“Every stroke is different,” says David Siegelman, Director of Rehabilitation at The Hebrew Home in Riverdale by RiverSpring Health in the New York City area. “People can experience vastly different effects based on such factors as the type, location and severity of the stroke.”
“This is what people most often associate with a stroke,” Siegelman says, “but depending upon its location, a stroke also may affect balance, vision or communication. The inability to communicate is often a major issue that people experience immediately after a stroke. They may lose their ability to speak or they’ll use words that don’t make sense. They may develop swallowing difficulties, also called dysphagia.”
Stroke victims also may have problems with attention or judgment. “It’s not uncommon for people to not understand their deficits after the stroke, which creates its own set of barriers,” Siegelman says. One common effect, for example, is “neglect,” in which the person has no awareness that one side of the body exists.
Personality Changes After a Stroke
Personality changes after a stroke also can occur. This may or may not be an after-effect of the stroke itself. “You’ll see more personality issues if the stroke affects the frontal lobe of the brain,” Siegelman says. “However, you may also see personality changes for reasons that are secondary to the stroke. As the individual learns to deal with their new deficits, you may see signs of depression or anger. They may become withdrawn or lose interest in activities or in eating.”
Additionally, Siegelman reports that a stroke may cause emotional problems. “If the stroke affects areas of the brain that control specific emotional behaviors, you may see such alterations as emotional lability, in which the person laughs or cries inappropriately.”
With some strokes, memory loss is an issue. One of the most common causes of memory loss in the elderly is multi-infarct dementia, which Siegelman explains is caused by a series of small strokes. Also known as vascular dementia, it is the second most common form of dementia after Alzheimer’s disease.
Caregiving After a Stroke
The post-stroke plan of care must take into consideration the person’s unique circumstances and needs. “There is no cookie-cutter approach to care,” says Siegelman. “It needs to be individualized. In some cases, therapy is restorative in nature, in that you are trying to restore function. For instance, for somebody who is unable to feed themselves, you’re trying to get them to be able to feed themselves again. However, therapy can also be adaptive. A person may have lost the use of one hand, so they may need to use adaptive feeding equipment such as built-up utensils or specialty plates with a wall that they scoop against to get everything on their spoon.”
Typically post-stroke care requires the attention of a multidisciplinary team, headed by the patient’s physician but also including nursing, therapy, perhaps a dietician and other medical professionals. “From a therapy standpoint, there may be physical, occupational and speech involved depending upon the individual deficits,” Siegelman says. “A lot of the therapy is educational, both for the patient and the caregiver.”
A stroke patient will typically transition from a hospital to an in-patient rehab hospital or sub-acute rehabilitation center such as the sub-acute care units at RiverSpring Rehabilitation. The patient’s stay in a rehab facility may last several weeks or even a few months, depending upon the rate of progression. Whether the patient then goes home or to a long-term care facility is dependent upon which is the best environment for ongoing care. “It also depends largely on what family and resources are available to meet their needs when they return home,” Siegelman says.
In anticipation that their loved one will be returning home, Siegelman advises family members to make preparations for home care without delay. This may include modifications to the home environment, such as removing clutter, rearranging furniture, widening doorways or (if financial resources allow) remodeling the bathroom. If a personal home health aide is required, it may take time to find an individual who is the right fit.
“That’s why starting the process right away is so important,” Siegelman says. “If it turns out that a long-term care environment is more conducive to your parent’s recovery, it’s far easier to cancel those plans rather than scrambling last-minute to put a plan in place. The family and the patient need to work together to come up with a plan that they’re both comfortable with.”
Recovery After Stroke
Siegelman reports that the greatest recovery from a stroke usually takes place within the first six months, though research shows that recovery can continue for a year or longer. “People with larger support systems often do better post-stroke. They have people to lean on and help them through the process.”
The amount of home care required can vary greatly. Says Siegelman, “It can be a full-time job for some people. Others may just need intermittent support —maybe somebody to come into the home in the morning and again in the evening.”
The good news is that more than one-third of stroke survivors recover almost completely or with minor impairments. Many are able to resume a life in which they can drive, run errands and interact with family members as they did prior to the stroke.
“I’ve seen some people recover to the point where they can essentially return to work,” Siegelman says. “I’ve also seen patients who continue to require total care.”
With care and support, a broad range of stroke survivors can adjust to a life that still has pleasure and purpose. “Deficits may occur after a stroke, but that doesn’t mean that quality of life needs to end,” Siegelman concludes.
Important: Read about how to prevent a stroke…