A stroke happens when blood flow to a part of your brain is cut off. Without the oxygen in blood, brain cells start dying within minutes.
By Belinda Pfende
DID YOU KNOW that
1. According to WHO October 2017, Stroke is the 5th cause of death in Zimbabwe
2. 1 in 6 people will have a stroke in their lifetime
3. Stroke is responsible for more deaths annually than those attributed to AIDS, TB and MALARIA COMBINED
4. A stroke can happen to anyone at any age but in our country Stroke is now affecting younger people who are economically active
Yet Stroke remains a silent epidemic.
The injury to the brain caused by a stroke can lead to widespread and long-lasting problems.
Although some people may recover quite quickly, many people who have a stroke need long-term support to help them regain as much independence as possible.
This process of rehabilitation depends on the symptoms and their severity. It often starts in hospital and continues at home or at a local clinic in your community once you’re well enough to leave.
A team of specialists are available to help with your rehabilitation, including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, and specialist nurses and doctors.
You are encouraged to actively participate in the rehabilitation process and work with your care team to set goals you want to achieve during your recovery.
Below are some of the main problems caused by stroke and how they can be managed
Psychological impact
Two of the most common psychological problems that can affect people after a stroke are:
• depression – many people experience intense bouts of crying, and feel hopeless and withdrawn from social activities
• anxiety – where people experience general feelings of fear and anxiety, sometimes punctuated by intense, uncontrolled feelings of anxiety (anxiety attacks)
Feelings of anger, frustration and bewilderment are also common.
You should seek a psychological assessment from a member of your healthcare team soon after your stroke to check if you’re experiencing any emotional problems.
Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship.
There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.
These problems may settle down over time, but if they are severe or last a long time, GPs can refer you for expert healthcare from a psychiatrist or clinical psychologist.
For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT), can help. CBT is a therapy that aims to change the way you think about things to produce a more positive state of mind.
Cognitive impact
Cognitive is a term used by scientists to refer to the many processes and functions our brain uses to process information.
One or more cognitive functions can be disrupted by a stroke, including:
• communication – both verbal and written
• spatial awareness – having a natural awareness of where your body is in relation to your immediate environment
• memory
• concentration
• executive function – the ability to plan, solve problems and reason about situations
• praxis – the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea
As part of your treatment, each one of your cognitive functions will be assessed and a treatment and rehabilitation plan will be created.
You can be taught a wide range of techniques that can help you relearn disrupted cognitive functions, such as recovering your communication skills through speech and language therapy.
There are many ways to compensate for any loss of cognitive function, such as using memory aids, diaries and routines to help plan daily tasks.
Most cognitive functions will return after time and rehabilitation, but you may find they don’t return to the way they were before.
The damage a stroke causes to your brain also increases the risk of developing vascular dementia. This may happen immediately after a stroke or may develop some time after the stroke occurred.
Movement problems
Strokes can cause weakness or paralysis on one side of the body, and can result in problems with co-ordination and balance.
Many people also experience extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.
As part of your rehabilitation, you should be seen by a physiotherapist, who will assess the extent of any physical disability before drawing up a treatment plan.
Physiotherapy will often involve several sessions a week, focusing on areas such as exercises to improve your muscle strength and overcome any walking difficulties.
The physiotherapist will work with you by setting goals. At first, these may be simple goals, such as picking up an object. As your condition improves, more demanding long-term goals, such as standing or walking, will be set.
A careworker or carer, such as a member of your family, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises you can carry out at home.
If you have problems with movement and certain activities, such as getting washed and dressed, you may also receive help from an occupational therapist. They can find ways to manage any difficulties.
Occupational therapy may involve adapting your home or using equipment to make everyday activities easier, and finding alternative ways of carrying out tasks you have problems with.
Communication problems
After having a stroke, many people experience problems with speaking and understanding, as well as reading and writing.
If the parts of the brain responsible for language are damaged, this is called aphasia, or dysphasia. If there is weakness in the muscles involved in speech as a result of brain damage, this is known as dysarthria.
You should see a speech and language therapist as soon as possible for an assessment and to start therapy to help you with your communication.
This may involve:
• exercises to improve your control over your speech muscles
• using communication aids – such as letter charts and electronic aids
• using alternative methods of communication – such as gestures or writing
Swallowing problems
The damage caused by a stroke can interrupt your normal swallowing reflex, making it possible for small particles of food to enter your windpipe.
Problems with swallowing are known as dysphagia. Dysphagia can lead to damage to your lungs, which can trigger a lung infection (pneumonia).
You may need to be fed using a feeding tube during the initial phases of your recovery to prevent any complications from dysphagia.
