You or a family member have survived a stroke. Now what? While every stroke is different, some types of disabilities or limitations are common. Setting reasonable goals concerning the following important aspects of your life may be a good next step for you:
- Regaining as much mobility and independence as possible.
- Staying safe at home (preventing falls)
- Living life as comfortably and fully as possible after your stroke.
Common Limitations After Stroke
Stroke survivors suffer a wide range of physical and functional limitations following a stroke from mild deficits to locked-in syndrome. Many common limitations following a stroke include the following:
- Vision Problems;
- Shoulder Pain;
- Difficulty Swallowing (Dysphagia);
- Difficulty Expressing or Recalling Language (Expressive and Receptive Aphasia);
- Central Post-Post Stroke Pain Syndrome;
- Claw-toe and Hammertoe;
- Poor Balance;
- Poor Motor Skills; and
Vision changes following a stroke are common. Vision problems can effect every area of a survivor’s life. For example, a person with a condition called visual midline shift may think the floor and walls are tilted. Often, the survivor will tilt his body to compensate. Because the visual system is telling him that the world is tilted, the brain tries to adjust accordingly.
Double vision usually comes from a brain stem stroke. With double vision, a person loses depth perception. As a result, he may get confused by what he sees. The easiest fix for double vision is to cover one of the eyes with a patch. The patch does not fix the problem, however. But it does reduce the amount of visual information the brain has to process. Therapy, on the other hand, may fix the problem.
The goal of therapy is to get the patient to see out of one eye, or monovision. There are many therapeutic techniques that need to be considered. Does the eye turn out because of damage to a nerve that controls one of the six muscles in each eye? The location and cause of double vision can determine the type of treatment.
Sometimes after a stroke the eyes cannot track or smoothly between objects. Where a normal person’s eyes may smoothly move from Point A to Point E, a person with a stroke may jerk from Point A to Point B to Point C to Point D and finally to Point E with stops and hesitations along the way. The person’s eyes may overshoot the target altogether.
This condition often causes reading problems because survivors can’t keep their place. They may skip over lines or may not be able to find where to go at the end of the line. It may affect walking because they can’t scan the environment accurately, and thus they misjudge things.
Visual Midline Shift
Many patients who have had a stroke experience a visual shift in their field of vision. When the visual field shifts, it causes the person to feel like the world is not centered. Rather, the person will feel like the world is tilted, including floors, ceilings, and walls. In order to feel centered in the world, the person will tilt his body in order be even with the world around him. This can cause serious injuries in balance and walking resulting in serious risks of falling.
Therapists can address these problems through balance activities. One technique includes training stroke survivors to put more weight on the foot on their unaffected side. Therapists also use special prism glasses called yoked prisms that can affect spatial perception and body posture.
A stroke can impact a portion of the patient’s field of vision. The condition is referred to as a ‘field cut’. It is called this because a portion of the visual field is cut away or gone. This happens when the area of the brain that processes light is damaged.
Vision rehabilitation is important for patient’s with a field cut. Scanning can be a big part of rehabilitation. Reading can be a chore, and therapy may involve using a line guide or typoscope – a device that helps isolate the lines when reading.
These are the most common vision deficits among survivors. Often times stroke survivors’ vision is affected by more than one of these.
Shoulder pain is a well-known complication after stroke. A separated shoulder (shoulder subluxation) is a common consequence of stroke. Separated shoulders can be very painful. The shoulder can separate because of weakness or spasticity. It is characterized by the upper arm bone (humerus) falling out of the shoulder socket.
The muscles may be too weak to hold the arm bone securely into the shoulder socket or spasticity can cause separation by pulling the bone into an abnormal position. Both muscle weakness and spasticity can cause the shoulder blade (scapula) to be abnormally positioned as well.
Difficulty Recalling and Expressing Language (Aphasia)
After a stroke it is very common to have communication problems. A condition known as aphasia can affect a person’s ability to find the right words. It can also make it difficult to understand the words that others are saying and /or reading and writing.
Aphasia is not a disease. Aphasia is a symptom of brain damage. It is most commonly seen in adults who have suffered a stroke.
