Living after a Stroke

Weakness, lack of coordination or uncontrolled movement. It's a secondary disability that tend to improve, but even with rehabilitation therapy, complete recovery cannot be guaranteed.

More likely to suffer falls. It is important to exercise and strengthen muscles, and also improve balance. Features in the home that imply an increased risk of falls should be identified and modified; for example, remove rugs, use bath or shower chairs, fit handles and wear nonslip shoes.

Visual disturbances. Sometimes patients lose half their visual field, a condition called hemianopsia. With a little training can be compensated for by turning the head to look towards the damaged side.

Language disorders. A speech therapist will assess and rehabilitate, where possible, any post-stroke speech disorders.

Spasticity. Is another common problem comprising a permanent contraction of certain muscles. This can lead to stiffness, pain, spasms and hinder certain

Disorder senility. Manifesting with symptoms of pins and needles, uncomfortable sensations or numbness to touch.

Superficial pain. Known as central pain syndrome, that produces a burning or stinging sensation which worsens when touched, in contact with water or upon moving. Some antidepressants and anticonvulsants are effective at controlling this type of pain. Stroke patients who subsequently suffered paralysis in one arm may feel pain in that shoulder. Episodes of pain can be treated with simple painkillers but if the pain persists patients should be. 

Dysphagia or difficulty swallowing. It is one of the most common complications after having a stroke, so screening is always performed during hospitalisation. To help patients with dysphagia, we can modify the diet, adjust food textures or use safe feeding techniques when needed. Providing health education at discharge is essential to prevent complications in these patients. After hospital discharge, it’s important for a speech therapist to oversee rehabilitation and regularly reassess the patient’s swallowing difficulties.

Urinary incontinence. It tends to be a temporary effect, although it may endure in patients with significant sequelae. If the problem persists when the patient is discharged from hospital, healthcare professionals should be consulted about incontinence treatment and management.

Mood disorders during convalescence, rehabilitation and even after recovery. Depression, apathy, irritability or emotional lability (uncontrollable swings from crying to laughing, or crying and/or laughing for no apparent reason) are potential sequelae of a stroke. Healthcare professionals should be consulted whenever a stroke patient presents any signs of a mood disorder.

Cognitive impairment (e.g., a decline in memory, attention span and orientation, or difficulty planning and organising tasks). Although this decline can improve over time, if it affects the patient’s recovery they will probably need to be referred to a specialist.

Healthy diet. Following a healthy diet is essential for both primary and secondary stroke prevention. Following a Mediterranean diet has been shown to reduce the risk of stroke. This diet is rich in fruit and vegetables, virgin olive oil, whole grains, pulses, nuts and unsaturated fats. It’s important to limit salt intake, processed meats, and sugary drinks.

Maintaining a healthy weight and exercising. Physical activity is essential not only for preventing stroke but also for supporting recovery after having one. Exercise helps improve your functional capacity and quality of life while also reducing the risk of developing cardiovascular diseases by lowering blood pressure and blood sugar levels. Whenever possible, it is recommended to do low to moderate intensity aerobic exercises (such as walking, jogging, cycling, dancing, or swimming) about 3 to 5 days a week, during 20 to 40 minutes per session.  It is also important to include strength training exercises about twice a week.

Stop smoking. Stopping smoking after a stroke brings many health benefits, both in the short and medium term, and reduces the risk of having another stroke or other cardiovascular problems. In the short term, you will notice improvements in your sense of taste and smell, feel less tired during activities, and save money, among other benefits. After one year of quitting smoking, the risk of stroke is cut in half, and after five years, the risk is similar to that of non-smokers. Primary care centres have teams of professionals who can help patients that want to stop smoking.

Drugs. Prevention treatment is not always the same for each patient, as it must be adapted to the underlying disease responsible for the stroke. There are two large groups of medicines used to reduce the chance of producing a blood clot:

• Antiplatelet agents. These medicines inhibit platelet function; platelets are blood cells involved in the formation of plaques on artery walls and blood clots. The most commonly used antiplatelet agent is acetylsalicylic acid, better known as Aspirin®.
• Anticoagulants. Anticoagulants form the second group and work by inhibiting substances known as coagulation factors. The most widely used anticoagulant in Spain is Sintrom®. It must be monitored regularly to determine if coagulation is well controlled and to discover the correct dose for each patient. In recent years, three anticoagulants have been marketed which provide the same function as Sintrom® but they are administered in fixed doses and without the need to monitor the anticoagulant effect.
• Drugs to control high blood pressure, diabetes and hypercholesterolemia. Sometimes specific medicines are also required to maintain blood pressure (below at least 14/9), blood sugar (glycaemia) and cholesterol levels within normal values.