Life after Stroke
This particular section provides educational content about potential problems that may arise when dealing with life after stroke. Not only can recovery be challenging physically, but it can also be extremely challenging mentally. Your recovery is your business so whether or not you feel comfortable with the more common approaches (even though they are the most proven and supported by the scientific data), you can approach your recovery in the way that you best see fit, provided that a healthcare professional supports you along that course of action. Here are some tips about what might help during this difficult time.
Recovery and rehabilitation
After having a stroke, there is a long road to recovery that can take anywhere from months to years. Having access to quality rehabilitation is very important because it can help to accelerate recovery and if not done soon after the stroke, can take a very long time to recover the lost functions, if they can be recovered at all [1]. The ultimate goal of rehabilitation is to recover the lost nervous system functions and starting therapy as quickly as possible gives the best chance of this happening. The only time when you should not prioritize rehabilitation is when it endangers your overall health. As always, please consult with a healthcare professional to determine which rehabilitation plan is best for your specific needs.
Complementary and Alternative Medicine (CAM)
Complementary and Alternative Medicine (CAM) is a branch of stroke treatment options that includes herbal remedies, acupuncture, art and music therapy, and many others. Even though some of these remedies are supported by scientific literature, it is important to remember that most of them are supported by anecdotal evidence. This means that they might work for some people under very specific circumstances, but have not been proven to work effectively for the majority of stroke patients. Please do your own research to determine whether or not these work best for your situation. However, these therapies may be a good alternative treatment option when coordinated with a healthcare professional.
Here is the breakdown for some CAM that is backed by scientific studies:
- Acupuncture : Acupuncture is a form of therapy that involves putting very small, thin needles into a person's skin at varying depths. Acupuncture therapy is both safe and inexpensive, when conducted by someone who is properly trained. One study showed that it was relatively effective for patients who suffered an ischemic stroke [2] while another showed that it was good for dealing with some of the depressive symptoms that come after stroke [3].
- Herbal remedies and supplementation: In a meta-analysis, or a study that looks at other scientific studies, conducted by Chinese scientists, they found that 4 different herbs used in 28 different studies- Shuxuetong, Mailuoning, Xuesaitong, and Buchang Naoxintong- might improve neurological function after stroke [4]. And even then, it is not guaranteed that they will improve neurological function for everybody. However, this provides some evidence that herbal remedies might help stroke survivors recover. It is important to note that supplementation and herbal remedies that are bought in store are not subject to quality control, meaning that they do not have specific guidelines they need to meet. This could affect the dosage of specific supplements and the quality as well. Please take this into consideration before starting this alternative therapy and make sure to consult with a healthcare professional.
- Aromatherapy: Aromatherapy is the use of plant oils and extracts in massages, baths, or in other forms to help someone relax. One study shows that compared to back massage therapy, aromatherapy significantly lowered levels of stress in stroke patients [5]. Please keep in mind that the aromatherapy is not compared to other proven stroke treatments, but to a control. This means that aromatherapy is better than doing nothing, but does not necessarily mean that it is more effective than the other treatment options like rehabilitation.
Emotional and Behavioral Challenges
Every stroke survivor and their loved ones will have emotional challenges that come on top of the physical effects from stroke. Since different parts of the brain control different functions, the emotional changes will vary based on the location of stroke in the brain. One of the more consistent emotional challenges is depression and other mood changes. Please take the time to care for yourself, either as a caretaker or as a stroke survivor. This guide from the Cleveland Clinic gives good advice on how to deal with the emotional challenges of depression that you or a loved one may experience after stroke.
Another common problem that happens after stroke is figuring out how to best approach intimacy. This can be the result of any of the physical effects, ranging from hemiplegia, drooling, communication issues to fatigue and inability to control one's faculties. The best way to approach intimacy is to slowly introduce it back into your life. It may be difficult to be for your significant other to act as a caretaker in one moment and to act in an intimate way the next. If it makes sense for your situation, it might make sense to hire a health homeworker to be a full-time caretaker. Another possible solution is to have someone, either a friend or family member, that can act as a caretaker for you so that your significant other can feel comfortable with intimacy [6].
