Depression after a stroke is not uncommon and is perfectly understandable, but it is a clinical condition that is more serious than feeling sad or very upset with a loss of independence. Up to one out of three stroke survivors experiences some symptoms of depression sometimes after their stroke, a fraction of them will even experience severe depression.

These symptoms can occur right after the stroke, during rehabilitation or once you get home. The size and location of the stroke, previous or family history of depression and pre-stroke social functioning all seem to affect the likelihood and severity of post-stroke depression. Identifying the signs of depression early and dealing with it appropriately is important to maximize the post stroke recovery.

What follows is a list of useful advices to keep an eye on depression and address it promptly.

1. DEPRESSION MUST BE IDENTIFIED AND ADDRESSED THE SOONER THE BETTER.
Depression can cause behavioral and personality changes in stroke survivors and, unfortunately, stroke recovery can also be negatively affected, especially by major depression, as it can cause them to loose motivation and to become less compliant with their rehabilitation program. In fact, several medical studies have concluded that depression can delay or damage the prospects of stroke recovery. It is thus very important to identify and address depression. Yet there is no need to worry: there are ways to recover!

START BY KNOWING ITS SYMPTOMS.
A stroke may cause dramatic changes in your behavior or diminish your ability to function or communicate, and thus make it hard for people around you to distinguish disability from depression. Depression is thus commonly viewed as a natural or inevitable response to the effects of the stroke and often left undiagnosed and untreated. However, depression is a separate illness that can be treated successfully with the help of friends, family, support groups and professional care.

The National Institute of Mental Health recommends that anyone experiencing five or more of the following symptoms for more than two weeks should seek a medical evaluation for depression:

• Persistent sad or “empty” mood
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being “slowed down”
• Sudden trouble sleeping or oversleeping
• Sudden loss of appetite and weight, or weight gain
• Difficult concentrating, remembering, making decisions
• Irritability
• Excessive crying
• Chronic aches and pains that don’t respond to treatment
• Thoughts of death or suicide, suicide planning or attempts

If you feel suicidal contact your doctor or a mental health professional immediately and contact friends or family for company - anyone who feels suicidal should not be alone.

CHOOSE THE RIGHT TREATMENT AND GO AHEAD.
The treatment of post-stroke depression depends on its severity. Normally we separate between reactive depression and major depression. Reactive depression describes a depressed state that occurs after an event or change. The common theme is a state of transition and hence it is common after a stroke. Reactive depressions are less severe than major depression. Its treatment may involve talking therapies, which can be obtained from rehabilitation counselors, psychologists, psychiatrists and general practitioners. Major depression describes a state of low mood or a loss of enjoyment of daily activities. Its management will involve the use of medication, normally in combination with talking therapy. Major depression may occur in combination with reactive depression.

KEEP YOUR DOCTOR INFORMED OF ALL MEDICATIONS YOU ARE TAKING.
If on medications it is important that all doctors are aware of all of the medications that have been prescribed to avoid unfavorable interactions. This is very important as some medicines commonly used to treat depression are dangerous for stroke survivors and other common post-stroke medicines can deepen depression. Always using the same pharmacy, allowing for the pharmacist to alert your doctor of potential problems, could thus be a good idea.

Here are some activities that may help stroke survivors avoid or fight against depression:

• Make the most of your rehab: the more you recover, the better you will feel and the better you feel the more motivated you will be for you rehab exercises (in this way you are creating a virtuous cycle) – however it is essential to look at the progress over longer periods (month) as it is not visible on a day-to-day basis. At the same time it is important to realize that adequate therapy for depression can trigger rehab activities.
• Get involved in daily activities with friends or family. Many stroke survivors feel isolated and alone, even if they aren’t physically incapacitated from the stroke.
• Ask your family to stimulate your interest in people and social activities.
• Set goals and measure accomplishment.
• Plan daily activities to provide structure and sense of purpose.
• Join a stroke support group. Other survivors will understand your issues, and offer support and ideas to help you manage your emotions.
• Speak openly and honestly to your caregivers about your emotional changes. They’ll be glad you did, and together you can work out a solution.
• Maintain your quality of life by staying active and doing things you enjoy
• If you’re capable of volunteering, even if it’s just an hour or two a week, it will not only help others, but could also help you feel better about yourself.
• Ask your doctor how to relieve any physical discomforts like pain, muscle spasms, and constipation that can all add to depression.

