Jack’s Story (symptoms on left side of the body)

Jack had a stroke yesterday. He has muscle weakness in his left arm and weakness in his left leg. When you visit today Jack is sitting up in bed but he doesn’t seem to notice you when you walk in to the room from his left side. The nurse mentioned that a therapist will assess Jack to see if this lack of attention to the left side might be unilateral spatial neglect. Jack seems a little confused today about where he is and why. During your conversation Jack is able to speak and he understands you. He has only moved out of bed once to sit on a chair and it took a lot of effort for the nurse to get him there. He needs to use the armrest because he cannot maintain his balance in the chair. The nurse mentions to you that it is very important to position Jack correctly in bed and in the chair, to prevent shoulder subluxation and pain. As a family member you may feel concerned about Jack and his recovery from stroke.

What is a stroke?
A stroke is a sudden injury to the brain. A stroke is caused by uncontrolled bleeding in the brain, or by a blood clot in the brain that interrupts the blood flow to the brain. This limits oxygen to the affected part of the brain, causing injury or death to the cells in that area. The effect of the stroke depends on what part of the brain was injured and how much injury to the brain occurred.
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Click here to visit the Heart and Stroke Foundation website for more information on stroke including causes, types, symptoms and effects of stroke.

Why is arm weakness associated with stroke?
Damage to one side of the brain results in difficulties with movements on the other side of the body. Because of this, a person who has had a stroke on the left side of the brain may have difficulty moving the right side of the body. Many patients who have had a stroke experience muscle weakness (hemiparesis) or loss of movement (hemiplegia) on one side of their body.  This can affect their ability to use the arm on that side of the body. Muscle weakness or loss of movement can make it difficult to do everyday activities. Some of the effective therapies to improve arm weakness in the early phase of recovery include: Modified constraint-induced movement therapy (mCIMT) Task-oriented training (upper extremity) Repetitive Transcranial Magnetic Stimulation (rTMS) Functional electrical stimulation (FES) for the hemiplegic shoulder or the upper extremity
Why is leg weakness associated with stroke?
Damage to one side of the brain results in difficulties with movements on the other side of the body. Because of this, a person who has had a stroke on the left side of the brain may have difficulty moving the right side of the body. Many patients who have had a stroke experience muscle weakness (hemiparesis) or loss of movement (hemiplegia) on one side of their body.  This can affect their ability to use the leg on that side of the body. Muscle weakness or loss of movement can make it difficult to do everyday activities. Some of the effective therapies to improve leg weakness in the early phase of recovery include: Functional electrical stimulation (FES) Strength training
What is Unilateral Spatial Neglect and why is it associated with stroke?
Unilateral spatial neglect (USN) refers to a tendency to neglect things to one side of the body. The patient may appear to neglect one side of the body or may have difficulty seeing objects on one side of the body. This is a common condition following stroke, and is more common in patients who have had a stroke on the right side of their brain. A stroke on one side of the brain causes neglect on the other side of the body. For instance, a patient who has had a stroke on the right side of the brain will tend to ignore or neglect things in his left visual field. In this way, someone who has a paralysis on the left side of his body may also tend to neglect things to the left of his body. This condition can be treated. Click here for more information on unilateral spatial neglect
Why are balance difficulties associated with stroke?
Stroke can affect the systems of the body and areas of the brain that are responsible for balance. Side effects of stroke (e.g. hemiparesis, perceptual problems, spatial neglect) or side effects of medication can also affect balance. After a stroke, some patients may feel dizzy or unsteady on their feet. They may have difficulty keeping their balance when sitting, standing and walking. Patients may be prone to falls and will need help when transferring from one position to another (e.g. moving from the bed to a chair). A health professional will recommend positioning the patient for safety and may use assistive devices to help the patient during transfers. A health professional may use balance training to help improve balance.
What is shoulder subluxation and why is it associated with stroke?
Shoulder subluxation occurs when the bone of the upper arm (called the humerus) separates from the shoulder socket. It is common in patients who have hemiplegia after stroke. Shoulder subluxation can cause a lot of pain and impacts on movement of the arm. Shoulder subluxation can be treated using Functional Electrical Stimulation (FES). It is also very important to consider safe and comfortable positioning of the body and arm.
What is cognition and why is it associated with stroke?
Cognition refers to mental processes such as memory, orientation, perception, reasoning and judgement. Stroke can cause damage to the parts of the brain that are responsible for cognition. This can result in problems with thinking, attention, learning, judgement and memory. Some patients may appear disoriented or easily confused. They may have difficulty understanding or remembering information. This can be very frustrating and can impact on relationships and recovery after stroke.
What about the family?
A stroke can be a very stressful event for the patient and his/her family members. Knowledge of stroke can help family members cope during this difficult time, and support the patient. Resources such as written information, group education programs and family support clinicians may be helpful for supporting patients and family members.