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Stroke - Recovering from stroke

NHS Choices Medical Reference

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  • depression  many people experience intense bouts of crying and feel hopeless and withdrawn from social activities 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

You will receive a psychological assessment from a member of your healthcare team within the first month after your stroke.

Feelings of anger, anxiety, depression, frustration and bewilderment are all common, although they may fade over time. Your healthcare team, family, friends and organisations such as the Stroke Association can all provide you with support and care you need.

Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship. There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.

These symptoms tend to settle down over time but if symptoms are severe or last a long time, GPs can refer people for expert healthcare from a psychiatrist or clinical psychologist. For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT) can help. CBT is a therapy that aims to change the way you think about things in order to produce a more positive state of mind.

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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, solve problems and reason about situations 
  • 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 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 return to their former levels.

The damage that a stroke causes to your brain also increases the risk of developing vascular dementia. The dementia may happen immediately after a stroke or may develop some time after the stroke occurred.

Physical impact

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

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.

Physiotherapy 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 careworker or carer, such as a member of your family, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises 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.

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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 sometimes also known as dysphasia. 

Aphasia can be caused by damage to the parts of the brain responsible for language, or be due to muscles 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 communication skills.

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Visual problems

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

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Sex after stroke

Even if you have been left with a severe disability, it is important to experiment with different positions and find new ways of being intimate with your partner. Having sex will not put you at higher risk of having a stroke. There is no guarantee you will not have another stroke but there is no reason why it should happen while you are having sex.

Be aware that some drugs can reduce your sex drive (libido), so make sure your doctor knows if you have a problem, there may be other medicines which can help.

Read more about good sex.

Bladder and bowel control

Some strokes damage the part of the brain that controls bladder and bowel movements. This can result in urinary incontinence and difficulty with bowel control.

Most people who have had a stroke regain control in a week or so. If there are still problems when they leave hospital after a stroke, there is help in the community available from the hospital, GP or community continence nurse.

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Driving

If you have had a stroke, 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 you drive.

Your GP can advise about whether you can start driving again a month after your stroke or whether you need further assessment at a mobility centre.

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Caring for someone

There are many ways you can provide support to a friend or relative who has had a stroke to speed up their rehabilitation process. These include:

  • helping to practice physiotherapy exercises in between their sessions with the physiotherapist 
  • providing emotional support and reassurance their condition will improve with time 
  • helping motivate the person to reach their long-term goals 
  • adapting 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 appear to act irrationally at times. 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 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 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 can provide advice and relevant contact information.

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Will I be able to lead a normal life again?

  • A third of people will make an almost full recovery physically and should be encouraged to lead a normal life. 
  • A third of people will have a significant amount of disability. This will vary from the severely disabled, e.g. people who need help getting in and out of bed, to milder things, such as needing help with bathing. 
  • A third of people will be severely affected by stroke and will die within the year. The majority of these people will die in hospital in the first few weeks.
Medical Review: August 27, 2012
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