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

Jase is starting rehabilitation. he has right arm weakness but is able to move his right arm with effort. Jase also has right leg weakness (hemiparesis). his balance is poor so he must use a quad cane when he walks with the therapist. The right side of Jase's face is drooping slightly. he has difficulty finding words (aphasia) but he is able to speak in one to two word sentences. he seems to understand when you talk to his. Jase is still having difficulty swallowing medication with water and he coughs while eating (dysphagia). Jase seems to be depressed since the stroke.

As a family member you may feel overwhelmed at this point and may be thinking about the future and wondering how things will work out once Jase is home. You also are concerned about how Jase will do over the next weeks and how he will cope with all of these changes in his life.

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.

What is stroke rehabilitation?

Stroke rehabilitation aims to help patients recover 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, dietitians 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.

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 therapies that may help to improve arm weakness in the rehabilitation phase of stroke recovery include:

Constraint-induced movement therapy (CIMT)

Functional electrical stimulation (FES)

Mirror therapy

Motor imagery

Repetitive Transcranial Magnetic Stimulation (rTMS)

Task-oriented training

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 therapies that may help to improve leg weakness in the rehabilitation phase of stroke recovery include:

Body-weight supported treadmill training

Functional electrical stimulation (FES)

Mirror therapy

Strength training

Task-oriented training

Why are walking difficulties associated with stroke?

Stroke can cause muscle weakness or paralysis on one side of the body. Stroke also causes difficulties with balance. This in turn can affect walking after stroke. Patients are encouraged to take great care when walking, as falls are common after stroke. Patients with walking difficulties may be instructed to wait until another person can help them.

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

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Patients may participate in therapy to improve their walking skills. Some of the
effective therapies to improve walking skills after stroke include:

Body-weight supported treadmill training

Functional electrical stimulation (FES)

Motor imagery

Strength training

Task-oriented training

Virtual reality

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.

Some of the therapies that may help to improve balance during the rehabilitation phase of stroke recovery include:

Balance training

Body-weight supported treadmill training

Strength training

Task-oriented training

Virtual reality

Why is facial paralysis associated with stroke?

Stroke can cause weakness in the muscles of the face. This is called facial paralysis and is caused by damage to a part of the brain that controls the muscles of the face. Facial paralysis can affect the ability to move one side of the face. This can in turn, impact on tasks such as eating, drinking and talking.

Why are communication difficulties associated with stroke?

Some patients find it difficult to communicate or use language after a stroke. This is referred to as aphasia. Aphasia is common in patients who have had a stroke on the left side of their brain. There are different types of aphasia and the symptoms depend on which area of the brain was affected. One type of aphasia affects the ability to say words and sentences. Patients may have difficulty finding the words they want to use. Another type of aphasia affects the ability to understand what people are saying. Aphasia can also affect the ability to read and write. Aphasia can range from mild to severe. It can be very frustrating for patients who cannot communicate their needs, feelings or thoughts to other people.

Click here for more information on Aphasia

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For more information on aphasia including symptoms, diagnosis, treatment and tips, visit the Aphasia Institute of Canada.

Why are swallowing difficulties associated with stroke?

Difficulty with swallowing after stroke is referred to as dysphagia. It is caused by damage to the areas of the brain that control the nerves or muscles used to swallow. If the area of the brain that controls muscle movements is affected, then it may be difficult to use the muscles of the lips, cheek, tongue, throat, or esophagus to move the food. This can cause aspiration or pneumonia.  If the area of the brain that controls sensation is affected, then it may be difficult to taste flavors, feel different textures, or identify the temperature of foods or drinks. Dysphagia may cause difficulty or discomfort when eating and drinking.

Click here for more information on Dysphagia

Is depression common after a stroke?

Depression is very common after a stroke. Depression 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.

Click here for more information on Depression

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.