Stroke happens suddenly. But recovery after stroke will take time.
Stroke survivors may often be in hospital for around 3 weeks. The time a stroke survivor needs to stay in hospital can depend on how severe the stroke is.
The injury to the brain caused by a stroke can lead to long-term challenges and issues. You may need specialised multidisciplinary support. This is to help with your recovery and return to independence.
Rehabilitation will depend on your symptoms and how serious they are. This process will start in the hospital as soon as possible after your stroke.
Stroke survivors may have therapy at home with an early supported discharge team. This team provides stroke rehabilitation to patients in their own homes. Patients may also have therapy in a rehabilitation centre before going home. Some patients may need specialist rehabilitation in the National Rehabilitation Hospital.
Multidisciplinary teams
A multidisciplinary team of specialists will help you with your recovery from stroke.
The team may include:
- dietitians
- doctors who specialise in stroke and rehabilitation
- nurses who specialise in stroke and rehabilitation
- occupational therapists
- pharmacists
- physiotherapists
- psychologists
- speech and language therapists
- social workers
- therapy assistants
You will work with your care team to set goals you want to achieve during your recovery.
There are different treatment and rehabilitation methods for problems caused by strokes.
Psychological impact
Depression and anxiety are two of the common problems that can affect people after a stroke.
You may have difficulties controlling feelings of sadness or anger after a stroke.
You may have difficulty adjusting to the impact your stroke has on relationships with family and friends.
Before you leave hospital, you should have an assessment of your mood. This is to check if you are having any emotional problems. Your team can then help you put a plan in place to manage any issues that are picked up.
You will get advice to help you deal with the psychological impact of stroke. Your family members or friends can be involved in this process. This will only be done with your permission.
Medicine and psychological therapies such as counselling or cognitive behavioural therapy (CBT) may also be offered.
Some patients will need antidepressants for a period of time after a stroke. Your doctor will discuss this with you. It's important to discuss any feelings of depression with your healthcare team.
Cognitive impact
A stroke can impact on how our brain processes information and carries out cognitive functions. One or more cognitive functions can be impacted by a stroke.
These may include:
- communication - verbal, written, expression and understanding
- spatial awareness – knowing where your body is in relation to objects or other people
- memory and concentration
- executive function - being able to plan, focus attention, remember, and juggle multiple tasks
- praxis - being able to carry out normal everyday activities such as getting dressed or making a cup of tea
As part of your stroke treatment, your cognitive functions will be assessed. A treatment and rehabilitation plan will be created for you if there are any areas for improvement.
You can be taught techniques that can help you relearn disrupted cognitive functions. For example, recovering your communication skills through speech and language therapy.
Most cognitive functions will return after time and rehabilitation. But you may find they do not return to the way they were before.
A stroke can also increase the risk of developing a type of dementia called vascular dementia. This may happen immediately or may develop some time after the stroke.
Movement problems
Strokes can cause weakness or paralysis on one side of the body. They can also result in problems with coordination and balance.
You may also experience extreme tiredness (fatigue) in the first few weeks after a stroke. Fatigue is very common, even after a mild stroke. It can take several months to improve. Listening to your body when tired is important. But it's also important to gradually build your activity levels to manage fatigue. You may also have difficulty sleeping, which will make you even more tired.
As part of your rehabilitation, you will see a physiotherapist. They will assess any physical disability and create a treatment plan.
Physiotherapy will often involve several sessions a week.
The physiotherapist will focus on areas such as:
- exercises to improve your muscle strength, coordination and function
- walking and giving advice on help that you might need
- balance and avoiding falls
- muscle stiffness, spasms and pain
The physiotherapist will work with you by setting goals. At first, these may be simple goals, such as sitting at the side of the bed or picking up an object. As your condition improves you will be given long-term goals, such as standing and walking on your own.
A 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 do at home. These exercises will help you maintain your recovery.
Getting help with everyday tasks
An occupational therapist (OT) can help you if you have problems with movement and things like getting washed and dressed. They will also be able to tell you and your family or carers what help you need and what equipment or aids might help you.
They can also give advice about adapting your home or using equipment to make things easier.
Your OT may also need to assess and advise you on your ability to drive.
Communication problems
After having a stroke, many people have problems with speaking and understanding.
Parts of the brain that are responsible for language can be damaged. This is known as aphasia or dysphasia.
Slurring of words (dysarthria) is common after a stroke.
Coordinating the speech muscles (speech apraxia) can also be affected after a stroke. This is less common and harder to treat but your speech and language therapist can help.
A speech and language therapist can help with your communication problems.
