Following a stroke, weakened muscles in the mouth or throat, a loss of sensation in the tongue, poor muscle coordination, or the inability to cough can impair swallowing. For example, the tongue is a key participant in the mechanism of swallowing. It moves food around the mouth and helps to form an adequate food bolus which can be handled by the rest of the swallowing apparatus. The tongue is also needed for transporting this food bolus back toward the pharynx. If half of the tongue is damaged, it may be difficult for a person to initiate the swallowing reflex effectively by moving food to the back of the throat. Beyond the tongue, if certain muscles are affected, they may not close off the airway enough to prevent food or liquid from leaking into the lungs. Weakened muscles may also delay swallowing or result in an incomplete swallow.

What are the typical signs of Dysphagia? You may want to refer to an expert or a speech-language therapist if you experience these:

• Excessive drooling
• Food falling out of the mouth
• Clumsiness in getting food to the back of the mouth
• Difficulty starting or completing a swallow
• Food remaining in the mouth after swallowing
• Frequent throat clearing, coughing or choking after eating or drinking
• Voice that sounds wet or gurgling
• Complaints of food or drink sticking in throat

The speech-language therapist will then suggest ways of managing a patient’s swallowing problems. To avoid aspirating liquid, for example, making a simple change in head position may work, like turning it more to one side, or tucking in the chin. The therapist can also teach the patient ways to strengthen the muscles involved in swallowing. A therapist also recommends tips for caregivers or family members to protect the patient from aspiration, such as:

• Make sure that the person with dysphagia sits up in a chair at a 90-degree angle while eating, and continues to sit upright for at least 30 minutes after a meal.
• Don’t use straws which make it too easy for liquid to leak into the airway from the back of the throat
• Allow plenty of time for meals
• Encourage smaller bites and sips
• Reduce distractions like television, music and number of people in the room
• Make sure the person has good oral hygiene

Eating is one of life’s simple pleasures. With proper treatment, most stroke survivors who struggle with swallowing problems will be able to enjoy eating again. “Even stroke survivors who may have to stay on feeding tubes for an extended time don’t have to be completely deprived of their favorite foods”, says a speech and language therapist at St. Mary’s Medical Center Acute Rehabilitation unit in San Francisco, “We can work with them so they can tolerate a small amount of the food they love”…

Sources:
Strokeassociation.org
Stroke.about.com

Why stroke could lead to a higher risk of osteoporosis? The exact mechanism which is responsible for the reduced BMD observed on the hemiplegic side after stroke has not been yet fully understood until now. In 2000, five Japanese scientists have demonstrated that immobilization following acute hemiplegia enhances bone resorption, and it increases inonized serum calcium levels. Later, in the course of stroke, factors such as the degree of functional recovery, duration of the hemiplegia, reduced vitamin D and anticoagulation with warfarin may contribute to ongoing bone loss. After a stroke, these factors cited above contribute to the loss of BMD and fracture. Therefore, a pre-stroke low BMD and vertebral fracture may add to the risk of osteoporosis and fracture, as well as further contribution to additional functional loss. Also, in a consideration that osteoporotic vertebral fractures share some risk factors with stroke such like reduced physical activity, excessive alcohol consumption, smoking and poor calcium intake, etc.

A special attention should be paid concerning the nutrition. A diet high in protein (acids) and salt but low in potassium might aggravate osteoporosis and increase risk of stroke. Potassium is the seventh most plentiful mineral on earth. More potassium, say experts, would help protect us against high blood pressure, strokes, kidney stones, and bone loss.

Sources:
Bone Journal
American Heart Association

As increased age relates to increased incidence of stroke, many people who suffer from stroke may also have pre-existing age-related visual deficits. Following a stroke, a patient may suffer from additional visual deficits in addition to any age-linked unfavourable conditions previously that may have been pre-existing. The visual changes associated with stroke can be categorized as sensory (visual acuity and visual field), motor (extra ocular muscle motility), and perceptual.

For instance, hemianopia, or loss of visual field on one side, is a result of a stroke and is detected after 36% of right brain strokes and 25% of the left brain strokes. Following a stroke, changes in the visual field can include absolute versus relative loss or constriction. With a lesion in the brain disrupting the visual pathways, a person’s ability to take the entire visual field may be interrupted. Deficits in the quantity of what our eyes can perceive are referred to as deficits in our visual field.

Do you or a person you know suffer from any of the following symptoms?

