Medical Impact of Stroke

A stroke can affect many areas of functioning. Our rehabilitation treatment team addresses all major functional areas with each individual patient.

Medical Management

• Breathing: Patients can have difficulty breathing after a stroke, so a tracheotomy tube may need to be placed in the neck to help with breathing. Even when patients can once again breathe on their own, the tube may remain in place to help clear secretions from the trachea. The ability to produce an audible voice is temporarily affected by the presence of this tube.
• Swallowing: During the course of rehab, a patient may have an objective study performed to ensure the least restrictive diet and to prevent pneumonia. Many individuals with stroke have trouble swallowing safely (dysphagia). Food may be chopped or pureed, and liquids may be thinned or thickened. In some cases, a feeding tube must be inserted through the nose to give liquid nutrition. When swallowing problems are severe and likely to last for a while, a gastrostomy feeding tube can be surgically placed in the stomach. This allows liquid nutrition to be given in large amounts several times a day instead of continuously dripped in, and is often more comfortable for the patient. Generally, this tube can be removed once swallowing improves.
• Seizures: When the brain is injured, it becomes more sensitive to developing seizures. Seizures are caused by abnormal electrical discharges in the brain. Symptoms may vary depending on the part of the brain that is affected, but seizures often cause unusual sensations, uncontrollable muscle spasms and even loss of consciousness. Medications can be used to stop and prevent seizures.
• Spasticity: Spasticity is a condition in which muscles are continuously contracted. This abnormal increase in muscle tone results from a faulty signal from the brain to the muscles. The stiffness and tightness of the muscles can interfere with movement, speech, and the quality of walking. The degree of spasticity can vary from mild muscle stiffness to severe, painful and uncontrollable muscle spasms. Treatment depends on the individual’s circumstances, but could include medications and stretching exercises.

Cognition

Cognition is often adversely affected by stroke, and includes things such as attention, memory, language, visual-spatial abilities, alertness, and executive skills. Some patients can be confused and restless, and have problems with insight, irritability, restlessness, poor attention, poor memory and difficulty solving everyday problems.

Cognitive changes with strokes are more likely seen with someone who has had a cerebrovascular accident on the right side of the brain. Cognitive deficits can vary from mild to severe or profound, and often show improvement as recovery progresses. Some areas of cognition may be more impaired than others.

As patients improve, they often begin to participate more meaningfully in therapies and other activities.

Cognitive deficits can sometimes be subtle. They may still include mild memory deficits, and difficulties in planning and organizing day-to-day functioning, particularly in complex activities. Rehabilitation efforts at this level are focused on teaching the patient strategies to help in these areas.

Communication

Problems communicating can range from mild to profound. Individuals with the most severe strokes are unable to communicate at first. They may sometimes have their eyes open, and appear to be awake, but may not be able to speak or respond. Having difficulty speaking or understanding words is called aphasia, and this is usually associated with strokes on the left side of the brain.

Some individuals can follow simple directions and may be able to talk using simple words or gestures, but may have difficulty finding the right words to say. Words said may not always make sense.

Patients can also experience dysarthria, in which weakness of the face, lips, tongue and larynx (voice box) can cause speech to be slurred and unintelligible.

Apraxia

Apraxia can also be caused by a stroke. This is a motor planning disorder that can cause the patient to know what word they want to say, but have difficulty planning the speech sounds. They may appear to be searching for a word with long delays in initiating speech.

Our speech pathologists evaluate and recommend treatment for communication and swallowing problems. Generally, as the patient improves, communication skills become more accurate.

Mobility

Mobility is about movement, whether it’s going from laying down to sitting up, walking to the bathroom, or wheeling a wheelchair down the hall. In order to move the body, the brain must coordinate balance, strength, and motor control.

Mobility deficits in stroke patients are most commonly addressed by physical therapists in rehabilitation. At WakeMed, we use a variety of approaches to facilitate mobility, and we encourage the patient to use the affected side of the body as much as possible to retrain those muscles and pathways in the brain.

Areas of function that can affect mobility in a person with a stroke are:

• Balance: Allows upright posture without falling over
• Strength: The amount of power that the muscles have
• Coordination: The smooth movement of multiple body parts in harmony
• Sensation:  Whether hot or cold, or sharp or dull
• Proprioception: Tells the body where it is in space
• Tone: An increased resistance to movement, which can increase with laughing, coughing, sneezing, infection, fever, or impaction
• Range of motion: Orthopaedic injuries, increased muscle tone, or changes in motor control can reduce the patient’s ability to maintain joint flexibility
• Posture: The ability to sit up or stand, including head position
• Motor control: A combination of strength, balance, coordination, and sensation to produce purposeful, controlled movement.
• Motor planning: The selection of the correct motor plan, including starting, continuing and stopping a desired movement