The tube is usually put into your nose and passed into your stomach (nasogastric tube), or it may be directly connected to your stomach in a minor surgical procedure carried out using local anaesthetic (percutaneous endoscopic gastrostomy, or PEG).
In the long term, you’ll need to see a speech and language therapist several times a week for treatment to manage your swallowing problems.
Treatment may involve tips to make swallowing easier, such as taking smaller bites of food and advice on posture, and exercises to improve control of the muscles involved in swallowing.
Visual problems
Stroke can sometimes damage the parts of the brain that receive, process and interpret information sent by the eyes.
This can result in losing half the field of vision – for example, only being able to see the left- or righthand side of what’s in front of you.
Strokes can also affect the control of the movement of the eye muscles. This can cause double vision.
If you have any problems with your vision after a stroke, you’ll be referred to an eye specialist called an orthoptist, who can assess your vision and suggest possible treatments.
For example, if you’ve lost part of your field of vision, you may be offered eye movement therapy. This involves exercises to help you look to the side with the reduced vision.
You may also be given advice about particular ways to perform tasks that can be difficult if your vision is reduced on one side, such as getting dressed.
Bladder and bowel control
Some strokes damage the part of the brain that controls bladder and bowel movements. This can result in urinary incontinence and difficulty with bowel control.
Some people may regain bladder and bowel control quite quickly, but if you still have problems after leaving hospital, help is available from the hospital, your GP, and specialist continence advisers.
Don’t be embarrassed – seek advice if you have a problem, as there are lots of treatments that can help.
These include:
• bladder retraining exercises
• medications
• pelvic floor exercises
• using incontinence products
Sex after a stroke
Having sex won’t put you at higher risk of having a stroke. There’s no guarantee you won’t have another stroke, but there’s no reason why it should happen while you’re having sex.
Even if you’ve been left with a severe disability, you can experiment with different positions and find new ways of being intimate with your partner.
Be aware that some medications can reduce your sex drive (libido), so make sure your doctor knows if you have a problem – there may be other medicines that can help.
Some men may experience erectile dysfunction after having a stroke. Speak to your GP or rehabilitation team if this is the case, as there are a number of treatments available that can help.
Driving after a stroke
If you’ve had a stroke or TIA, you can’t drive for one month. Whether you can return to driving depends on what long-term disabilities you may have and the type of vehicle you drive.
It’s often not physical problems that can make driving dangerous, but problems with concentration, vision, reaction time and awareness that can develop after a stroke.
Your GP can advise you on whether you can start driving again a month after your stroke, or whether you need further assessment at a mobility centre.
Preventing further strokes
If you’ve had a stroke, your chances of having another one are significantly increased.
You’ll usually require long-term treatment with medications aimed at improving the underlying risk factors for your stroke.
For example:
• medication – to help lower your blood pressure
• anticoagulants or antiplatelets – to reduce your risk of blood clots
• statins – to lower your cholesterol levels
You are encouraged to make lifestyle changes to improve your general health and lower your stroke risk, such as:
• eating a healthy diet
• exercising regularly
• stopping smoking if you smoke
• cutting down on the amount of alcohol you drink.
Caring for someone who’s had a stroke
There are many ways you can provide support to a friend or relative who’s had a stroke to speed up their rehabilitation process.
These include:
• helping them practise physiotherapy exercises in between their sessions with the physiotherapist
• providing emotional support and reassurance their condition will improve with time
• helping motivate them to reach their long-term goals
• adapting to any needs they may have, such as speaking slowly if they have communication problems
Caring for somebody after a stroke can be a frustrating and lonely experience. The advice outlined below may help.
Be prepared for changed behaviour
Someone who’s had a stroke can often seem as though they’ve had a change in personality and appear to act irrationally at times. This is the result of the psychological and cognitive impact of a stroke.
They may become angry or resentful towards you. Upsetting as it may be, try not to take it personally.
It’s important to remember they’ll often start to return to their old self as their rehabilitation and recovery progresses.
Try to remain patient and positive
Rehabilitation can be a slow and frustrating process, and there will be periods of time when it appears little progress has been made.
Encouraging and praising any progress, no matter how small it may appear, can help motivate someone who’s had a stroke to achieve their long-term goals.
Make time for yourself
If you’re caring for someone who’s had a stroke, it’s important not to neglect your own physical and psychological wellbeing. Socialising with friends or pursuing leisure interests will help you cope better with the situation.
Ask for help
There are a wide range of support services and resources available for people recovering from strokes, and their families and carers. This ranges from equipment that can help with mobility, to psychological support for carers and families.
The hospital staff involved with the rehabilitation process can provide advice and relevant contact information.
The Stroke Organisation Zimbabwe offers support to Stroke Survivors and their carers through support groups.
Belinda Pfende is a the founder of Stroke Organisation Zimbabwe and writes in her own capacity
