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

Blake has been home from hospital for six months after a stroke that affected his right side. He has been treated for right arm weakness and right leg weakness (hemiparesis) and for a right facial droop. Blake is communicating much better but still has difficulty speaking in full sentences (aphasia). He understands when his friends and family speak to his.

Blake is walking with a quad cane and his balance is improving. He no longer needs help when walking indoors but he would like to get better at walking outdoors. Blake uses his right arm and hand for activities such as washing and dressing but still finds the hand is clumsy and he tires easily when using it. He has some assistive devices at home but he would like to see what else is available to make life easier.

He has days when he is depressed, especially because he gave up many of his leisure and sports activities after the stroke. People have been encouraging his to start an aerobic exercise class and to use mirror therapy and constraint induced therapy for his arm. It is also time to resume his leisure activities or to find new ones that will provide pleasure.

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.

Is there anything new in the treatment of my arm long after a stroke?

Many patients who have had a stroke continue to 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 his/his 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 might be useful in improving arm function long after the stroke has occurred include:

Aerobic exercise

Constraint-induced movement therapy (CIMT)

Mirror therapy

Motor imagery

Virtual reality

The following therapies are useful for improving hand skills (e.g. treatment for a 'clumsy' hand) long after a stroke:

Functional electrical stimulation (FES)

Motor imagery

Repetitive Transcranial Magnetic Stimulation (rTMS)

Is there anything new in the treatment of my leg long after a stroke?

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 that are shown to improve leg weakness at this stage of after stroke recovery include:

Functional electrical stimulation (FES)

Virtual reality

Is there anything new in the treatment of walking long after stroke?

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:

EMG-Biofeedback

Functional electrical stimulation (FES)

Motor imagery

Task-oriented training

Virtual Reality

A health care professional may have also prescribed an assistive device. Mobility aides such as a quad walker, walking stick, roller walker or wheelchair may be used long-term to assist with balance when walking or moving.

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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:

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

Positioning for safety

Assistive devices when moving and transferring from one position to another

Is there anything new in the treatment of aphasia long after stroke?

Language and communication difficulties (aphasia) are common among patients who have had a stroke on the left side of the brain. These difficulties can persist long after a stroke.

There is evidence that some interventions are effective in treating aphasia long after stroke, including communication groups, constraint-induced therapy, repetitive transcranial magnetic stimulation (rTMS), intensive speech and language therapy and transcranial direct current stimulation (tDCS).

Click here for more information on Aphasia.

For additional information on aphasia including symptoms, diagnosis, treatment and tips, visit the Aphasia Institute of Canada (www.aphasia.ca).

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. Sometimes a patient will feel depressed
soon after the stroke, while other times a patient may begin to feel depressed several months or years after the stroke.

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

Is it safe to do exercise after a stroke?

The effects of stroke, such as muscle weakness, hemiparesis, balance and walking difficulties, can make it difficult to do exercise. However, it is important to resume exercise after a stroke because this will help with recovery of muscle strength and motor control. Exercise is good for heart and lung function, fitness and endurance. It also benefits mental health and well-being

It is recommended that patients have a full medical evaluation before starting an exercise program. Health professionals can help choose a suitable program. It is best to start with activities the patient can enjoy and succeed at.

Click here for more information on aerobic exercise

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.