Swallowing problems
The damage caused by a stroke can interrupt your normal swallowing reflex. This can result in small particles of food entering your windpipe.
Problems with swallowing are known as 'dysphagia'. Dysphagia can lead to damage to your lungs. If something you swallow goes down the wrong way it can trigger a lung infection (aspiration pneumonia).
If your ability to swallow is affected you may need to be fed using a feeding tube (nasogastric tube). The tube is usually put into your nose and passed into your stomach. This is to prevent any complications from dysphagia such as pneumonia.
Your speech and language therapist will work with a dietitian and stroke team to help with your swallowing problems.
Treatment may involve:
- tips to make swallowing easier, such as taking smaller bites of food
- advice on posture
- exercises to improve control of the muscles involved in swallowing
Visual problems
Stroke can damage the parts of the brain that receive and process information sent by the eyes.
This can result in you losing half your field of vision. For example, only being able to see the left or right 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 a stroke causes you vision problems, you'll be referred to an eye specialist. They will assess your vision and suggest possible treatments.
Bladder and bowel control
Poor mobility and difficulty communicating can lead to incontinence after a stroke. Sometimes constipation or retention of pee (urine) can happen when you cannot move.
The part of the brain that controls bladder and bowel movements can be damaged by a stroke. This can cause urinary incontinence and problems with bowel control.
Treatments include:
- inserting a urinary catheter
- wearing an incontinence pad
- a regular toilet schedule
- use of laxatives or an enema
Do not be embarrassed. Incontinence problems are common. Hospital staff are used to helping people with them.
If the problem continues at home talk to your GP or public health nurse. Your GP may refer you back to see your stroke team.
Sex after a stroke
Having sex does not put you at higher risk of having a stroke. Returning to normal sexual activity is an important goal for stroke survivors.
Even if you've been left with a severe disability, you can find new ways of being intimate with your partner. Like re-learning other skills after a stroke, a gradual approach is advised for rebuilding confidence.
Both men and women may feel less desirable to a partner after a stroke. Some medicines can reduce your sex drive (libido). Your GP may be able to prescribe other medicines that can help.
Some men may have erectile dysfunction after having a stroke. There are treatments available that can help. Ask your GP for advice.
Driving after a stroke
If you've had a stroke or TIA, you usually cannot drive for 1 month unless your doctor tells you otherwise.
Returning to driving will depend on what impairments you may have from your stroke. It will also depend on the type of vehicle you drive.
Problems with concentration, vision, reaction time and awareness can make driving dangerous.
You will need to tell your insurance company you have had a stroke.
Your GP can tell you if you can start driving again a month after your stroke. Sometimes an 'on the road' assessment with a trained assessor is needed before you can drive again.
Medical fitness to drive - rsa.ie
Caring for someone who has had a stroke
Caring for somebody after a stroke can be a rewarding but also a frustrating and lonely experience.
There are many ways you can provide support to a relative or friend who has had a stroke.
You can help their rehabilitation process by:
- helping them practice physiotherapy, occupational therapy and speech and language therapy exercises between their sessions with the therapist
- giving them emotional support and reassurance during their recovery
- motivating them to reach their long-term goals
- adapting to their needs, such as speaking slowly if they have communication problems
- encouraging them with lifestyle changes such as stopping smoking, eating healthier and taking exercise where possible
- helping them enjoy life and getting them to meet other people socially - this is important for cognitive and mental health
- helping them to find and access the available support services
- going to support sessions with them
Be prepared for changed behaviour
Someone who's had a stroke can often have feelings of depression and anxiety, or seem as though they've had a change in personality. They can appear to act irrationally at times. This is the result of the psychological and cognitive impact of a stroke.
They may become withdrawn, tearful and express pessimism or even feelings of 'wishing to be dead'. This can be difficult to hear. They may become angry or resentful towards you. It may be upsetting, but try not to take it personally.
Someone who has had a stroke usually starts to return to their old self as they improve and begin to recover.
Try to remain patient and positive
Rehabilitation can be a slow and frustrating process. There will be times when it seems little progress has been made.
Encouraging and praising their progress can help them to reach their long-term goals.
Make time for yourself
If you're caring for someone, it's important not to neglect your own wellbeing. Spending time with friends and making time for yourself will help you cope better.
Ask for help
The Irish Heart Foundation has telephone and online support for stroke survivors and their carers.
Phone 01 6685 001 Monday to Friday, 9am to 1pm.
support@irishheart.ie
Family Carers Ireland offer support for people caring for a loved one.
Freephone: 1800 24 07 24