Interview with CBT specialists: Rehabilitation process post stroke

Jānis Grants, a psychology doctor and brain injury rehabilitation specialist, begins the interview by explaining the complexity of stroke rehabilitation process. "It is very complex and difficult, not only for the stroke patient but for the whole family. There are several changes that happen very rapidly. One day a person is perfectly able to function, communicate with others, and the next day they are without these functions." In this article, read an interview between Latvia's leading professionals in the field Janis Grants and Agnese Orupe, a cognitive behavioral therapist, who talk about the rehabilitation process post stroke, what is to be expected, how a stroke occurs and how the different types of stroke manifest.

Rehabilitation process post stroke: Introduction

Agnese and Jānis both describe the main changes that occur to a stroke survivor. Janis mentions that these changes manifest in different ways: "One of them is with a person's cognitive abilities. Then, language ability, the ability to think rationally. Behavior certainly changes. Before stroke one is able to do almost everything, post stroke they are limited due to their physical abilities. Emotions, the ability to maintain relationships change. These are some of the most significant changes post stroke."

Janis continues about what should be done if there's a stroke survivor in the family: "I think many families don't really know what to do. They lack the information and support." He mentions that stroke survivors and their families often obtain a negative perspective towards recovery because of what doctors and medical professionals tell them. "Of course, a negative outcome can occur if there isn't a proper rehabilitation intervention. Yet with a proper stroke rehabilitation program, very good recovery results can be achieved." Agnese sums up that most importantly the stroke survivor should follow their according rehabilitation program and consult with medical professionals and doctors. In case a stroke survivor doesn't have a prescribed rehabilitation program, Vigo can help with its structured exercise plan. "Most importantly you should exercise daily, exactly as instructed, even if it's very difficult," Agnese emphasizes. Jānis mentions that a stroke survivor will experience difficulties doing various things and also lacks motivation. Therefore support from loved ones is very important.

Brain neuroplasticity: What is a stroke?

Agnese and Jānis talks about how a stroke occurs. Agnese explains that a brain injury occurs during a stroke: "There are two options - either a blood vessel clogs, as a result not enough blood flow occurs. Or the vessel bursts, and a haemorrhage in the brain occurs. Unfortunately these injuries are irreversible, unless the stroke is not very mild. And the more extensive the injury, the more affected the ability to function, the body and the emotional system." But in this case, brain neuroplasticity helps. Jānis explains what brain neuroplasticity is.

"There are very important changes that occur in the brain, brain activity and cells. Let's say, the injured brain cells won't be able to perform those same functions they used to. However, the brain can restructure itself such that other parts of the brain take over those same functions that the affected part of the brain used to perform." Jānis emphasizes that the brain neuroplasticity process is very much dependent on how diligently the rehabilitation program is followed. If a stroke survivor doesn't follow the program and doesn't perform the necessary exercises that promote brain neuroplasticity and stimulation, then the link between the active brain cells and affected body parts won't be formed. "If there isn't a lot of activity, no improvements will be seen. This new "conversation" in the brain won't be formed, and unfortunately the stroke survivor will become disabled," reveals Jānis.

Agnese says that a rehabilitation program needs to be started as soon as possible. As soon as the doctors allow to begin the rehabilitation process after the acute phase, it should be done. "Why is that so important? If time passes, some months or even a year, then the chance to reprogram the brain will be greatly reduced. Therefore, the optimal time to do so will be during the first few months. A lot should be done in the first year. Progress can occur later as well, but it won't be as obvious and vast," says Jānis. The patient will have more permanent damage, and the condition won't improve as rapidly anymore. "Problem is that often times people lack the energy, they don't know what to do, how to do it and what is the right amount. And it is important that clear instructions are given, that for example Vigo provides. Support from loved ones that can help maintain the motivation and positive spirit is crucial as well," says Jānis. Agnese sums up that involvement from relatives is very important, both to perform the physical exercises and emotionally, such that the stroke survivor has a positive outlook towards their recovery. "Because the brain neuroplasticity basically promises us that there can be improvement. And this improvement can be significant."

Types of stroke and after effects

Agnese and Jānis talk about the different types of stroke. "So, what we know when this brain injury occurs, different parts of our brains are responsible for different functions. And depending on where the brain injury occurred, one function or the other will be affected - either the ability to talk, the emotional system, etc." Both specialists describe the different types of stroke and their typical after effects. Jānis mentions there are three main types of stroke. One of them is when a stroke occurs in the right side of the brain. That is when the left side of the body won't work as it previously did. He mentions the most typical signs for this type of stroke: "There will be muscle weakness, muscle activity will be affected. Paralysis could also occur when the right part of the brain is affected. There could also be problems with focusing. A person might not be able to recognize things, they may feel confused. This type of injury could also cause changes in emotions." He also mentions that the person can seem lethargic, could be overcome by inadequate emotions.

Jānis describes the second type of stroke, when the left part of the brain is injured. In this case the right side of the body will be affected. There will be weakness in the right arm and leg, could also be paralysis. "And that is the difference, how severely the arm and the leg will be affected. The important part about injury in the left side of the brain is that language is severely affected. Those can be difficulties talking, understanding language, different types of aphasia. That is the hardest part because the person can no longer communicate," says Janis. He emphasizes that this is usually the most difficult part for a stroke survivor - to lose the language and speech abilities. And it requires hard work to regain these functions. It is possible that language ability won't return the same way it was before. Both specialists mention that there are different types of speech impairments that can occur. Agnese says: "A stroke survivor may understand what they are being told, but they cannot express themselves." Janis mentions: "Or the contrary - they may be able to talk and express words, but it makes no sense and others are unable to understand what they are trying to say." He continues: "Or it could be that the stroke survivor is spoken to in their mother language, but it may seem foreign to them."

Janis describes the third type of stroke which occurs in the brain stem: "With this type there are significant problems, because the most basic "ingredients" are affected. Those that we don't even think of daily - breathing, heart function. As well as coordination, the ability to keep your balance." He mentions that this type of stroke survivor will experience impairments in muscle activity, and won't be able to use them like before. Difficulties are in that cognitive abilities are very good in this case. The stroke survivor is able to perceive and understand information well, however physically they look incapable. Agnese mentions that double vision may occur: "The person is ready to do things, however they cannot manage to navigate the space since the coordination is greatly affected. Which is a big problem when a person wants to exercise." Loss of balance creates the risk of falling which can cause more injury to the stroke survivor.

The pace and intensity of stroke rehabilitation

Both specialists talk about the pace and intensity of the rehabilitation, how fast the stroke survivor can begin the rehabilitation process and what families can expect. "As we mentioned before, it is important to begin rehabilitation as soon as possible. A person has suffered a major injury, and their ability to mobilize their energy and fully work on the rehabilitation exercises will be very limited at first. They will be very weak." Janis says that initially exercises should be performed very carefully, in small intervals. Someone who is physically stronger can help out. Because strokes differ in their intensity, the pace for the exercises will differ too: "It is very important to notice how capable the person is, how much energy they have. And simply take small breaks to relax," explains Jānis. He mentions that loved ones should encourage the stroke survivor, give praise and express their care in different ways. "You can bring them tea, a snack, and then continue with exercising once more. And every day, many hours a day, in the same manner. You can work a few minutes, then take a break, then increase intervals gradually. And continue with this kind of routine," Jānis suggests.

