Common effects of stroke
Paralyzed shoulder muscles are not able to help tendons keep the upper end of the arm in the shoulder joint. As a result the arm drops from the joint which is very painful and can prevent rehabilitation of the hand and arm. Rehabilitation and medication can help.
Depression after stroke, as after any severe illness, is very common, often goes without diagnosis, reduces motivation and capacity for rehabilitation and affects quality of life. Depression not only affects the individual who has had a stroke, partners, family members and carers are also at higher risk of depression. Post-stroke care should encommpass mental health and well-being and appropriate treatment should be offered.
Changes in cognition
Stroke and TIA (transient ishemic attack or mini-stroke) can lead to changes in the thinking ability of survivors and can cause problems with memory, including dementia. TIAs are often not recognised and over time can cause significant problems for patients.
A third of stroke survivors will experience aphasia a disorder that affects how the brain processes language. Aphasia can affect speech, comprehension, reading and writing. With specialist speech and language support, survivors with aphasia can learn new ways to communicate.
Spasticity is like a "wicked charley horse" or severe cramp. Brain injury caused by a stroke sometimes causes paralyzed muscles to involuntarily contract (shorten or flex) after trying to move a limb. This creates stiffness and tightness. The contracted muscles often freeze the joints of the hand and arm permanently into an abnormal and often painful position. When a muscle can't complete its full range of motion, the tendons and soft tissue surrounding it can become tight. This makes stretching the muscle much more difficult. Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest. This can seriously interfere with a stroke survivor's ability to perform daily activities such as dressing. Spasticity in the leg may cause a stiff knee, pointed foot and curling toes. Spasticity can be addressed with medication and rehabilitation.
For most stroke survivors, caregivers and families, the impact of stroke means that life will be different and the challenges of recovery are very real, but it is possible to moderate the impacts of stroke by working with a healthcare team, developing new routines and tracking small step-by-step goals.
WSO Post Stroke Checklist, a tool to improve long-term care
Once the initial stroke recovery stage is over, continued focus on ensuring the best possible quality of life for survivors is essential. The Post Stroke Checklist (PSC) is a tool that aims to improve long-term stroke care. The Checklist is a simple, easy to use tool that helps survivors and health care professionals identify changes and problems so that , where possible, these can be effectively treated. Areas of care addressed include:
- Secondary stroke prevention
- Activities of daily living
- Life after stroke
- Relationship with family
- Carers needs
The Checklist should form part of patient discussions with clinicians as part of their regular follow up. Clinicians are encouraged to ensure that caregivers have access to support that will help them to stay well and provide the support needed by the people they care for. Ask your clinician if he or she has a copy and refer them to the World Stroke Organization website for more information.