More than 700,000 Americans suffer a major stroke each year, according to the National Institute of Neurological Disorders and Stroke. Two-thirds of them require intensive rehabilitative therapy in order to regain independence, mobility and strength and improve their quality of life. Rehabilitation can improve or alleviate debilitating and painful symptoms, increase range of motion and assist the survivor in relearning skills or otherwise compensate for those lost because of the stroke.
Physical Problems
The Washington Hospital Center suggests that there are several complicating physical problems following a stroke that can create excess suffering. The symptoms include brain edema, also known as swelling; seizure activity or convulsions; bed sores; limb contractures, known as shortened muscles; complications from depression that can disrupt physical therapies; shoulder pain; deep venous thrombosis, or blood clotting; urinary tract infection and bladder control problems; and pneumonia, a lung infection that can result from aspiration of food and drink due to choking. The American Heart Association's American Stroke Association says that the attending physician will be watching for any of these symptoms and that treatment is available.
The Evidence-Based Review of Stroke Rehabilitation reports that shoulder pain is the result of the dragging of the affected side, which begins to pull down from the neck and into the shoulder. It occurs in as early as two weeks post-stroke, but more often after about two to three months. To relieve this weight on the affected arm and shoulder, it is important to raise the arm and support it with something soft, to the level of the unaffected side.
Paralysis and Movement Problems
Thalmic pain can produce further disabling conditions. Thalmic pain, which is pain triggered by a neurological wiring problem, can be persistent and difficult to manage. According to the National Institute of Neurological Disorders and Stroke, this type of pain is in addition to that associated with paralysis and pulling of muscles, which leads to frozen joints creating this musculoskeletal element of pain.
Swallowing is considered a movement disorder called dysphagia and can accompany speech impairments, also known as dysarthria/aphasia. The National Institute of Neurological Disorders and Stroke lists the movement disorders of the mouth as among the most problematic in the long term. Dysarthria, or slurred speech, can sometimes occur with strokes, resulting in difficulty pronouncing words, delivery or the rate of normal speech sounds. Speech therapies can improve this situation greatly. However, communication barriers of this nature may result in the failure to relay needs to care providers and leave unaddressed and unnecessary pain.
The CHEST Journal defines dysphagia as the difficulty swallowing food and beverages that not only produces a serious choking hazard, but can lead to aspiration, malnutrition and pneumonia. Aspiration, or the inhaling of food and drink, occurs when the materials in the mouth enter the airways and lungs rather than being swallowed normally into the digestive tract. Stroke often leaves an individual unable to notice foreign objects swallowed in this manner, which prevents food from nourishing the body and eventually becomes pneumonia.
Behavioral Problems
The National Institute of Neurological Disorders and Stroke further describes the behavioral effects resulting from stroke as bouts of depression; one-sided neglect, where the affected side is ignored and is prone to pain, injury and stiffness; and overall changes to personality. Depression is a mood disorder that can result in emotional outbursts, bouts of crying, social isolation, withdrawal, feelings of worthlessness, fatigue and thoughts of suicide. While depressive symptoms have been treated successfully with medication, one-sided neglect is of considerable concern. Injurious one-sided behavior can be remedied with the continuing use of physical therapies and encouragement from care-providing staff.
References
- Washington Hospital Center: Complications After Stroke
- American Heart Association's American Stroke Association: Let's Talk About Complications After Stroke
- Evidence-Based Review of Stroke Rehabilitation: Painful Hemiplegic Shoulder
- National Institute of Neurological Disorders and Stroke: Post-Stroke Rehabilitation Fact Sheet
- CHEST Journal: Aspiration Pneumonia and Dysphagia in the Elderly