In any case, it is important to acknowledge that recovery from depression takes time, even some anti-depressants take several weeks before they begin to help. It takes much of your own effort and decisiveness, and it is perfectly possible and expected that you will get over it and move on in your stroke recovery.

http://www.stroke.org/site/DocServer/NSAFactSheet_Emotions.doc?docID=989
http://www.strokensw.org.au/depression.html
http://www.ahealthyme.com/topic/depstroke
http://stroke.about.com/od/lifeafterastroke/p/depression.htm

What follows is a short list of critical tips, to start your rehabilitation on the right foot.

1. MAKE ARRANGEMENTS BEFORE YOU LEAVE THE HOSPITAL. Don’t forget to ask your doctor before leaving, to arrange a home visit by an occupational therapist (OT), who is trained to help you manage daily activities and regain your independence. This person will check your home and may suggest simple changes to make everyday living easier, and they also will arrange for changes to be finished before you return home.

2. ACCOMMODATE YOUR HOUSE TO YOUR RECOVERY. Forty percent of stroke survivors suffer serious falls within a year after their strokes. That’s why the OT will suggest you to move extra furniture out of the way either to corners or another room, to move electrical cords out of pathway, to remove loose carpets and runners in hallways and stairwells or to fasten them with non-skid tape to improve traction. Low pile carpeting is better than a thick one because it makes wheelchair or walker movement easier. Try stair glides, stair lifts and platform lifts if you need to use the stairs many times during the day.

3. ACCOMMODATE YOUR BATHROOM. The bathroom usually poses challenges. To make bathing both simple and safe, use sturdy hand rails, grab bars in the tub or shower, non-slip flooring strips installed inside and outside. Don’t hesitate to use them to stabilize and balance yourself. The bathing supplies should be easy to reach and use.

4. ACCOMMODATE YOUR BEDROOM. The bedroom is a place where you should feel safe and comfortable. To make your private world safer, make sure that all the utilities are easy to be reached, like the telephone, the light switch and other personal items. Use a nightlight and clear a path for easy access to the toilet at night. At last, since some accidents are unavoidable, consider placing disposable “blue pads” underneath your sheets, which prevent bed staining, with cloth on one side and waterproof material on the other.

5. GET 100% INVOLVED IN YOUR RECOVERY. After a stroke, home treatment will be an important part of your rehabilitation. You may need assistive devices to help you to eat, to get dressed, to walk, or you may feel like letting a caregiver take charge; however, for a successful recovery, you have to be as involved as possible. The more you can participate, the better. After a stroke, a combination of physical, speech, and occupational therapies can help you manage the basics of daily living.

6. SLOW DOWN AND PLAN YOUR RECOVERY. It is important that you slow down, take time, plan a task and break down tasks into a series of simple steps. Day after day, you will find these little steps add up to a large progress. Furthermore, a regular exercise program for stroke survivors is recommended, including 20 to 60 minutes of aerobic exercise three to seven days a week, a strength training with resistance or light weights two to three times per week and other stretching and flexibility exercises, as well as trainings in balance and coordination.

7. TRY TO ADD FUN TO YOUR RECOVERY. Not only can regular physical exercise improve the quality of life for stroke survivors by increasing their strength and mobility, it can also reduce their risk for a repeat stroke and a heart attack. If you want to have some fun while practicing, try this video game especially designed for home stroke therapy.

8. DO NOT BE AFRAID TO FACE YOUR RECOVERY. A stroke is always stressful for the family therefore; the caregiver needs as much support as possible from others. It would be better if the family members and the caregiver work together in order to ease the stress on everyone. When everything is being prepared, you are still asking yourself thousands of questions, you may be afraid of facing your disabilities. No worry, considering new resources, equipment and therapies which are available each year, just take advantage of them to improve your quality of life. Continue to set new goals for your stroke recovery, and tomorrow will always be a better day!

