stroke after effects

What are stroke after effects?

There are various effects and consequences that a stroke survivor experiences, both physically and emotionally. In this article, we will cover functional changes that a stroke survivor might experience. Stroke after effects can include physical changes, psychological changes, cognitive changes and more. Since no two stroke cases are the same, these can vary in type and severity.

Common physical stroke after effects

Weakness or paralysis on one side of the body

If the stroke occurs on the brain’s right side, the left side of the body and face (sparing the forehead) will be affected. It’s the opposite for a stroke that occurs on the left side of the brain. There are also differences in effects depending on which side of the brain the stroke occurred.

If the left part of the brain was affected:

  • Paralysis on the right side of the body
  • Speech/language problems
  • Slow, cautious behavioral style
  • Memory loss
  • Vision problems

If the right part of the brain was affected:

  • Paralysis on the left side of the body
  • Vision problems
  • Quick, impulsive behavioral style
  • Memory loss

Fatigue After a stroke

Everyone feels tired sometimes, but post-stroke fatigue is not a typical tiredness. The extreme tiredness that a stroke survivor experiences is called post-stroke fatigue. Unlike usual tiredness, fatigue doesn’t always improve with rest and it isn’t related to how busy or active you’ve been. Post-stroke fatigue usually starts to lessen a few months after the stroke. But for some people, tiredness may continue for years. If you’re experiencing post-stroke fatigue, talk to your medical team about ways to reduce it.

Spasticity

After a stroke, muscles may become stiff and tighten up. This condition is called spasticity. It refers to muscle tone which is the natural tension or contraction in a muscle that resists stretching. Spasticity makes stretching a muscle much more difficult, also causing the tendons and soft tissue around the muscle to become tight or stiff. It is important to treat spasticity because it can lead to the muscle freezing into an abnormal, painful position. If you have spasticity, talk to your doctor about the best way to treat it.

Seizures

Some stroke survivors may experience seizures. Seizures occur when cells in the brain send electric signals to one another that pass along your nerves in your whole body. The electric disturbance happens due to the damage in the brain caused by a stroke. A seizure is most likely to happen within the first few days after a stroke, but can possibly occur much later. It is painless yet disorienting and upsetting, and can last few seconds or minutes. Some stroke patients may experience repeated seizures. Overall, your risk of having a seizure reduces over time after a stroke. Consult with your doctor if you think you might have had a seizure.

Psychological impact

Two of the most common psychological problems that can affect people after a stroke are anxiety and depression. To learn more about this, read in our article “Depression and anxiety after stroke”. Feelings of anger, frustration and confusion are also common as well as lack of motivation. If you haven’t received a psychological assessment from your healthcare team after experiencing a stroke, you might want to reach out to a psychological counselor to check whether you’re experiencing any emotional problems. CBT is a common type of therapy used after a stroke. It aims to change the way you approach things and helps you adopt a more positive state of mind.

Cognitive impact

“Cognitive” is a term that describes the many functions and processes that the brain uses to process information. One or more cognitive functions can be affected by a stroke. Examples are:

  • Communication
  • Spatial awareness (The natural awareness of where your body is in relation to your environment)
  • Memory
  • Concentration ability
  • Executive ability (planning, solving problems, reasoning in situations)
  • Praxis (The ability to perform skilled physical activities)

During treatment, these cognitive functions should be assessed and treatment and rehabilitation planned accordingly. You may need language and speech therapy to recover communication skills, use memory aids such as writing a diary, planning daily tasks to regain your memory, etc. You will find that most of your cognitive functions will return with time and treatment, but they may not be the same they were before.

One of the risks after a stroke is developing vascular dementia. This is a condition that describes problems with planning, judgment, memory and other thought processes due to brain damage from impaired blood flow to your brain.

Movement problems

When body muscles cannot properly perceive messages sent by the brain, this causes movement problems like paralysis and muscle weakness. Muscle weakness makes supporting the body difficult, causing movement and balance problems. A stroke can also cause weakness or paralysis on one side of the body, depending on which side of the brain was affected. This results in coordination and balance problems. To regain movement function, a stroke patient will usually need a rehabilitation program. To learn more about rehabilitation after stroke, read in our article “What are the options for stroke rehabilitation?”.

Communication problems

Communication problems are very common after a stroke. Around one-third of stroke survivors have problems with speaking, reading, writing and understanding what other people say to them. Most common communication problems are as follows:

  • Aphasia affects your ability to speak and understand what others say. It can also affect your ability to read and write. It happens when you’re no longer able to understand or use language. Aphasia is a common problem after stroke and around a third of stroke survivors have it.
  • Dysarthria happens when you’re not able to control the muscles in your face, mouth and throat too well. This creates difficulty to speak clearly. Your speech may become slurred or slow or your voice may sounds quiet.
  • Apraxia of speech is when you can’t move the muscles in your face, mouth or throat in the order you need to when you’re speaking. This can make it difficult for other people to understand you.

For assessment of your communication abilities, you should seek out a speech and language therapist. They will help you with regaining your lost communication abilities. Speech and language therapy might include:

  • Exercises to improve your control over your speech muscles
  • Use of communication aids – letter charts, electronic aids
  • Use of alternative communication methods, i.e, gestures or writing

Although it can be assumed that communication problems affect your intelligence, it is mistaken. If you experience communication problems, you simply have problems with the process of speaking and understanding language.