Everyone expresses aphasia differently, and there are different types of aphasia. The exact type of aphasia depends on what part of the brain was injured by the stroke. Aphasia can be divided into four broad categories:
- Expressive aphasia – You know what you want to say, but cannot find the words you need.
- Receptive aphasia – You hear someone talking or see the printed page but cannot make sense of the word.
- Anomic or amnesia aphasia – You have difficulty in using the right names for objects, people, places, or events
- Global aphasia – You cannot speak or understand speech, nor can you read or write.
Difficulty Swallowing After Stroke (Dysphagia)
Dysphagia is the term for difficulty swallowing. Dysphagia can make eating, drinking, taking medicine, and breathing difficult. Many stroke survivors experience dysphagia or trouble swallowing at some point after a stroke. Difficulty swallowing is most common immediately after a stroke. It commonly declines over time.
Symptoms of disphagia you might experience include:
- Difficulty starting to swallow
- Choking when food gets stuck
- Coughing or gagging while swallowing
- Liquid coming out of the nose after trying to swallow
- Food getting caught in the lungs
- Weak voice
- Poor tongue control
- Loss of gag reflex
Central Post-stroke Pain Syndrome
Central pain syndrome is a chronic condition caused by injury to the brain or brain stem. Patients may not feel any sensation in a limb when touched, but can feel constant pain. Other survivors with chronic pain syndrome may report reduced sensation, the inability to feel normal stimuli, all while feeling a constant burning sensation.
The body becomes hypersensitive to pain as a result of damage to a part of the brain that affects sensation. Primary symptoms are pain and loss of sensation, usually in the face, arms, and/or legs. Pain or discomfort may be felt after being mildly touched or even in the absence of any stimulus at all. The pain may worsen by exposure to heat or cold and by emotional distress.
Treatment for central pain syndrome typically includes pain medications to provide some reduction of pain. Complete relief of pain may not be possible. Antidepressants or anticonvulsants can sometimes be useful. Lowering stress levels may also reduce pain.
Fall Risks After Stroke
Many stroke survivors have poor balance. Balance problems can be due to muscle weakness and paralysis, damage to the areas of the brain that help control balance, loss of sensation in the limbs, damage to the vestibular system, spasticity or flaccidity of limbs which cause muscular imbalances, impaired vision, medications, low blood pressure, lack of coordination, and poor awareness of body position. These balance problems increase the risk of injuries from falling. Falls are common at all stages after stroke.
Almost 60 per cent of people who have a stroke experience one or more falls afterwards – most often in their own homes – and some are left with serious injuries, according to a study released today at the Canadian Stroke Congress.
Falls can occur during or immediately after a stroke, during rehabilitation for stroke, and during the chronic phase after the stroke. Falls can result in injuries ranging from the most minor to death. The fear of falling can overtake a person’s independence. These consequences can have implications for quality of life after stroke.
Claw Toe or Claw Foot After Stroke
Stroke can cause claw foot when blood stops flowing to an area of the brain due to a blood clot or weak blood vessels. Strokes can cause serious nerve damage and affect the muscles, including muscles in the feet.
Claw foot is also called as claw toes. It’s a condition that can occur after a stroke. It’s a condition in which your toes bend into a claw-like position. It’s usually not a serious problem on its own, but it can be uncomfortable.
For a person with claw foot, the toe joints closest to the ankle point up, while the other toe joints point down. This makes the toes look like claws.
Sometimes claw foot doesn’t cause any pain at all. Other times, the toes might hurt badly, and it’s possible to develop calluses or corns or ulcers on parts of the foot that rub against your shoes.
Claw toes are sometimes mistakenly called to as “hammer toes.” While they share some similarities, hammer toes and claw toes are two different conditions. They are caused by different muscles in the foot.
Foot drop, sometimes called “drop foot,” is the inability to lift the front part of the foot. A person with foot drop may have difficulty walking. While walking, a person with foot drop will drag the toes along the ground or bend the knee high to lift the foot higher than usual to prevent the foot from dragging on the ground. Foot drop may be temporary or permanent. Foot drop can occur in one or both feet.