Agnese explains that it is important to create a daily regimen for the stroke survivor. "What doctors often mention in hospitals is that stroke survivors often have a reversed daily regimen. They sleep during the day and want to exercise at night, when everyone else in the household is asleep. This wouldn't be a good routine, especially at home - when the family wants to relax, the stroke survivor is finally ready to exercise. That is why a daily regimen is very important," she explains. Jānis adds: "Why is it important to be active at day and sleep at night? We have our natural rest/activity rhythm. We are awake during the day such that we can get energy from the sunlight." He suggests holding on to a specific daily regimen - wake up at 7:00-8:00 AM and go to sleep at 9:00-11:00 PM. He explains why such a daily routine is important: "A routine helps calm people and give them the structure they need. So in the morning it could be breakfast, a cup of tea or coffee, personal hygiene. Then could be some time to perform work, for entertainment or a hobby. The intervals shouldn't be too long." It is important to pay attention to how much the stroke survivor is able to do, and when he is no longer able to perform the necessary exercises as successfully. Jānis mentions that exercises should be performed when the stroke survivor still has the energy: "It is important to understand that post stroke a person gets stronger progressively and starts recovering. You don't regress post stroke." He mentions that a stroke survivor's condition stabilizes with time, progresses with exercising by following the rehabilitation program.

Pace of recovery post stroke

Both specialists talk about the pace of recovery and when some improvements can be observed. Jānis mentions: "If you think it will happen tomorrow, you will be disappointed. The recovery process from stroke is very slow compared to what we are used to. It will take time. If the rehabilitation program is followed consistently, then step by step the situation will improve." Jānis explains that the process is long, it lasts several years, and in some cases can last 5-10 years. "But if the person continues with the exercises, do what they have been shown and what they have learned. They will continuously improve little by little. The problem is that we are used to working a little, then stopping and hoping everything will be fine," says Jānis. He emphasizes that it is important not to discontinue the rehabilitation process, keep up with the exercises, otherwise the progress will stop. He mentions that families need to understand that their support will be needed for many years. "It won't happen that after a few months of exercising consistently you will be able to relax. Therefore it is also important that family members come up with their own routines for this situation, and have patience. "They should switch roles, relax at times, because it will be very demanding and stressful to support a person with a major injury like this," Jānis admits. Agnese adds: "Returning back to the metaphor about a child - the greater the brain injury, the smaller the "child". And the more years they will need to recover, the more support system they will need."


Stroke and coronavirus: How are they related?

Researchers from Thomas Jefferson University claim that young patients without any stroke risk factors might have a higher risk experiencing a stroke if they have contracted COVID-19. That is regardless whether they are showing any stroke symptoms or not. Surgeons at Thomas Jefferson University with team analyzed patients with stroke from March 20th until April 10th at their institutions. The strokes they observed were unlike what they usually see. In this article, read about research and observations made by American medical specialists about stroke and coronavirus, and how they might be related.

Stroke and coronavirus - Observations are worrisome

"We were seeing patients in their 30s, 40s and 50s with massive strokes, the kind that we typically see in patients in their 70s and 80s," says Pascal Jabbour, MD, Chief of the Division of Neurovascular Surgery and Endovascular Surgery in the Vickie & Jack Farber Institute for Neuroscience - Jefferson Health. He is a senior author of a study published in the journal Neurosurgery June 4th that examines and characterizes strokes of patients who tested positive for COVID-19, performed in collaboration with surgeons from NYU Langone Medical Center in New York.

"Although we have to stress that our observations are preliminary, and based on observations from 14 patients, what we have observed is worrying," says Dr. Jabbour. "Young people, who may not know they have the coronavirus, are developing clots that cause major stroke."

The researchers, including first author Ahmad Sweid, MD, examined 14 patients who had come into their stroke unit for acute stroke. Eight patients were male, six were female, 50% did not know they had COVID-19, while the rest were already being treated for other COVID-19 symptoms when they developed stroke.

Some of the paper's major points:

  • Patients with signs of stroke were delaying coming to the hospital for fear of getting the coronavirus. There's a small window of time in which strokes can be treated, therefore delays to seek help can be life threatening.
  • The mortality rate in these COVID-19 stroke patients is 42.8%. The typical mortality from stroke is around 5-10%.
  • 42% of the stroke patients with COVID-19 were under the age of 50. Most strokes in the US (over 75%) occur in people over the age of 65.
  • The incidence of coronavirus in the stroke population was 31.5%, according to this sample of patients.
  • These patients had stroke in large vessels, in both hemispheres of the brain, and in both arteries and veins of the brain. All of these observations are unusual in stroke patients.

The coronavirus, which was assumed to be a disease of the lungs, is apparently causing blood clots that lead to a higher incidence of stroke. Researchers have shown that the coronavirus enters human cells via a very specific access point - a protein on human cells called ACE2. The virus latches onto this protein and uses it as an entry point into the cell, where the virus can replicate. Not all cells have the same amount of ACE2. This protein is very abundant on cells that line blood vessels, the heart, kidney, as well as the lungs. Dr. Jabbour and colleagues speculate that the virus may be interfering with this receptor's normal function, which controls blood flow in the brain, also using it as a gateway to the cell.

Another possibility is that the inflammation of the blood vessels (called endothelium) causing vasculitis with injury to the cells lining the lumen of the vessel, and causing micro thrombosis in small vessels.

"Our observations, though preliminary, can serve as a warning for medical personnel on the front lines, and for all of those at home," says Dr. Jabbour. "Stroke is occurring in people who don't know they have COVID-19, as well as those who feel sick from their infections. We need to be vigilant and respond quickly to signs of stroke."

Observations of stroke patients with COVID-19 in New York

An article in New York Times reports disturbing cases of stroke among young adults. Neurologists in New York City, Detroit, New Jersey and other parts of the country have reported a high number of such cases. Many are now convinced that these unusual strokes represent yet another unknown manifestation of Covid-19.

The cases add to evidence that the avirus attacks not only lungs, but also kidneys, brain, heart and liver. In rare instances, it seems to trigger a life-threatening inflammatory syndrome in children. “We’re seeing a startling number of young people who had a minor cough, or no recollection of viral symptoms at all, and they’re self-isolating at home like they’re supposed to - and they have a sudden stroke,” said Dr. Adam Dmytriw, a University of Toronto radiologist who is a co-author of a paper describing patients who suffered strokes related to Covid-19. The paper has not yet been peer reviewed.

Though a number of those patients had diabetes and hypertension, none had heart risks known to be risk factors for developing stroke. Many were under age 65. For some, stroke was the first symptom of COVID-19, and they postponed going to the emergency room, fearing exposure.

Out of 10 patients described in Dr. Dmytriw’s paper, two died because the coronavirus attacked their lungs, and two men (ages 46 and 55 respectively) died due to strokes.

Doctors at Mount Sinai Health System in New York have also seen an unusual number of young stroke patients. They claim they treated five such patients with Covid-19 during a recent two-week period. The hospital typically sees only one stroke patient under the age of 50 every three weeks, Dr. Johanna Fifi, a neurologist, and her colleagues noted in a letter in The New England Journal of Medicine.

Alarming observations in young people

An article in health portal Healthline, draws links between COVID-19 and strokes as well. It points out that:

  • Although typically considered a lung infection, COVID-19 has been found to cause blood clots that can lead to severe stroke.
  • Experts say that this can happen to anyone regardless of age, and even in those with few or no symptoms at all.
  • People with COVID-19 as young as 30 are experiencing strokes even when their symptoms were mild.

COVID-19, the disease caused by SARS-CoV-2, has been thought to attack lungs. Some of the symptoms it causes include cough and difficulty breathing, however doctors are noticing a disturbing trend. People as young as 30 are experiencing strokes, even when their symptoms were all in all very moderate. “The coronavirus has been shown to cause development of microthrombi [small clots]. These clots can travel to the lung and obstruct blood flow to the lung, which is called pulmonary embolism, or travel to brain circulation and cause ischemic stroke,” Dr. Theresa Capriotti from Villanova University, told Healthline. “It seems to be happening to those affected with severe COVID symptoms,” Capriotti said. “It can occur in any age group and it occurs suddenly.”

