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

Susan has been home from hospital for six months after the stroke that affected her left arm and left leg. She still has some left arm weakness and left leg weakness but she is getting stronger. She wants to know about arm therapies and leg therapies that are effective at this stage. She walks independently and uses a cane only when walking outdoors. She wants to know about effective therapies to improve her walking speed.

The unilateral spatial neglect that Susan had early on after the stroke has resolved. But, she finds that her cognition is not like before the stroke and she would like to know about cognitive therapies to improve her memory and her attention. This is especially important to Susan because she wants to resume driving. She is waiting for her driving assessment appointment and is anxious to know more about what happens when you go for the driving assessment.

She also wants to play golf and resume other leisure activities but is not sure she will be able to keep up with her friends. Also, she is concerned that she is not getting as much aerobic exercise since her stroke because she has stopped her usual activities these past months. She is also wants to know more about how to prevent another stroke (secondary stroke prevention).

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). Rehabilitation may begin 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 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/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 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 cognitive rehabilitation long after a stroke?

Stroke can have a long-term impact on Cognition (i.e. mental processes such as memory, orientation, perception, reasoning and judgement). Cognition difficulties such as poor attention, memory and judgement, or difficulty learning new information, can be very frustrating and can impact on relationships and recovery after stroke. There is evidence that Cognitive rehabilitation can improve memory and cognitive skills long after stroke.

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Click here for more information on cognitive rehabilitation

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?

Some people may have difficulty driving after a stroke. The effects of stroke can impact on motor, visual and cognitive skills required for driving. It may be necessary to sit a driving assessment after a stroke, to determine whether it is safe to resume driving. Health professionals can provide rehabilitation to assist with return to driving.

Click here for more information on driving after stroke

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

Why do health professionals prescribe assistive devices after stroke?

Assistive devices are pieces of equipment that make daily activities easier to perform. Health professionals such as occupational therapists and physiotherapists may recommend that a patient uses assistive devices after a stroke. There are various assistive devices that can be used for tasks such walking, eating, grooming, dressing, bathing, toileting, communicating and participating in leisure activities. They can help regain independence after a stroke.

For more information on assistive devices, click here.

How can we avoid another stroke?

Unfortunately, the chance of having another stroke is quite high in patients who have already had a stroke. The second stroke may occur in a different area of the brain, causing different problems. Some risk factors cannot be controlled. However, it is possible to make changes to other risk factors such as diet, lifestyle and health, in order to reduce the likelihood 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.