Source:
National Stroke Association NSA
Stroke Recovery Association NSW
WebMD – Stroke guide
American Heart Association
Youtube

We all know the importance of a good night of sleep. To sleep is an essential part of our daily life and sleeping problems can make you tired, depressed, frustrated and irritable. Yet, sleeping problems can be even more severe for stroke survivors: both affecting the rehabilitation process and, more importantly, increasing the risk of having another stroke. Rehabilitation after a stroke is hard by itself and requires much from the patient. As progress cannot be assessed on a daily basis the success of a physiotherapy program depends heavily on the patient’s concentration, motivation and energy. In other words, it doesn’t combine well with sleeping disorders. Unfortunately, however, stroke survivors commonly suffers from sleeping problems. Luckily, sleeping disorders -if properly diagnosed- can often be managed easily.

The most common sleeping disorder among stroke survivors is Sleep-disordered breathing, were abnormal breathing patterns is causing your sleep to be interrupted several times during the night. It is particularly important to be aware of signs of sleep-disordered breathing as it, in addition to sleepiness, increases blood pressure, heart stress and blood clotting. Typical symptoms include:

• Loud snoring
• Frequently waking up gasping for breath
• Increased sweating
• Breath shortness
• Unability to fall asleep or remain asleep

Another typical disorder experienced by stroke survivors is Sleep-wake cycle disorders (circadian disturbances) resulting from a sleep schedule no longer determined by day and night. Common symptoms are:

• Difficulty initiating and/ or maintaining sleep
• Non-restorative sleep
• Daytime sleepiness, poor concentration and headaches
• Impaired performance, including a decrease in cognitive skills
• Poor psychomotor coordination
• Gastrointestinal distress

Insomnia, characterized by inadequate sleep quality and quantity, is experienced by many people and it frequently affects stroke survivors as well. It causes people to feel tired and often get very worried about not getting enough sleep. Typical symptoms include:

• Difficulty falling asleep
• Waking up often during the night and having trouble going back to sleep
• Waking up too early in the morning or feeling tired upon waking
• Sleepiness during the day
• Irritability and problems with concentration or memory

If you experience any of the above symptoms and believe you are suffering from a sleeping disorder, do not hesitate contacting a doctor or another profession that can help you. It can improve the quality of your life!

Sources:
Stroke.org
NeurologyChannel.com
WebMD.com

New research, published in the peer-reviewed medical journal “Brain”, suggests that listening to music could help stroke patients to recover from brain damages after having suffered from a stroke. The study carried out in Finland, randomly allocated patients into three groups, and the patients in one of them were instructed to listen to their favorite music at least one hour a day and keep a diary of how much they listened. Following the study the researchers concluded “that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood”.

It is time to pick up your old favorite CD, be it jazz, classical or pop, and start recovering… it can’t be more relaxing and comfortable than this!

Read more at MedicalNewsToday.com

There is a great potential benefit participating in support groups for stroke survivors, yet many are not aware of the existence of these groups. This article will thus try to shed some light on support groups and their activities.

What are support groups?

Firstly, what is a support group? Generally speaking, a support group is a group of people sharing a common characteristic who provide non-professional help and advice to each other. The help may take on several forms -also depending on the common characteristic of the support group- including sharing personal experiences, serving as motivators, providing relevant information, developing social networks and just being available to listen, provide understanding and share frustration with the other members. Support groups normally meet monthly, bi-monthly or weekly.

How can you benefit from stroke support groups?

Support groups provide stroke survivors, their friends and family with an excellent opportunity to meet with other stroke survivors as well as caregivers to exchange experience and information. Building a network of people knowing what you are going through will not only help you gather useful advice regarding stroke and your daily activities to achieve full recovery; it can also help you preventing future strokes, assist you in identifying the best local resources and allow you to receive support.