Swallowing problems

Damage to the area of your brain that controls eating and swallowing can cause you to have problems with the respiratory system. When the damage caused by a stroke interrupts your swallowing reflex, this is called dysphagia. If the muscles in your throat, tongue or mouth aren’t able to direct food correctly, food and liquid can get into the airway and settle in the lungs. This can cause serious complications, like infection and pneumonia. If you are experiencing issues with swallowing, you might need to be fed with a feeding tube during the first phase of your recovery. While dysphagia is a common symptom after a stroke, it usually improves with time.

Visual problems

After stroke, you might experience changes in your vision. Visual problems occur when the parts of the brain that receive, process and interpret information sent by the eyes is impaired. Some of the stroke after effects that affect vision include:

  • Problems with seeing clearly
  • Loss of ability to judge space and depth
  • Loss of half the field of vision (Only being able to see the left or right side of what's in front of you)
  • Double vision (When control of eye muscles is affected)

If you are experiencing vision problems after a stroke, you should be referred to an eye specialist called an orthoptist. An orthopist will assess your vision and suggest possible treatment options.

Bladder and bowel control

Some strokes may damage the part of the brain that controls the bladder and bowel. This can cause loss of control over these functions, resulting in incontinence. You might need to go to the bathroom more often, urinate during sleep, etc. Some stroke survivors may regain bladder and bowel control quite quickly. But if you still experience problems after leaving hospital, you should seek medical help from your hospital or general practitioner.

The aforementioned stroke after effects can certainly be a lot to deal with. Yet there is hope to regain your lost functions and abilities after a stroke with a proper treatment plan, self motivation and time. New routines will become second nature all of a sudden. Rehabilitation can build your strength and confidence, and seeing your own improvement will undoubtedly provide you with motivation. Having a strong support system and medical team will also be key to help you recover. It is important to remember that recovery from stroke is not a linear process, and staying encouraged can sometimes be hard. Yet your own motivation and active participation in recovery are the most important aspects to achieve progress.


What can help prevent a stroke?

Turns out, there are various factors that you can control to help prevent a stroke. If you are a smoker, you might want to quit smoking since it is considered a risk factor. If you have high cholesterol levels, consider what steps you can take to control that. These among others are factors under each individual's control, and for stroke prevention, that can be defining.

For the majority, personal choice largely determines whether a stroke is down the line. Guidelines on the prevention of stroke suggest that having a healthy lifestyle can cut the risk of experiencing a stroke by 80%. No medical intervention can come close to doing that.

When a stroke occurs, it seems sudden and unexpected. But the sudden occurrence stems from a long and steady development of stroke causes such as damaged blood vessels, the growth of artery-clogging plaque, or the development of atrial fibrillation. Read more in our article "What causes a stroke?" to learn more about predispositions for experiencing a stroke. Here we will cover preventative measures you can take to help avoid experiencing a stroke.

9 factors to consider for stroke prevention

Below we have listed the most common medical and lifestyle factors to take into consideration if you want to lower your risk of experiencing a stroke.

Controlling high blood pressure if you have one

This is one of the most important things you can do to reduce the risk of experiencing a stroke. If you've had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke. High blood pressure can be treated effectively which you can discuss with your doctor.

Lower cholesterol levels if elevated

Since high cholesterol levels is one of the most powerful stroke causes, it is a paramount to keep it normal by diet and if necessary - medication. Speak to your doctor regarding specific measures to be taken if you have a high cholesterol.

Follow your glucose levels and treat diabetes if you have it

High glucose level is one of top stroke causes. In case blood glucose levels are raised, discuss the issue with your doctor and treat it seriously.

Blood thinning medications

These are often used in case of heart arrhythmia, or any problems to heart valves to prevent blood clots from forming in the heart or on valves. Please speak to your doctor about lowering the risk of stroke in case you have any condition described above.

Keep weight down and exercise

Your chances of a stroke go up if you're overweight. You can lower your odds by staying physically active which helps reduce your blood pressure and cholesterol levels.

Healthy diet

Diet that increases your risk of stroke is one that’s high in salt, saturated fats, trans fats and cholesterol. To keep cholesterol levels in check avoid such foods and choose a diet that is rich in fruits, vegetables, whole grains and healthy fats instead.

Quit smoking

If you smoke, quitting now will lower your risk of experiencing a stroke. Avoid exposure to secondhand smoke as well.

Consume alcohol in moderation

Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may also interact with other drugs you're taking.

Get regular checkups

Stay on top of your health. This means getting regular checkups (for cholesterol and blood pressure) and managing other health conditions you may have. Discuss medication options with your doctor if necessary and address any other health concerns you may have.

Prevention is possible, whether you’re preventing a first stroke or trying to prevent a second. Together with your doctor you can find a prevention strategy that works best for you, either with medical intervention, lifestyle changes or most likely with both combined.

Generally, the more risk factors you are exposed to, the higher your chance of getting a stroke. Therefore, it is very important that you take good care of your health and manage the factors that are in your hands to help you against experiencing a stroke.


How to create a safe home after a stroke?

Stroke is one of the most common causes of functional disability in the world. The movement and cognitive disturbances that it causes can manifest differently. The after effects a stroke survivor may experience are aphasia (inability to perceive spoken or written language), vision problems (from partial impairment to overall worsening vision), paresis (weakness) in one side of the body, spasticity (increased muscle tension) in arm or leg which can significantly affect the range of motion or the ability to control it. A stroke survivor may experience balance and coordination disturbances as well as memory loss. In this article, we will cover why home adjustment after stroke is important for a better and safer recovery.

