Impact and frequent after effects following a stroke

Patients who have suffered a stroke may experience a variety of limitations and complications that can hinder optimal recovery. The most common after-effects are:

Physical after-effects

These include all injuries or complications that affect the patient’s body. The most common are related to motor deficits, sensory or language disorders and urinary incontinence:

• Patients who have suffered a stroke should work to strengthen their muscles and train their balance, as they have a higher risk of falls.
• Patients will see speech therapists in the case of language disorders such as:
  • Misunderstanding or problems using language (aphasia).
  • Speech disorders that manifest in difficulty articulating words (dysarthria).
  • Inability to pronounce words (mutism).
• Stroke sufferers can also suffer changes to senses on the side where they have mobility problems, such as tingling, unpleasant sensations or a lack of touch. Special care must be taken to prevent injuries or burns as the patient may not notice them.
• Spasticity, or permanent contraction of certain muscles, can cause stiffness, pain, contractures and difficulty in some movements. The specialist will recommend the most appropriate treatment.
• Pain in the shoulder of the paralysed arm will need rehabilitation and is the most common complication in people with hemiplegia.

Although less common, other injuries such as problems with sight, central pain, or infections can also occur.

• Problems with sight are related to the loss of vision of half of the visual field (hemianopsia). However, the patient is not always aware of this and should be reminded to look at the affected corner as recovery will require training.
• In case of difficulty swallowing (dysphagia), changes to diet and safe-eating techniques will need to be used. In more severe cases, it may be necessary to resort to a nasogastric tube or, if it is going to be used for a long period of time, a gastrostomy.
• Central pain is a burning or stinging sensation that worsens on touch, in water, or during movements. 
• Urinary incontinence is usually temporary, although it may persist in patients with significant after-effects.

Alterations in mood

During recovery, rehabilitation, or later on, mood swings may be noticed. These usually occur in the first three months after a stroke, although there are cases where they occur later. Symptoms are similar to other depressions: problems sleeping, difficulty concentrating, and reduced appetite.
The most common psychological problems are depression and anxiety. Depression usually occurs in one in three patients, and is more common in women and patients with previous problems with depression, psychiatric disorders or social isolation or poor family structure.
Emotional instability, apathy, irritability, and lack of awareness can also occur following a stroke. 

Cognitive impairments

In this case, the most common cognitive impairment occurs in the form of dementia, attention deficit, and decreased memory. There are also patients who present with problems relating to orientation, difficulty in planning, and organising tasks.

Guidelines for caregivers

All of these factors have an impact on the patient’s family. In 60% of cases, the person who assumes the role of caregiver suffers from overload and anxiety at discharge. It is important:

• To ask for help and use social and community resources.
• To plan activities and find time for the caregiver.
• Not to abandon relationships with friends.
• To express thoughts and emotions without judging one’s own feelings.
• To set boundaries and not self-medicate.
• To participate in family associations and support groups, and in family respite programmes.

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