Foot drop is common after a stroke. If you have foot drop you may trip and fall if your foot and ankle are not supported by a brace at all times. Foot drop increases the risk of falling after a stroke, which is a major hazard that stroke survivors face.
Foot drop is caused when nerves are damaged during a stroke. It is usually the nerves and not the muscles that are damaged. Although the muscles in the foot are not damaged during the stroke, the muscles become weak and atrophy from lack of use quickly following the stroke.
It is important that stroke survivors with foot drop get physical therapy. Physical therapy is central in strengthening muscles and joints. With physical therapy, partial or complete recovery may be possible.
Seizures are a common problem after a stroke. Seizures are a sign of brain injury. They are caused by sudden disorganized electrical activity in the brain. Seizures can be characterized by uncontrollable convulsions or spasms of a part of the body. Stroke is the most common cause of seizures in older people.
It is difficult to predict which stroke survivors will have a seizure. Around 5% of people who have a stroke will have a seizure within a few weeks of the stroke. Some people with have a seizure within 24 hours of the stroke. These are referred to as acute strokes. Acute strokes are more likely following a severe stroke, a stroke that affect the cerebral cortex, and a hemorrhagic stroke. Just because you had a seizure immediately after the stroke does not mean that you will go on to experience repeated strokes, called post-stroke epilepsy.
A small number of people will develop post-stroke epilepsy, a condition in which repeated strokes occur.The risk of having seizures goes down with time. If a person has recovered from a stroke and has not yet had a seizure, the chance of developing post-stroke epilepsy is low. However, if you have seizures a month or more after your stroke, you are at greater risk for epilepsy. If chronic and recurring seizures are a result of a stroke, then a stroke survivor may be diagnosed with epilepsy.
Loss of bowel and bladder function can also be side effects of stroke. The loss of control over bladder and bowel function can be one of the more psychologically devastating effects of a stroke. If problems with this persist, patients and caregivers can start a toileting schedule to help prevent accidents. A catheter may be ordered by a physician in the early days following stroke until a patient becomes more mobile. Depending on the other physical abilities of the stroke survivor, sometimes home health aides may be necessary in order to properly care for the survivor.
Often described as muscle stiffness or tightness, spasticity can impact one’s ability to work towards greater physical recovery. But treatments are available to alleviate some the discomfort and limitations brought about by spasticity.
Following a stroke, damage to the brain can interfere with messages between the brain and muscles. This interference can cause arm and leg muscles to cramp or spasm (spasticity). These are similar to a bad cramp an athlete may experience from dehydration. This spasticity limits coordination and muscle movement. Spasticity makes daily activities such as bathing, eating and dressing more difficult.
Spasticity can cause long periods of strong contractions in major muscle groups. This results in painful muscle spasms. These spasms can produce:
- A tight fist
- Bent elbow
- Arm pressed against the chest
- Stiff knee
- Pointed foot
- Stiffness in the arms, fingers or legs
Flacidity is the opposite of spasticity. Flacidity (also called “hypotonia”) is when there is decreased or no tone in a muscle. This condition is often present immediately after a person has experienced a stroke. The leg or arm will appear limp as if just hanging on the body. Some stroke victims will have permanent flacidity. Most stroke survivors, however, will acquire improved muscle tone as time progresses.
Fatigue is a common occurrence after stroke. Even patients who experience only a mild or moderate stroke can have persistent fatigue. Fatigue can interfere with activities of daily living by making regular everyday activities time consuming and exhausting.
Studies have shown an increase in mortality rate for post stroke patients that have fatigue especially those who are single, have little family support, are institutionalized, or have a significant decrease in daily function.
The Road to Recovery: Maximizing Physical Recovery & Independence
Coping With Pain
Stroke survivors often experience pain after their strokes. This spans a spectrum from irritating headaches to crippling joint pain to shoulder subluxation to the often-difficult-to-treat central post-stroke pain (CPSP). For some patients, post-stroke pain may be serious enough to jeopardize their recovery by preventing them from participating in therapy. Whatever the level of pain, it compromises quality of life for patient and caregiver alike.