Symptoms to watch out for include:

  • weakness or paralysis of arm and leg on one side of the body
  • lack of sensation in arm or leg on one side of the body
  • facial droop on one side of the face
  • speech impairment

To learn more about stroke signs and symptoms, read in our article "What are the symptoms of a stroke and when to seek medical help?".

Doctors in New York "sound the alarm" about stroke and COVID-19

When doctors like Dr. Johanna T. Fifi at Mount Sinai saw unusual numbers of stroke patients with COVID-19 in March, she and colleagues decided to release a public warning. “We’re hypothesizing that the virus is having an effect on the lining of the blood vessels all through the body - and that is what is leading to the clots,” she said. Their report was published in the New England Journal of Medicine (NEJM).

“We published that report because that was a little bit unusual to see so many young patients in such a short period of time,” said Fifi. “But we have some other research looking at our overall numbers, and we saw about double the amount of large vessel strokes than normal during the peak weeks of COVID.” She confirmed it’s very likely these blood clots are COVID-19-related, and added that it can occur in any age group and can occur suddenly.

“It’s definitely something that COVID is doing, it seems too strong of an association to be unrelated at all, it’s just too much of a coincidence,” said Fifi. “What we know is that COVID is causing blood vessel blockages in other regions, the legs for instance, and COVID is damaging the blood vessel lining throughout the body

How COVID-19 might be causing stroke

A recently published research finds COVID-19 and other diseases that cause severe inflammation throughout the body can increase the risk of fatty plaque buildup and blood vessels rupturing. This can lead to stroke and other cardiovascular diseases.

“Patients with COVID-19 are also at an increased risk of VTEs,” the study authors wrote. According to the American Heart Association (AHA), a venous thromboembolism (VTE) is a blood clot that starts in a vein, and it’s the third most common vascular diagnosis after heart attack and stroke. Influenza and other particular viruses have also been associated with an increased risk of plaque ruptures, noted the authors.

The research, conducted by University of Virginia (UVA) Health Systems’ Dr. William Brady and team, is intended to serve as a guide for emergency medicine doctors treating people with, or suspected to have, COVID-19.

“In writing this article, we hope to increase emergency physicians’ knowledge and awareness of this new pathogen and its impact on the cardiovascular system,” said Dr. Brady in a statement.

Although typically considered a lung infection, COVID-19 has been found to cause blood clots that can cause severe stroke. Experts say that this can happen in any patients regardless of age, and even in those with few or no symptoms at all. Because of this, Mount Sinai Hospital in New York City began treating people with blood thinners in April. A new study released in May also found that severe inflammation from COVID-19 might lead to a build up of plaque that can increase the risk of stroke. Concerns regarding getting sick could delay stroke treatment, and doctors encourage not to delay getting treatment for stroke under any circumstances since it is a life threatening condition.


What happens 5 years post stroke?

A stroke occurs suddenly and unexpectedly, however dealing with stroke after effects can take several years. In this article read about what happens 5 years post stroke and what can be expected during this time.

In the early rehabilitation period, stroke survivors may experience different kinds of attitudes. Most common thoughts are:

  • "I am going to recover very quickly. Just a little bit longer, and I will be completely fine!"
  • "This process will be long, but I am ready to work such that I get better!"
  • "What's the point in trying, nothing is going to change anyways.."

It is understandable to have such thoughts since it's the first experience with stroke for most people. Their expectations also alternate with the doctors' forecasts about their recovery. Every case is unique and no outcome can be immediately dismissed. Research shows that neuroplasticity is active throughout lifetime.

What can be expected during the first years of recovery?

Initially a stroke survivor will require a rigorous rehabilitation regimen and support from the medical team since most of the recovery results will be observed during the first year post stroke. You can also achieve good results years post stroke. However it will be much easier to learn correct movement at the beginning, instead of unlearn incorrect habits and then relearn them correctly. That's why it is important to pay attention to activities that give long term as well as short term functional results. In order to achieve the best results possible, you should begin rehabilitation as fast as possible.

VIGO can serve as a good aid for recovering from stroke. It is available upon request and it can be used at home. VIGO combines the "Gold standard" for stroke rehabilitation. It contains emotional support through CBT (cognitive behavioral therapy) techniques, physiotherapy exercises in order to improve functional abilities and educating materials about stroke causes, after effects and ways to recover.

After hospitalization and acute care, the patient will be appointed for inpatient rehabilitation at a rehabilitation center. However it is possible that you may have to wait before the appointed course. Therefore we suggest that when consulting with your doctor, you consider rehabilitation at home.

During the first stage of rehabilitation, recovery will happen very quickly, even on a weekly basis. However it will be a result of hard work.

What is the active period for neuroplasticity?

The active period for neuroplasticity is the time period after trauma when the body is trying to use its resources to "mend" or to compensate the damaged part of the brain. It is necessary to create new neural pathways to replace the damaged ones. Several studies have proven that damage at a certain part of the brain makes the brain actively react. Furthermore, that causes neuroplasticity and stimulates fast renewal of bodily function.

Neuroplasticity in case of brain damage is like building a new road to replace the old one. Meaning, when an old road that is unfit for driving needs to be replaced for a new one. It can be shifted to one side or the other yet will lead to the same destination. Same thing happens with the reorganizing of the brain map. When one neural pathway is damaged, it can be replaced by a new one which can be located at a different area (even in the opposite side of the brain), but will lead to a particular body movement or destination.

To promote this recovery, it is necessary to do seemingly redundant exercises often and correctly. This will help build new neural pathways that control movement.

Even though the creation of neural pathways happen throughout lifetime, the active period for neuroplasticity is unique for each individual. After stroke it can last up to one year.

What happens after the active period for neuroplasticity?

The most significant and fastest changes will happen during the first year post stroke, however rehabilitation shouldn't be stopped even when you think you have reached the maximum results. When you've reached your goal, consider whether it is possible and necessary to modify the exercises, increasing the difficulty level. However exercises should only be modified such that they are safe for the stroke survivor's physical and mental health, yet challenging enough.

It is proven that patients who perform exercises for physiotherapy and fine motor skills five days a week reach very good results within five years. And in case of a less severe stroke, a complete recovery is possible during this time. However patients who had a more severe or a very severe stroke will need more time.

5 years post stroke - What comes next?

It is difficult to forecast the exact results that can be achieved within five years time since it depends on various factors. It depends on the stroke survivor's previous physical state, age, rehabilitation intensity, motivation and other factors. However it is possible to reach new heights after the five year mark as well.

After 5 years post stroke or more, with a rigorous rehabilitation at least five days a week, the stroke survivor still has a potential to improve their physical state. VIGO offers rehabilitation six days a week with an option to exercise on the seventh day, performing existing exercises of the week. Therefore it serves as a great tool for staying active and continuing your recovery even years post stroke. The best results can be attained if you start using the program in the first few days after returning home from acute rehabilitation hospital. This tool offers a personalized rehabilitation program for each individual's functional state, and the exercise plans are created with the help of medical professionals

To sign up for VIGO, write to hello@vigo.health


Types of vision impairment after stroke

Vision impairment is quite a common stroke after effect. At least half of the stroke survivors will experience some kind of vision impairment. However others may have blurry vision or have other sorts of changes in vision. In this article find out what kinds of vision impairment after stroke are the most common.

It is also not rare to experience vision impairment on one side. For example, if you experienced a stroke in the left side of your brain, you may have vision impairment on the right side. If the right side of your brain was damaged, then you might experience vision impairment on the left side. Optic nerves as well as body sides are controlled by the opposite side of the brain. This means that vision impairment will align with bodily disability.

