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

Olivia was transferred to the rehabilitation unit today. She has muscle weakness in her left arm and weakness in her left leg. Olivia would like to start walking but needs assistance from another person and a quad walker. She needs to be reminded to wait for help before moving from the bed to a chair or wheelchair because She had a fall when trying to move by himself this morning.

Olivia tends to slump to one side when She is sitting and She does not seem to notice that her left arm dangles over the sidearm of a chair. She mentions that She has pain in her left shoulder. Olivia needs help with bathing and grooming for her own safety, and needs reminders to tend to the left side of her body. She often does not make it to the toilet on time. Olivia is easily distracted during conversation but can answer basic questions. She is tearful and easily upset.

As a family member you may feel concerned about Olivia and her recovery from stroke.

Before the stroke Olivia was living with her spouse in their two-storey home. The couple shared domestic activities and J enjoyed swimming, golfing, socializing, and driving to various activities. They have 2 adult children: the daughter lives close by and visits frequently. The other child has very little contact with the couple.

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

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 her left visual field. She may not remember to wash the left side of her body or shave the left side of her face. The patient may also neglect the left side of her body and may need reminding to place her left arm or leg in a safe position.

Click here for more information on USN patient/family information

Some of the therapies that are used in the treatment of unilateral spatial neglect include:

Repetitive Transcranial Magnetic Stimulation (rTMS)

Mirror therapy

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. It is 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, or difficulty solving everyday problems. This can be very frustrating and can impact on relationships and recovery after stroke. Cognitive rehabilitation programs aim to improve cognitive skills such as memory, attention and concentration, so that patients can do daily activities independently (e.g. use the phone, manage medication).

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 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.