Common Changes Following Stroke

No two strokes are the same. However, there are certain changes that are common in most patients. Many changes are dependent on the severity of the stroke and where the stroke occurred in the brain.

• Physical Changes
• Cognitive Changes
• Speech Changes
• Language Changes
• Swallowing Changes
• Visual Changes
• Daily Living Changes
• Leisure Changes
• Mood and Psychosocial Changes

Physical Changes

Most people experience loss of movement or weakness on one side following stroke. This is because of how our brain works. The left side of our brain controls movement on the right side, and the right side of our brain controls movement on the left side. When a stroke occurs, it typically happens to one area of the brain. Therefore, it is most common to see loss of movement on one side only.

Here are some common physical changes that you or your loved one may be going through:

• Inability to move the affected arm or leg at all, especially early in recovery
• Loss of feeling in the affected arm or leg (touch, pain, temperature or position)
• Swelling in the affected arm or leg
• Weakness in the entire body, making it difficult to sit, stand or walk
• Difficulty overall with balance
• Difficulty perceiving position of the body in space (A person’s body may feel so different that he/she cannot tell where his/her “middle” is or where his/her arm or leg is positioned.)
• Difficulty with coordination -- controlling the direction, force or speed of movement that his/her body or limbs perform
• Imbalance of muscle activity in the affected arm or leg (As movement returns, some muscles may involuntarily work too hard and cause pain or stiffness in the joints.)
• Tightness in all joints throughout the affected arm or leg may occur if movement does not return
• Inability to move the affected arm, as well as the weight of a person’s arm, may cause a condition known as shoulder subluxation. This means that the shoulder becomes separated or dislocated and is not in its normal position. It is commonly managed by proper positioning of the shoulder in relation to the body.
• Pain may or may not be experienced after a person suffers a stroke. Oftentimes pain can be prevented by proper positioning, range of motion and overall mobility. If pain is present, it will be managed by both the physician and therapy team.

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Cognitive Changes

Some people experience changes in cognition, or thinking, following a stroke. Because the stroke occurs in the brain, it is only logical that there may be some change in how the person thinks following the stroke. However, some problems are very mild and resolve fairly quickly, while other problems may persist and cause difficulty in even basic daily activities. Your therapists will try to be very thorough to assess any difficulty with cognition following the stroke to ensure a safe transition home.

Here are some common cognitive changes that you or your loved one may be going through:

• Difficulty with orientation to self, place, time or situation
• Limited attention to an activity either in an isolated or a distractible environment
• Limited ability to switch attention between two or more tasks (for example, answering the phone while in the middle of cooking, but being able to return to cooking activity)
• Limited ability to attend to two or more things at once (for example, holding a conversation while driving)
• Limited attention to details (for example, when filling out a form, a person may miss a question or section without realizing it)
• Difficulty with long term, short term or immediate memory
• Difficulty solving either routine daily problems or high level problems related to time management or work skills
• Difficulty with reasoning skills (drawing conclusions, understanding the rationale for doing something)
• Difficulty with sequencing or putting things in order
• Impaired insight (The person does not believe he/she is having difficulty with things that seem to be apparent problems to others.)

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Speech Changes

Some people may experience difficulty with speech production following a stroke. The medical term for this is dysarthria. This typically involves changes in the muscles of the lips, tongue and throat. It can also be caused by weakness in the muscles used for breath support.

Here are some common speech changes that you or your loved one may be going through:

• Slurred speech
• Unintelligible speech or speech that is not able to be understood
• Slow or uncoordinated speech
• Extremely soft speech

Another cause of impaired speech production is termed verbal apraxia. This is the inability to plan the movements required to make a certain sound or word. Severity can range from occasional sound substitutions to complete inability to make a sound. The person may be able to say “hi” or “how are you” automatically when seeing someone. If asked to say these words or phrases though, the person may not be able to do so.

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Language Changes

Language problems typically appear in persons whose stroke occurred on the left side of the brain. The medical term for a difficulty with language is aphasia, which can be defined as a total or partial loss of the ability to use words. It can affect someone’s ability to speak, write, read, gesture and/or understand spoken, written or gestural language. There are two main types of aphasia.

1. Fluent aphasia: A normal rate of speech may be present, but the person may use words that don’t make sense or that are not actually words. The person sometimes has more difficulty understanding what is said and also has difficulty realizing that his/her speech is not being understood by others.
2. Nonfluent aphasia: Generally, the person has more effortful, hesitant speech. The person often understands much of what is being said and is more aware of his/her errors. Therefore, this individual tends to get frustrated.

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Swallowing Changes

Following a stroke, a person may have difficulty with swallowing. The medical term for this is dysphagia. This problem may be due to weakness and/or poor coordination of the muscles used for swallowing. To evaluate a swallowing problem, we will perform a video swallow study, which is an x-ray procedure that views the inside of the mouth and throat while a person is swallowing liquids and solids.

