Learning to Adjust to Life Following a Stroke

Statistics indicate that strokes are often life-altering. Sadly, fifteen percent will die, twenty-five percent will recover with only minor impairment and ten percent will almost completely recover. But the rest, fifty percent, will require some type of care.

There are huge challenges in adjusting to the effects of a stroke. There will likely be fear, apprehension, uncertainty and usually life changes. It will be important for the stroke sufferer to gain some control over his/her life and to work towards independence. They will need to work diligently to improve their emotional and physical well-being by thinking positively. It will be important for them to remain positive as expectations, by necessity, will be altered.

Adaptations will have to be made to overcome limitations. Practicing daily will be necessary as continual effort will have a cumulative effect on their abilities. It will be important to set goals, to do things they enjoy, to be social and to try new things. It will be important also to accept the many changes in their life and to adjust to how their stroke affects other people. It will be natural to initially fear the future because strokes affect the body, mind and emotions.

Following a stroke there may be paralysis, weakness in the limbs, difficulties with balance or language, pain or vague sensations of feelings in their body, cognitive and memory problems, feelings of frustration, feeling a sense of loss, difficulties with bowel or bladder control, fatigue, trouble swallowing or difficulty maintaining their hygiene. There may also be depression. It will be important to seek help if depression is suspected.

In some cases, brain cells may be only temporarily damaged. In other cases, different areas of the brain will take over from the damaged areas. Rehabilitation will play a large part in helping the brain sufferer. Goal setting will also be important. And as with everything, a proper diet is necessary.

It will be important for either the stroke-impaired person or his/her caregiver to ask questions regarding their care, to allow him/her to express their wishes and opinions and to be made a partner in their own health care. It will be important to keep them informed and to encourage them to join a stroke support group.

Special equipment may also be required following a stroke, i.e.: a cane, walker, wheelchair, orthotic devices or communication aids. There are also services available such as meals on wheels and transportation services.

Adjusting to the effects of a stroke will be different for each stroke survivor because, like every brain injury, each stroke is different also. A lot will depend on the attitude of the survivor and how hard he/she is willing to work at rehabilitation. It will also depend on the severity of the stroke and where it was. Whether there is a family member and/or caregiver available to assist with follow-up care and rehabilitation will make a difference too in both physical recovery and in a positive attitude.

Helping Victims of Strokes

More than 700,000 people suffer from a stroke each year in the United States. Strokes are the fourth leading cause of death in the United States and the most common cause of long-term disability. One American dies of a stroke every four minutes.

It is thought that sensory stimulation, i.e.: gentle touching of the face and hands, etc. or talking in a soft voice to the person who is suspected of having a stroke may reroute the brain's blood supply while waiting for an ambulance to arrive. By doing this, it is hoped that the stimulation may assist in keeping cells from dying while a person is experiencing a stroke.

There is also a drug available that breaks up blood clots if it is administered within three hours following a stroke. However, it doesn't work for everyone and of course, getting help quickly is of paramount importance.

But what is required after someone has had a stroke? A person who has suffered from a stroke should begin rehabilitation no longer than 24 to 48 hours following their stroke because most will require at least some rehabilitation in order to become as independent as possible in the future.

It may be necessary to relearn some skills that may have been lost, i.e.: walking or talking. They may have to learn new ways of doing things, i.e.: how to bath, dress themselves or to eat. They may only be able to use one hand. If that is the case, they will have to practice repetitive exercises to strengthen the stroke-impaired limbs. If there is some weakness or paralysis on one side of their body, they should use those limbs to do basic activities for their daily living. Once begun, it may be an ongoing process to maintain and refine these skills.

Strokes can affect both speaking or understanding; motor control, i.e.: their face, arm or leg usually on one side of their body; sensory disturbance problems; memory and cognitive problems; emotional disturbances, i.e.: psychological trauma as a result of the stroke, and depression. As in other brain injuries, stroke victims will not usually experience all of these problems and the fortunate ones will have only mild limitations that may require little rehabilitation.

Many people are involved in stroke rehabilitation: the patient, family member, caregivers, doctors, rehabilitation nurses, physical therapists, occupational and recreational therapists, speech therapists, and vocational therapists.

As a family member, if you have been there when the stroke happened, your most important task is to get your loved one to the hospital as quickly as possible because early intervention will mean there will be a more positive outcome.

It is important if a family member has had a stroke that he/she and/or his family members/caregivers do all they can to work towards rehabilitation so they are not one of the more negatively impacted.

Assessment Tools for Concussions

As there is more awareness of the dangers of concussions, particularly when playing sports, most now realize that concussions have to be assessed early and that proper follow-up care is necessary. As a result, there are now several assessment tools now available for the amateur, scholastic and professional level of athletes.|

The following are some of the diagnostic and assessment tools now being used:

- The C3 Logix system is an assessment tool that was initially used for research into Parkinson's disease but is now being used to assess those with concussions. It determines rate of dizziness, balance and visual disturbances. The data is stored in the system, eliminating the guesswork and makes managing brain injuries, and particularly concussions, easier. Tpad2's are currently being used along with the C3 system as the assessment tool. A baseline assessment is done on players pre-season so that if there should be a suspected concussion then another follow-up assessment will be done to compare the two assessments in order to determine the degree of the injury. Another assessment may be done during the recovery period to determine rate of injury improvement and another before the player is allowed to return to the game. By doing these types of assessments, it ensures that no player will be allowed to play with any symptoms that have not been resolved. This data collection system assesses the neurocognitive symptoms, balance, reaction times, memory and motor function to determine brain health so that concussions can be better managed. It is portable and accurate and is able to focus on moving objects. It can test athletes at all levels.

