Post Stroke

A person’s first stroke inevitably comes as a huge surprise. You simply don’t anticipate such an event. “So what happens next?” you wonder. Strokes vary widely in their severity, so we’re going to generalize and describe your post-stroke world in terms that apply to pretty much any stroke survivor, regardless of the seriousness of the event.

Post Stroke Complications

Some people have a stroke, and no further negative event.  But some suffer post-stroke complications that need to be treated.  These may include a swelling of the brain, pneumonia, which is common after many illnesses, depression, which we’ll discuss more in a moment, and physical afflictions like urinary tract infections and bed sores. Your medical team will monitor your condition and treat any complication as soon as it appears.

Stroke And Your Emotions

If somebody who has never had a stroke tells you, “I know exactly how you feel,” be polite and maybe not answer at all, because the fact is that person can’t possibly know what you are going through. For example, you’ll find it hard to control your emotions after a stroke. Suddenly important things you had counted on doing may have to be cancelled or at least postponed. It’s not uncommon for people to fall into depression after a stroke. If so, don’t hesitate to ask for help.

You may also feel frustrated that you can’t do what you would like.  You may suffer anxiety because the doctor can’t tell you exactly what your future will be like. Depending upon your makeup, you wish to lash out in anger. Or maybe you just say “I quit,” and give up.

Confide in your medical team.  Let them know how you feel. If they prescribe medication or other treatment, cooperate with them fully. It’s the only way you will recover.

When You Leave The Hospital

When you are discharged from the hospital, if you are sufficiently recovered and have family members who can help you convalesce, you may go directly home.

Your home wasn’t designed to accommodate a stroke survivor, so it may need some modifications.  Furniture may need to be moved — or in some cases even removed — so that you have a clear pathway from room to room and even within a room, particularly if you’re using a wheelchair or a walker. Bathrooms and showers may need to be refitted with grab bars on the wall so that you can more easily get up and stand. One study showed that nearly 40% of stroke survivors suffered a serious fall within a year after their strokes occurred.

Your treatment will very likely continue at home.  A physical therapist or other health care professional may come one or more times a week to treat you and to assess your progress.

If your team determines that your condition still requires extensive therapy, your doctor may send you to a specialized rehabilitation facility where you can continue your recovery until you are sufficiently independent to go home.

Some stroke survivors are so afflicted that they need ongoing nursing care, on a low level basis or even 24/7.  Such patients may go from the hospital directly to a nursing home.

Rehabilitation

Any stroke affects the brain directly and, because the brain controls all our actions, it inevitably affects other parts of the body indirectly.  For example, if it strikes that part of the brain that controls speech, then it may also affect your ability to talk. If it strikes that part of the brain that controls the movements on the right side of your body, then you may lose some mobility in your right arm or leg. Other strokes can negatively affect sight, hearing, memory, and so on.

It’s natural for stroke victims to worry that whatever condition they find themselves in immediately after a stroke is how they will be for the rest of their lives, but that’s just not true. Your medical team‘s goal will be to have you regain the use of any affected part of your body. So once you have been stabilized and your condition has been evaluated, they will begin laying out a course of rehabilitation or rehab. They want you to get back as close to normal as you can and if 100% recovery isn’t possible, to have you learn how to function as independently as you can with your new normal.

There’s one other important aspect to your recovery. Your medical team doesn’t want you to undergo another stroke in the future.  So they will work with you to make any changes in your day-to-day lifestyle that might help you avoid another stroke. That may involve a medical intervention  (e.g., steps to lower your blood pressure) or a change in your daily routine (e.g., giving up smoking).

