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Dealing with the Five Disabilities Resulting from Stroke

Part II

By Walt Kilcullen

 

Part 2.

 

III. Problems with language

IV.Problems with Memory and Reasoning

V.†† Problems with Emotion

 

 

III. Problems with language: Language difficulties include the ability to speak, understand, write, read, add and subtract. All of these problems occur as a result of a left brain stroke.

 

†††††† Aphasia, which has many components, can be simplified by using just two terms. Expressive aphasia is the lack of ability to verbally express thoughts. The survivor can understand what is said, but response can be one word, or just a few words. Sometimes speech can be extremely slow, while other patients speak so rapidly, it is difficult to understand them. The second category is receptive aphasia. Sounds are heard but the patient cannot understand what was said.

 

†††††† Alexia simply means the lack of the ability to read. My experience is that both expressive and receptive aphasia patients experience difficulty in reading.

 

†††††† Agraphia simply means the lack of ability to write. This usually, but not always, goes along with Alexia.

 

†††††† Acalculia is the loss of mathematical ability including addition, subtraction, division, and multiplication.

 

 

Treatment options for problems with language:

 

An article that I wrote for the June, 2009 issue of the Strokenetwork.org newsletter deals extensively with aphasia. I recommend the following:

 

Join an aphasia support group. Check www.aphasia.org to find one in a location near you.

Investigate the use of computer software and speech devices to see if they can help you with speech therapy on your own. Bungalow software, Parrot software, Communication Script Inc, and Lingraphica are examples.

Investigate clinics and community groups that specialize in aphasia. Again visit www.aphasia.org to see what is available in your state. Be sure to get details such as cost, and success rate before you invest your time and money.

 

I also wrote an article for the July, 2011 issue of the StrokeNet dealing with alexia. Although there are numerous exercises available, none to date have a high success rate.

Hope for the future

 

Pharmaceutical companies are testing drugs such as Piracetam, amphetamines, and Bromocriptine to improve speech for aphasia patients.

Neural Regeneration has also shown promise. Researchers have used cell transplantation which is designed to restore brain tissue after a brain injury.

Constraint Induced Aphasia Therapy has also shown positive results. During CIAT, the speech therapist spends three hours per day, five days per week, for three weeks giving intensive speech therapy targeting the patientís specific weaknesses.

 

IV. Problems with Memory and Reasoning: Stroke can result in problems with short term memory, judgment, and also the ability to plan, comprehend meaning, learn new tasks, and solve problems.

†††††† Apraxia is the impairment or loss of ability to carry out learned movements despite having the desire and the physical ability to perform the movements.

†††††† Anosognosia is a deficit of unawareness. The patient seems unaware of the existence of his or her disability.

 

Treatment options for problems with memory and reasoning:

 

Most stroke survivors recognize their short term memory loss and are able to adjust to it. Cognitive therapists develop strategies such as keeping a daily planner which focuses on organizing activities one day at a time.

There is little consensus on assessing apraxia but treatment includes speech, occupational and physical therapy. Some patients show significant improvement while others do not. Unfortunately, those patients that do not respond to therapy may not be able to function independently. There is no drug available to treat apraxia.

No long term treatment is known to help anosognosia, however, the condition usually disappears in time.

 

 

V.Problems with Emotion: Many people experience a range of emotional changes after a stroke. These changes can cause the personís personality to change and can be disruptive and problematic.

 

†††††† Depression is a common condition after a stroke. It can be mild or it can be all consuming. Although depression is a normal part of grief after a stroke, if it continues for the long run, professional help is called for.

 

†††††† Anger is also common after a stroke. In my support group, once every two months we split into two groups; one for survivors and one for caregivers. Many times I have heard a caregiver complain about fits of anger from their loved one for no apparent reason.

 

†††††† Emotional Lability is a condition of the brain that causes sudden, uncontrollable crying or inappropriate laughter. Of course this can result in embarrassing situations for both the survivor and the caregiver.

 

†††††† Apathy is not the same as depression even though the behavior is similar. The survivor, who is apathetic, cannot seem to get motivated. He stays in bed too long, sits or lies on the couch for hours, and often will not leave the house.

 

†††††† Anxiety is an unpleasant feeling which often includes nervous behavior such as wringing the hands or pacing about. It is a feeling of fear or distress over something that is unlikely to occur such as a heart attack or car accident.

 

Treatment options for problems with emotion:

 

Antidepressants, drugs that control mood, psychological counseling, and psychiatric therapy are treatments for depression, anxiety, and anger management.

Apathy is more difficult to treat because there are no drugs available to treat it. However, therapists and counselors have had success by developing a routine for the patient to follow. This includes getting up every day at the same time and scheduling events or activities at certain times each day. The focus is on action which will later lead to motivation toward everyday life.

I could not find any treatment for emotional lability, but fortunately after a few months, it usually (but not always) fades away.

 

I wrote an article in the September, 2012 issue of strokenetwork.org on anger and aggressive behavior. There are drugs that are sometimes successful in treating this problem, but there is much the caregiver can do to lessen anger.

 

Remember that anger and aggressive behavior are a result of the stroke. Your loved one cannot always control this behavior.

Stay calm. Do not over react to your loved oneís outbursts. Speak slowly and softly without raising your voice until your loved one calms down.

Avoid arguing or confrontation with your loved one. Redirect her attention to something else.

After you identify things that create anger in your loved one, avoid them as much as possible. For example, if you observe that being around a large group of people sets her off, avoid that environment.

If you as a caregiver become angry or frustrated, back off and cool down. Chances are she will also calm down after you step back and remain calm.

Stay safe. If your loved one becomes violent, back away keeping a safe distance, and seek help if need be.

 

 

Dealing with the Five Disabilities Resulting from Stroke Part I

I. Movement dysfunction and paralysis

II. Sensory dysfunction

Published July 2014

 

 

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The Stroke Network, Inc.

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