Articles - Stroke Support

Every year more than 130,000 people in England and Wales suffer first strokes – about 10,000 are under the age of 55 and of these 1,000 are under the age of 30. (The Stroke Association).

Jo Lawrence, our practice neurological physiotherapy specialist, claims that despite this, many people who suffer from stroke have never met anyone else with the condition and have no idea of the symptoms associated with it, often believing it to be something that affects only the elderly. Whether someone has prior knowledge of this or not, having a stroke can be a terrible shock and have a devastating effect on the lives of the sufferer and those close to them.

Stroke (or cerebrovascular accident) happens when the blood supply to the brain is disrupted. Causes can be a clot from diseased arteries or a bleed where the artery walls have weakened and ruptured. There is resulting damage of the area of the brain supplied by the block or ruptured blood vessel.

The location and extent of this damage determines the parts of the body affected. Symptoms can be many and varied including:-

  • Hemiplegia, which is paralysis of one side of the body, occurring on the opposite side to the brain damage.
  • Loss or diminished sensation of this side of the body with the patient experiencing, for example, hypersensitivity, parathesiae (“pins and needles”), numbness.
  • Changes in muscle tone, i.e. spasticity (increased tone) or flaccidity (decreased tone). With increased tone it is often very difficult for the stroke patient to move out of their spastic pattern. Tone can further increase when the patient uses effort, is upset or angry, under stress, unwell or cold. With decreased tone the limbs feel very heavy. There is a lack of control and even dragging to one side. Both of these can be extremely uncomfortable.
  • Change of body image – neglect of the affected side especially if sensation is poor.
  • Problems with balance in sitting, standing and walking – this can be due to weakness on one side especially the trunk muscles, weight bearing too far to the unaffected side, poor judgement of space, balance areas of the brain being damaged.
  • Problems with speech, understanding, concentration and memory – speech problems usually occur when the stroke affects the left side of the brain where the areas for speech and language are situated.
  • Problems with swallowing and chewing, dribbling from the side of the mouth, weeping from the eye due to weakness affecting the facial muscles.
  • Incontinence

It is usual to feel very tired after having a stroke. Patients are often surprised how even small activities such as washing and dressing can be so exhausting. They are also often distressed at finding they break into tears very easily. Even though they are understandably upset at having a stroke, symptoms can actually include being emotionally labile. These episodes of crying usually become less over the following weeks and months.

Following medical and/or surgical treatment there is a gradual re-absorption of the blood and swelling into the tissues relieving the pressure on the brain. This is when the patient can start working on re-educating their body and functional recovery.

The physiotherapist is one of the multi-disciplinary team of professionals involved in the treatment of stroke patients. Ideally physiotherapy should begin as early as possible to prevent complications and compensatory strategies setting in such as painful stiff joints, muscle contracture (shortening of soft tissues) and over-use of the unaffected side. The physiotherapist will fully assess to find out how a stroke has affected each patient and develop an individual regime of treatment/exercise to re-educate and regain strength, mobility and function for which there are many techniques available. Some patients whose strokes are very minor may not have been admitted to hospital but may find a physiotherapist assessment useful if they have noticed a residual weakness which does not seem to be resolving.

Although there are similar symptoms following a stroke, no two people are the same. Therefore it is very difficult to compare one person’s recovery to another. The amount of recovery and time taken to achieve it depends on many factors, i.e. the severity of the stroke and the general health of the patient along with the need to maintain a positive attitude and have patience as recovery will be gradual. Specific exercises and functional activities must be practised regularly in order to improve. Also being as active as possible within a patient’s limitations is an important factor in increasing stamina and exercise tolerance, advice on which can be provided by the physiotherapist.

There are various support groups available for stroke sufferers, their families and carers where information, advice and help can be found about the effects of stroke on aspects of peoples lives, e.g. The Stroke Association (0845 303 3100), Different Strokes – specifically for younger adults (0845 130 7172)

Jo Lawrence - October 2004

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