, such as counselling or psychotherapy.
It is also important to consider family members who may also be struggling to come to terms with the stroke and the impact it has both on the patient but on themselves, particularly if they become the primary carer.