Vision impairment on one side

Field of vision can narrow or a part of it "goes missing". This condition which stroke survivors often experience is called homonymous hemianopsia. In this condition, an injury to the left part of the brain results in the loss of the right half of the visual world of each eye. An injury to the right part of the brain produces loss of the left side of the visual world of each eye. This condition is created by a problem in the brain function rather than a disorder of the eyes themselves. As a stroke after effect, it is most common to experience homonymous hemianopsia on the left side.

 

Defects in visual perception

Around one third who has experienced a stroke can experience defects in visual perception. It can manifest as not being aware of one side of the body, difficulties of recognizing faces, objects or color perception. When a stroke survivor is not aware of one side of their body, it is a kind of attention impairment which means being unaware of that whole side. It is caused by a stroke in the parietal lobe. This impairment is not only related to vision, it also relates to one's spatial perception. In certain cases it is possible to experience difficulties perceiving moving objects. Also experiencing impairments in perceived information from the surrounding environment is common.

Eye movement impairment

It is quite common to experience a defect due to eye position called strabismus. Strabismus is an incorrect eye position in relation to eyelids and the corners of the eyes. With strabismus, the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. Having difficulties focusing vision on objects that are closer or further is also a type of eye movement impairment. A common occurance both during stroke and as a result of stroke is double vision or twitching.

How to recognize if your loved one has vision impairment?

If your loved one with stroke doesn't recognize or doesn't inform you about any of the aforementioned impairments, others may notice them only much later during rehabilitation. Especially if a part of the field of vision is missing or is narrowed. Because the brain can activate a compensation mechanism that replaces the missing part of the field of vision with another image. When one experiences narrowed field of vision, they may run into a doorway, a pole in the street, etc. They may also not notice objects on the right or left side. Other kinds of vision impairment is difficulty finding objects on colorful, flat surfaces or difficulty reading. Along with these impairments comes decreasing self-confidence and independence in daily life because of loss of stability. Therefore the person doesn't want to go outside on their own, because they are experiencing fears of missing something or falling.

What can be done in the case of vision impairment?

In most cases vision impairments are permanent, however it is possible to minimize them with eye training or coming up with a compensation mechanism. In case of any vision impairment it is important to consult with an ophthalmologist or neurologist. That way you can find out whether there are any methods or options to alleviate a stroke survivor's daily life and promote independence. In the case of double vision, covering one eye might help. It might be possible that an eye specialist will recommend you some technical vision aids (glasses, magnifying glass, screen reader,etc).

Vision impairments cause a lot of discomfort to anyone, besides after a stroke this can be an additional factor for unsafety. Even though most such impairments are irreversible, sometimes it can happen that vision recovers spontaneously or due to diligent eye training. In this case VIGO can help you. It is digital therapy for stroke rehabilitation which you can use in a tablet. The screen is big enough, and the option for resizing the letters is suitable for patients with vision impairment. That way a stroke survivor can use it safely and comfortably during their recovery process.


Interview with CBT specialists: "Stroke affects the whole family, not just the stroke survivor"

Agnese Orupe, a cognitive behavioral therapist in Latvia, says: "In our country we tend to not see it that way, but elsewhere it is considered that the whole family suffers from stroke, not just the stroke survivor. A stroke basically affects the whole family ecosystem." It really is true that not only the stroke survivor is in need of support - the whole family involved is. In this article, read an interview about stroke with Latvia's leading CBT specialists Yanis Grants, a psychology doctor and a brain injury rehabilitation specialist, and Agnese who talk about stroke patients, the role of their families in the recovery process, and the support needed for the stroke survivor and their families - a very important yet often forgotten subject.

Agnese mentions that stroke can affect a person emotionally, and that can be very stressful for both the stroke survivor and their families. "It can show in many different ways. A stroke survivor can become very tearful. Or aggressive. They might not recognize common items anymore, and they can become scared of them. It can even happen that a person who has never cursed in their lives, suddenly is cursing all the time," says Agnese. Yanis emphasizes that great changes come along with stroke. One has been able to cope with their own life all their life suddenly feels stressed about everything they try to attempt: "Family members who are used to a person who is competent, capable, someone they liked spending time with. Who was able to give and to take. And now they experience something very different." As a result the whole family experiences a lot of stress and the sudden changes take a lot of energy.

Family's role after a stroke

Both therapists talk about the role of the family during the rehabilitation process, adding that the stroke survivor has found themselves in a difficult, life changing situation. "Because of the limitations the stroke survivor experiences, they practically need to find a new meaning in life. And the more severe the damage, the harder it is to find one. A stroke survivor can feel like a huge burden to their family, therefore love from the family, as well as patience, care and support are invaluable. Without them, it might not even be possible to cope," says Agnese.

Yanis adds that roles in the family often change after a stroke. If previously a person was supporting other family members, then all of a sudden they are in need of support. "Now they are ones incapable and need to be cared for. And I think these changes in family roles are very, very difficult." Agnese compares it to when a baby is born. The help and support needed is about the same, and even the length of recovery can be similar to raising a baby. Yet, comparing to a child, accepting help for an adult can be very difficult. As Agnese says, "If a child accepts help without hesitation, and sometimes even asks for it, then an adult has it especially hard that all of a sudden he needs to be cared for."

Yanis adds that while it is very important for the families to support their loved one with a stroke, it is also important to encourage them to act and do things on their own. When you allow that instead of doing things for them, It will promote a better recovery progress and won't let them get accustomed to too much help. "They need to do their exercises, but I think that sometimes family members who are very nice start doing what the patient needs to do. They start to serve them in all kinds of ways where it would be better if the stroke survivor did that for themselves." And sometimes the stroke survivor, in the confused state that they are, would not be able to evaluate how much help they should or shouldn't accept. As a result, it does more harm than good. "Hence it is important to define those roles. And the family has to support, encourage, and help, but they can't do the things that the patient needs to do," Agnese sums up.

Both therapists stress that it is important for the stroke survivor to be as independent as possible, yet support from family is an integral part. "It is important to express pride, support and be happy even about the smallest steps of progress. And to give positive encouragement and feedback," says Agnese. Yanis agrees, "Positive reaction is the best thing that you can give. And when you walk into their room to help, it is important that you do it with a smile. That you show that you want to be there. That you are happy to see them." He stresses that family arguments should be avoided in front of the stroke survivor loved one, and conflicts resolved elsewhere. Otherwise that will only add more stress to everyone, and a stroke survivor has a harder time dealing with stress.

Most common fears for families

Agnese says that a stroke is usually something new for a family, something that they haven't experienced before. Therefore families might feel scared about the new situation. Yanis and Agnese discuss the most common fears that families experience, and what can be done to cope with them. "From experience I'd like to mention that most often families fear that they will do harm to their loved one," says Yanis. Family members often think that by urging their loved one to move, to use their arms and legs, they do harm because their loved one is in pain. And then the opposite happens - family members back out and don't get involved anymore.

"It is important to understand that the injury, the damaged cells are in the brain. And the brain controls the movement in our arms and legs with the signals that it sends through our nervous system. Hence, when family tries to help their loved one and he or she says "It's hard, i'm in pain", it is not because their body parts hurt. It is due to the over sensitivity caused by the trauma." It is important to understand that it is nothing bad and no harm is being done. "We are used to that we experience pain only when something harmful happens. But it is not the case with stroke. And people often don't know this and they back out not to cause harm." Therefore, Yanis considers that the greatest fears families have is to harm their loved one. And as a result they back out and don't provide the kind of support and help that is needed.

Agnese says that it is not only recommended to encourage to act and do things, it is necessary: "The worst thing we can do to a stroke survivor is to let them sleep all the time. It increases the chance for blood clots to form in the joints. Then when they stand up, they will get dizzy which is normal, but it will get harder and harder for them. The joints will become stiff and they will basically start hurting not because of the stroke induced trauma, but from the fact that they are not used for a prolonged time."