* Double vision
* Headaches
* Blurry vision
* Dizziness or nausea
* Attention or concentration difficulties
* Staring behaviour (low blink rate)
* Spatial disorientation
* Lose place when reading
* Can’t find beginning of next line when reading
* Comprehension problems when reading
* Visual memory problems
* Pulling away from objects when they are brought close
* Disturbance of behavioural or emotional functioning
* Partial or total functional disability
* Physiological maladjustment
* Visual dysfunction

Vision impairment is one of the most commonly overlooked and under-treated conditions of the elderly and those who have had traumatic brain injury or stroke. However, vision rehabilitation after a stroke is worthwhile and often necessary for a stroke or brain injury survivor to enjoy a normal life. Neuroaid gives a good add-on treatment to enhance the rehabilitation. In a recent case study of 10 patients post-stroke under Neuroaid, published on European Neurology, significant improvements were recorded in visual.

On the other hand, vision therapy can be a very practical and effective. After evaluation, examination and consultation, the doctor determines how one person processes information after a stroke, and where that person‘s strengths and weaknesses lie. Then he or she prescribes you a treatment regimen incorporating lenses, prisms, low vision aides and specific activities designed to improve control of your visual system and increase vision efficiency. An interesting video can give you an idea on how it works: view YouTube Video.

For hemianopia, on average Vision Restoration Therapy can help recover a 5 degree border shift (or 12% improvement in stimuli accuracy) in the central visual field. This 5 degree border shift can make a significant impact in the daily lives of patients: Indeed, seeing more is better!

Sources:
helpforvisionloss.com
Stroke Rehabilitation Journal
Youtube

Stroke patients may lose the ability to feel touch, pain, temperature, or position. Sensory deficits may also hinder the ability to recognize objects that patients are holding and can even be severe enough to cause loss of recognition of one’s own limb.

Recent studies have provided evidence of the widespread incidence of sensory dysfunction following stroke. The incidence of sensory deficits in stroke is high ranging from 50% to 74%. The importance of these findings lies in the association between sensory loss post-stroke and poorer outcomes in motor capacity, functional abilities, length of inpatient stay, and quality of life.

QST systems are separable into devices that generate specific physical vibratory or thermal stimuli and those that deliver electrical impulses at specific frequencies. The objective is to test the sensory threshold as follows for instance: a thermode (thermal stimuli surface) contacts the skin and the subject is asked to report sensation of temperature change or heat pain. An alternative stimulation modality utilizes electrical stimuli of variable frequency and intensity to determine sensory thresholds. QST could contribute and has the potential to further contribute to research of sensory dysfunction.

Apart from the loss of abilities, there’s another consequence that could not be ignored which seems to be quite on the contrary, however comes from the same origin. Some stroke patients experience pain, numbness or odd sensations of tingling or prickling in paralysed or weakened limbs, a condition known as paresthesia, a neurological skin disease.

Stroke survivors frequently have a variety of chronic pain syndromes resulting from stroke-induced damage to the nervous system (neuropathic pain). Patients who have a seriously weakened or paralysed arm commonly experience moderate to severe pain that radiates outward from the shoulder. Most often, the pain results from a joint becoming immobilized due to lack of movement and the tendons and ligaments around the joint become fixed in one position. This is commonly called a “frozen” joint; “passive” movement at the joint in a paralysed limb is essential to prevent painful “freezing” and to allow easy movement if and when voluntary motor strength returns. In some stroke patients, pathways for sensation in the brain are damaged, causing the transmission of false signals that result in the sensation of pain in a limb or side of the body that has the sensory deficit.

The loss of urinary continence is fairly common immediately after a stroke and often results from a combination of sensory and motor deficits. Stroke survivors may lose the ability to sense the need to urinate or the ability to control muscles of the bladder. Some may lack enough mobility to reach a toilet in time. Loss of bowel control or constipation may also occur. Permanent incontinence after a stroke is uncommon. But even a temporary loss of bowel or bladder control can be emotionally difficult for stroke survivors.

Moreover, sensory disturbance means loss of sight, hearing or the ability to communicate clearly; the results can be the same: a sense of isolation and loss. This section lists organisations working to help people deal with these feelings and find practical ways to carry on with their lives, in spite of their disabilities.

Sources:
Stroke Rehabilitation journal
American Academy of Neurology

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.

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

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:

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

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.

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.

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

• 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