Surely, the extent and types of consequences after experiencing a stroke depend on several factors. Those include age, the magnitude of the stroke experienced, other existing health conditions as well as which side of the brain has been affected. Each of these factors affect both the type of disturbances caused by a stroke and the extent of functional limitations which can either be permanent or temporary.

Rehabilitation at home

The first stage of treatment is at an inpatient emergency treatment facility where the patient spends two to three weeks. In certain cases, it can take more time. The next step in recovery is rehabilitation at an inpatient or an outpatient facility, or at home. All the mentioned rehabilitation types foresee that the patient will soon be able to return back home. The rehabilitation process will also continue at home or on an outpatient basis after receiving treatment in rehabilitation centers. Therefore, we encourage that you create the best recovery environment possible for yourself or your loved one. This will ensure that recovery can be continued without unnecessary stress and obstacles.

Before returning home, consult with your occupational therapist. They will help you address questions regarding home accessibility. During the consultation, find out what functional limitations you face after experiencing a stroke. This will allow determining what would be the best solution to relieve your daily life.

Why home adjustment after stroke is important

There are several obstacles that a person faces after a stroke, which can be little details in daily life. For example, after experiencing a stroke, a person may need a threshold that is a couple inches high or a carpet by their bedside. The details you may want to change around your house depend on the functional limitations you are experiencing. In case of impaired fine motor skills, a person may experience discomfort or lots of extra effort if the spoon handle is too thin or the table top is too slippery. A home that is not well adjusted or fairly well adjusted often influences the rehabilitation process and the patient’s motivation. This can affect recovery in a negative way, causing a fall, burning oneself or other traumas.

Practical suggestions for home adjustment after stroke

  • Remove all unstable and fragile objects at the house as well as furniture that can potentially cause the stroke patient to fall.
  • If the table top at your house is slippery, you can use rubber or silicone mats to prevent dishes from falling.
  • If it is not possible to level the threshold for the shower or to install a bathtub, you can attach a special handle in the shower to ease showering or bathing.
  • To minimize the risk of falling when you get up from a seated position, attach a handle at the toilet.
  • In case of difficulty balancing, a stroke survivor might experience difficulties to get up from and sit down on the toilet bowl. You may want to get a toilet lid with a raised edge.
  • If you have high shelves that you need to use daily, you should install a handle such that you can reach them safely.
  • If the thresholds in your house are high (higher than 1.5 cm), remove them or level them with the floor.

It might be wise to create “safe paths” around your house to get around the areas you visit the most. These will be obstacle-free routes from your bed to, for example, your bathroom and kitchen.

More tips for home adjustment after stroke

  • If you need to climb stairs daily, install another stair handle that is lower than the existing one.
  • If you need to use a wheelchair and the doorways are narrower than 90 cm, you will have to widen them.
  • Remove power wires and cables that may obstruct walking around the house.
  • If you are experiencing vision impairments, it may be wise to use scotch tape in bright color to mark your “safe paths” and use them on the edges of the stairs, etc.
  • If your vision is severely impaired after experiencing a stroke, you will need more light around the house. You may want to switch your light bulbs for brighter ones.
  • To ease the daily life for a stroke survivor, you might also want to use some technological solutions. You might want to use sensors, safety alarms, rechargeable devices that replace disposable batteries, etc.

Make your home more accessible

To modify your home in a better way and to make it more accessible, you may need some reconstruction work done around your house or to buy some new furniture. If you need to use a wheelchair for a prolonged time, you should get a ramp or a stair lift. If the stroke patient lives in an apartment building without an elevator, it should also be ensured that the building has one. These adjustments are usually financed by municipalities, therefore contact the office of social services about this option.

The rehabilitation process and limitations of each stroke patient is unique, therefore the adjustments needed around the house might also differ. These are some of the most general housing adjustments you can perform which can be achieved with fairly small financial and labor input.

Some patients might need these adjustments for a longer period of time, some a shorter time. However, the rehabilitation process should also be continued once you think you have already reached your best state. Such that the recovery process doesn’t stagnate, it is important to continue doing the rehabilitation exercises and follow the recovery plan that you have created with your doctor at home, throughout the whole rehabilitation process, as much as possible.

For this, you can also seek help from Vigo which is the only digital therapy tool for stroke available so far. It helps you with physical and emotional recovery at the comfort of your home. Read more about Vigo on the website and sign up at info@vigo.health.


depression and anxiety after stroke

Depression and anxiety after stroke

It is well known that a stroke can have a significant impact on a person's health and later life. Many of these effects are physical and, therefore, easily recognizable, while others are more difficult to notice, especially when they manifest in thoughts and feelings. In this article, we will look at mental health consequences, in particular, depression and anxiety after stroke.

Thoughts and emotions can change behavior and signal that something is wrong. Quite often, people who have survived a stroke suffer from mood disorders such as depression and anxiety. Unfortunately, these problems are often unrecognized and therefore left untreated.

The effects of stroke on mental health

The effects of stroke on the human psyche can manifest in a variety of ways. Studies have shown that stroke-survivors have a higher risk of developing depression and anxiety. At least one in three people after a stroke suffers from depression, while approximately one in five has post-stroke anxiety. It is not uncommon for people to suffer from both conditions at the same time and other psychological problems as well. About as often as depression, stroke survivors suffer from post-stroke apathy. Other less common but still devastating disorders include post-traumatic stress disorder, emotional liability, and personality changes. Changes in the psyche do not always lead to mental illness, but in some cases, they become pathological and interfere negatively with a person's life.