Furthermore, by meeting regularly to share experiences and provide (receive) feedback, members inspire one another to overcome major challenges. Motivation is one of the key ingredients for the successfully completion of a rehabilitation program. Also, given the isolating nature of a stroke, stroke support groups can be an excellent place to socialize, make new friends and have fun. Following a stroke physical and emotional difficulties often arise and relationships and friends are lost. Stroke support groups can help stroke survivors adjust to this new situation and create a meaningful life by joining in a caring environment among friendly people sharing similar problems, who thus understand what you are going through. Finally, support groups are an excellent way to help others that are in the same situation as you. Consequently, we can conclude that stroke support groups promote good health as well as better quality of life.

Online stroke support groups

Stroke support groups are available almost everywhere. Still can’t find a group near you? Don’t worry they exist online as well. Online stroke support groups besides bring another dimension into support groups as their reach is only limited by people’s internet access and you thus significantly increase the likelihood of finding someone in a situation just like yours. This could be of huge advantage as it would allow you to receive advice and feedback particularly relevant for your situation. But the “online benefit” is not restricted to that. Contrary to normal real-life discussions, discussion on an internet forum gets saved and can be made available for other users and thus ensure that knowledge and experience doesn’t get forgotten as time goes by. Moreover, having such information available online makes it accessible by a much larger patient/ caregiver group and it easily allows for it to be tied to reliable medical resources. Online support groups is also an excellent opportunity to give it a try if you are not convinced this is something for you yet. Here you find some stroke support groups available on the internet:

• StrokeNetwork.org
• MDJunction.com
• Boards.WebMD.com

Want to know more?

Under you will find some links to sites with more information about stroke support groups, covering everything from locating a group in your neighborhood to setting-up your own support group.

Read More:
StrokeCenter.org
Stroke.org
StrokeAssociation.org

Smoking: a poisonous stroke factor

We have all been told over and over that smoking kills, but we may not picture what it represents actually. Strokes are the third leading cause of death in the United States. Cigarette smoking is a major cause of strokes.

Cigarette smoking is directly linked to 30% of all heart disease deaths in the United States each year. Indeed, smoking is hard on the heart, and the toxins in cigarette smoke cause plaques to form in the arteries, which leads to atherosclerosis; arteries progressively harden because of the deposit of fatty plaques and the scarring and thickening of the artery wall. Inflammation of the artery wall and the development of blood clots can obstruct blood flow and cause heart attacks or strokes. Heavy smokers have a relative risk of stroke 2 to 4 times greater than non-smokers.

And what is worse; not only smokers put themselves at risk, but they also threaten other’s health. Cigarette smoke does not just affect smokers. People around smokers are also at risk for developing health problems, especially children that are much more fragile than adults. Passive smoke (also called second-hand smoke) affects people who are frequently around smokers. According to the American Heart Association estimates, each year about 37,000 to 40,000 people die from heart and blood vessel disease caused by other people’s smoke.

But there is a positive point to underline: it is never too late to stop smoking! There are clear health benefits from giving up, regardless of how much you smoke, how affected your health, or your age when you stop. Quitting smoking will reduce your risk of high blood pressure, peripheral artery disease and stroke. To push up your decision to stop smoking, you should know that the risk of stroke decreases steadily after smoking cessation. Former smokers have the same stroke risk as nonsmokers after 5 to 15 years. Better stop right now then and lower our risk to suffer a stroke! Overall, you will only feel healthier. Quit now, be free!

Sources:
Stroke Association
American Heart
BMJ Editorial
Quit Smoking at About.com
Doctor Online NHS UK

Your diet is an important part of your lifestyle after a stroke. Eating the right kinds of foods may help you feel better and get stronger. A well balanced diet helps your body build tissues that may have been harmed and also gives you energy. A low-salt, low-fat, low-cholesterol diet can help prevent a recurrent stroke. People with high blood pressure should limit the amount of salt they eat. Those with high cholesterol or hardening of the arteries should avoid foods containing high levels of saturated fats (i.e., animal fats). These diet controls can enhance the benefits of the drugs which may have been prescribed for control of a specific condition.

Here are some useful cooking tips to help you cook in a healthy style.

• Fill your grocery cart with a variety of lean meats and low-fat dairy products, whole grains and lots of fruits and vegetables.
• Use cooking methods like roasting, baking, broiling, grilling, braising, sautéing, stir-frying and microwaving to help retain vitamins and minerals and keep fat and calories down.
• Choose cooking oils that contain 2 grams or less of saturated fat per teaspoon, such as safflower, soybean, corn, canola and olive oil. Choose liquid or soft-tub margarine and oil-based salad dressing.
• Baste meats and poultry with fat-free ingredients, such as wine, fruit juice or defatted beef or chicken broth.
• Use chopped vegetables as a substitute for some of the bread when you make stuffing.
• Add a few drops of lemon juice to the water you cook pasta in, and eliminate the salt and oil.
• Cut down on saturated fat in creamy salad dressings by mixing in some nonfat or low-fat plain yogurt.
• In most recipes, one egg white and a little acceptable vegetable oil will substitute well for a whole egg. Egg whites contain no cholesterol and are rich in protein.
• Fruits that are fresh or canned in water have fewer calories than fruits in juice or syrup. Drain fruits canned in syrup.

If you have diabetes, high blood pressure or high cholesterol, your doctor may have special recommendations.

Sources
The American Stroke Association
www.bethabe.org
www.stroke.org

Constraint-induced movement therapy (CIMT) started with the idea that the more you stimulate a limb, the more it is prone to react and gain agility. The idea behind CIMT is to restrain the movement of the unaffected limb so that the person is forced to mobilize his affected limb more often.

First, studies were conducted on monkeys and they showed the phenomenon of “learned non-use”. First the animal stops using the affected limb right after injury and learns to get along with the 3 remaining limbs. As time goes on, even after the affected limb heals, the monkey typically under-use the healed limb as it has gotten used to get along with the three remaining limb – this phenomenon was described as the “learned non-use” and it limits the recovery of the initially affected limb. By constraining the opposite limb, the animal is forced to use its healed or partially healed limb this reversed the “learned non-use effect”.

This forced use of the unaffected limb is known as constraint-induced movement therapy (CIMT).

A recent randomized controlled trial of CIMT was conducted on 227 patients who had a first stroke within the previous 3 to 9 months. Patients were assigned to either a 2-week program of CIMT (wearing a restraining mitt on the unaffected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand) or usual and customary care (this could range from no treatment to pharmacologic or physiotherapeutic interventions). The CIMT group demonstrated statistically significant improvements in all outcome measures that persisted for at least 1 year.

For patients to benefit from CIMT, it is often recommended that they have intact cognition and also meet the minimum motor criteria of being able to extend the impaired wrist and fingers to 20 and 10 degrees respectively. As for today, CIMT is still at an initial phase of development and requires a strong personal commitment as it is a very constraining technique and often an unpleasant experience. Yet, if you are interested by CIMT, don’t hesitate to mention it and discuss it with your physician.

Sources
MediFocus Guide from Medifocus.com
www.annals.edu.sg

For many stroke survivors, being able to drive is a big step, and a big achievement. It does support a fuller independence. A stroke can affect many of the skills necessary for independent driving. A number of stroke survivors will return to independent driving.

The first objective in evaluating the possibility of independent driving is to ensure safety. Safety is always an issue as soon as someone gets behind the wheel. It’s even more important after a stroke. Injury to the brain can result in deficits in strength, coordination, vision, perception, and cognition – all these will impact the stroke survivor’s safety in driving.

Adaptive aids, such as steering wheel pegs and accelerator extensions, can certainly be incorporated to help compensate for some of the motor deficits. A spinner knob can be attached to the steering wheel to allow controlled steering with the use of one hand. A left gas pedal may be used if you are unable to use your right foot to gas or brake. All these aids will require training to ensure safety with a new adapted driving method.

Before one returns to driving it is advisable to have an Occupational Therapist perform an evaluation of one s driving ability. This can include an assessment of vision, muscle and grip strength test, brake reaction time, and perceptual and cognitive abilities. Driving skills can be tested in a simulator or behind-the-wheel with an instructor. In some case the therapist will recommend additional driver training such as visual scanning and tracking, reaction time, spatial perception, execution of complex actions. Your doctor can guide you on training and evaluation options.

