Of 40,000 Australians having strokes annually, 28,000 survive, of these 14,000 make a complete recovery, 14,000 are left with some form of disability
Effects of Stroke
The most common problems in daily life are likely to be caused by:
- Weakness or lack of movement (paralysis) in legs and/or arms
- Shoulder pain
- Trouble swallowing
- Changes to way things are seen or felt (perceptual problems)
- Changes to the way things are felt when touched (sensory problems)
- Problems thinking or remembering (cognitive problems)
- Trouble speaking, reading or writing
- Feeling depressed
- Problems controlling feelings
The specific abilities that will be lost or affected by stroke depend on the extent of the brain damage and, most importantly, where, in the brain, the stroke occurred: the right hemisphere (or half), the left hemisphere, the cerebellum or the brain stem.
Effects of Right Hemisphere Strokes
The right hemisphere of the brain controls the movement of the left side of the body so stroke in the right hemisphere often causes paralysis in the left side of the body. This is known as left hemiplegia.
Survivors of right-hemisphere strokes may also have problems with their spatial and perceptual abilities. This may cause them to misjudge distances (leading to a fall) or be unable to guide their hands to pick up an object, button a shirt or tie their shoes. They may even be unable to tell right side up from upside-down when trying to read.
Along with these physical effects, survivors of right-hemisphere strokes often have judgment difficulties that show up in their behaviour. They often act impulsively, unaware of their impairments and certain of their ability to perform the same tasks as before the stroke. This can be extremely dangerous. It may lead them to try to walk without aid or to try to drive a car.
Survivors of right-hemisphere strokes may also experience left-sided neglect. This is a result of visual difficulties that cause them to "forget" or "ignore" objects or people on their left side.
Some survivors of right-hemisphere strokes will experience problems with short-term memory. Although they may be able to recall a visit to the seashore that took place 30 years ago, they may be unable to remember what they ate for breakfast that morning.
Effects of Left Hemisphere Strokes
The left hemisphere of the brain controls the movement of the right side of the body. It also controls speech and language abilities for most people. A left-hemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia.
Someone who has had a left-hemisphere stroke may also develop aphasia. Aphasia is a catch all term used to describe a wide range of speech and language problems. These problems can be highly specific, affecting only one part of the patient's ability to communicate, such as the ability to move their speech-related muscles to talk properly. The same patient may be completely unimpaired when it comes to writing, reading or understanding speech.
In contrast to survivors of right-hemisphere stroke, patients who have had a left-hemisphere stroke often develop a slow and cautious behaviour. They may need frequent instruction and feedback to finish tasks.
Patients with left-hemisphere stroke may develop memory problems similar to those of right-hemisphere stroke survivors. These problems can include shortened retention spans, difficulty in learning new information and problems in conceptualising and generalising.
Effects of Cerebellum Strokes
The cerebellum controls many of our reflexes and much of our balance and coordination. A stroke that takes place in the cerebellum can cause abnormal reflexes of the head and torso, coordination and balance problems, dizziness, nausea and vomiting.
Effects of Brain Stem Strokes
Strokes that occur in the brain stem are especially devastating. The brain stem is the area of the brain that controls all of our involuntary functions, such as breathing rate, blood pressure and heart beat. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing. Since impulses generated in the brain's hemispheres must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis in one or both sides of the body.
Other Effects of Stroke
Depression is very common amongst people who have had a stroke. It can be quite severe, affecting both the survivor and his/her family. A depressed person may refuse or neglect to take medications, may not be motivated to take part in physical rehabilitation or may be irritable with others. This in turn makes it difficult for those who wish to help, and tends to deprive the survivor of valuable social contacts that could help dispel the depression. In time the depression may lift gradually, but counselling and appropriate medication may be necessary. In the past, researchers speculated that some of the older anti-depressant drugs might interfere with a person's mental performance but recent studies suggest that anything that can effectively treat post-stroke depression, whether an old or new treatment, may also improve mental ability and enhance rehabilitation.
Sudden laughing or crying for no apparent reason and difficulty controlling emotional responses also affects many stroke survivors. There may be little happiness or sadness involved, and theexcessive emotional display will end as quickly as it started.
Apparent changes in personality following a stroke may be very disturbing to the survivor’s family. Stroke affected people may not seem the same person as before. The way in which they think, feel and react may be altered. Problems and activities once tackled easily may be difficult or impossible, while other tasks are unaffected.
The way in which the person affected by stroke reacts to these changes will affect their personality, and may cause changes in control of emotions and behaviour. People affected by stroke may become confused, self-centred, uncooperative and irritable, and may have rapid changes in mood. They may not be able to adjust easily to anything new and may become anxious, annoyed or tearful over seemingly small matters.
Reviewed by Professor Alastair Corbett, Consultant Neurologist, Concord Hospital