Along with intimacy and mood changes, it is possible that personality may change. It is possible that if the stroke affected the frontal lobe, the patient may become more prone to impulsivity or inappropriate behavior. While it is not always permanent, family and friends of the patient might need to remind them about what is appropriate in a given social setting.
One of the most common emotional challenges, alongside depression, is that of low self-esteem. This may be the result of many of the physical effects or may stem from some of the emotional challenges such as depression. However, similar to how one can rehabilitate physically, one can rehabilitate emotionally. Some people journal their thoughts or recognize and try to dispel negative self-talk while others turn to develop themselves spiritually. This means that they might turn to prayer, meditation, or visualize what they want their life to look like after a stroke. There are many more methods out there to combat low self-esteem. Try as many as you would like and find out which one works best for you.
One of the stranger emotional effects that can happen after a stroke comes in a condition known as pseudobulbar affect (PBA). PBA is a disorder of the nervous system that is characterized by events of involuntary laughing or crying. They may be prompted by a sad or happy experience like when watching a funny movie, but will last a lot longer than is appropriate and these events can be very difficult to stop. This happens because the stroke has affected a part of the brain that regulates emotion and can be treated through antidepressants or therapy [7].
All of these emotional effects are extremely common across stroke patients, regardless of where in the brain the stroke occurred. This is why stroke support groups can be helpful, as people in them might have trouble with some of the same issues. This is why it is important to see if family members are able or willing to help, if at all possible. It is entirely possible that your family may not want to talk about the event and how it is affecting the rest of the family. Please remind everyone in your family and network of friends that it will take time to adjust to changes.
Medication and Healthcare Barriers
A major issue that comes along with stroke is the massive cost of rehabilitation and recovery, especially given the amount of time that the patient is kept in the hospital after the stroke (about 5 to 7 days) [8]. Depending on insurance and whether the hospital is public or private, each day can cost thousands of dollars. All of the doctor's visits and rehabilitation appointments will cost a fair amount of money as well.
While the majority of people will be able to make this work financially, it is possible that some people will not be able to pay for this. Here are some resources that might be able of some use:
- Unidos US: Unidos US is a nonprofit organization that advocates for Latinos in different areas such as immigration, civil engagement, and healthcare. Visit their website to find out more.
- If you live in the East Bay of Northern California, La Clínica might be a good option for you. The best option for stroke rehabilitation is Intensive Outpatient Care Management (IOPCM) and they aim to provide comprehensive community health with both English and Spanish care visits available.
- Covered California: If you live in California, Covered California determines whether or not you can qualify for Medicaid. Visit their website to find out more.
- Community Health Centers: This government website has a directory of community health centers that may offer services for outpatient stroke rehabilitation.
References
[1] https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172
[2] Chavez LM, Huang S-S, MacDonald I, Lin J-G, Lee Y-C, Chen Y-H. Mechanisms of Acupuncture Therapy in Ischemic Stroke Rehabilitation: A Literature Review of Basic Studies. International Journal of Molecular Sciences. 2017; 18(11):2270. https://doi.org/10.3390/ijms18112270
[3] Tseng S-P, Hsu Y-C, Chiu C-J, Wu S-T. A Population-Based Cohort Study on the Ability of Acupuncture to Reduce Post-Stroke Depression. Medicines. 2017; 4(1):16. https://doi.org/10.3390/medicines4010016
[4] Han SY, Hong ZY, Xie YH, Zhao Y, Xu X. Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis. Medicine (Baltimore). 2017;96(49):e8830. doi:10.1097/MD.0000000000008830
[5] Lee JH, Seo EK, Shim JS, Chung SP. The effects of aroma massage and foot bath on psychophysiological response in stroke patients. J Phys Ther Sci. 2017;29(8):1292-1296. doi:10.1589/jpts.29.1292
[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline