Depending on where it occurs, it can result in an arm being pressed against the chest, which can seriously interfere with the ability to perform daily activities such as dressing. One may also suffer from spasticity in the leg, which may cause a stiff knee or a pointed foot and curling of the toes that interferes with walking. It can also be accompanied by painful muscle.

Spasticity is like a “wicked charley horse” Brain injury from stroke sometimes causes muscles to involuntarily contract (shorten or flex) when trying to move limbs, creating stiffness and tightness.

Several tests can help confirm the diagnosis. These tests would evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.

Healthcare providers will therefore consider the severity of spasticity, overall health, and other factors to prescribe an appropriate treatment plan for an individual. This treatment is often a combination of therapy and medicine, including:

Physical exercise and stretching
Stretching helps you to maintain the full range of motion and helps you to prevent permanent muscle shortening.

Braces
Braces can help you to hold a muscle in a normal position to keep it from contracting.

Oral Medications
Several oral medications are available that can help relax the nerves so that they do not send a continuous message to the muscles to contract. NeuroAiD™ has been shown to reduce muscle spasticity in stroke patients.

Intrathecal baclofen therapy (ITB)
It consists of long-term delivery of baclofen to the intrathecal space. This treatment can be very effective for patients with severe spasticity, particularly for whose conditions are not sufficiently managed by oral baclofen and other oral medications. A small pump is surgically implanted which supplies baclofen to the spinal chord.

Injection
Some medications can be injected to block nerves and help relieve spasticity in a particular muscle group, like botulinum toxin (BOTOX etc.) or phenol. This treatment weakens or paralyses the overactive muscle. Side effects are minimized, but you may feel sore where injected.

Surgery
This is the last option to treat spasticity. It can be done on the brain or the muscles and joints. Surgery may block pain and restore some movements.

Talk with your doctor about the treatments that may be most effective for you. Every individual responds differently to the various treatments.

To know more, read the testimonial of Tom Schneider and Derell Schooley and discover how NeuroAiD™ helped them to reduce the spasticity on http://www.neuroaid.com/testim.php

Meanwhile, mild exercises which should be undertaken everyday can take the form of a short walk or a simple activity like sweeping the floor.

Sources:
National Stroke Sssociation
WebMD
American Stroke Association
Movement Disorder Virtual University

A number of studies have shown that TIAs carry a significant short-term risk of stroke, especially in the first few days. A 6-point score, based on age, blood pressure, clinical features and duration (ABCD) was shown to effectively stratify the short-term risk of stroke after a TIA. One can calculate the ABCD score like this:

Don’t wait for the symptoms to go away, because nobody can tell whether it is a stroke or a TIA. The goal of TIAs management is to prevent a future stroke. The treatment used depends on the exact cause of the TIAs. In addition to lifestyle changes such as diet and exercise, doctors may recommend drugs to treat high blood pressure, high cholesterol or heart disease. These changes may reduce the risk of further Stroke.

Sources:
Stroke Journal
Stroke Org Uk
Journal Watch

The definition of advocacy is “active support”, especially the act of pleading or arguing for something. In this case it is for the patient himself, for his own well-being. To be a self-advocate is definitely to be a supporter, believer, encourager, and activist of and for oneself. Patients should state their needs in a clear, specific and firm ways, and don’t be afraid to ask for help.

Suffering a stroke is often an overpowering experience, which takes from survivors a sense of control, both over their physical and mental health and well being. Self-advocacy is important, because it is a way of empowering oneself; that allows patients to personally take responsibility in making the most of their recovery from stroke. Patients have to identify and explain what they want and need, which can directly impact their own quality of life.

First step, you may ask yourself or ask your dear one what you/he can do to prevent another stroke. Take the steps necessary as prescribed by the doctor. This includes things such as monitoring blood pressure, finding out cholesterol numbers and working to control them, quitting smoking.

As one advocates oneself, education is critical. Gather information to help understand what has happened and what to do next. Learn about stroke, the disabilities, and what treatment options are available. Books, pamphlets and fact sheets are quite good resources for getting this information. Watching informational videos, CD-ROMs or DVDs are excellent methods too if patients and family want to know more. You can surely find these resources on some online bookstores like Amazon. Meanwhile, browsing the web or having a friend or family member to do it for you stays the easiest way, as many sites give quite good and useful information, like www.strokeassociation.org, or www.mystroke.org. Besides this, attending a workshop, seminar or talk allows the family to get directly in contact with experts; otherwise you can talk to a social worker, case manager or community resource specialist.

It is vital to seek out and listen to those individuals who are familiar with or specialized in stroke rehabilitation. This includes not only the healthcare team but also other stroke survivors and their family. Ask questions, stay positive, and stay in the course!

Sources:
National Stroke Association

• Forced to retire by employer
• Unable to meet expectations
• Unable to drive or use public transport
• Fear of losing benefits
• Not fit enough to work
• No longer able to do previous job, face demotion

However, for most of the younger stroke survivors their main objective is getting back to work - not only for financial reasons but also to help to rebuild their confidence, regain their independence and even enhance their recovery. Yet not all of those stroke survivors are able to make the return. Among the ones that don’t make it back to work, many might have been able to re insert themselves, if they had been given better support and followed an adequate rehabilitation program.

Rehabilitation helps
Depending largely on the level of the impediments at the acute phase, a stroke can often lead to long disability periods for the stroke survivors, making the possibility of returning to work fade away. Yet, for many, taking the right action can make all the difference. Long term support and appropriate rehabilitation tailored to the needs of the patient, is crucial for stroke survivors aiming to return to work. The patient’s firm will to return to work, can also serve as the motivational factor needed to initiate an intensive rehabilitation process. Physiotherapy, speech and language therapy, and psychological support all work help achieve faster and more complete recovery.