- SCAT2 is another diagnostic assessment tool for determining concussions. It is a standardized method of evaluating athletes for concussions from as young as ten years and older. The SCAT2 also does pre-season baseline testing of athletes.

- ImPact Sports Concussion Assessment and Cognitive testing is also utilized. It tracks the injury from the time of concussion and throughout the recovery process.

- The C3 Application is often used with the ImPact Sports Assessment. It is an iPad based application to assess concussions. All information is put into the medical record system so that follow-ups can be made. As part of this assessment, there will likely be a physical assessment done as well, i.e.: a drop test and a balance test.

There are approximately 500,000 sports related concussions in the United States each year. MRI's and CT scans do not detect concussions. Because concussion symptoms can be very difficult to correctly determine the degree of injury, these diagnostic assessment tools are a huge advantage to medical professionals as well as athletes to ensure that proper care is received and that hopefully long-term problems can be avoided in the future.

These diagnostic assessment tools are being used more and more frequently within schools and universities in the United States. Hopefully the advantages of their use will begin to be realized.

Brain Injuries and Behavioural Problems

Behavioural problems quite often are a result of brain injuries. There can be many problems or few depending upon the severity of the injury and in what part of the brain the injury is located. Some of the potential problems are as follows:

Mood swings, depression, hyperactivity, aggression, sexual inappropriateness and/or promiscuity, lack of initiative or motivation, changes in emotional control, lack of impulse control, poor concentration, lack of empathy, fatigue, thoughtless or hurtful remarks, difficulty in relating to others, excessive demands, personality changes, a tendency towards being frustrated, irritated or angering easily. Unawareness of others' feelings is other another deficit and may be something that has to be relearned. Another serious and very common problem is short-term memory difficulties, as is a lack of awareness of their deficits.

If a brain injury survivor is affected with any of these behavioual problems, it is very stressful for family members and caregivers. It may be important to have cognitive and behavioural rehabilitation and possibly the help of a neuropsychologist. It will also be important to have an assessment done which will help both the survivor and the family member. And because behavioural problems not only affect relationships but performance in school and work, it will be necessary to attempt to alleviate the problems or at the least, to help cope with their impact. The following are some of the things that can be done in order to help minimize problems associated with behavioural changes following a brain injury:

- to be calm and speak in a soothing manner when the brain injured survivor is angry or frustrated;

- help them attempt to problem-solve their difficulties;

- use anger management strategies and remain low-key;

- avoid confrontation if they are angry;

- attempt to distract;

- attempt to identify any triggers so as to avoid future difficult situations;

- encourage the survivor to join a support group;

- be non-judgmental;

- help a sufferer of a brain injury to have positive experiences by offering encouragement and support;

- avoid arguments and criticism;

- help them to have a schedule and structure in their lives;

- don't give too much information at one time;

- establish consistency and always remain calm;

- and, if depression is suspected, have survivor see the doctor and if necessary, ensure that he/she gets treatment.

A total reversal of behavioural problems following a brain injury may not be possible. Modifying behaviour may be a more realistic goal while working towards improved quality of life and successful community integration.

Developing adaptive behaviour requires recognizing triggers and anticipating factors preceding the behaviour. These may be internal such as fatigue or hunger. External factors may be a frustrating task or increased levels of stimulation. Prior signs to difficult behaviour may be pacing, becoming fidgety, their face may become flushed, or they may begin muttering to themselves. Early intervention when a problem arises may assist them, over time, in changing their behaviours.

Brain Injuries and Sensory Deficits

Sensory deficits following a brain injury are usually the result of damage to either the right side of the brain or the parietal and occipital lobe region. Sensory deficits are those to do with hearing, smell, taste, touch and body language such as emotional and non-verbal signals. These deficits can lead to lack of communication, confusion and frustration. Some may even develop tinnitus, a ringing in the ears.

Other problems may be auditory perception having to do with sounds and visual perception relating to colour confusions, shapes, size, depth and distance. Those who suffer from the sensory deficit of vision loss, problems with hand-eye coordination or having blind spots or double vision may, as a result, be somewhat clumsy.

Another sensory deficit is textile perception relating to pain, pressure and temperature. The skin may also tingle or itch excessively. Olfactory perceptions relates to smells where everything has an unpleasant odor, and gustatory perceptions relate to taste where everything tastes bitter are some of the other deficits.

Those suffering from sensory deficits may also have problems copying or recognizing objects, being able to tell their left from right, doing mathematics, or analyzing and remembering visual information. They may also have a problem with awareness of their body such as when climbing stairs, following directions or constructing even simple objects.

One well-known syndrome involves ignoring something from, typically the left side, i.e.: food on the left side of their plate. They may also have an inability to recognize faces, even those very familiar to them, such as their own spouse, and are often unable to determine emotional cues of any kind. In some cases, they will not even be able to recognize a picture of themselves.

Identifying any object requires most of the senses: sight, (What does it look like?); touch, (What does it feel like?); sound, (What does it sound like if chewed? Does it even have a sound?); smell, (Does it have a smell?), and by taste, (What does it taste like?). If one or some of these senses don't work, the person will have to rely on their other senses.

Other solutions may be retraining which would include repetitive and intensive exercises of the necessary skills. This can be effective with specific skills, i.e.: recognizing faces of their closest family members. Compensatory strategies may be another solution. Modifying their environment may also be necessary using safety devices such as hand rails, ramps or by moving furniture, etc. to make movement within their home environment easier.

Some sensory deficits may initially go unnoticed by others such as the sense of smell or taste but can be unpleasant for the sufferer. Whereas others can cause severe problems such as vision or communication deficits. Helping to find a solution to these deficits will be important for your loved one.