Reducing Risk Of Falls
Falls are one of the hazards faced by stroke survivors. Many stroke survivors are elderly and had an increased risk of falling even before the stroke. It is important to reduce the risks for falls after a stroke as most falls occur within the home. Some tips for reducing serious falls include:
- Caution Around Throw Rugs
- Clear Cluttered Walkways
- Wipe Up Spills Immediately
- Avoid Loose Fitting Shoes
- Use Proper Walking Devices
- Use Night-Lights in the Bedroom,
- Bathroom & Hallways
- Use Bath Mats With Suction Cups
- Exercise Regularly to Improve
- Muscle Strength & Flexibility
Treatment for Disphagia
The most common treatment for difficulty swallowing is swallow therapy done with the help of a speech language, occupational, or physical therapist. Some stroke survivors may be candidates for Neuromuscular Electrical Stimulation (NMES). If you show signs of aspiration or have difficulty managing your diet, you may be a candidate for this type of dysphagia therapy.
Exercising the tongue, lips, throat, and mouth can help relax and strengthen the muscles as well as increase their flexibility (examples include tucking the chin or rotating the head).
A speech language therapist can teach special exercises to stimulate the nerves involved in swallowing. These can include changing posture and sitting position, reducing distractions at mealtime, eating slower with smaller amounts of food, and changing food texture.
Some medications, such as muscle relaxers, can help open the throat and make swallowing easier.
Treatment for Claw Foot or Claw Toes
To treat claw foot, your doctor may recommend a combination of medical interventions and home care.
If your toes are still flexible, your doctor might tape them or ask you to wear a splint to keep them in the right position. They may teach you how to perform home care exercises to maintain your toes’ flexibility. They may also encourage you to wear certain types of shoes, while avoiding others.
If these treatments don’t help or your toes have become too rigid, your doctor might recommend surgery. Your surgeon can shorten the bone at the base of your toe, giving your toe more room to straighten out.
If your claw foot is linked an underlying disorder, your doctor may prescribe medications, surgery, or treatments to help address it.
If your toes are still flexible, performing regular exercises may help alleviate your symptoms or prevent them from getting worse. For example, your doctor may encourage you to move your toes toward their natural position, using your hands. Picking up objects with your toes may also help.
Wearing shoes with plenty of room can help alleviate discomfort. Don’t wear shoes that are too tight or shoes with high heels. If your toes are becoming more rigid, look for shoes that have extra depth in the toe area. You can also use a special pad to help take pressure off the ball of your foot.
Treatment for Foot Drop
Treatment varies as does the severity of drop foot after a stroke. A lot depends on your activity level and willingness to engage in long-term physical therapy to strengthen the affected muscles. Active movement and exercise helps to strengthen the connections between the muscle and the brain.
The assistance of a plastic brace, also known as an ankle-foot orthosis (AFO), is very helpful. These braces support the foot and ankle to help minimize tripping and reduce fall risks.
Physical therapy and ankle-foot orthotics are two of the three main treatments for foot drop; electrical stimulation is the third. With neuromuscular electrical stimulation (NMES), your leg muscle is directly stimulated. This helps your nerves fire, making your muscles contract. Over time, the idea is that your leg muscles will be retrained.
While the same approach may not work for each stroke survivor, trial and error can help doctors and physical therapists figure out the best possible therapies for you.
Problems with Fine Motor Skills
Fine motor skills are small, precise, coordinated movements, like using your fingers to pick up a coin. Fine motor skills require integrating muscular, skeletal and neurological functions. Physical and occupational therapists can work with you to practice these skills after stroke. And there are exercises you can do at home to continue improving.
