Coping With Stroke

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Coping with having had a stroke looks different for every individual. While some effects of a stroke may be immediately apparent and, perhaps with therapy, relatively short-lived, others may take months or even years to develop and may be long-lasting.

Having support and getting proper rehabilitation from your care team is essential to making life after a stroke as good as possible. In addition to physical, occupational, and speech therapy, many people find talk therapy with a psychologist or social worker and in-person or online support groups can go a long way toward helping them cope.

Emotional

Sadness, anxiety, anger, and grief are all common responses to a stroke. This is can be due to physical or biochemical changes in the brain as well as the emotional response to post-stroke life.

Talk to your doctor about your emotional health and any changes in mood or behavior as it may be a serious side effect of the stroke. There are medications and treatments that can help you deal with these emotions. Your doctor may recommend seeing a psychiatrist or psychologist for specialized treatment.

Different psychological approaches for treating post-stroke emotional disorders include solution-focused therapy (SFT), problem-solving therapy (PST), cognitive-behavioral therapy (CBT), attitude and commitment therapy (ACT), interpersonal therapy, and mindfulness therapy, also called mindfulness-based cognitive therapy. Group therapy can also be helpful and many people find the social interaction of a group helps to relieve feelings of isolation following a stroke.

Grief

Many people go through a grieving process after a stroke. As you begin to come to terms with new limitations and mourn the loss of your life before stroke, you may experience periods of denial, anger, bargaining, and depression before finally coming to acceptance. This is perfectly normal. Journaling or talking with a friend or therapist can help your emotional healing.

Self-Esteem

With this can also come challenges to your self-esteem. For example, it can be especially hard on you if the stroke has impaired your mobility and limited your independence, affecting, perhaps, what has made you feel like a confident individual.

Be gentle with yourself, avoid being self-critical, and try to reframe negative self-talk with positive thoughts.

Behavioral Changes

After a stroke, new behaviors can include a lack of inhibition, which means that people may behave inappropriately or childlike. Other changes in behavior include a lack of empathy, loss of sense of humor, irrational jealousy, and anger. Talk to your doctor about these changes in behavior as there may be medications that can help.

Pseudobulbar affect (PBA), also known as emotional lability, reflex crying, and involuntary emotional expression disorder, is more common following a brainstem stroke. In PBA, there is a disconnect between the parts of the brain that control emotions and reflexes. People with PBA may briefly cry or laugh involuntarily, without an emotional trigger, and in ways that are not appropriate to the situation.

While there are helpful PBA medications and strategies, such as preventing episodes with deep breathing, distractions, or movement, some people find simply alerting those around them in advance can help reduce embarrassment and make it easier to cope.

Depression

Up to two-thirds of stroke patients experience clinical depression after a stroke, and stroke survivors are twice as likely to attempt suicide as the general population. If you are experiencing symptoms of depression or having suicidal thoughts talk to your doctor or call the Suicide Prevention Hotline at 1-800-273-TALK (8255)‎.

Treating depression with a combination of medication, talk therapy, and group support should improve your mood and also boost physical, cognitive and intellectual recovery. 

Physical

Coping with physical limitations after a stroke can be a struggle. While many of these challenges will improve over time, it can help to know what you can expect during recovery and where to turn for help.

Many long-term physical complications from a stroke can be helped with therapies, while others may be helped with medication or adaptive technologies and other tools that can help improve independence and quality of life.

Weakness

Most of the time, weakness caused by a stroke affects one side of the body, known as hemiparesis. This commonly affects the face, arm, or leg or a combination of the three. While the weakness may linger long-term, physical therapy can help you to regain strength and occupation therapy can help you develop alternative strategies.

Balance

Many stroke survivors report feeling off-balance, dizzy, light-headed, or as if the room is spinning. These sensations may come and go but typically stabilize about six months after a stroke. Physical therapy is the most effective way to combat balance impairment after a stroke. Your therapist can show you safe, at-home balance exercises or yoga poses to improve balance and combat dizziness.

Vision Changes

Vision problems that may result from a stroke include double vision (diplopia), visual field loss (hemianopsia), jerking of the eyes (nystagmus), loss of vision, and dry eyes. Ophthalmologists and occupational therapists can advise you on the best method to manage vision changes, including therapy to compensate for vision loss, prism lenses, sunglasses, an eye patch, or eye drops.

Communication Problems

Difficulty speaking or understanding words is one of the most well-known results of a stroke and among the most impactful. Speech-language therapy can help people cope with aphasia—which is trouble speaking or understanding words due to a disease or an injury of the brain, and dysarthria, difficulty articulating words due to muscle weakness or diminished coordination of face and mouth muscles.

Cognitive Deficits

Cognitive changes after a stroke include memory glitches, trouble solving problems, and difficulty understanding concepts. While the severity varies from one stroke survivor to another, research shows cognitive remediation can help significantly. These interventions include exercises to improve memory, processing speed, and attention and teaching compensatory strategies, such as making lists and keeping a planner.

Hemispatial Neglect

A stroke on one side of the brain can lead to difficulties with the field of vision or movement on the other side of the body, known as hemispatial neglect. For example, a stroke in the right cerebral cortex can lead to the diminished ability to notice and use the left side of the body. Depending on the part of the body affected, an optometrist, neuropsychologist, or physical or occupational therapist can help you cope with hemispatial neglect.

