Life After Stroke

Recovery is a gradual process as the brain takes time to heal.  Rehabilitation can help this recovery.

The recovery varies from person to person and ranges from those who are left with a slight disability, to those with more serious impairments. In general, most recovery is made in the first six months, but progress can continue after this time.

Getting better with rehabilitation

Stroke rehabilitation includes help with areas such as:

Stroke rehabilitation should start in the hospital where you work with different therapists and medical professionals. When you are ready to leave hospital the team working with you will work out a care plan to help when you go home. This is often called 'discharge planning'.

The plan will include arrangements for you to receive any care you need at home, equipment you may need and support to link in with services which are available in the community.

Dealings with the effects of stroke

The effect of stroke varies from person to person and depends on the part of the brain which was injured during the stroke. You may experience a number of different changes.

Hemiplegia / half paralysis / weakness

This means a loss of movement along one side of the body caused by damage to the area of the brain which sends messages to the arms, legs and face. Balance may also be affected so that you may be more likely to fall or bump into things.

Loss of sensation on one side of the body

This loss of sensation can mean that without looking at them you do not know how your arm or leg is positioned. You may also have difficulties knowing your left from your right side and judging distances.

Loss of vision

This can mean that one half your field of vision is affected – you cannot see from the left or from the right. If you are unaware of this problem you may bump into things you have not seen.

Difficulties in communication

There are a number of ways in which your communication may be affected after a stroke.

How severe these disorders are vary from person to person and may change over time. It is also possible to have more than one of these communication disorders at the same time. A sudden change in the ability to communicate may have a devastating effect on the person, especially at a time when communication seems so important, for example, asking questions, taking in information, conveying fears and anxieties.

Try to be patient and work with the speech and language therapist on how best to help with communication.

We have listed some of the terms used by the speech and language therapist to describe communication difficulties after stroke.

Aphasia is a disorder that affects a person’s ability to understand and use language. People with aphasia can think clearly, but may have difficulty getting their message in and out.  Aphasia takes many different forms. It may be characterised by total or partial loss of understanding words, speaking, reading or writing.

There are a wide range of symptoms of aphasia which can vary from person to person, for example:

Dysarthria is the name given to a group of disorders, which affect movement of the muscles involved in producing speech including the lips, tongue, soft palate, and vocal folds. Weakness, slowness, or poor co-ordination of movements will result in slow, slurred or nasal - sounding speech,which may be difficult to understand.

It is often accompanied by difficulties with swallowing.

Apraxia is a disorder which results in difficulties putting speech sounds together correctly. Its severity varies from being unable to put any meaningful words together to slightly ‘foreign’ sounding speech. It rarely happens on its own, there is usually an element of aphasia.

Right-hemisphere damage causes certain communication problems following a stroke to the right side of the brain. Some of these may include difficulty understanding what people mean by what they say, in other words, understanding the intention behind a conversation for example, understanding sarcasm, humour and irony. People with right-hemisphere communication problems may have difficulty following conversational rules for example, they may ‘butt in’ and interrupt inappropriately when someone else is speaking. They may also have problems changing their voice to match their emotions.

Memory

You may experience difficulty concentrating, working out new problems or understanding new information. Often, things which have happened recently are harder to remember than events in the past.

Bladder and bowel control

It is common for a person to have difficulty controlling their bladder or bowel after a stroke. For many people this control will come back over time.

Emotional issues

Having a stroke is a difficult thing for you to go through and can be very upsetting.

The time after a stroke is often a stressful and traumatic time. You may feel anxiety about your finances and relationships with loved ones. Having a stroke may cause you to reflect on your life and to worry about the future.

After a stroke you may experience emotional changes caused by changes in the brain. You may find that you have little or no control over your emotional responses, for example you may start crying or laughing for no apparent reason.

As time passes and you start to understand the nature of your stroke, find out about supports that are available and receive the support of your loved ones, things can start to get easier.

Stroke Care team

Recovery from stroke will require a team to work together. This group of people are often called the community care team and can include:

• GP
• Public Health Nurse
• Physiotherapist
• Occupational Therapist
• Speech and Language Therapist
• Medical Social Worker
• Dietitian
• Clinical Psychologist
• Family members and carers also play an important role

GP – this is the doctor who will see you morst regularly after you have left hospital. They will look after any problems, make sure medicine is working correctly and may refer you to a hospital consultant or to therapists when you need specific help.

Public Health Nurse – gives useful advice on managing any difficulties you may have in your basic care at home. They can also provide practical aids and help to arrange personal care if required.

Physiotherapist – helps with your physical recovery to enable you to have as much movement as possible. Often, they will help you to do exercises to improve your mobility and will give advice about the best positions for sitting and sleeping.

Occupational Therapist (OT) – works to help you become as independent as possible in your daily life, including working, socialising, leisure activities and driving. If you are having a difficulty in areas such as these your OT will work to put together a treatment programme. Your OT may also visit you at home to see what alterations or equipment they may need to assist you to be as independent as possible.

Speech and Language Therapist – works with you on any speech and communication difficulties you are having, and any problems swallowing. They can help you to get communication aids you need, such as a picture or alphabet chart or a computer.

Dietitian – looks at your diet and nutritional requirements. They will watch what you are eating and explain what food and drinks are good for your particular needs and help you to maintain a healthy lifestyle.

