Think FAST

Understanding Stroke

A stroke happens when the blood supply to your brain is cut off.  If your brain doesn't get enough blood to provide the oxygen and nutrients it needs, your brain cells will become damaged or die. Most people who have a stroke are over 65, but many are younger than this. Anyone can have a stroke, including babies and children.

TYPES OF STROKE

• Ischaemic stroke happens when the blood supply to part of your brain is blocked by a blood clot or a piece of fatty material. This is the most common type of stroke.
• Haemorrhagic stroke is caused by bleeding inside your brain. This can happen when a blood vessel bursts inside your brain or, more rarely, on the surface of your brain.
• Transient ischaemic attack (TIA or ‘mini-stroke’) is an episode when the blood supply to your brain is interrupted for a short time. The symptoms are only temporary – they won’t last for more than 24 hours.
• Stroke from cervical artery dissection is caused when the lining of one of the arteries in your neck is torn, restricting the blood supply to your brain.

COMPLICATIONS OF STROKE

Some strokes may be quite mild and the effects only temporary, whereas others may be more severe and cause lasting damage. Complications of stroke include:

• weakness or paralysis, often on one side of your body
• lack of awareness of one side of your body (usually the left-hand side)
• seizures (fits)
• loss of sensation on one side of your body
• difficulty swallowing
• extreme tiredness and sleep problems
• problems with your speech, reading and writing
• problems with your vision – for example, double vision or partial blindness
• memory and concentration difficulties
• difficulty controlling your bladder and bowel movements (incontinence or constipation)
• changes in personality and behaviour
• psychological problems such as anxiety or depression

If you can’t move because of stroke, you could be at risk of:

• bed sores (pressure ulcers)
• deep vein thrombosis (DVT) – this is a blood clot in a vein in your leg
• pneumonia (infections in your lungs)
• contractures (altered position of your hands, feet, arms or legs because of muscle tightness)

Stroke affects everyone differently. Some people may find several of these complications improve gradually over time, whereas for others they may not.

OUR TASKS.

During rehabilitation the physiotherapist will help the person who has had a stroke with any balance problems, paralysis and muscle weakness. But it is also important that other health professionals also show you how to move and handle the person they are supporting.

For example, helping them in or out of bed so as not to cause injury to them or to yourself.  When a person requires extensive moving and handling, equipment such as hoists should be provided. Someone who has balance problems, muscle weakness or is learning to walk again is likely to fall more easily.  Be prepared for this but do not prevent the person you support from being active as this will slow down recovery. Advice on using aids such as walking frames or sticks should be provided.

After a stroke many people have problems swallowing fluids or food (called dysphagia).  This may reduce a person’s ability to take nutritionally adequate food and drink which can lead to dehydration or weight loss. There is also a risk that food or drink will go into the lungs (aspiration) rather than the stomach, which can cause choking and/or a chest infection.

A speech and language therapist will have assessed whether there are any problems

with swallowing and be able to give advice on how to deal with them. For example,

sitting in an upright position whilst eating and tilting the head down with the chin

slightly tucked in can make swallowing easier. Also making sure food is well chewing small mouthfuls are best.  

Food and drink shouldn’t be mixed in the same mouthful.  For some people food may need to be pureed or drinks thickened.  A dietician may also provide advice on what foods and consistencies are appropriate.  If there are long term problems with swallowing, a PEG tube (Percutaneous Endoscopic Gastrostomy) may be needed.

A stroke can lead to loss of bladder control (urinary incontinence), bowel control (faecal incontinence) or both. Most people regain continence in a few weeks as their body recovers from the effects of their stroke.  For a small proportion of people, bladder or bowel problems can be more long term but with help and treatment can become more manageable.  Medication can improve continence and exercises can help improve bladder control.

Exercises which help mobility will also help to get to the bathroom on time.  Equipment and adaptations to bathrooms may also be appropriate to help make it easier to use the toilet.  Personal items, such as pads, are also available to help the person remain dry and comfortable. The continence nurse will be able to give specific advice.

Stroke can affect the ability to speak write and understand what is being said, this is known as aphasia. The effects of the stroke on speech, reading and writing will be fully assessed by a speech and language therapist and they will give advice on how best to communicate together.  Using simple words and short sentences can help

the person get meaning from what you are saying.  You can find out whether someone can use yes or no, or a signal such as thumbs up or thumbs down accurately. If they can do this most of the time, then you can ask questions to which the answer is yes or no.  You can be shown how to reinforce your verbal message, using facial expressions, gestures, writing or showing pictures if they are finding it difficult to follow instructions or understand what is being said.

More information can be found on the THINK FAST website.

Agnieszka Korpalska

Professional Advisor - Physiotherapy