Depression

To feel sadness, despair, and to be gloomy for some time after a person has had a stroke, is normal. A stroke is undoubtedly not only a physical but also an emotional turmoil. However, the depressed mood may become prolonged and so deep that it develops into a depression, which can significantly impact a person's ability to feel joy and to execute everyday activities. A person who has depression may feel gloomy and exhausted for a prolonged time, he might lose interest in things and activities that previously brought joy, speech and movements may become sluggish, feelings of hopelessness and guilt can emerge.

Often a depressed person may lose his appetite or, on the contrary - may start overeating. Sleep disturbances may arise, which can manifest either as insomnia or the other way around - hypersomnia or severe drowsiness. Unfortunately, a person with depression may find themselves with suicidal thoughts. Many reliable depression tests are available to help recognize symptoms and signs of depression. However, only a doctor may establish a diagnosis.

Anxiety

After experiencing a stroke, a person may feel fearful, agitated, or worried for some time. If the agitation is overwhelming and accompanied by other specific symptoms, a person may have developed post-stroke anxiety. A person who suffers from anxiety feels worried often, or even all the time. It is difficult to get rid of the worrisome thoughts, they may be tense and have difficulty relaxing. They may also become easily irritable or develop somatic symptoms such as heart palpitations or increased sweating, among others.

Anxiety can also cause sleep disturbances, fatigue, and eating disorders. Not all people experience anxiety in the same way, and there is more than one form of anxiety disorder. These include generalized and phobic anxiety. A phobia is characterized by a fear of specific situations. Generalized anxiety, on the other hand, produces general worry that can be about different situations, in all aspects of life. Phobic anxiety is more common among stroke survivors, but they may develop any other form.

In the case of post-stroke phobic anxiety, an anxiety attack may be provoked by a specific situation. It is usually associated with fear of having another stroke or with the moment they actually had a stroke. It could be a variety of situations. For example, stroke survivors are quite often afraid of going out alone, being in a crowded place, or using public transportation. They may have a fear of staying home alone or doing some specific activity, for example, exercising. Unconsciously, this fear can influence a person to change their behavior and to avoid a variety of activities in their everyday life.

Consequences of depression and anxiety after stroke

Both depression and anxiety can cause suffering, distorted thinking and negatively affect the recovery from stroke, and the general health of a person. Research suggests that post-stroke mood disorders negatively impact the rehabilitation progress and recovery results, and also significantly lowers the person's quality of life. Furthermore, these problems also affect the relatives and caregivers of stroke survivors, increasing their risk of suffering from exhaustion and depression themselves.

Treatment options

Only a doctor may confirm the diagnosis of depression or anxiety disorders. However, the person suffering, sometimes with the help of their caregivers, may recognize the symptoms of these disorders and can, therefore, seek medical advice. Personal habits play an important role in regulating mood; therefore, the doctor may initially recommend some lifestyle changes. However, the main evidence-based treatment methods used for managing mood disorders are psychotherapy and specific medications.

In addition to these methods, there are other interventions available that offer a chance for the person to help themselves to improve their well-being. These include a variety of meditation practices, breathing exercises, mindfulness-based training, relaxation techniques, and many other promising methods. However, the most widely used method in treating mood disorders is cognitive-behavioral therapy (CBT). It is a psychotherapy form that can be implemented not only within a therapist's office but also with the help of digital solutions. This kind of digital therapy is provided by Vigo chatbot, which carries out a CBT-based conversation to help stroke survivors who suffer from depression, anxiety or other mental health issues.


relative with a stroke

How do you care for a loved one with stroke?

If you want to learn more about the stroke itself, its causes and after effects, read more in our article What is a stroke?. When a person experiences stroke, there are certain steps they and their loved ones can take to help with recovery process. For your relative with a stroke, your participation in their recovery can be very important and helpful.

In this article, we will go over what relatives can do if a family member or a close one has been hospitalized and diagnosed with a stroke. Stroke is a rather broad concept in the medical context - it hides several meanings. A stroke can be both a sudden haemorrhage in the brain or a disruption of the cerebral blood circulation. However, both diagnoses involve more or less severe movement, speech, mental and possibly cognitive impairment after recovery from initial state.

What to do to help your loved one or relative with a stroke

The most important initial step you can take to help your loved one feel better is to visit them. If they are unconscious in the intensive care unit, it is still important to do so. An unconscious person still feels and perceives their surroundings, and their state is similar to a person asleep who perceives bits of reality. Take at least 30 minutes a day to go to your loved one, talk to him, or read a book he or she loves.

How to communicate with your relative with a stroke

If your loved one is conscious or became conscious after a few days, check that they understand and recognize you. You can ask them simple questions that can be answered with a yes or a no. Asking "Do you know what year it is?" or "Do you know who I am?" can be good to test cognitive abilities in the first stage of recovery.

It is possible that if artificial lung ventilation is performed, the relative will not be able to respond vocally. However, another way of communication can be found. The recommended types are blinking, for example, one blink - yes, two - no. There are other options, such as moving your finger once or twice. These methods of communication are quite restrictive, with questions answered only in the negative or in the affirmative. If they can use one finger, it is possible to use a letter board app or similar type of app. You can obtain these in your cell phone or iPad.

In order to reduce stress for your close one, it is important to choose a communication method that fits them the most. This will reduce their feeling of loneliness and will bring awareness to you about their physical and emotional condition.

