Stroke, consequences and rehabilitation

Rehabilitation helps patients to regain their skills that they’ve lost due to brain damage after a stroke. These skills may include coordination of movements or performing gradually complex actions. Also, rehabilitation teaches patients how to solve different problems in order to compensate for the limited opportunities that arise after a stroke. Patients may need to learn how to bathe or dress using only one hand or how to effectively communicate when there is a speech disorder.

There is a general consensus among rehabilitation experts that the most important element of any rehabilitation program are the repeated practical exercises which need to be performed by people learning new skills. Rehabilitation begins at the emergency department of the hospital after the general condition of the person has stabilized. It often begins within 24 to 48 hours after having suffered a stroke. The first steps involve urging the patients to perform independent movements, because many people are paralyzed or seriously weakened. Patients are encouraged to change their position in bed or do passive or active exercises. ("Passive" exercises involve the therapist actively helping the patient to move the limbs, while "active" exercises are performed by the patient without the assistance of a therapist). Depending on many factors, including the degree of initial trauma, the patient can begin rehabilitation by simply sitting on a chair, moving between a bed and a chair, standing without support or walking unaided. Rehabilitation specialists help patients who are able to perform more and more complex and intensive tasks, such as bathing, dressing and using the toilet. Doctors encourage patients by showing them the movements and taking part doing these tasks. Learning how to perform basic daily activities is the first stage. For some patients after a stroke, rehabilitation will be a continuous process aimed to maintain and improve skills. It may involve working with specialists for several months or years after the stroke.

Paralysis or movement control problems

Paralysis is one of the most common complications of a stroke. Paralysis, which usually develops in the opposite side of the damaged area in the brain, can affect the face, hands, legs, or all sides of the body. One-sided paralysis is called hemiplegia. If there is more than a general feeling of weakness, it is called hemiparesis. Patients who had a stroke and developed hemiparesis or hemiplegia may experience difficulties in daily activities, such as walking or holding objects. Some patients after stroke experience swallowing disorders (dysphagia), due to damage to the part of the brain that controls the muscles used for swallowing. Damage to the lower part of the brain, the cerebellum, can affect the body's ability to coordinate movements (ataxia), which leads to problems with body position, walking, and balance.

Sensory disorders, including pain

Patients who have suffered a stroke may lose their ability to feel the touch, pain, and temperature. Sensory deficits can also interfere with their ability to recognize objects. Some patients feel pain, numbness or tingling in the paralyzed limb after stroke, or weakness, a symptom known as paresthesia.

Urinary incontinence is the combination of sensory and motor deficiency. It occurs quite often in patients who have suffered a stroke. Patients may lose the ability to feel the urge to urinate or the ability to control the muscles of the bladder. Some patients may not have sufficient mobility to have timely urination. Loss of control over the intestines and constipation are also common conditions in such patients. Constant urinary and stool incontinence after a stroke is rare, but even a temporary loss of such functions can be emotionally difficult for the patient.

Also, patients after stroke often experience various chronic pain syndromes as a result of damage to the nervous system (neuropathic pains). In some patients, false signals are transmitted to the brain, leading to a sensation of pain in the limb or part of the body. The most common of these is the "pain syndrome of the thalamus" (caused by a stroke in the thalamus, which processes sensory information from the body to the brain). This syndrome is difficult to treat even with medications. Finally, pain can be caused not by damage to the nervous system, but by mechanical problems. Patients who have severely weakened or paralyzed hands usually experience moderate to severe pain that emanates from the shoulder. Most often, pain occurs due to lack of joint movements. Passive exercises help in this case.

Problems using and understanding language (aphasia)

At least 25% of all patients after stroke have serious problems associated with loss of speech and understanding of written and spoken language. This complication can seriously worsen the patient's verbal communication. Damage to the language center of the brain located in the dominant hemisphere, known as the Broca zone, is called expressive aphasia. Such patients find it difficult to communicate their thoughts through words or writing. They lose the ability to express their thoughts and build words into sentences. In contrast, damage to the language center located in the back of the brain, called the Wernicke zone, leads to susceptible aphasia. Patients with this type of aphasia have difficulty understanding oral or written speech and often incoherently utter words. Although they can form grammatically correct sentences, their statements are often meaningless. The most severe form of aphasia is caused by the large damage to several areas of the brain that participate in the speech function. People with severe aphasia lose almost all their language abilities, they do not understand the language and can not convey their thoughts.

Thinking and memory problems

Stroke can damage the part of the brain responsible for memory, learning and awareness. Patients with this case suffer from attention deficit and experience a loss of short-term memory. They may also lose the ability to make plans, understand the meaning of something, learn new tasks, or participate in other complex mental activities. Two fairly common deficiencies are anosognosia (inability to recognize the reality of physical disorders as a result of it or lack of insight) and neglect (loss of ability to respond to objects or sensory stimuli). Patients who develop apraxia (loss of ability to perform recognizable, purposeful movements) can not plan complex tasks and fail to perform them in the right order. As we understand it, apraxia is caused by a dysfunction of delicate connections between thought and action.

Emotional disorders

Many patients after stroke feel fear, anxiety, disappointment, anger, sadness, grief, etc. These feelings are a natural reaction to a psychological trauma - stroke. Some emotional disorders and personality changes are caused by physical effects of brain damage. Clinical depression, which is expressed by a feeling of hopelessness, affects a person's ability to perform their normal functions. Signs of depression include sleep disorders, radical changes in nutrition, which can lead to sudden weight loss or weaknesses, social isolation, irritability, fatigue, self-loathing and suicidal thoughts. Post stroke depression can be treated with antidepressants and psychological help.

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Also see other articles on this topic:

• Depression is a risk factor for stroke
• Coffee prevents stroke
• Pradax prevents stroke

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