Pain

As many as 60% to 70% of stroke survivors experience new-onset pain after a stroke. Post-stroke pain can include muscle pain, facial pain, headaches, low back pain, and neck pain. Rest, physical therapy, and medication can help you to cope with the pain. Post-stroke headaches require special attention from your doctor, but they can improve with the right treatment.

Fatigue and Sleeping Problems

Half of all stroke survivors report experiencing long-term fatigue following a stroke. For some, this manifests as excessive sleeping or the inability to feel rested, while others wake in the middle of the night, have difficulty falling or staying asleep, and nap sporadically throughout the day.

These problems may be due to the stroke itself or a secondary cause, such as depression, pain, or nutritional deficiencies. If you experience fatigue or trouble sleeping talk to your doctor who can run additional tests, prescribe medication for insomnia, or offer other strategies to help you cope.

Swallowing Difficulties

A speech and swallow evaluation can identify problems with chewing and swallowing, a common stroke complication known as dysphagia. Most patients see improvement within the first few weeks after a stroke, however, swallowing problems can be quite dangerous.

Choking due to stroke-induced muscle weakness may cause serious illness, such as aspiration pneumonia or even life-threatening breathing obstruction problems. Feeding therapy may help you to regain the ability to swallow safely, although some patients may require a feeding tube to get adequate nutrition.

Trouble With Urination

After a stroke, many stroke survivors experience incontinence, which is urinating when you do not want to. Some stroke survivors also experience bladder retention, which is the inability to urinate on demand. Both of these problems can be managed with medical treatment and physical therapy.

Urination problems can be embarrassing and inconvenient. Discrete bladder-leak protection products like pads for both men and women, disposable underwear, and leak-proof underwear can help you feel more confident going out in public.

Muscle Atrophy

Post-stroke muscle weakness can lead to a lack of movement. A recent stroke patient may need assistance getting up and around in the days following a stroke and staying in bed too long can result in the muscles shrinking and becoming weaker.

Muscle atrophy can be prevented through pre-emptive post-stroke rehabilitation methods that engage weakened muscles before they shrink. It is difficult to recover from muscle atrophy, but rehabilitation techniques can help improve the situation and slowly rebuild muscle.

Muscle Spasticity

Sometimes weakened muscles become stiff and rigid after a stroke, possibly even jerking on their own. Muscle spasticity and rigidity is often painful and can result in diminished motor control of the already weakened muscles. Active post-stroke rehabilitation can prevent this and there are a number of effective medical treatments. Your physical therapy team can provide exercises you can do throughout the day at home to prevent and ease spasticity.

Seizures

As many as 30% to 50% of cortical stroke patients experience seizures due to erratic electrical brain activity. Seizure prevention may be part of the post-stroke care program and post-stroke seizures are typically managed with medication. Some cortical stroke survivors, however, develop seizures years later in the context of a serious medical event, such as surgery or a major infection.

Social

Whether your stroke left you with minor physical limitations, speech difficulties, or serious mobility challenges, many people feel isolated after a stroke. Getting back into the stream of life can take time.

Many patients and caregivers find joining a support group can offer both social engagement and emotional support. Your local hospital or rehabilitation center likely hosts a regular support group or you can check the National Stroke Foundation's website.

For people with limited mobility, joining an online support group that holds regular online meetings, a Facebook community group, or message boards to talk with other stroke survivors and caregivers can be a lifeline keeping you connected to others. Online support is available through the Stroke Network.

Practical

The after-effects of a stroke can present unique individual challenges. Lingering weakness, mobility challenges, difficulty communicating, and visual problems can lead to a lack of independence.

Help With Daily Living

Depending on the degree of your stroke, you may require help with activities of daily living, including cooking, cleaning, and grooming. In some cases, family members step up to help, while others may require a visiting nurse, a part-time aide, or even live-in help like a housekeeper, companion, or nurse. Some people choose to move to retirement complexes that provide varying levels of care or assisted living facilities.

Getting Around

Some people lose the ability to drive and other physical changes that make it difficult to get around. Some stroke survivors find getting a mobility scooter can help them get out in the world independently. Many communities offer senior or disability buses to help you go shopping or offer car services to bring you to your doctor and therapy appointments. You can also use a ride service like Uber or call a taxi to get from place to place.

Employment

Roughly one-quarter of strokes occur in people who have not yet retired. If you are working full-time at the time of your stroke, you should be able to apply for temporary disability until you are able to resume working. If the stroke has left you with minor impairments, but you can still perform some of your former duties, the American Stroke Association recommends entering into a Reasonable Accommodations Agreement with your employer. If you are unable to work, you may qualify for long-term disability through Social Security.

A Word From Verywell

Coping with the long-term effects of a stroke can be challenging. It is understandable that you may feel discouraged at times but learning to accept your new limitations can help your outlook. Remember to work with your doctors and therapist to treat ongoing symptoms and learn adaptive strategies, and reach out to those in your support network when you are feeling down. Keeping a positive outlook can go a long way for your overall recovery.

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