A person with swallowing difficulties may be placed on an altered diet or tube feedings and may also learn different techniques to assist with swallowing, such as tucking the chin or taking small bites. A person with dysphagia is at risk for aspiration pneumonia if food, liquid or saliva containing bacteria enters the lungs. Good oral care is essential to aspiration pneumonia prevention. Small sips and bite size, allowing time between swallows, also cut down pneumonia risk.

The Frazier Water Protocol allows patients on thickened liquids to drink water between meals. This promotes increased fluid consumption and decreases risk for dehydration. Water is permitted until you take your first bite of food. No water is allowed during a meal or for 30 minutes following the meal. People drinking thickened liquids often report the thickened liquids do not quench their thirst. Fewer glasses of liquid are consumed, which can lead to serious health consequences. Water does quench most people’s thirst. A person taking thickened liquids should be encouraged to drink water to meet the body’s daily fluid requirements for health.

Individuals receiving their nutrition through tube feedings may have water anytime.

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Visual Changes

Some stroke survivors experience visual changes. However, it is important to understand that most often the changes are in visual perception vs. visual acuity. Because a stroke causes damage in the brain, the changes in vision occur where the sensory information is gathered. Therefore, the person may be able to see things in his/her environment, but the way that he/she sees the environment may be altered. This does not rule out visual acuity as a problem following stroke, but it is important to realize that some visual changes after stroke are not able to be corrected by traditional glasses. If acuity is a problem, it is typically due to impaired motor control of one of the eyes.

Here are some common visual changes that may occur after stroke:

• Difficulty visually attending to the affected side. The person may look briefly to that side when encouraged to do so, but most often holds the head in the other direction. This causes problems finding items in his/her environment, avoiding obstacles during mobility, and performing reading and writing activities.
• Difficulty seeing things on one side of the environment. This can be due to a limited visual field since the stroke. When a person turns the head, he/she is able to seek and find an object on the impaired side. But without turning the head, that visual information is not there. Again, problems may be encountered when finding things, avoiding obstacles, and performing reading and writing activities.
• The person may see double. This is typically due to weakness in one of the eyes. Because one of the eyes is weak, it is unable to focus with the other eye to receive a clear image. This is more typical in near activities.
• Limited visual attention to details. The person may “skip over” small visual information that may be of importance. For example, the person may misread simple directions on a package when cooking (using 2 teaspoons water vs. 1 tablespoon).
• Inability to find objects in clutter. The person may have difficulty locating objects in a drawer when looking for something.
• Difficulty organizing the position of an object in space. The person may turn his/her shirt several times when donning, with problems finding the top or realizing that it is inside out.

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Daily Living Changes

Following a stroke, life becomes very different if there are changes in how a person walks, talks, moves, eats or sees. Mundane daily activities do not seem as easy as they once were. They can even be extremely challenging. Getting dressed, bathing, going to the bathroom, brushing teeth, managing hair and shaving are all activities that were once taken for granted. All areas of life are affected. Work roles, family roles and other responsibilities may be difficult or impossible for the time being. However, with the help of skilled therapy, the impossible may become possible. There are techniques, equipment and technology available to assist stroke survivors with becoming more independent in their daily activities. There is also the potential for return of lost skills. It is extremely important for the stroke survivor to participate in these familiar activities. These activities provide rehearsal for all problem areas, and they also allow the person to begin taking part in old routines. A person is unable to know current abilities unless the opportunity has been given to show his/her abilities.

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Leisure Changes

Not only have basic daily activities been affected by a stroke, there are also significant changes in leisure activities. Leisure activities provide an outlet for stress relief and relaxation. Following a stroke, this outlet is desperately needed. However, there are often changes that may occur.

• Inability to pursue leisure activities of interest due to physical or cognitive changes
• Inability to use one side of the body for activities
• Inability to socialize due to speech or language problems
• Frustration over lack of leisure options
• Inability to problem solve or find resources for participation in leisure activities
• Lack of transportation for leisure activities
• More time spent on daily activities, leaving no time for leisure

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Mood and Psychosocial Changes

Life can change quickly and drastically following a stroke. This life change is often difficult to manage emotionally. Here are some common problems that can occur following stroke.

• Depression or grief over the loss of old abilities
• Language problems, creating a lack of adequate communication, which can put a distance between the patient and family or friends
• Dealing with the social stigma of having a disability
• Lack of or altered sexual intimacy
• Denial of disability
• Anxiety over current situation and future
• Lessened self-esteem due to loss of control over situation

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Stroke Information

• What Is A Stroke?
• Common Changes Following Stroke
• Inpatient Rehab
• Outpatient Rehab and Ongoing Therapy
• Nursing And Nutrition Needs
• Interdisciplinary Team of Experts
• Facility Features
• Robotic Arm Therapy
• How Can Family Members Or Loved Ones Help?
• Community Resources
• Prevention, Wellness and Advocacy
• Frequently Asked Questions
• Glossary