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Stroke health centre

Recovering from stroke

NHS Choices Medical Reference

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The damage caused by a stroke can be widespread and long-lasting. Many people need to have a long period of rehabilitation before they can recover their former independence.

The process of rehabilitation will be specific to you, and will depend on your symptoms and their severity. A team of specialists are available to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

The damage that a stroke causes to your brain can impact on many aspects of your life and wellbeing, and depending on your individual circumstances, you may require a number of different treatment and rehabilitation methods. These are discussed in more detail below.

Psychological impact

The two most common psychological conditions found in people after a stroke are:

  • depression - many people experience intense bouts of crying and feel hopeless and withdrawn from social activities,
  • anxiety disorder - many people experience general feelings of fear and anxiety, often punctuated by intense, uncontrolled feelings of anxiety (anxiety attack).

You should receive a psychological assessment within the first month of your stroke. Depression and anxiety can be treated using psychological therapies, such as counselling or cognitive behavioural therapy - a therapy that will aim to change the way you think about things in order to produce a more positive state of mind.

More severe cases of depression and anxiety may require additional treatment with medicines. The antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are most commonly used to treat depression. Other types of antidepressants may be used if you cannot take SSRIs, or do not respond to treatment.

Anxiety disorders can be treated in the short term using medicines known as benzodiazepines. These medicines have potentially serious side effects, so can only be used for two weeks. After that time, antidepressants may be prescribed.

Talking about your experience and concerns for the future can be a great help in coming to terms with the psychological impact of a stroke.

Cognitive impact

'Cognitive' is a term used by scientists to describe the many processes and functions our brain uses to process information.

One or more cognitive functions can be disrupted by a stroke. Cognitive functions include:

  • communication - both verbal and written,
  • spatial awareness - having a natural awareness of where your body is in relation to your immediate environment,
  • memory,
  • concentration,
  • executive function - the ability to plan, problem solve and reason about situations, and
  • praxis - the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea.

As part of your treatment, each one of your cognitive functions will be assessed and a treatment and rehabilitation plan will be created.

You can be taught a wide range of techniques that can help you 're-learn' disrupted cognitive functions, such as recovering communication skills through speech therapy.

There are also many methods that can be used to compensate for any loss of cognitive function, such as using memory aids or a wall planner to help plan daily tasks.

Most cognitive functions will return after time and rehabilitation, but you may find that they do not fully return to their former levels.

Physical impact

Strokes can cause weakness or paralysis in one side of the body. Also, many people have problems with coordination and balance.

As part of your rehabilitation you should be seen by a physiotherapist, who will assess the extent of any physical disability before drawing up a treatment plan.

Treatment will normally begin as soon as your medical condition has stabilised. At first, your physiotherapist will work with you to improve your posture and balance.

After this, you will have short sessions of physiotherapy that last a few minutes. The sessions will then increase in duration as you start to regain muscle strength and control.

The physiotherapist will work with you by setting goals. At first, these may be simple goals like picking up an object. As your condition improves, more demanding long-term goals, such as standing or walking, will be set.

A member of your family, such as an unpaid carer, or a paid careworker, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises which you can carry out at home.

Sometimes, physiotherapy can last months or even years. The treatment is stopped when it is no longer producing any marked improvement to your condition.

Communication problems

After having a stroke, many people experience problems with speaking and understanding, as well as with reading and writing. This is called aphasia, and is sometimes also known as dysphasia. 

Aphasia can be caused by damage to the parts of the brain that are responsible for language, but it can also be due to the muscles that are involved in speech being affected. You should see a speech and language therapist as soon as possible for an assessment, and to start therapy to help you with your communication skills.

Visual problems

Stroke can sometimes damage the parts of the brain that receive, process, and interpret information that is sent by the eyes. Some people may have double vision, or lose half of their field of vision. This means that they are able to see everything that is on one side, but are blind on the other.

Tiredness

Many people suffer from extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.

Driving

If you have had a stroke, or transient ischaemic attack (TIA), you cannot drive for one month.  Whether you can return to driving depends on what long-term disabilities you may have, and the type of vehicle that you drive.

Your GP will be able to advise you about whether you are able to start driving again a month after your stroke, or TIA, or whether you may need to have a further assessment at a mobility centre. 

Providing support

There are many ways that you can provide support to a friend or relative who has had a stroke in order to speed up their rehabilitation process. These are listed below.

  • Help practice physiotherapy exercises in between their sessions.
  • Provide emotional support and reassurance that their condition will improve with time.
  • Help motivate the person to reach their long-term goals.
  • Adapt to any needs they may have, such as speaking slowly if they have communication problems.

Caring for somebody after a stroke can be a frustrating and sometimes a lonely experience. The advice outlined below may help.

Be prepared for changed behaviour

Someone who has had a stroke can often seem as though they have had a change in personality, and they can sometimes appear to act irrationally. This is due to the psychological and cognitive impact of a stroke. They may become angry or resentful towards you. Upsetting as it may be, try not to take it personally. It is important to remember that a person will 'return to their old self' as their rehabilitation progresses.

Try to remain patient and positive

Rehabilitation can be a slow and frustrating process, and there will be periods of time when it appears that little progress has been made. Encouraging and praising any progress, no matter how small it may appear, can help motivate someone who has had a stroke to achieve their long-term goals.

Make time for yourself

If you are caring for someone who has had a stroke, it is important not to neglect your own physical and psychological wellbeing. Socialising with friends or pursuing leisure interests will help you cope better with the situation.

Ask for help

There are a wide range of support services and resources available for people who are recovering from strokes, and their families and carers. This ranges from equipment that can help with mobility, to psychological support for carers and families.

The hospital staff involved with the rehabilitation process will be able to provide advice and relevant contact information.

If you have had a stroke you can read more about support and obtaining help to look after yourself on Carers Direct. 

Glossary

  • Arteries: Arteries are blood vessels that carry blood from the heart to the rest of the body.
  • HRT: Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.
  • Cholesterol: Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.
  • Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
  • High blood pressure: Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
  • Heart: The heart is a muscular organ that pumps blood around the body.
  • Obesity: Obesity is when a person has an abnormally high amount of body fat.
  • Genetic: Genetic is a term that refers to genes: the characteristics inherited from a family member.
Medical Review: January 04, 2008

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