Visiting your relative with a stroke in hospital

Your relative may be transferred from the intensive care unit to the ward or is on the ward from the beginning. Either way, it is recommended you visit them daily. If it is not possible daily, try to find someone else who can visit on days you cannot. This step is necessary to follow the condition of a person close to you every day.

There is often a shortage of medical staff in hospitals. Therefore, it is important that you also get involved in the care taking of your loved one. Ask a nurse to show you how to properly do care taking routines. These may be help with getting up to a seated position and others. Also, make sure to involve other medical specialists such as occupational therapists and physiotherapists.

These skills may not necessarily be useful when your loved one gets more independent. However, you will have contributed to their recovery. Your relative may not be able to take care of themselves physically yet. Every time you visit, check whether the hygiene routines have been done such as body rinsing and change of diaper. If it hasn’t been done, call the nurse or perform the routines yourself.

Returning home

After hospital, your loved one is ready to return home. You also need to be prepared for that since this may bring changes to your loved one. Due to physical disturbances as well as cognitive and mood changes, returning home can be difficult for everyone.

Be prepared for shifts in their health condition and unsteady rehabilitation results. Recovery from stroke is not a linear process, the health of your loved one won’t be improving steadily. Instead, there will be ups and downs, with some days or weeks with more rapid improvements, others with less rapid or even worse than before. In worse times, it is important not to cheer your close one up or try to get them to be more active. The best support you can give them is to listen and be by their side. It is important to understand that your loved one may be experiencing both physical pain and emotional hardships due to their post-stroke condition. Additional pressure will not help resolve the difficult experience and mood changes they are going through.

Emotional support

A person who has experienced a stroke may feel lonely and not needed. Overdoing with care taking may make him feel disabled and helpless. Therefore, it is important to allow them independence in things they are able to do themselves. This state is dependent on both the stroke patient and their close ones. Vigo can help to actively engage the mind of the stroke patient and can help boost their recovery in abilities, thus boosting their self-confidence. In addition, there are certain ways close ones can help:

  • Offer help to your loved one if you see they are really not able to do a certain task.
  • Most importantly, ask first if they need help with this particular task.
  • Often after a stroke, the person becomes slower. Therefore, it is important not to rush them or bother with your help only because you can do something faster.
  • Allow them to take their time and soon you will see their movements are becoming quicker.
  • Allow them their independence and don’t limit them with overdoing with care taking. Of course, as long as it doesn’t endanger them or someone else around.
  • Try to motivate and encourage your loved one on their good days, however on the bad days, just be there for them. It may please them if you do some simple things together like watching a favorite movie, drinking tea together, taking a slow walk or other activities they enjoy.

Coping with stroke through mutual support

Often after experiencing a stroke, the person may go through a denial phase and rebel by trying to do everything by themselves. During this time, they may show anger if someone helps them without a previous warning or asking whether the help is needed. It is very important to be understanding and tolerant since a stroke survivor has a hard time accepting themselves, and involvement from others should be done very gradually and carefully.

In this situation, when your loved one experiences sudden changes in their health, it is important to remain calm as much as you can and try to accept that this state is temporary. It may undoubtedly leave marks in your family life or relationship, however with mutual support and patience you can do a great deal to cope with this situation as well as possible.

 


stroke rehabilitation

What are the options for stroke rehabilitation?

Medical stroke rehabilitation is considered to be the process of regaining lost abilities and motions or relearning them anew. A stroke survivor may experience paralysis or problems controlling movement (also called motor control), sensory disturbances, speech and language ability (also called aphasia), cognitive function, vision as well as emotional well being.

Stroke rehabilitation oversees multidisciplinary medical professional involvement. Those include a rehabilitation doctor, physiotherapist, occupational therapist, psychologist and others. Before a stroke survivor is discarded from acute treatment, they are evaluated by a physical and rehabilitation medical doctor. They are given a rehabilitation plan, recovery options and motivation incentives. The medical specialist together with the patient sets the main recovery goals and therapy is prescribed for the patient's individual situation. The patient after seeing a medical specialist may not be given an obligatory palliative care. Then, it is possible to seek rehabilitation options that are covered by the state, insurance or paid out of pocket.

Why stroke rehabilitation is important?

The rehabilitation and support a stroke patient receives can greatly influence their recovery levels and health outcome. Quality, timely rehabilitation that is suitable for the patient will be their best chance to achieve a most successful recovery. After stroke, the first three months the brain is much like a new brain. It can learn and adjust immensely (ability called neuroplasticity), thus it is crucial to start rehabilitation right after acute treatment. After three months, neuroplasticity returns back to a more normal state. However, the stroke patient can continue to regain lost functions, now at a slower pace.

Depending on the country, the types of stroke rehabilitation available are:

  • Acute care and rehabilitation hospitals
  • Outpatient rehabilitation
  • Nursing facilities
  • At home

Acute care and rehabilitation hospitals

Inpatient medical rehabilitation is the most common immediate type of rehabilitation to prevent consequences that stroke brings about. Before a stroke patient is discarded from acute treatment, the attending physician or rehabilitation medical doctor provides a referral and signs them up for rehabilitation in a nearby rehabilitation center. Even though it is possible to access rehabilitation a few weeks after discharge from inpatient treatment, there are cases when waiting to start rehabilitation can take up to 6 months.