Yanis also mentions that the situation is even more serious because stroke survivors are usually elderly people. And when their muscles are not being used, they can experience muscle atrophy very quickly. After that regaining muscle function can be very difficult, sometimes even impossible. "It is very important to stand as much as possible, move, walk. Just constantly do things," Yanis adds. It is better to do something than do nothing at all, Agnese continues: "Anything, even if it is not so good, even if it is not so right. Any movement is better than no movement at all. And if it is unclear what exercises to do, VIGO program will provide exercises and show step by step what can be done. You just have to do them, little steps, in order to achieve progress," says Yanis.

Possibility to recover - more possible than it seems

Both therapists stress one very important aspect which often affects how the stroke survivor and their family sees recovery from stroke. They mention that the stroke survivor and their families often leave the hospital with a very gloomy and dark view of the future, without much hope to recover. It happens because medical personnel is not used to organized planned rehabilitation programs, knowing that they haven't been available due to lack of resources, finances and other circumstances for most people. And it is understandable that without rehabilitation, hopes to recover aren't really high.

"And so family members and their loved one perceive a very negative picture of the future while still at the hospital. They are given predictions from a position that such rehabilitation programs aren't available. And even if they are, people don't use them, and this view becomes so dark, so hopeless, thinking that everything is going to be as it is or even worse," says Yanis. He mentions that because people are in a sensitive position, they listen to such recovery prospects and accept it as truth. "But here medical specialists don't consider that there are ways how everything can be changed. And that is what successful rehabilitation does. VIGO is one of very concrete and well made rehabilitation options that can indeed change this outcome. And you shouldn't accept such hopeless views towards future," Yanis discloses.

Agnese also talks about the discoveries that are made everyday about our brains, therefore any kind of recovery prospects cannot be assumed with certainty: "None of us know how capable our brains are. And what scientists discover every day more and more is that our brains are phenomenal. There are even cases where damage has been so severe and widespread, yet despite prognosis, even lethal prognosis, people recover and are able to function." Therefore, not knowing the ability and the potential of our brain, Agnese emphasizes the only known truth: "What we can assure with 100% certainty is that if you are not going to exercise, you are not going to improve. But if you exercise, the only way to see how great the improvement can be is with time and consistency."

Recovery from stroke - a collaboration process for the family

Yanis also emphasizes the need to collaborate and maintain a positive environment for a more successful recovery. "The family members should collaborate. If there is more than one person, it could be a good idea to work almost like in shifts helping each other. While one works and helps the loved one with a stroke, others rest, and so on. It is very important to try and maintain that positive environment within the family, and be grateful for everyone who gets involved and tries to help. It is very important to provide this positive feedback and express gratitude." Yanis says that in this way a positive energy is being created in the family, along with nice words and support. The stroke survivor will feel this and it will definitely help.

Stroke is very tough on everyone involved, and family members shouldn't feel guilty about their anger and negative emotions. "We talk about the feelings and emotions that the stroke survivor might experience. But we sometimes forget that family members also have a lot of feelings in this situation. They can also feel angry, sad, want to cry, and it is very important for them to take care of their emotional health," Agnese emphasizes. She mentions that it would be important for family members to talk to someone they trust, who listens to them and supports them during this difficult time. One way is to write a diary to record feelings and emotions. "Probably what you shouldn't do is be angry in front of your loved one with a stroke. Because that can only increase their sense of guilt and feeling like a burden to their family."

Both therapists emphasize that even though recovery from stroke is a long and time consuming process, and is also very tiring, it can also be very rewarding as time goes by. "Seeing a person who only slept after the hospital and couldn't move now being able to cook and take care of themselves. It can bring a lot of joy," says Agnese. Yanis agrees and mentions that the reward can be even greater with time when the stroke survivor will not only take care of themselves but will also give to others. And may even regain the role they used to plan in the family, and give their loved ones what they used to give. Both therapists sum up that the most important thing is not to give up, to stick to the rehabilitation program meticulously. And give praise to your loved one and yourselves about the good job that you have all done and the progress that you achieved.


Stroke in men and women: Are there differences?

Diseases for both men and women are mostly similar, however they can show with different symptoms or occur due to different risk factors. This also goes to stroke. Stroke is one of those conditions where men and women experience many things in common, however there are also noticeable differences. Anyone can experience a stroke, and it is a tough condition for anyone. However stroke in men and women can appear differently.

Disease prevention and control centers say that men have a higher chance of experiencing a stroke in the short term. However in the long term men have a smaller risk than women. Men are more likely to experience a stroke at a younger age. However women have a higher chance of dying from stroke. In this article read about the stroke symptoms and risk factors that are different and common for men and women.

Stroke signs and symptoms

A sudden arrival or worsening of the following is characteristic for both women and men who experience stroke:

  • Difficulties understanding speech and language
  • Loss of balance, poor coordination
  • Numbness or tingling in the face, legs or arms
  • Difficulties walking, stumbling
  • Difficulties talking or slurred speech
  • Worsening eye sight in one or both eyes
  • Weakness in face, legs or arms - especially in one side of the body

Most of these stroke signs are widely known. To learn more about stroke signs and symptoms, read in our article "What are the symptoms of a stroke and when to seek medical help?".

Stroke symptoms and risk factors for women

There are also some less known stroke symptoms, and women report them more often than men:

  • Fainting or loss of consciousness
  • Seizures or hallucinations
  • Loss of breath
  • General weakness in the body
  • Nausea or vomiting
  • Hiccups

These symptoms can show independently or together with other more common symptoms. Women also reported more nontraditional symptoms like headaches, dizziness, changes in emotional state such as confusion. Sometimes men also experience the aforementioned symptoms.

There are also certain stroke risk factors that apply specifically to women. Women are at a higher risk of experiencing a stroke if:

  • A woman is pregnant. The body experiences natural changes during pregnancy. For example, stress on the heart, increased blood pressure, etc, that increase the risk of a stroke.
  • Birth control pills. It is still being researched how much exactly can birth control pills increase a risk for stroke. Newest studies show that mainly such risk exists for women who already have other risk factors like obesity or increased blood pressure. If you do not have any other risk factors, the increased risk from birth control pills exists but it is very little.
  • Hormone replacement therapy (HRT). It can alleviate the symptoms of menopause like heat waves or increased sweating. However it also increases stroke risk. This has become a popular topic for research, and newest studies are still evaluating whether this is true.
  • Migraines increase the risk of experiencing a stroke 2.5 times. And most people who experience migraines are women.
  • Mental health disorders. Depression, anxiety and stress are related to an increased risk of a stroke, and women are more likely to experience them.
  • Atrial fibrillation (jeb AFib). This heart condition is prevalent for both men and women, however women are more likely to experience it. Also, women with AFib have a tendency for experiencing heavier strokes.

Stroke symptoms and risk factors for men

Men more often than women have diabetes, smoke cigarettes and drink heavily which increases their risk of experiencing a stroke. In one study about stroke it was evaluated what differences women and men experience when it comes to stroke. The most common symptoms for men were:

  • Difficulties keeping balance, poor coordination abilities
  • Weakness in one side of the body
  • Numbness in one side of the body

Because men experience symptoms that are more widely known, the surrounding people and medical personnel will have an easier time diagnosing a stroke for men. This also reduces the time in general between experiencing a stroke and getting medical help.

In one study about stroke it was determined that men who experience stroke in general leave the hospital with fewer stroke after effects than women. Also, men after a stroke are more active daily than women. This might be due to the fact that men are generally younger when they experience a stroke than women. Because of that it is easier for them to recover.

In general, men recover from a stroke faster and more successfully. Men also have a smaller chance of experiencing:

  • Stroke related disability
  • Difficulties with daily tasks
  • Depression
  • Fatigue
  • Mental health issues
  • Worse quality of life after a stroke

A stroke can occur suddenly. Even if you actively try to live a healthy lifestyle, there are stroke risk factors that are outside your control like having a stroke in family. However it is important to control the risk factors that are under your own control for the most part. To learn more about risk factors, read in "What causes a stroke?".