Medical Social Worker – helps you and your family with the emotional impact of your stroke. They will support you and provide a link to all the different therapists and medical professionals they are working with. They can also refer you to services that might be helpful and give advice in areas such as personal finance, employment, housing or care needs.

Clinical Psychologist – helps you to improve your thinking skills, such as attention span, memory and reasoning and helps you to adjust to the big changes which the stroke may have had on your day-to-day life.

Family and friends – support and encourage you during the different stages of recovery, help you to build up your confidence and encourage you to be as independent as possible.

Dealing with day-to-day activities

You may find that they have difficulty with some day-to-day activities. By talking to your care team, you can find ways to make things easier.

Standing and walking – can be made easier with shoes which offer good support and rearranging the furniture in your home. Some people may also need to use a stick, a walking frame or a wheelchair. An occupational therapist (OT) can advise you about the use of a wheelchair. Walking up and down stairs can be difficult, but fitting handrails or a stair lift can make it easier.

Getting out of chairs/bed – standing up from sitting or getting out of bed can be difficult. OTs can advise you on the best types of chairs and mattresses. A physiotherapist can explain the best transfer technique to help you move about. 

Dressing – putting on and taking off your clothes can be difficult. Occupational therapists can advise you on simple procedures which can make dressing easier, such as if a person puts their weak arm or leg into clothes first and the use of shoehorns.

Eating – sometimes it can be difficult to use knives and forks after a stroke. Using utensils with thick handles can help, as can non-slip mats with prevent the plate from moving around the table.

Washing and grooming – again there are many simple tips an OT can give you which will may make it easier, such as using a free standing shower.

Going to the toilet – if your toilet is upstairs and you find it difficult to walk, you might use a commode or move your toilet downstairs. You might also need to have rails fitted in the bathroom. Public health nurses and OTs will be able to give you advice about this. 

It may be possible to get a Housing Adaption Grant to pay for equipment or adaptations to your home. These grants are provided by Local Authorities. 

Support in your home

After a stroke, you might need to get extra help around the house or with personal care. There are different services in different areas, but can include:

• Home help
• Care assistants
• Meals on wheels
• Respite in a respite centre to give carers a short break

Sometimes you may need more care than they can receive at home. If this is the case, a social worker can help you to think about the type of care which would be suitable for you, from sheltered accommodation, to residential care in a nursing home to 24-hour nursing care.

Organisations providing support

There are organisations in the community who can help you as you settle in to your life after stroke.

Day hospitals are generally in the grounds of a larger hospital. They care for mainly older people who are well enough to live at home but who need regular medical care or the services of the hospital therapists. When you leave hospital arrangements may be made for them to go to the day hospital if this is necessary.

Day centres provide an important social outlet, the opportunity to meet other people who have had strokes and activities such as painting, swimming and outings.

Stroke support groups help people who have had strokes to meet up and discuss how they are feeling. Groups often meet once a month and many also organise social activities and outings.  Find the group nearest to you.

Financial support - many people who have had a stroke may be entitled to receive social welfare payments. Payments are made by the Department of Social and Family Affairs and the Health Service Executive (HSE). People can qualify for certain payments if they are sick for just a short time. For other payments people may need to show that you have an illness or disability that will last longer than one year.

You can receive information on the different types of payments and grants available from the Citizens Information Service at lo-call 1890 777 121, or www.citizensinformation.ie. Information is also available from local social welfare offices and local health offices .

Moving On

Getting back to work

Once a person has begun to recover and has developed ways of managing the difficulties caused by their stroke, they might start to think about going back to work.

It may be possible for you to return to work part or full time, or maybe to a different job with their previous employer or with a new employer.

You should talk to your OT and care team about the best way to approach your employer about going back to work.

The law says that employers must make reasonable adjustments to help their employees to return to work after a stroke. Employers may need to make some adaptations to their workplace, such as getting a new type of office chair or a computer. A person returning to work may also need to change the way they work if, for example, their stroke has affected their ability to manage equipment which is relevant to their job.

If you will not be returning to a previous employer you could undertake a vocational assessment to think about what type of job you would like to do. An OT will be able to provide information about what assessment services are available.

You can also talk to FÁS, the training and employment agency (www.fas.ie) who offer employment support schemes and workplace adaptation grants.

Driving

If you would like to continue driving you should tell your motor licensing authority and insurance company that you have had a stroke. A doctor familiar with you and any disabilities the stroke may have caused will then need to provide a medical report. In some cases, the doctor will not allow a person to return to driving, such as if you have convulsions after a stroke or if you have a particular type of sight loss called hemianopia.

If you or your family has concerns that the stroke has affected your ability to drive you should talk to a member of the care team and an on-road driving assessment may be arranged.

If you drive a commercial or public-service vehicle, current Irish driving regulations are very restrictive after a stroke. Even if you recover enough to start driving your private car, only in exceptional circumstances will you be able to go back to commercial or public service driving. If you are concerned about this you should talk to their consultant and care team.

Sex after stroke

Sex is an important and normal part of people’s lives. It is understandable that you might feel concerned about whether you will be able to have sex after a stroke. You may be worried about whether you will be physically able to have sex or concerned about changes to your appearance which you may think makes you less attractive. Or you may be feeling low and not interested in sex.

The good news is that the ability to have sex is rarely damaged by a stroke and sex is unlikely to cause another stroke. At the same time it might take awhile to get back to a satisfying sexual relationship and you might have to make some changes, depending on how their stroke has affected your physical movement.

It is very normal to have questions about sex and any concerns should be discussed with your care team.