Stroke
Changes Following A Stroke

The most common changes following stroke are depression and anxiety.  Depression may be a reaction to the changes that the stroke has caused. The person may be worried about being a burden to family members or about being able to function as she or he did before the stroke. Sometimes there is an organic cause when the stroke has affected the parts of the brain that control emotions.

Signs of depression are sadness, tearfulness, loss of interest in daily activities, changes in weight, sleep or appetite; agitation or fatigue; feelings of worthlessness or guilt; difficulty in thinking or concentrating; thoughts of death or suicide. Usually depression following a stroke goes away as the person begins to recover. Support of family, friends and rehabilitation professionals can help tremendously. But if symptoms of depression continue, help from a professional primary care physician, rehabilitation physician, psychiatrist or psychologist--is needed.

Physical Changes

Sometimes stroke leaves its survivors with weakened limbs. The patient may experience stiffness or spasticity. This can lead to difficulty with motion, mobility and range of motion. Persons with these problems should see a doctor. The physician may prescribe more physical or occupational therapy, splints, a change in the home exercise or therapy program.

Cognitive and Memory Problems Following a Stroke

Following a stroke, a person may experience changes in her mental abilities. The patient may be confused about age, location, or sense of time. For example, she may state her age as is ten years younger than she is, she may think she is at home rather than in the hospital, or she may think that it is July when it is November. All of these problems reflect a difficulty in orienting oneself.

The person may find it more difficult to pay attention to things after a stroke. She may be distracted by a radio or the television or a conversation when she is trying to do something else. Following a stroke, a person may have trouble understanding what is said, or may not be able to make herself understood by others. Vision may also be affected; the person may have blurred or doubled vision, or she may not see things at all on one side.

Changes in memory are also common. Generally, these problems are evident in learning new information. Memories of past events are usually not lost; the patient will remember events from childhood or events that occurred prior to the stroke as well as before.

A stroke may affect a person's ability to perform more complex mental activities. She may find it more difficult to make plans or decisions, to solve unfamiliar problems, to form judgments, or to think abstractly.

Many of these changes in a person's mental abilities may improve but other changes in thinking may last longer. Cognitive training may lessen the impact of these mental changes and increase the person's independent functioning.

Communication and Swallowing Problems Following a Stroke

Aphasia is a communication problem that can affect speech, reading, listening, and writing. People who suffer from aphasia may be unable to express a basic idea, such as hunger, or remember a single word, like the names of their children. They may not be able to read a newspaper, or even write their name.

In addition to aphasia, people who have had strokes may also experience slurred speech and/or swallowing difficulty. Dysarthria is the name of a communication problem that affects the clarity of speech. Weak muscles and poor coordination involving the mouth and throat can cause speech to be either slurred, too fast, too slow, too soft or too loud, and hard to understand.

Very often stroke can cause a problem with swallowing, which is called dysphagia. This problem can range from a mild drooling to severe coughing and choking. In the most extreme case a patient may need a feeding tube, either in his nose or in his stomach.

Many of us take our ability to communicate and swallow for granted. Suddenly losing these abilities can be devastating. Patients with these problems are referred to a professional, known as a speech therapist.

The speech therapist evaluates the patient's communication and swallowing skills, identifies any problems, and designs an individual therapy program to help the patient improve his skills to the maximum potential. The therapist also provides counseling and support to the patient and family, to help them understand the changes in the patient's abilities, and facilitate communication between the patient and family.

Thanks to the clinicians and supervisors of the MossRehab Stroke Center
for providing this information.
Stroke Center leaders: Peggy Seminara and Dr. Arthur Gershkoff

reviewed October 2003