Recovery from stroke for men and women

Some people recover from stroke completely and do not experience any lasting after effects. Others need a prolonged physical therapy, rehabilitation and medications. Those can be blood thinners, to lower blood pressure, to lower cholesterol level, etc.

Whether you are a man or a woman, recovery from stroke depends on various factors. Those include:

  • What side of the body was affected
  • Time when oxygen and blood flow were blocked
  • Overall health condition before the stroke

It is very important to seek medical health immediately, treat stroke and prevent lasting after effects. Recovery from stroke requires hard work. Even though rehabilitation cannot reverse the brain trauma caused by a stroke, it does help you relearn your lost skills and functions. The time required, as we found out, to recover from a stroke depends on the severity of the stroke.

Even though there are cases when people recover faster, recovery from a stroke can take years. Because women are usually older when they experience a stroke, recovery can take longer due to the older age. The bodies of elderly people tend to recover slower from a trauma. However men usually are more physically active as well as younger when they experience a stroke. Therefore the stroke after effects are usually not as severe as they are for women. Men however often encounter other stroke risk factors such as smoking, alcohol consumption, etc. Either way both men and women after a stroke have a chance to return to fulfilling lives with the help of rehabilitation and healthy lifestyle. This helps them avoid another stroke and protect them from other diseases.


Can stress cause a stroke?

It is well known that too much stress is bad for our health. It can cause headache, digestive issues, anxiety, problems with sleep, etc. But can stress cause a stroke? In this article read about research on stroke and stress, what doctors say as well as stroke risk factors that are directly linked to stress. It will help you determine whether the amount of stress you experience in your life can put you at increased risk of experiencing a stroke. Even though one stressful day most likely won't put you at risk, research shows that chronic, prolonged stress can increase your risk of experiencing a stroke.

What does research about stress and stroke say?

Based on research that showed up in "Stroke", an American Heart Association journal, middle-aged and elderly people who experienced high levels of stress, depression and hostility are at a much higher risk for stroke and TIA (Transient Ischemic Attack). In the study with almost 7000 participants, everyone did a survey about their stress levels which included questions about chronic stress, signs of depression and hostility.

During the survey, none of the participants had any cardiovascular disease. However in the follow up surveys, around 10 years later, 147 participants experienced a stroke and 48 had a TIA. It might not seem like a big number considering the volume of the surveyed, yet those who experienced stress had a 59% greater chance of getting a stroke or a TIA due to stress. And those who showed signs of hostility had a two times greater possibility of experiencing a stroke. From the research it was concluded that stress contributes to an increased risk of a stroke.

One Harvard University research about the relation between stress and stroke claims that stress can be just as dangerous and defining of a stroke risk factor as smoking and high blood pressure. Research showed how when experiencing stress, amygdala (an area of the brain that deals with stress) sends signals to the bone marrow to produce extra white blood cells. This however causes inflammation in the arteries. And inflammation as we know is involved in processes that lead to heart attack, angina and stroke.

Even though the aforementioned is based on research, there are various more factors that serve as evidence that stress can lead to stroke. And because stress is very common everywhere in the world, it is very important to look into this question further, learn more about stress, how to control it and minimize it as much as possible.

Am I experiencing too much stress?

Ryan Sundermann, an MD from UnityPoint Health says that too many people ignore the stress they're experiencing and doesn't treat it as serious as they should. Determining how much stress a person experiences is difficult because each person has a different tolerance for stress. “One person’s stress is not the same as another’s. Some folks have a lot of stress just from dealing with kids and finances. Others might carry the stress of running a small business or an entire corporation. Then, there are jobs where people are faced with real world dangers, like firefighters and police officers where real world dangers are no big deal and they are as happy as anyone else. Regardless of your job, if you feel you’re under stress, you probably are,” Dr. Sundermann says.

If you are not sure whether you are under stress, ask yourself the following questions:

  • Is my partner telling me that I seem stressed?
  • Am I experiencing conflicts at work or at home more than usual?
  • Do things that used to make me happy do not bring me as much joy?
  • Is it hard for me to fall asleep or stay asleep unlike before?
  • Is it hard for me to get out of bed in the morning, especially in days I know will be more draining?
  • Do I use alcohol, drugs or tobacco to feel less stressed?

What happens to my body when I experience stress?

During stress the brain releases chemicals that do several things to prepare us for a threat. These chemicals are being produced no matter the kind of stress we experience. It can be due to physical harm, fear, grief, daily stress from work or relationships, etc. The chemical process in the body will be the same. The two main chemicals that are released during stress are cortisol and adrenaline.

  • Cortisol is a hormone that makes our body retain water and sodium which causes increase in blood pressure. It also has different other mechanisms like storing sugar in the body, and it also makes the sugar available for use such that our bodies get energy. Evolutionary this process served well. It prepared us to protect ourselves and run from a dangerous animal, attacker, and in today's world helps us deal with a big, urgent problem when otherwise we are tired from a long day and out of energy.
  • Adrenaline is a hormone that is also known as epinephrine and is a type of catecholamines. Adrenaline and the hormones similar to it cause increased heart rate and and increased blood pressure. The increased blood pressure will pump blood to vital organs.

Does stress cause a stroke?

Two of the main types of stroke are ischemic stroke (stroke that occurs due to blocked arteries) and hemorrhagic stroke (stroke that occurs due to bleeding arteries). To find more about the types of stroke, read in our article "What is a stroke?".

As we discovered the stroke risk factors (read in "What causes a stroke?"), for example, high blood pressure, high cholesterol levels, obesity, etc. And knowing that stress can exacerbate them, then it is for a good reason to think that stress and stroke are indeed linked. Stress can also lead to unhealthy habits like smoking, sedentary lifestlye, unhealthy diet, etc, which are also stroke risk factors.

“If you’re at increased risk because of your family history or you have other risk factors, such as tobacco use, high blood pressure, etc., then a very stressful event is going to increase cortisol and adrenaline, which can raise blood pressure and stress vessels already at risk. The increased blood flow could also disrupt plaques that might be fragile,” Dr. Sundermann says. He also adds that if you live in a chronic or persistent state of stress, there is some evidence of increased stroke risk, which we also found out from the aforementioned research results. However, this connection is complex and not fully understood. But when looking at the basics of stress and stroke, it makes sense.

“When under constant stress, you have persistent high levels in cortisol and other stress hormones. This causes retention of salt, which increases blood pressure. Overtime, that would cause stress on blood vessels. Stress also causes an increase in blood sugar, which means the vessels can’t dilate or contract to better control blood flow. Increased cortisol also disrupts sleep cycles, which can make us more stressed and release more cortisol. Poor sleep means fatigue, and fatigue can cause us to gain weight for several reasons. Simply, when we are tired we are less likely to exercise and more likely to eat poorly,” Dr. Sundermann says.

How to control and minimize stress levels?

With so many stress causes and obvious link between stress and stroke, it is very important to consciously try and control it. Stress can lead to unhealthy lifestyle, however consciously sticking to healthy lifestyle can help control stress and minimize it. It is a vicious circle. You can keep it under control with physical activities, well balanced diet, regular sleeping patterns, etc. Certainly there will be life events and times that are going to cause a lot of stress. It can be at work, a difficult life experience, relationship difficulties. However within your capabilities it is recommended that you do what you can to reduce it due to your own health. These are some suggestions that may help you.

