Stroke Damage - Likely Constraints

Disabilities after stroke

People with stroke damage may have trouble with many activities that were easy before, such as walking, talking, and taking care of "activities of daily living" (ADLs). A "disability" is difficulty in doing something that is a normal part of daily life.

These include basic tasks such as bathing, dressing, eating, and using the toilet, as well as more complex tasks called "instrumental activities of daily living" (IADLs), such as housekeeping, using the telephone, driving, and writing checks.

Some stroke damage disabilities are obvious right after the stroke. Others may not be noticed until the person gets back home and tries to do something for the first time since the stroke.

Likely constraints on going home

For the stroke survivor, it may be hard to transfer the skills learned during rehabilitation to a new location. Also, more stroke damage may appear as the person tries to go back to old activities. During this time, the stroke survivor and family learn how the stroke will affect daily life.

At this stage, it is a must to remember that adjusting to the effects of stroke takes time. Many adaptive devices and techniques have been designed especially for stroke survivors to help them retain their independence and function safely and easily.

Muscle spasticity

Approximately one in five stroke survivors suffer from painful muscle spasms, which result when weakened muscles contract abnormally. Stroke damage to muscles may include a tight fist, an abnormally bent arm, a stiff knee, or a pointed foot. Not only are these muscle spasms extremely painful but they can interfere with walking or performing routine tasks.

If left untreated, muscle spasticity may actually deform a stroke survivor's limbs, restrict his ability to move, and lead to pressure sores.

Treatment for muscle spasticity may be a mix of rehabilitation therapies, medications, and even surgery. Rehabilitation therapies include full range-of-motion exercises several times a day, gentle stretching of tight muscles, and frequent repositioning of body parts. Some devices, such as the Biomove can be used with great effect.

Memory and problem solving

Even a mild stroke can affect your ability to learn and remember. Stroke damage may result in trouble learning and remembering new information. Applying learning to a new setting could be difficult. For example, a stroke survivor may learn how to move from a wheelchair to a bed while in the hospital, but is unable to do the same task at home.

A stroke survivor may be confused or lost in what should be a familiar place or may lose track of the time or date. Negative effect on memory and inability to make decisions are other stroke damages that make it hard for a stroke survivor to organize thoughts.

The techniques that may help a stroke survivor to manage memory problems include repeating information in the mind, patience with oneself, concentrating on one thing at a time, memory aids such as appointment books, and breaking tasks into smaller steps.

Dressing and clothes

Dressing oneself is a basic form of independence. The added value of being neatly and attractively dressed enhances a stroke survivor's self-image. There are many ways to eliminate the difficulties in getting dressed.

Stroke survivors should avoid tight-fitting sleeves, armholes, pant legs and waistlines; as well as clothes which must be put on over the head. Clothes should fasten in front. Velcro fasteners should replace buttons, zippers and shoe laces.

Devices which can aid in dressing and grooming include a mirror which hangs around the neck, a long-handled shoe horn and a device to help pull on stockings.

Reduced appetite and eating problem

Some stroke survivors may have a reduced appetite. Ill-fitting dentures or a reduced sense of taste or smell can make food unappealing. The stroke survivor who lives alone might even skip meals because of the effort involved in buying groceries and preparing food.

Soft foods and foods with stronger flavors may tempt stroke survivors who are not eating enough. Special utensils can help people with physically-impaired arms and hands at the table. These include flatware with built-up handles which are easier to grasp, rocker knives for cutting food with one hand and attachable rings which keep food from being pushed off the plate accidentally.

Language problems

Language difficulties are common in people who've had strokes. Stroke damage may cause trouble speaking or understanding speech, a problem known as aphasia. Other common language difficulties include speech apraxia i.e. difficulty planning the physical movements necessary for speech, dysarthria i.e. difficulty or inability articulating speech and writing impairment, which also includes difficulty reading.

A speech therapist can help a stroke survivor relearn language skills, and can also come up with strategies for communicating.

Depression

Many people who survive a stroke feel fear, anxiety, depression, frustration, anger, sadness and a sense of grief for their physical and mental losses. More than half of all stroke survivors become depressed at some point during their recovery. These feelings are a natural response to the psychological trauma of stroke. Some emotional disturbances and personality changes are also caused by the physical effects of brain damage.

Post-stroke depression can be treated with antidepressant medications and psychological counseling. It is possible that the depression may lift by itself with passing time. Family members can help by encouraging and facilitating leisure and social activities as well as emotional and spiritual support.

Adjustment problems with the caregiver

Adjustments after stroke damage are a physical and emotional challenge for the main caregiver as well as the stroke survivor. The caregiver has many new responsibilities and may not have time for some favorite activities.

The caregiver needs support, understanding, and some time to rest. Caregiving that falls too heavily on one person can be very stressful. Even when family members and friends are nearby and willing to help, conflicts over caregiving can cause stress. So, breaks should be planned so that patient and caregiver are not together all the time.