What to expect after a stroke

What to expect after a stroke

Often referred to as ‘the silent killer’, a stroke is a life-threatening and potentially life-altering condition. Known by the medical name of cerebrovascular accident (CVA), but commonly referred to as a stroke, this condition is a medical emergency whereby blood supply to part of the brain is cut off.

If you ever suspect that someone in your presence is experiencing a stroke – exhibiting symptoms such as facial weakness, arm weakness, speech difficulty or comprehension problems – it’s vital that you phone 999 and ask for an ambulance to be sent. The faster that a person receives treatment can save their life and minimise long-term damage caused by the condition.

Our guide is for those who have previously experienced a stroke and seek more information or those with a loved one who has had a stroke. We will walk you through the causes of strokes, who is at risk, what to do and what to expect after a stroke.

What causes a stroke?

Our brains need the oxygen and nutrients found in blood to function correctly. When blood supply has been reduced or even stops, the brain cells in these areas get damaged or die – causing brain injuries, disability and even death.

While deaths related to strokes have declined by approximately 49% over the past 15 years, there are still 32,000 stroke-related deaths in England every year. According to Public Health England (PHE), the majority of strokes (59%) happen to those who are 70 years or over and 38% of first-time strokes happen to those aged between 40 and 69. The average age of males having a stroke is 68 years, whereas for females it is 73 years as of 2016.

If someone survives a stroke, they may experience differences in the way they move, think or even speak. While there are risk factors relating to lifestyle that can greatly increase our risk of having a stroke, there are two primary types of strokes: ischaemic strokes and haemorrhagic strokes.

Ischaemic strokes

This is the most common type of stroke. It generally occurs when blood clots form in areas that have been affected by atherosclerosis. Atherosclerosis is the result of arteries becoming clogged with deposits of fat called plaques – creating blood clots that will either partially or fully block the flow of oxygen and blood to the brain.

While the arteries may narrow as a result of the ageing process, particular risk factors can increase the chances of someone suffering an ischaemic stroke, such as:

  • High cholesterol
  • High blood pressure
  • Smoking
  • Obesity
  • Uncontrolled diabetes
  • Excessive alcohol

However, ischaemic strokes can also occur as a result of atrial fibrillation – a condition that causes a type of abnormal heartbeat that allows blood clots to escape from the heart and get lodged in the blood vessels serving the brain.

Haemorrhagic strokes

While less common than ischaemic strokes, haemorrhagic strokes mostly occur when a blood vessel bursts within the skull – causing bleeding in (or around) the brain. This is often as a result of high blood pressure which can weaken the brain’s arteries and cause them to become more likely to rupture or split.

Risk factors of haemorrhagic strokes include:

  • Smoking
  • Excessive alcohol
  • Overweight or obesity
  • Little or no exercise
  • Stress causing a temporary rise in blood pressure

However, haemorrhagic strokes can also be brought about by a brain aneurysm or atypical formations of blood vessels in the person’s brain.

Mini-strokes

While not full-blown strokes, as in the case of ischaemic and haemorrhagic strokes, mini-strokes – or transient ischaemic attacks (TIAs) – occur as a result of a temporary reduction in blood supply. This reduction in blood supply causes symptoms such as short-term speech loss or difficulties. The symptoms should pass within 24 hours without causing permanent damage.

Who is at risk of a stroke?

As well as the shared risk factors mentioned for both types of stroke, some people are genetically or medically more susceptible to suffering a stroke. Unlike most of the previously mentioned factors, these are factors that are inherently part of a person and cannot be altered or changed.

The first factor is age. As aforementioned, the average age of most people who have a stroke is over the age of 65. However, it’s important to note that roughly a quarter of all stroke victims in the UK are under this age. Your ethnicity can also impact your chance of having a stroke. Those of African, south Asian or Caribbean descent face an increased risk of a stroke due to high blood pressure and diabetes also being more prevalent in these ethnic groups.

The next two factors relate to medical history – your family’s medical history, and your own personal medical history. If you’ve had a close relative who has had a stroke – such as a parent, grandparent, sister or brother – then you also face a higher risk of having a stroke. Your own medical history also factors into your chances. If you’ve previously had a heart attack, stroke or a TIA, your risk of having a stroke is higher.

While you are not able to change the above factors, you can consume less alcohol, cut out smoking, keep active and fit, reduce stress, reduce your weight and pay more attention to what you are eating. These lifestyle changes can reduce your risk of having a stroke – regardless of your age, ethnicity, and family/personal medical history.

Recovering from a stroke

It can be hard to know what is to be expected in the immediate aftermath of a stroke, as well as what the road to stroke recovery and rehabilitation entails. It can be a worrying and uncertain time for the person affected by the stroke, as well as for their family and friends.

The recovery ability of someone who has had a stroke can vary from person to person. For some, recovery can be quite quick; for others, long-term support may be required. The way in which rehabilitation is approached depends upon the symptoms caused by the stroke as well as the intensity of these symptoms.

Stroke recovery begins as soon as the person arrives at the hospital and is stabilised. Most improvements will occur within the first few weeks after the stroke – when you are likely to still be in the hospital. However, some improvements may take months or years.

A team of medical personnel will action the rehabilitation process – doctors, specialist nurses, occupational therapists and physiotherapists all play a role during this time. They communicate with both the patient and the family to establish what is needed for the fullest recovery possible. The goal of stroke recovery is to achieve as much, if not total, independence for the patient in their life.