What You Will Do in Rehab

Rehab can be a little like going back to school, because you may have to learn all over again to perform actions that you’ve been doing on auto-pilot for most of your life. Depending upon how the stroke affected you, you may need help with any of the following:

• Simple everyday tasks like getting dressed, eating a meal and bathing

• Ordinary physical actions like standing up, walking or moving about with a walker, a cane or a wheelchair

• Rehabbing your intellect by doing exercises to improve your memory, your problem-solving ability, and other functions of the brain

• Overcoming any impairment the stroke may have caused in your capacity to speak

• Psychological treatment if the stroke has caused you to suffer from depression, anxiety, apathy or any other emotional malady

• Relearning ordinary social skills so you can function naturally with family, friends and others

 

Your Rehabilitation Team

The medical world has made huge advances in the treatment of strokes.  These days a stroke survivor stands a good chance of being treated by health professionals whose jobs were in their early stages of development a relatively few decades ago.  Your team may consist of any of the following:

A physiatrist. It looks like a misspelling, but it’s not. It’s a medical doctor whose specialty is rehabilitation.

An occupational therapist (OT). This is a skill builder, or rebuilder, someone who helps you relearn common daily activities like dressing, bathing and eating.

A physical therapist (PT). Your stroke may have impaired your walking, balance and coordination abilities.  The PT will help you restore these as much as possible.

A rehabilitation nurse. A nurse who coordinates your medical needs for the duration of your rehab.

A speech therapist.  If the stroke has affected your speech or language skills, this professional will help you recover them.

A recreational therapist. You enjoyed recreational activities before your stroke, and it’s important that you enjoy them just as much afterwards. A recreational therapist will help you adjust your previous activities to your new condition and help acquire new activities if that’s needed.

A psychiatrist or psychologist.  A stroke can punch holes in your normal way of living. A psychiatrist or psychologist can help you overcome the emotional distress this causes and adjust to what has become your new normal.

Vocational rehabilitation counselor.  If your return to work is made problematical because of a stroke-related disability, a vocational rehabilitation counselor can evaluate your skills and help you determine if you should return to your former position or seek a new one more compatible with your current skills.

Returning To Work

It’s common for stroke survivors to want to get back to work as soon as possible. There’s the financial motivation  — you may just need the income — but there’s also an emotional pull. A stroke can rob you of some of your sense of self-worth. If your physical or mental abilities have been limited by the stroke, you may feel you are not the whole person you once were. But if your work provides you with a lot of satisfaction, and if your job is important because you manage other people or because you are a key contributor on a team that has a critical mission, getting back to work can restore that self-worth and increase your self-esteem.

If you return to work with a disability that you didn’t have before, several different things may happen.

Under the Americans with Disabilities Act, your employer may be required to provide an accommodation to help compensate for the disability.  That can be something as simple as a specialized chair or a change in your duties so that you no longer have to climb ladders or stairs.  One expert in the field estimated that more than half of all accommodations cost less than $100 and many are paid for out of public funds.

If your disability prevents you from operating efficiently in your former position, you may have to transfer to a new one. Having a positive attitude about this is crucial.  Rather than thinking of it as a demotion (which it may or may not be), recognize that your employer thinks enough of you to find you a worthwhile place in the company.  Whatever the new position is, if you make up your mind you’re going to be every bit as good at that as you were in your former role, you probably will have a long and fulfilling career with that organization.

Hope After Stroke Foundation Support Groups

It’s natural for stroke survivors to get a serious case of the blues. Your world has been unexpectedly turned on its head. But you don’t have to go it alone during your recovery and beyond.  The Hope After Stroke Foundation offers free twice monthly Stroke Support Groups where stroke survivors and their family members, friends and others learn more about a stroke, share their experiences, and become inspired to move forward. It’s not possible to overstate what hugely positive effects these support groups have in the lives of stroke survivors and those close to them.

A stroke can be very isolating, so it is important for stroke survivors to meet regularly with other members who will help each of them face and overcome common challenges. A stroke support group is a place for stroke survivors and caregivers to make new friends, socialize, gain realistic feedback, help others and find meaning in life that may have been lacking in their lives since their stroke. Stroke support groups often are the key to uncovering the hidden strengths in many survivors with the warmth, acceptance and emotional support that is needed after a stroke.