Martha’s Story (symptoms on right side of the body)

Martha is nearing discharge from hospital. she still has some left arm weakness and left leg weakness. Martha sometimes neglects people and objects on her left side – but much less so than when she first had her stroke. Martha is also less confused than she was soon after her stroke, but still has memory and problem-solving difficulties.

Martha is now able to transfer out of bed and in to a chair by himself. she has good sitting balance but still has trouble with balance when walking so she is using a quad walker. The therapist says that Martha should work on balance activities and on strengthening her leg and arm. She suggested that she would benefit from arm therapies such as constraint-induced movement therapy, task-oriented training, virtual reality, rTMS, motor imagery, mirror therapy, and functional electrical stimulation. For strengthening of her legs and to improve balance the therapist suggests aerobic exercise, balance training, functional electrical stimulation, mirror therapy, strength training or task-oriented training.

Martha is returning to her two-storey home that she shares with her wife and adult daughter. There are 5 steps up to the bedroom and she is able to go up the stairs using the newly-installed railing. she will need other assistive devices for bathing, etc. Martha is anxious to return home and becomes tearful (something that happens quite often these days) when discussing discharge. You might be worried that she is experiencing depression.

Before the stroke Martha and her wife shared domestic activities and she enjoyed swimming, golfing, socializing, and driving to various leisure activities.

As a family member you may feel concerned about how things will work out once Martha is home and how you will cope with all of these changes in your life. You have spoken to the doctor and to the nurse who also suggest that Martha would benefit from learning more about how to prevent another stroke.

Do you need a refresher on what causes a stroke?

A stroke is caused by uncontrolled bleeding in the brain, or by a blood clot 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.

Click here to visit the Heart and Stroke Foundation website for more information on stroke including causes, types, symptoms and effects of stroke.

What is stroke rehabilitation?

The term ‘stroke rehabilitation’ refers to therapy for patients to help in their recovery from stroke. A rehabilitation program is designed for each patient by the rehabilitation team. The stroke rehabilitation team is made up of doctors, nurses, pharmacists, dieticians and therapists (e.g. physiotherapist, occupational therapist, speech language pathologist, psychologist, social worker). Early rehabilitation may occur as soon as 1-2 days after a stroke and usually takes place in the hospital or in a rehabilitation facility. Some patients may require ongoing rehabilitation to help them regain their skills or learn to adapt to the difficulties they experience following stroke.

Is there anything new in the treatment of my arm at this stage of stroke recovery?

Many patients who have had a stroke experience muscle weakness (hemiparesis) or loss of movement (hemiplegia) on one side of their body. Muscle weakness or loss of movement can make it difficult to return to everyday activities.

Rehabilitation may focus on improving the patient’s use of her/her affected arm and hand. This will enable the patient to resume daily activities such as dressing, bathing and grooming, using cutlery during meals, participating in work or leisure activities, etc.

Some of the therapies that may be effective in improving arm function at this stage of stroke recovery include:

Constraint-induced movement therapy (CIMT)

Functional electrical stimulation (FES)

Mirror therapy

Motor imagery

Music therapy

Repetitive Transcranial Magnetic Stimulation (rTMS)

Virtual reality

Is there anything new in the treatment of my leg at this stage of stroke recovery?

Many patients who have had a stroke experience continued muscle weakness (hemiparesis) or loss of movement (hemiplegia) on one side of their body. This can affect the patient’s use of the affected leg for movement and everyday activities.

Some of the therapies to improve leg weakness at this stage of stroke stroke recovery include:

Functional electrical stimulation (FES)

Mirror therapy

Music therapy

Strength training

Rehabilitation may also include activities to improve walking. Some of the therapies that have been shown to improve walking skills at this stage of stroke recovery include:

Functional electrical stimulation (FES)

Gait trainers

Task-oriented training

A health care professional may also prescribe an assistive device. Mobility aides such as a quad walker, walking stick, roller walker or wheelchair can help regain walking skills and independence.

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Is there anything new in the treatment of balance at this stage of stroke recovery?

Side effects of stroke (e.g. hemiparesis, perceptual problems, spatial neglect) and side effects of medication can have a long-lasting impact on balance. Even weeks or months after a stroke, patients may feel unsteady when they are moving from one position to another (e.g. getting out of bed or up from a chair), walking on uneven ground (e.g. in the garden), or walking up stairs.

A health professional may recommend the following interventions or strategies to improve balance during stroke rehabilitation:

Aerobic exercise

Balance training using activities such as aquatic therapy, balance platform exercises and tai chi

Body-weight supported treadmill training

Functional electrical stimulation (FES)

Positioning for safety

Assistive devices when moving and transferring from one position to another.

Why do health professionals prescribe assistive devices after stroke?

Assistive devices are pieces of equipment that make daily activities easier to perform. Health professionals may recommend assistive devices for a patient when he/she is leaving hospital and returning home, as they can help the patient regain independence in everyday activities.

For more information on assistive devices, click here

Is depression common after a stroke?

Depression is very common after a stroke. Depression after stroke can be caused by injury to the areas of the brain that control our emotions. Also, stroke is a serious condition that causes big changes to the patient’s life. Everyday activities become very difficult and require a lot of effort. People may not be able to do the activities they used to enjoy. These changes can cause feelings of sadness, depression and mood swings. It is important to try to treat or manage depression as it can have a negative impact on recovery.

Click here for more information on depression

What leisure activities can people do after a stroke?

The side effects of stroke can make it difficult to return to hobbies, sports and activities that the patient enjoyed before the stroke. However, leisure activities are very important to our well-being and quality of life. Leisure and social activities are good for maintaining and improving physical health and mental health, which in turn helps the recovery process. Health professionals can help patients return to leisure activities, by helping to regain skills, adapt activities, or find new activities. Assistive devices can be used to make leisure activities more manageable.

Click here for more information on leisure & participation

Some people may have difficulty driving after a stroke. The effects of stroke can impact on driving skills. Health professionals can provide rehabilitation to assist with return to driving.

Click here for more information on driving after stroke

How can we avoid another stroke?

Unfortunately, the risk of having a stroke increases after a first stroke. If a second stroke does occur it will not necessarily occur in the same area of the brain as the first stroke, and so it could have different effects on the patient than the first stroke.

There are some uncontrollable stroke risk factors, such as age (over 60), gender, family history of stroke, ethnicity, and a previous incidence of stroke or transient ischemic attack (TIA).

Preventable risk factors include blood pressure, blood cholesterol, heart disease, type II diabetes, body weight, alcohol consumption, physical inactivity, smoking and stress. Lifestyle changes such as increasing exercise, ceasing smoking, diet changes and reducing stress can reduce the risk of a second stroke.

Click here for more information on secondary stroke prevention.

Click here for information from the Heart and Stroke Foundation regarding stroke prevention and risk factors

Click here for information from the Heart and Stroke Foundation regarding stroke warning signs.

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.