  • Listen to music that makes you feel good
  • Talk to a loved one or a friend when you are feeling low
  • Write, paint, draw or express yourself creatively in any other way
  • Take a walk outside
  • Accept that there are things that you cannot control
  • Learn and try a relaxation technique: yoga, meditation, etc
  • Do your best to organize your time and schedule
  • Set achievable goals and learn to say "no" when you feel like you are being asked too much
  • Allow some time for your hobbies, interests and relaxation
  • Rest enough after a stressful day or a difficult experience
  • Try to avoid alcohol, drugs and any other compulsive behaviors to reduce stress
  • If you have the chance, you might want to talk to a therapist

Life after stroke: Psychological tips

Recovery from stroke entails physical therapy and rehabilitation. However psychological stance towards your recovery and health is also extremely important to achieve better recovery results. To experience a stroke is very tough, both physically and emotionally. To lose function, have a disability all of a sudden and other stroke after effects is difficult. It is understandable that a stroke survivor goes through a hard time emotionally as well. Acceptance of what happened comes at a different pace for each stroke survivor. In this article, read some psychological tips after stroke that may help you during your recovery.

Learn about neuroplasticity

For brain to heal after stroke, it is necessary to activate neuroplasticity. Neuroplasticity is a brain mechanism that it uses to reprogram itself. Neuroplasticity is the number one thing to focus after a stroke - all the rehabilitation and physical therapy is done to activate it. Therefore it is incredibly important to keep a regular, intense rehabilitation regimen. Learning about neuroplasticity will help you understand what is happening to your body and mind while you recover. You'll learn about how function is regained and how your brain reacts to the new information while healing from the stroke induced trauma.

Recovery timeline after stroke.. Not set in stone!

Even though it is known that recovery after stroke is the most rapid and effective for the first few months, don't let it limit you! Even when recovery results seem to slow down and seem less visible, you shouldn't stop there. That is not the end of your recovery. Even after the first few months and most visible results, continue your rehabilitation regimen, exercise regularly, yet it might be a good idea to introduce a greater exercise variety. Significant recovery results can also come after the first few months!

In order not to lose function of your affected side..

Even though after a stroke it is easier and more convenient to use your strong side, during recovery it is especially important to move and exercise your affected muscles, arm and leg. If you don't use them, the affected arm and leg might completely lose function and your body will forget how to use them. This happens because when you don't move a part of your body, your brain might completely forget how to use that part with time. To prevent this from happening, it is recommended to use the affected parts every day, even if it is for a little bit. But regularity is crucial. Your rehabilitation plan should provide that your affected side is exercised enough on a daily basis.

"Nocebo" effect

Avoid the "Nocebo" effect which can significantly affect your stroke recovery results. "Nocebo" effect happens when a doctor or someone else limits you with their forecast about your recovery. For example, a doctor tells you that you will never be able to walk without a walking stick again. Limiting statements like these can have a strong effect on your psyche when you believe them. This is the "Nocebo" effect and it can even prevent you from recovering from a stroke fully when otherwise it would be possible.

Believing in a limiting recovery forecast might make you try less and acquiesce with what is told. This only shows how extremely important is to maintain your own belief in your body and health, believe in your recovery potential and not allow external opinions limit you. In the end, it is up to you. Don't allow an external opinion to become your only truth!

Most importantly.. Attitude!

Often times a successful stroke recovery depends on the attitude that a person has towards themselves, their health and how strong their will to get better is. There are cases when doctors' forecasts aren't as hopeful, yet a stroke survivor is very determined and recovers much better than expected. A traumatic brain injury survivor Nicole Marquez was given poor recovery chances, yet she ended up regaining way more function that the doctors expected. She says, “You can either take that leap of faith or you can stay here idle. But you have to do something. And if it works, it works. And if it doesn’t, at least you tried. But anything is possible.” Having faith in yourself and self motivation can truly bring about more successful recovery results.

Follow a "1% a day" approach

Thinking "all or nothing" won't work for stroke recovery. Recovering from stroke is a long, gradual process, therefore your best approach will be to have patience with it. If you feel exhausted, take a break and relax. It is not necessary to achieve results rapidly - you need to take the recovery steps day by day, and everyone has their individual timing. Instead of trying to complete and achieve as much as you can, set yourself a small goal every day. Thus, the "1% a day" recovery goal. This will protect you from burning out and disappointment, when you don't achieve the desired results after trying so hard. And instead of throwing everything away, you achieve progress slowly yet steadily, with results that are there to stay.

Slow down..

Continuing the previous point, nowadays the society encourages fast results, rush and productivity. Such societal standards are pressuring and those who don't comply might feel like they are failing. Slow processes are resisted, fast solutions and efficiency sought after. This puts pressure on everyone to be the best and the most successful, and if one fails to achieve results rapidly and successfully, it can often cause self criticism and low self esteem. Same goes to when recovering from stroke. Just like with everything else, it is supposedly necessary to achieve recovery results quickly. It is important not to pressure yourself, not to criticize if you don't succeed at achieving results as rapidly and successfully as you would have wanted. Everyone has their own tempo - tune into that instead of following external pressures.

Allow yourself to feel grief and difficult emotions

A person who experiences loss will be met by feelings of grief. This is a natural process which shouldn't be resisted. Same thing happens when a person experiences a stroke - it is also a loss to an extent, since you often lose a great part of your old self. If you do not allow yourself to feel your emotions and grieve, they will get suppressed which will cause stress in your body and unpleasant feelings either way. Even more, it will prolong the process of grief and make the negative emotions even more intense.

Instead of trying to suppress your anger, depressive mood and other difficult emotional states you may have, accept them and let them be. Eventually you will feel much better and more liberated, as you will be able to get through the difficult emotions and grief sooner.

Get rid of negative thinking.. with gratitude

Our brains have a natural bias towards the negative, and they remember negative events more vividly than positive ones. To resist this mechanism, the practice of gratitude is a great tool. Even though you have difficulties after a stroke, it is possible that there are things you feel grateful for. It may be a loved one you are grateful for, having a home, having food on the table or having things you are still able to do after the stroke. You can develop a gratitude practice by spending just a brief moment every day, writing or thinking about what you feel grateful for. It can be a short amount of time, only two minutes, yet it should be done every day in order to create a habit.

It is also a type of neuroplasticity. Expressing gratitude can help reprogram your thinking, help you become more positive which will assisty you during your recovery and overall well being.

Seek help from others

It may be that you are used to doing everything on your own and you dislike asking for help. However after a stroke, you will need to change this. A stroke survivor needs help from others because they will simply not be able to do everything on their own. As much as you would like to, it will be too difficult. You may need help with chores around the house or you may feel low and need someone to talk to. Whatever it may be, try to overcome your pride and ask for help when it's necessary. You will find that people will be happy to help out! Even the seemingly strongest and most capable people need others.

Consider getting a pet

After a stroke it may be that you are alone at home and feel lonely. It might be a good time to consider getting a pet. A pet can serve as emotional support and will provide you company. It can also give you a greater motivation to recover since a pet needs to be cared for. For example, your pet may need to be brushed. Brushing it can also serve as a therapy exercise for your affected arm, and is also more enjoyable. Research shows that pets help for a better emotional state and well being. If you think that getting a pet might be for you, consider what kind of an animal could be right for you.


Personal story from stroke survivor Līga: "I was given a second chance".

Stroke is a disease that affects millions of people worldwide each year, and for Latvia with its less than 2 million population, 9000 people suffer from it every year and 30,000 people live with stroke after effects. Unfortunately the stroke recovery statistics in Latvia is below the EU average. Mainly it is due to insufficient resources and lack of guidance to receive proper, timely treatment.

Līga is a stroke survivor from Latvia who shares her story. She begins with how it started: "It happened suddenly. I was alone and felt dizzy. I couldn't move. That's when I knew it was serious". She talks about the fear and uncertainty she felt right after, not knowing what is going to follow. "I was told I would have to live differently. I had difficulties balancing and walked as if I was drunk. Something so seemingly simple as walking step by step I just couldn't do". After the traumatic experience of a stroke, Līga claims how she had fears that the stroke would return. Luckily she received a great emotional support from her husband - something incredibly important for a stroke survivor.