If inpatient doctor hasn't provided a referral, you should see a family doctor who can refer to an inpatient rehabilitation. Or they may refer to a physical and rehabilitation medical doctor for assessment of functional abilities. When evaluating a patient for potential rehabilitation services, the physical and rehabilitation medical doctor will assess:

  • the patient's health condition and related functional limitations
  • potential for medical rehabilitation
  • motivation of the patient and their loved ones
  • health stability in order to receive rehabilitation services

Inpatient facilities may be freestanding or part of larger hospital complexes. Patients stay in the facility, usually for 2 to 3 weeks, and engage in a coordinated, intensive program of rehabilitation. Such programs often involve at least 3 hours of active therapy a day, 5 or 6 days a week. Inpatient facilities offer a comprehensive range of medical services. These include full-time physician supervision and access to the full range of therapists specializing in post-stroke rehabilitation.

If you are interested to register for Vigo, write an e-mail to: info@vigo.health

Outpatient stroke rehabilitation

Outpatient rehabilitation occurs right after the physical and rehabilitation medical doctor or rehabilitologist creates a plan for the patient. It is usually a monoprofessional type of rehabilitation service. Every medical practitioner works according to a plan, collaborating with the patient. It is possible to receive it in polyclinics, day hospitals and inpatient rehabilitation facilities. Rehabilitation services will be paid for either by the state or out of pocket, depending on your case. There are various possible options for receiving outpatient rehabilitation:

  • In case the patient is in a relatively good physical condition and doesn't need to go to a rehabilitation facility. The patient can return home to continue their rehabilitation routines with the help of nearby practitioners (physiotherapist, occupational therapist, speech-language pathologist, psychologist, etc) in inpatient or outpatient facility.
  • The patient has already completed a rehabilitation course paid by the state or out of pocket in one of the rehabilitation centers and already returns home to complete their recovery. Or the patient has signed up for a following course and is waiting in line to receive the service.
  • The patient has received a disability status and can sign up for an evaluation with the physical and rehabilitation medical doctor or rehabilitologist, who will come up with a rehabilitation plan and who refers to a rehabilitation service.

Outpatient facilities are often part of a larger hospital complex and provide access to a full range of doctors and physicians that specialize in stroke rehabilitation. Patients typically spend many hours, often 3 days a week, in outpatient rehabilitation facility getting therapy. These facilities may offer flexible treatment programs - as intense as in inpatient rehabilitation facilities, as well as less demanding regimens, depending on the stroke patient's health state and condition.

Nursing facilities

Rehabilitation services available at nursing facilities are vary more than those available at inpatient and outpatient rehabilitation facilities. Skilled nursing facilities usually emphasize rehabilitation in particular, whereas traditional nursing homes emphasize residential care. Also, the regimens are not as demanding compared to inpatient and outpatient treatment programs, and fewer hours of therapy are offered.

The rehabilitation services available in skilled nursing facilities are for patients no longer needing hospital care but who still need nursing services, a less demanding rehabilitation program and 24-hour access to nursing support. You can find out more about the particular prerequisites whether you qualify for rehabilitation services in nursing facilities, depending on your country and particular case.

Stroke rehabilitation at home

If the patient has a severe or a moderately severe case, they have the option to receive rehabilitation or palliative care services at home from physicians, rehabilitation nurses, occupational therapists, recreational therapists, speech-language pathologists, vocational therapists and mental health professionals. This type of rehabilitation is prescribed by a physical and rehabilitation medical doctor or a rehabilitologist who accordingly create the rehabilitation plan. Medical rehabilitation at home can also be received through a referral from a family doctor which involves a rehabilitation plan, if the family doctor has learned to evaluate functional limitations and according improvement or preventative measures.

Home rehabilitation allows for greater flexibility so that patients can tailor their program of rehabilitation and follow individual schedules. Stroke survivors may participate in an intensive level of therapy several hours per week or follow a less demanding regimen. These arrangements are often best suited for people who require treatment by only one type of rehabilitation therapist.

For rehabilitation at home, the digital therapy tool Vigo is a great assistant which helps to create a stable daily regimen for a more successful recovery. It is accessible via software, at your home and anywhere with internet access. Vigo offers content to improve physical and emotional health, new and useful information about stroke, physiotherapy and breathing exercises every day as well as conversations based on effective psychological techniques. To register, write to info@vigo.health or fill out the registration form in the website.

Rehabilitation is a defining part of stroke recovery. Even though it doesn’t reverse the effects of a stroke, it makes you stronger, more capable and confident to help you return to a more independent life.


stroke support

What stroke support is available for stroke survivors with disability?

A stroke survivor often times experiences consequences that require rehabilitation, intensive after-care and a demanding regimen in order to recover. (Read more in the article "What are the options for stroke rehabilitation?" to find out about after stroke treatment). However, it can also lead to permanent disability. Disability after stroke may manifest as inability to perform work, profound functional limitations or even in paralysis, with the need of a wheelchair. As such, a stroke survivor is often times in the need for stroke support, emotionally, physically and financially.

Depending on the case, a stroke patient's health condition may be tolerable. Yet they can experience limitations that significantly influence their ability to perform work and go about in daily life. This can cause anxiety and fears about the future, and worrying about becoming a burden to loved ones, which is often accompanied by shame or other negative emotions. To reduce your fears, it is possible to seek social support from your country. Most offer disability support, social security benefit or pension, depending on the country and your personal case.

The Financial Costs of a Stroke

The Centers for Disease Control (CDC) estimate that strokes cost $34 billion per year in the U.S. This amount includes medical procedures, prescription medications, healthcare services and lost work hours for all adults affected annually.

