Life After Stroke
Therapy and support for stroke patients
By Andrew Morpurgo, M.D.
Strokes can be devastating. They come out of the blue and literally strike
people down, usually with no warning. Given their potentially devastating
impact, stroke prevention has become a priority within the national medical
community. The result is that the incidence of stroke has dropped within the
last decade, due to more effective recognition and treatment of stroke risk
factors like high blood pressure, diabetes, and atherosclerosis (the build-up of plaque in vessel walls).
Window of opportunity
Even with increasingly positive statistics, 450,000 people in the U.S. suffer
strokes every year. When a stroke occurs, recognizing the symptoms and seeking
immediate medical care by a neurologist can make a tremendous difference in the
New medications, such as the clot-dissolving drug t-PA, can break up
blockages that impair blood flow in the brain, thereby reducing the amount of
brain cell damage. However, diagnosis of the type of stroke that has occurred
must be made within the first three or four hours after the onset of symptoms
because t-PA can only be used in the treatment of some, not all, strokes. And
in order to be effective, it must be administered as soon as possible after the
stroke has occurred.
Types of stroke
There are essentially two categories of stroke. The most common is an
ischemic stroke, caused by a blockage (a blood clot) that cuts off the blood
supply to the brain. Approximately 90 percent of the people who suffer strokes
experience an ischemic stroke. These stroke victims can often be helped with
t-PA if they are diagnosed in a timely fashion.
The remaining 10 percent of stroke victims have hemorrhagic strokes, which
occur when a vessel in the brain ruptures and blood leaks into the brain. These
people should not be treated with t-PA, which is why early and proper diagnosis
of the type of stroke is imperative. The neurologists at Cayuga Medical
state-of-the-art CT scanning of the brain to determine the cause of the stroke
Symptoms and signs of stroke
If you or someone you are with experiences these symptoms, seek immediate
emergency medical assistance. Get to the nearest medical center as quickly as
- Sudden clumsiness, loss of
balance and coordination, or dizziness.
- Weakness, numbness, or
difficulty moving the face or limbs on one side of the body.
- Trouble with speech:
difficulty talking or slurring of words; the inability to find the right
word; not being able to understand what others are saying.
- Blurred vision or decreased
- A sudden, intense headache.
Impact and treatment of stroke
If we think of the types of impairments stroke victims suffer, they fall
into three general areas. They are motor functioning, which is movement in the
legs, arms, and hands; swallowing and speech; and cognitive functioning, which
relates to intelligence, reasoning, and emotions. The approach to treatment for
each of these areas is different and the recovery process varies. Recovery is
most rapid during the first three months. Progress continues, through usually
at a slower rate, through the following six months and generally stops at about
Stroke patients at Cayuga Medical Center typically spend up to a week in the
acute inpatient setting, after which they often go on to the medical
rehabilitation unit for up to 25 days. There, a team of rehabilitation
specialists works closely with the patient to restore function and to help the
patient prepare to cope with life-style changes. Various types of therapy
continue on an out-patient basis after discharge.
Stroke victims often find their lives significantly changed as a result of
their illness. Depending on the severity of the stroke, their ability to work, to
communicate, even to get around independently can be compromised or disappear
altogether. The impact can be devastating for the individual and the family.
In the hospital
Patients who have suffered a stroke often spend up to a week in the medical
center on the medical-surgical unit. From there, they are likely to be admitted
to the inpatient rehabilitation unit for intensive therapy. There, a team of
rehabilitation specialists works closely with the patient to restore function
and to help prepare the patient for life-style changes as a result of the
Speech therapists work with patients who are experiencing problems with
swallowing or language. Difficulty speaking, retrieving words, or understanding
what is being said are some of the ways in which language can be impaired by
stroke. It may take up to a year for speech to come back, if it returns at all.
Regaining the ability to swallow also takes time, often three to six months.
Occupational therapists teach the patient and his or her family activities
that will improve flexibility, strength, coordination, and visual perception
and understanding. Physical therapists help patients with exercises designed to
increase range of motion, improve coordination, and regain maximum function and
independence. An activity therapist creates a program of leisure activities
that will reinforce the patient’s recovery goals. Physicians also work closely
with patients and families on cognitive and emotional problems that may be
caused by the stroke. Depression, which is a common response to stroke, often
responds well to antidepressant medications.
Prior to leaving the hospital, medical social workers and discharge planners
help families arrange for continuing therapy and assistance at home. Patients
may progress to outpatient therapy depending on their goals and progress.
Hard work begins at home
The real work begins at home because it is there that patients and families
come to understand the new realities of life after stroke. People who have
suffered a stroke are changed as a result of it.
The ways in which they are different depend on the type and severity of the
stroke. People who used to be night owls may find themselves
tired and ready for bed by eight o’clock at night. A small cold can knock a
stroke victim off his or her feet for days. One glass of wine will have the
potency of three or four. People who used to enjoy large social gatherings may
now find those events difficult and exhausting. These changes, in addition to
new physical limitations, take some getting used to.
With hard work, many stroke victims are able to live relatively
self-sufficient lives. They can cook, take care of
themselves, even drive. Many can live independently, though they might be
walking with a cane or a brace. However, some abilities may never fully return,
and adjusting to this can be emotionally challenging for the patient and his or
The active involvement and support of family members can make a world of
difference during and after recovery. If a spouse is the primary caregiver,
other family members can help with regular visits so the spouse can take a
break. Caregivers may also find that participating in a support group of other
caregivers is extremely helpful.
Go for it!
People recovering from a stroke should try to do as much as they can safely,
and families should encourage patients to strive for a life that is as normal
as possible. This sometimes means resisting the urge to lecture or nag
recovering stroke victims about changing their life-style habits. Of course it
would be better if Uncle Joe used less salt on his food and quit smoking, but
Uncle Joe is coping with enough major change already as a result of his stroke.
Badgering him to make more adjustments and reminding him about his bad habits
will not help in the recovery process. However, if and when he decides to make
healthy life-style modifications, loving support from family and friends is
Dr. Morpurgo is a physiatrist, specializing
in rehabilitation and physical medicine. He is director of rehabilitation
services at Cayuga
He can be reached at his office at (607) 277-4097.