Once you have been discharged from the hospital, you will likely continue the rehabilitation process at a local clinic. At the local clinic, you will work with a care team who will help you set and reach goals that are obtainable and achievable. Recovery goals are often centred on counteracting the effects and symptoms resulting from the stroke. These symptoms often fall into seven distinct categories:

  • Psychological
  • Communication
  • Cognitive
  • Movement
  • Visual
  • Swallowing
  • Bladder and bowel control

Psychological symptoms

Both depression and anxiety are common problems faced by patients who suffered from a stroke. This can include feeling fearful or hopeless, withdrawing from socialising or social activities, as well as uncontrollable anxiety and tearfulness.

However, other emotions may also become more intense – such as frustration and anger. These problems can be temporarily linked to the stress and fear associated with living through and recovering from a stroke, but they may also be long-term conditions.

Your healthcare team should establish if you are dealing with psychological problems. This can be followed up by your GP who can refer you on to a psychiatrist or clinical psychologist to help alleviate these symptoms. Treatment may include medicine or a form of therapy – such as counselling or cognitive behavioural therapy (CBT).

Communication problems

It is common that those who have had a stroke develop problems when it comes to speaking, comprehending, reading and writing. This is often due to the left side of the brain being damaged – where language is controlled – and is known as aphasia or dysphasia. This is separate from dysarthria, another condition that can be caused by a stroke, which is difficulty speaking caused by brain damage before or during birth or changes to the brain later in life (e.g. a stroke or brain tumour). Symptoms of dysarthria include speech that is either too loud or too quiet, strained vocals, as well as nasally, slurred or monotone speech.

If you are struggling with communication, a speech and language therapist will be made available to you as soon as possible to help with the recovery process. They will work with you to understand and plan your goals, help you exercise your speech muscles to help with speech control, and utilise communication aids as an alternative way of communication.

Cognitive functions

This often relates to how our brain processes information. Communication falls under cognitive functions, but so does memory, concentration, spatial awareness (how you understand your body’s relationship to your environment), praxis (the ability to carry out physical tasks such getting dressed) and executive function (planning, problem-solving and reasoning).

Your cognitive functions will be assessed and a plan will be created for rehabilitation. This can include re-learning functions that have been affected by the stroke. With proper rehabilitation, many of these functions can be recovered.

Movement issues

Another common side effect of strokes can be reduced mobility due to weakness or paralysis to one side of the body. As part of the stroke recovery process, a physiotherapist will see you and assess your physical needs.

Physiotherapy will focus on improving your muscle strength through exercises in an attempt to boost your ability to walk and interact with objects.

Many of these exercises can be performed at any time – ensuring that progress can be achieved on an everyday basis at home. It can be vital for friends and family to help the patient cope with daily tasks and encourage exercise. A carer can help during this period – such as the live-in care and home care workers provided by Better Healthcare.

Visual difficulties

The brain’s ability to receive, process and interpret visual information can be affected by a stroke. Common problems include double vision or losing half the field of vision.

You can be referred to an orthoptist (eye specialist) who can assess and advise on treatments for these visual problems. For example, eye movement therapy can include exercises that can help you to re-establish your field of vision.

Difficulties with swallowing

Strokes can also affect swallowing reflexes, causing dysphagia that can, over time, damage the lungs and lead to pneumonia.

If these difficulties are particularly testing, you may have to be fed through a tube as you recover. This can either be connected through your nose or your stomach.

A speech and language therapist can work out a treatment plan to help manage these difficulties – including tips and advice that can help prevent the onset of dysphagia.

Bladder and bowel control

Bowel and bladder movement can be affected by a stroke – causing issues with bowel control as well as urinary incontinence.

While this control can be regained by most people in a short space of time, some may require longer-term support. This can be secured through your GP, hospital or specialists that deal with continence. While this can be an embarrassing issue for some, it’s essential to get help rather than suffer in silence.

There are several exercises and tools that can help alleviate these issues, including pelvic floor exercises, bladder retraining exercises, incontinence products, and medications.

Support for the stroke patient

If you have experienced a stroke, you will need the support of those around you to help overcome the above challenges and to support you through your stroke recovery and rehabilitation.

If your loved one suffered from a stroke, you will play an important role in helping them get through the psychological barriers that they may face daily – as well as helping them with physical activities as they journey on the road to recovery.

As such, the effort and patience required in the recovery process can cause relationships to become strained. A live-in care or home care worker may be able to help alleviate these issues and ensure that the survivor is receiving the best care possible.

This can be a temporary arrangement – to help the stroke patient with daily domestic tasks such as cleaning during the initial weeks after the stroke – or it can be long-term support to maximise the chances of a successful recovery.

In cases where the patient is finding it extremely difficult or impossible to cope with independent living, a live-in carer can negate the need for the patient to move into a care home.

One such service provider of carers, with an understanding and speciality in helping to support stroke survivors, is Better Healthcare.

Home care and live-in care for stroke survivors

At Better Healthcare Services, our qualified carers help people to achieve independence within the comfort of their own home. We understand the importance of home support to stroke survivors – particularly during the initial phase of rehabilitation.

With many patients struggling with everyday tasks, a carer can help the person get out of bed, get washed, help with meals and carry out domestic chores like cleaning. The effort required to keep on top of these small tasks can defeat us at the best of times. For someone who is recovering from a stroke, it can seem impossible.

But at Better Healthcare Services, our carers have lots of experience in working with stroke survivors and their families. This experience has allowed the team at Better Healthcare to tailor bespoke services to suit the needs of those recovering from a stroke.

Our carers can be as hands-on as required to ensure that the patient can focus their efforts and energy on recovering rather than on tackling everyday tasks, while simultaneously encouraging exercises and treatment plans to be followed.

To find out more about how our carers can help stroke survivors and their families, give Better Healthcare a call on 0800 668 1234 or get in touch with the closest Better Healthcare Services office to you.

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This post is not health advice and should not replace professional advice tailored to your specific circumstances. It is intended to provide information of general interest about current healthcare issues.