There are many strategies and treatments for spasticity to help you recover, return to work and regain function. In order to achieve the best results possible, a mixture of therapies and medications are often used to treat spasticity. Ask a healthcare professional about the best treatment plan for you. Some of the options include:
- Braces – Putting a brace on an affected limb
- Exercises – Range-of-motion exercises
- Stretching – Gentle stretching of tighter muscles
- Movement – Frequent repositioning of body parts
- Medications – Medications are available to treat the effects of spasticity
- ITB Therapy – A programmable, battery-powered medical device that stores and delivers medication to treat some of the symptoms of severe spasticity
- Injections – Injections block the chemicals that make muscles tight
- Surgery – Surgery on the muscles or tendons and joints may block pain and restore movement
Water therapy may be a good alternative for survivors with balance problems and hemiparesis. This article explores this therapeutic option and gives resources for accessing it.
Constraint-Induced Movement Therapy
Constraint-induced movement therapy (CI) forces the use of the affected side by restraining the unaffected side. With CI therapy, the therapist constrains the survivor’s unaffected arm in a sling. The survivor then uses his or her affected arm repetitively and intensively for two weeks.
The role of recreational therapy in stroke recovery by Janice Monroe, an associate professor in the Department of Recreation and Leisure Studies and at Ithaca College, Ithaca, New York.
Survivor and musician John Hopkins is the focus of this issue’s feature story, “Healing through Music.” For John and other survivors, music has taken on a healing role, a way to get beyond their deficits and find joy where once there was only despair. A sidebar on the benefits of music therapy.
Intimacy after Stroke
Sex is a sensitive subject for many stroke survivors and their mates. Stroke can cause serious changes in the lives of couples who are sexually active. Even talking about these issues may be extremely uncomfortable for some couples. Intimacy is a normal part of life an any disruption to it can be psychologically damaging. It is important to get physical therapy and take any measures needed physically regain the ability to be intimate. Even more important, however, is talking to an adjustment counselor or members of a help group who can share their own experiences.
No one needs to go through this alone, and it is important to remember that you are not alone. Seeking support from others who’ve experienced stroke can be a huge benefit to recovery. Stroke groups afford the opportunity to share feelings, ideas and resources. The American Stroke Association publishes a list of stroke groups that are searchable by area. Find a group in your area.
How Can A Lawsuit Help With Recovery After Stroke?
Many people don’t know where to turn after a stroke. Their lives have been turned upside down. The things they loved about life are a distant memory, and sometimes they cannot even describe their frustrations to the ones they love most. Often times stroke survivors can no longer work, need additional medical care, treatment, and medications they cannot afford, and no longer enjoy the day-to-day aspects of life.
A medical malpractice lawsuit after a stroke will not work magic, but it may be the only practical answer to regaining control over your life. How can a lawsuit help you regain control and hope? By providing you and your family with the freedom to get the help you need.
Past and Future Medical Expenses
Medical care can often be extremely expensive. Without a lawsuit, people whose lives have been ripped apart through no fault of their own often cannot get the help they need. They either go completely without proper medical care or feel like a burden relying entirely on family and friends. In a medical malpractice lawsuit for stroke, the following medical expenses are recoverable:
- Medical Procedures;
- Hospital Stays;
- Attendant Care;
- Home Modifications;
- Medical Devices; and
Past and Future Wage Loss
You are entitled to recover the lost wages (past and future) you would have received had you not suffered the stroke.
Physical and Emotional Pain and Suffering
Non-economic harms and losses are the real human suffering that injured people endure. These include no longer being able to do and enjoy the activities you once loved, the inability to find life fulfilling, the damage to interpersonal relationships, and commonly the loss of self-worth. These injuries are often the most difficult to cope with.
Speaking with a Stroke Lawyer
If you have suffered a stroke, speaking to a stroke lawyer may be one of the first steps you take on a long road to recovery. While many strokes are not preventable even with the best medical care, some strokes are caused by medical malpractice. Until you speak with a stroke lawyer, you may never know whether your stroke was caused by medical malpractice.
It is best to speak with a stoke lawyer as soon as possible. There are strict time limitations on when you can bring a lawsuit.
How do I Hire You to be my Ohio Stroke Malpractice Lawyer?
You can call us at 216-777-8856.
You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.
You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.
Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.
Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.
Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.
If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.