Please note that driving against your doctor’s advice can be dangerous and may be illegal. Some stroke survivors will unfortunately have to cut off or give up driving. They can still keep their independence with some planning ahead to go to the places they want to and meet the persons they want to. They should consider riding with family and friends, taxis, public transportation or even to walking. They also often have access to transportation services offered by senior centers and local service groups.

Sources
MediFocus Guide from Medifocus.com
www.nhtsa.dot.gov
www.driver-ed.org

How to train working memory after stroke?
Memory loss is something that everyone experiences at times, often increasing with age or a neurological problem such as a stroke. Working memory is what we call short-term memory; it is a key cognitive function that allows individuals to hold information “online” for short periods of time. Working memory is often affected after stroke and traumatic brain injuries resulting in problems with attention and planning. After a stroke, one of the main reasons for not being able to return to work is the cognitive problems.

While there are many therapies addressing problems with motor functions and language, there is currently no satisfactory way to treat the cognitive problems. A new study carried out by Dr. Westerberg has shown that victims of acquired brain injury can improve their attention by using a software-based program (Cogmed) to train working memory. 89% of stroke victims who participated in the training reported that after that they were less easily distracted, less likely to daydream and less likely to lose focus when reading. The study is the first of its kind to demonstrate that working memory training among stroke victims leads to improvements in daily life; yet it was performed on a too small sample to be significant and need be tested some more. Optimistic, Dr. Westerberg reported: “This study is an indication of the broad potential of working memory training. In many ways, we are only beginning to understand the tremendous impact that this kind of focused training can have on individuals suffering from various cognitive limitations.” If the method is once more proved to be truly efficient, it could bring new hope to the stoke survivors who suffer severe working memory deficits that impair their executive functioning and social interaction. Working memory capacity is a fundamental cognitive ability necessary for the rehabilitation of other mental functions.

Until such techniques get widely distributed, stroke survivors can make up their own way to train their working memory. The most important step toward improving memory skills is making a conscious decision to pay attention. Then, simple techniques can help to process information, store it and retrieve it when needed. Here are some tips to train your memory: pick the one that suits you best!

Association
You can learn or recall something more easily if you associate it with something you already know or remember. To recall a specific date, associate it with another well-known date (Christmas, your birthday, etc.)
To help remember names, associate the new name with a famous person or someone you already know.
Associate a person’s name with their physical characteristics (eyes, ears, weight, size); you don’t have to tell the person about your little trick.

Pair chores or tasks you might forget about with things you always remember to do. For example, if you drink tea every morning put your pills by the tea bags so you will not forget them.

Repetition and rehearsal
There is no such thing as “overlearning”; studying or reviewing the material more than you think you need to can prove very useful. Do not hesitate to repeat new information to yourself several times, spacing out these repetitions over time. If you must remember something quite long (story, map indications, etc.) break-up information into smaller pieces and learn them carefully the one after the other. Better training your memory carefully than rushing for nothing.

Compensation
“The weakest ink is stronger than the best memory”, Confucius said. Old sayings are often good advice; if you want to remember something, write it down. Get yourself a comprehensive calendar in which you can write down not only things to do, but also names and contact number, medication and any further information you want to remember about. In a nutshell, make sure you have plenty of space to store valuable information.

Personal training
Challenge yourself with easy mind games to train your memory without even noticing. Take a look a picture for a couple of minutes, then hide it and try to write down all the objects on it, or try to redraw it. Start with easy pictures and gradually increase difficulty. Play memory game with your children or grand children; not only will you train your memory but you will spend good time with loved ones and for sure they will enjoy it too!

Improving memory requires awareness of the possibility of forgetting and then making a conscious effort to use some type of memory tool. Experiment with a variety of techniques and find what works for you. And more importantly, have fun!

Sources:
http://strokeassociation.org/presenter.jhtml?identifier=3027313
http://www.mindtools.com/memory.html
http://www.sciencedaily.com/releases/2008/01/080107110401.htm
http://www.suite101.com/reference/memory_improvement_tips_and_ideas
http://findarticles.com/p/articles/mi_m0EIN/is_2007_June_11/ai_n19207683
http://www.cogmed.com/cogmed/articles/en/84.aspx