Continuing disability and the patients’ ability or not, to independently care for him or herself, is obviously an important determinant of whether it is possible to get back to work. Following and intensive and well tailored rehabilitation program will minimize the likelihood of needing to cope with such a situation. On the other hand, depression is one of the major causes of work failure, and has a significant impact of its own, on work status after a stroke. However – as discussed last month – depression is a separate illness that can be treated successfully if appropriately approached.

Make your employer prepared
The attitude and willingness to help shown by the employer is of major importance and can have direct impact on whether or not a stroke survivor returns to work. It is thus very important to contact the employer as soon as possible following the stroke, to agree on reasonable and necessary adoptions to the working arrangements and conditions to make the return to work as smooth as possible. Too many stroke survivors who go back to work leave soon afterwards because their employers have not made the necessary adaptations, making it impossible for them to fit in and perform at their capacity. There are several measures that you might ask the employers to take so as to help you continue your work:

• Allowing a phased return to work
• Changing working hours
• Part-time work
• Redeployment
• Job sharing
• Providing help with transport to and from work
• Arranging home working

Adaptations to a job or work environment must also be backed with appropriate training and guidance. For example, if a new tool is provided, the stroke survivor will need to receive training on how to use it.

Finally, negative employers – unwilling to make the necessary adoptions – exist, but mustn’t stop the patient. The sufferer should allow him or herself some time and look for new opportunities with employers that understand their situation and show the required flexibility. To consider a career change could also be an option, not forgetting that there is always life after work.

Sources:
Web MD Stroke News
Stroke Organization UK

The precise cause of post-stroke pain is unknown, although it may be due to a hyperactivity of the autonomic nervous system. Because the brain has been damaged, it feels pain when it should be feeling a sensation that is not painful. One major problem is that painkillers have no effect on this type of pain.

Patients may experience one type of pain or several kinds. The key is to figure out what is causing the pain so that the patient can treat it. There are basically two kinds of pain after stroke:

Central pain is constant, moderate or severe. It tends to be felt in one part of the body, usually an arm or a leg. It is always on the side of the body affected by the stroke. Central pain is produced within the brain as a result of the stroke. It does not stem from damaged nerve endings. Rather, the body sends normal messages to the brain in response to touch, warmth, cold and other stimuli. But the brain does not understand these signals correctly. Instead, it will register even slight sensations on the skin as painful.

To find a way of relief, patients should explain their symptoms to the doctor. Together, they can determine the best treatment. Patients could already try some solutions when at home. A start is to avoid things that can cause pain, such as hot baths, tight or easily bunched clothing, and pressure on the side of the body affected by the stroke. While sitting or lying down, support the paralyzed arm on an armrest or pillow to relieve shoulder pain from the arm’s weight; the same should be done with a sling while walking. At last, patients could use heart packs or simple exercises prescribed by their physical therapist.

What else can help besides asking the doctor? First of all, focus on thoughts or activities that are enjoyable. Patients can and should still be active, productive and have a good quality of life. Relaxation, meditation or hypnosis can also help to manage the pain. Secondly, finding and joining an adequate stroke support group. Other survivors will understand and validate the issues and offer encouragement and ideas for pain relief. At last, speaking honestly and openly with the care giver about the pain issues, who will be glad the patient did so, and together work out the best solution.

Further research will hopefully precisely evaluate the various mechanisms of pain and the impact of medications and non pharmacological treatments. So that pain after stroke will be no longer neglected because of its high prevalence.

Sources:
National Stroke Association
Journal of Neurology, Neurosurgery & Psychiatry

The prevalence rate of dementia is 9 times higher in patients who had a stroke than in people who didn’t. One year after a stroke, 25% of patients develop new-onset dementia. Within 4 years following a stroke, the relative risk of incident dementia is 5.5%.

Onset can be gradual or dramatic. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability.

Prevention
The underlying vascular disease has to be recognized and treated at early stage. The immediate cause of vascular dementia is stroke-interruptions in blood flow to the brain. So the best way to prevent it is to lower the risk of stroke, being high blood pressure or hypertension the single most important one. Other important risk factors are cigarette smoking, untreated diabetes, high cholesterol, a family history of heart problems, disease in arteries elsewhere in the body, and heart rhythm abnormalities.

Hence, not smoking, avoiding an excessive alcohol intake, a healthy diet and regular exercise will all lessen the risk of stroke.

Treatment
If the patient has been diagnosed with vascular dementia, the most important thing to do would be to minimize the likelihood of additional strokes occurring, causing the dementia to worsen.

To reduce symptoms of dementia, doctors may change or stop medications that can cause confusion, such as sedatives, antihistamines, strong painkillers, and others. Some patients treated for additional medical conditions such as heart failure, thyroid disorders, anemia, or infections, can increase confusion making it harder to reduce symptoms of dementia.

Doctors may prescribe aspirin, warfarin, or other drugs to prevent clots in small blood vessels. Medications also can help relieve restlessness or depression or to sleep better, thus alleviating symptoms.

Very rarely, a surgery can be useful if there is a significant narrowing in the carotid artery. Vascular dementia, unlike Alzhemier’s disease, does not always mean a permanent and unavoidable decline.

Sources:
Memory Loss & the brain Website
Alzheimer Scotland - Action on Dementia
North West Dementia Centre

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

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

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

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