Unlike other patients who receive rehabilitation services in inpatient or outpatient facilities, Liga used VIGO to assist her along the way during her recovery process. While her husband was away at work, she could use the program and exercise at home, making the most out of her time. When he would return home, he could get involved and do the exercises together with Līga.

To learn more about Līga's recovery path, how she found the motivation to recover and won't waste her second chance, as well as the challenges stroke survivors and medical staff face during COVID-19, watch the video below:

 


Life after stroke: Going back to work

Usually when hearing the word "stroke", one thinks of an elderly person. However, turns out that around 25% of all stroke cases are among people who are working age, and who have to stop working against their will. As we discussed in previous articles, stroke after effects are both physical and cognitive. Those include memory loss, short attention spam, difficulties processing new information, as well as speech and language function. Physically stroke affects balance, coordination, causes muscle weakness and physical pain. Emotionally a stroke can cause depression and changes in personality. These and more after effects affect how and whether a person will be able to return back to work. Nevertheless, returning back to work after a stroke is often possible.

Can a stroke survivor really work?

Almost half of the working age stroke survivors (till the age of 65) return back to work either full-time or part-time. Despite that, there are still prejudices in society about stroke survivors and their abilities. Dr. Mitchell Elkind, professor of neurology and epidemiology at Columbia University College of Physicians and Surgeons in New York and chair of the American Stroke Association Advisory Committee claims that “Most people, when they think of stroke, they think of a person who’s paralyzed and can’t walk or speak, is lying in bed and can’t take care of themselves. Certainly, there are strokes that do that. But there are a lot of strokes that don’t do that." He also stresses that employers and the society need to learn that just because someone experienced a stroke doesn't mean they can't return back to work and perform their work responsibilities. "It all depends on how serious the stroke was, how severe it was and the nature of the deficits. It’s really a very individualized kind of phenomenon,” says Dr. Mitchell Elkind.

After receiving rehabilitation, a stroke survivor indeed may be able to return to work but is often accompanied by doubts and uncertainty. Questions such as "Will I be physically capable to do my job? Will I lose the state benefits/allowance from my country? Do I need to discuss anything in particular with my employer before I can return back to work?"

First of all, it is a question of safety - such that the stroke survivor doesn't endanger themselves and others. Even though each stroke case is unique, it is most likely that a prolonged amount of time will be needed (6-8 months) before you can return back to work. Even if the stroke was relatively mild many most working age people experience, it is still important to receive treatment and properly evaluate your health condition together with your doctor. Your occupational therapist can help you with that, as well as with setting up realistic goals during your stroke recovery timely.

Employers should know..

Stroke researchers claim that both employers and doctors need to educate themselves more about the issues and limitations a stroke survivor faces when returning back to work. Because many of these issues are not immediately obvious (inability to focus, fatigue, etc), employers, general practitioners as well as stroke survivors themselves often overlook them. Yet they affect productivity and ability to work profoundly, and without understanding them, it will be hard to evaluate whether a stroke survivor is able to work.

With some adjustments both from the employer and the stroke survivor employee, returning back to work can be even very successful. Vocational rehabilitation counselor for the Rehabilitation Institute of Chicago, Robert Trierweiler helps by evaluating the stroke survivors' abilities to return back to work. He talks about a stroke survivor who worked at an export company. This employee had balance problems and had difficulties to climb ladders. However the employer allowed him to work on the ground floor with the ground crew with the condition that he will not have to climb stairs. Another employee, he claims, understood that work in the office is too challenging for him and applied for disability status.

How and why should an employer help?

It is important to properly evaluate your abilities and try working if you believe you are able to. Most employers nowadays are forthcoming and try to accommodate employees with disability to the best of their ability. If you aren't sure whether you are ready to go back to work, it might be a good idea to visit the work place before you return to work. Another option is to agree on a trial period with your employer or start part-time and return to work gradually. This will help both you and your employer to minimize the anticipation about whether you should come back to work or not.

An employer can even benefit if a stroke survivor returns back to work. An employee who has previously done the job will know the job responsibilities well, as well as the work environment and people. This allows for a more successful work than if a new employee who needs to be trained were to join. Therefore, it is both in the stroke survivor's and employer's interests that he or she can return to work as soon as possible and not lose their position. In order to do that, receiving a timely help and rehabilitation is crucial. To learn more about the different options for rehabilitation, read in our article "What are the options for stroke rehabilitation?". It is also recommended that the employer keeps in touch with their stroke survivor employee and shows support - this will give the stroke survivor a greater motivation to recover and to return back to a normal life.

Employer can help their employee who has physical functional limitations by offering some modifications. If a stroke survivor employee would like to request particular modifications for their workspace due to medical reasons, they might need a doctor's note. Such modifications can be:

  • Special tools as extensions to help reach necessary objects
  • Non-slip gloves for a better grip
  • Keyboard that is adjusted for writing with one hand
  • Speech recognition program
  • Work station that can be regulated (with the option to work while sitting and standing)

What can you do if you are not able to perform your previous job?

As mentioned in the article, there was a case when a stroke survivor returned to work and realized it is too difficult for them. What to do then? If you survived a stroke, you might have cognitive disabilities such as fatigue, significant memory loss, difficulties concentrating, Then you might not be able to return to do your job even if you are physically capable. If it is possible, you might try to work less hours first, work from home or if possible, return to work gradually.

According to a stroke survivor with the name of Paul E. Berger, who went on to become an entrepreneur, the most important traits when seeking for work is "creativity, good attitude and hard work". You may want to list your skills and qualifications from your previous jobs, and find that they translate in other possible careers. For example, if you were once a teacher and cannot return to the classroom, you might want to start writing textbooks or become an editor in the subject of your knowledge.

There are many people who return back to work after a stroke - you might want to reach out to them through stroke groups and forums. There are organizations that help stroke survivors find jobs and even employers who have had personal experiences with stroke and who are accommodating with hiring stroke survivors. By reaching out to these different channels, you might even find yourself starting out a new career.

If you worry that an employer might not want to hire you, look into the rights and policies for hiring with disability in your country. For example,  under the Americans With Disabilities Act, employers can't fire or refuse to hire people with disabilities and must do their best to accommodate for employees' disability-related needs. To learn more about disability discrimination policies in the US, read in the U.S. Equal Employment Opportunity Commission website.

Depending on your country, you may qualify for certain social benefits, tax relief or other relief programs. To learn more about social benefits and disability benefits for stroke, read in our article "What support is available for stroke survivors with disability?".

Returning back to work after a stroke - a personal decision

Every stroke survivor case is unique, and so is the time they will be able to return back to work. It also depends on how severe the stroke was, what are the side effects and after effects. It is necessary to receive treatment and rehabilitation in a timely manner as well as set goals to achieve better recovery. One of the main goals if the stroke survivor is younger than 65 might be returning to work. Stroke survivors and their families often undergo financial difficulties and even debt - rehabilitation and treatment often turns out to be expensive. As a more accessible and cheaper rehabilitation method, you might want to try digital therapy for stroke VIGO.

It is both in the family's and stroke survivor's interests for them to return to work, provided the health condition is stable enough. And even if you might need to do a career change, getting back in the workforce with minimal downtime might be a good decision. A job gives a sense of independence, confidence and motivation which are all extremely important for a stroke survivor. Working strengthens the bond with their local community and society, and expands one's social circle. Employers shouldn't be scared - just because a person experienced a stroke once doesn't mean it will happen again. To learn more about stroke prevention and how to prevent another stroke from happening, read in our articles "What can help prevent a stroke?" and "Preventing another stroke".