When it comes to a stroke patient's costs, these constitute diagnosis and initial treatment costs, and depending on the severity of the case, long-term rehabilitation and treatment costs. Also, costs associated with not being able to perform a job again.

Costs may include:

  • Rehabilitation and other healthcare services
  • Medications
  • Modifying your home or purchasing mobility assistance or other adaptive-living devices or equipment.
  • If necessary, health or residential nursing facility care

Some patients may also require home health or residential nursing facility care.

Coping with the consequences of stroke can be difficult. If you had a stroke, you and your family may suddenly experience financial struggles, especially if you are no longer able to work or need to buy specialist equipment. However, financial help is available in most countries. Many people are not aware that they can get help, or are not claiming all the support they may be entitled to. Therefore, make sure to find out about and take advantage of the financial and social stroke support resources your country offers. This may significantly lower the burden you and your loved experience.

You may find that Vigo is a fitting tool for you to help you recover from stroke. The advantage of Vigo as a digital therapy tool for stroke survivors is that it is much cheaper and much more accessible than regular rehabilitation and therapy services. Read more about Vigo in the website.

Social security and disability support

Social security administration benefits in the US

If you are among the 75% of stroke survivors who suffers from stroke after effects, you may be unable to handle your daily chores and tasks, let alone work. While some patients only experience after effects on a short term basis, others are left with permanent consequences. If you suffer from permanent, irreversible disability, you may be eligible for Social Security Administration (SSA) benefits.

For those with permanent of long-term impairments: you may be eligible to receive Social Security disability benefits. To qualify for disability benefits after a stroke, your condition must meet the SSA's prerequisites, outlined in the SSA's Blue Book.

For those who may be able to work again: The SSA has a trial work period for disability claimants during which they are able to determine whether they are able to get back into the workforce. During this trial period, you will not be at risk of losing disability benefits.

Read more in SSA website.

Stroke support resources in other countries

In the UK: https://www.stroke.org.uk/

In the EU: https://www.safestroke.eu/

In Canada: www.canadianstroke.ca

In Australia: https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Support-near-you

Life after stroke can be difficult in many ways. But it is important that you seek support and you may find that the resources available to you can help you deal with stroke after effects significantly. There are stroke groups and organizations in most countries, state support and benefits available as well as other stroke support resources.


stroke treatment

How is acute stroke treated?

We discussed in the article "What is a Stroke?" the two types of stroke - the first caused by occlusion of blood vessel by trombus and therefore disrupted blood flow (aka, ischemic stroke or cerebral infarct), and second - bleed caused by rupture of blood vessel inside the brain matter (aka, intracerebral haemorrhage, ICH). Moreover, stroke treatment for the two types differ profoundly.

Initially, both types of stroke appear very similarly. Symptoms include sudden weakness in the face and in one side of the body, difficulty speaking or understanding others. However, treatment for both types of stroke is radically different. Even more, treatment for one type of stroke can be life threatening if applied to another. Therefore, correct diagnosis prior to initiation of treatment is paramount.

Not to mention, most effective treatments in case of stroke are available only for a few hours after onset. Therefore, emergency medical attention is needed.

To differentiate one type of stroke from another, an emergency CT brain (computed tomography) scan with angiogram is performed as a routine diagnostic measure in most countries. This allows not only to distinguish between brain haemorrhage and brain infarct (ischaemia), but allows to detect the exact location of occlusion or rupture of blood vessel.

Once diagnosed, stroke treatment principles are as follows:

Cerebral infarct

A key concept in case of blood vessel occlusion is restoration of blood flow as soon as possible. Since brain cells are very oxygen dependent, restoration of blood flow is proven to be effective only if applied within 4-6 hours from onset of disease.  There are two main techniques used to restore blood flow:

  • Intravenously administered medication that is meant to dissolve blood clot. This medication is called recombinant tissue plasminogen activator (tPA) — also known as alteplase. It is usually administered within 3 hours from symptom onset (sometimes within  4.5 hours). The sooner treatment is applied the lesser is damage to the brain and better results can be expected.
  • Endovascular procedures. As you can understand from the title, these are procedures performed within the vessel. Artery in the groin is usually used to introduce the intravascular catheter which is then guided upwards into brain vessels under guidance of fluoroscopy. Once site of occlusion has been reached, doctors may use direct injection of alteplase through fine tubing to dissolve the clot or by using a specific device attached to the catheter and remove clot mechanically thereby restoring blood flow.

If the time frame allowed to use above mentioned techniques has passed, the key concept of treatment is limitation of so-called secondary brain damage. This is an expansion of cell death in areas around initial damage (called penumbra). Penumbra zone is partly supplied by blood from adjacent vascular territories. Improvement of blood flow in penumbra is achieved by various medications and i/v fluids.

Intracerebral haemorrhage

Key concept of treatment of cerebral bleeding is to stop its expansion thereby minimizing pressure and damage to the brain. This can be achieved by medication aiming to lower high blood pressure and medication aiming to lower intracranial pressure (pressure inside the skull).

If a patient has previously used blood thinning medications, effects of these medications may be reversed by drugs of blood products that are antagonists to blood thinners.

If hemorrhage is initially large or is rapidly expanding, the patient's condition is may be worsening. In this case, surgery may be performed as a life saving measure.

After emergency treatment is finished, the condition of the patient usually becomes stable in about 7 days. Then the next stage of treatment can be started. Lost function and regaining independence can be achieved through rehabilitation.


stroke causes

What causes a stroke?

A stroke occurs when blood flow to a part of your brain is cut off. Without the oxygen in blood, brain cells start to die rapidly. It turns out there are particular conditions that predispose you to risk of experiencing a stroke. Some of the most common stroke causes include high blood pressure, high cholesterol, diabetes, and smoking. People with heart rhythm disturbances and other heart diseases are also at risk. In this article, we will look into the most common stroke causes in detail.

In general, risk factors can be categorized in conditions that are manageable and treatable, and risk factors that are non-modifiable and unfortunately cannot be affected.

Stroke causes that can often be manageable:

High blood pressure

This is among the most common risk factors that expedites development of stroke. High blood pressure contributes to development of atherosclerosis (plaques of cholesterol deposited on walls of vessels) which finally are responsible for ischaemic stroke. It also contributes to weakening of brain blood vessels (known as amyloid angiopathy) which may lead to rupture of vessel and brain haemorrhage. Your optimal blood pressure should be around or even below 120/80 mmHg, but no higher than 140/90 mmHg (these are general guidelines and cannot be perceived as medical advice).

High cholesterol

It contributes to the development of atherosclerosis. Although your cholesterol levels are partially determined by your heredity, in case of elevated cholesterol levels, a lot can be done to normalize them. Options vary from diet to specific medication. It is very important to address this issue as early as possible as high cholesterol doesn't have specific symptoms and develop atherosclerosis unnoticed. Some people may develop a high level of cholesterol at a very young age. It is recommended to check your cholesterol levels according to guidelines in each country.

Smoking

Smoking or chewing tobacco raises your odds of a stroke. Nicotine makes your blood pressure go up and smoke causes a fatty buildup (atherosclerotic plaque) in your main neck artery. It also thickens your blood and makes it more likely to clot. Exposure to secondhand smoke also puts you at risk.

Diabetes

It is often accompanied by high blood pressure and people with diabetes are more likely to be overweight. Similarly as factors above, diabetes contributes to the development of atherosclerosis and it raises the chance of a stroke.

Heart disease

This includes defective heart valves, atrial fibrillation, or irregular heartbeat, which causes up to 25% of all strokes among the very elderly. These heart diseases carry a risk of development of blood clots within the heart which can subsequently draw away and travel by blood stream into brain vessels causing occlusion and circulation disruption.

Other stroke causes that are often manageable include being obese or overweight, having a sedentary lifestyle, heavy drinking and substance abuse, obstructive sleep apnea. Also, medications such as overuse of blood-thinning medicine, hormones or birth control pills have also been linked to a higher chance of stroke.

Non-modifiable stroke causes:

Genetics

The set of the genes that you have born with are not modifiable for now, however there are promising techniques (including CRISPR Genome editing) that may allow doctors to modify even those in the foreseeable future.

Increasing age

Generally, the chances go up the older you get. People over the age of 50 are increasingly at risk. Stroke for younger people is much rarer, and can happen due to abnormal blood conditions, inherited predispositions or substance abuse. There are few reports suggesting that novel SARS-CoV-2 virus responsible for COVID-19 disease can make blood clots more prone to form and cause strokes in younger and previously well individuals.

Gender

Men are more likely than women to experience strokes. Women are usually older when they have strokes. This can be explained by the protective effect of estrogens which are at high levels in women's organisms until menopause. That's why women usually get strokes at an older age and they're more likely to die of strokes.

These are the most common stroke causes to take into consideration. Furthermore, there are certain lifestyle and influential factors to consider to help prevent a stroke from happening. It is also important to manage the aforementioned medical factors. To learn more about stroke prevention, read in our article "What can help prevent a stroke?".


Stroke symptoms

What are the symptoms of a stroke and when to seek medical help?

It is important that once a person experiences stroke, they receive medical attention on an emergency basis. There are a number of ways to detect whether you or someone you know may be experiencing a stroke. If you notice any signs or symptoms of a stroke, don’t wait for the symptoms to pass, even if they come and go or even go away altogether. You should seek medical attention immediately.

The most common sign of stroke is sudden weakness of the face, arm or leg, most likely on one side of the body.

Signs and symptoms of a stroke may include:

  • Trouble with speech and understanding what others are saying. You may experience confusion, slur your words or have difficulty understanding others.
  • Problems seeing in one or both eyes. You may suddenly have blurred vision in one or both eyes, or you may see double.
  • Headache. A sudden, strong headache, with possibility of vomiting, dizziness or altered consciousness.
  • Trouble moving. All of a sudden, you may begin stumbling or lose your balance and coordination.

It is key to notice the time the symptoms began. Some treatment options are most effective when given as soon as possible after a stroke occurs.

To detect whether someone next to you might be experiencing signs or symptoms of a stroke, ask them to repeat the following and pay attention to the response in their body:

  • Face. Ask the person to smile. Does one side of the face droop?
  • Arms. Ask the person to raise both arms. Is one arm harder or unable to rise?
  • Speech. Ask the person to repeat a simple phrase. Is their speech slurred or unusual?

The signs of a stroke depend on various factors and each person may experience different stroke warning signs. It depends on the side of the brain that’s affected, the part of the brain affected, and the extent of the brain damage. Stroke may be accompanied by a headache, or may be completely painless.

Never try to diagnose or treat the problem yourself and do not leave it unattended even if the symptoms go away on their own. Even if the symptoms pass quickly without treatment, you should still seek medical help.

If you observe any of the stroke symptoms or signs, call 112 or your country’s medical emergency number immediately. Because stroke is a medical emergency that can lead to death or permanent disability, it is crucial that you seek prompt medical attention.