Disabilities Related To Stroke
The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged.
Generally, stroke can cause five types of disabilities:
- paralysis or problems controlling movement
- sensory disturbances including pain
- problems using or understanding language
- problems with thinking and memory
- emotional disturbances
Paralysis is one of the most common disabilities resulting from stroke. The paralysis is usually on the side of the body opposite the side of the brain damaged by stroke. It may affect the face, an arm, a leg, or the entire side of the body. This one-sided paralysis is called hemiplegia (one-sided weakness is called hemiparesis).
Stroke patients with hemiparesis or hemiplegia may have difficulty with everyday activities such as walking or grasping objects.
Some stroke patients have problems with swallowing, called dysphagia, due to damage to the part of the brain that controls the muscles for swallowing.
Damage to a lower part of the brain, the cerebellum, can affect the body's ability to coordinate movement, a disability called ataxia, leading to problems with body posture, walking, and balance.
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. Some stroke patients experience pain, numbness or odd sensations of tingling or prickling in paralyzed or weakened limbs, a condition known as paresthesia.
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 paralyzed 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 paralyzed 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 most common of these pain syndromes is called "thalamic pain syndrome," which can be difficult to treat even with medications.
Incontinence 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 also may 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.
At least one-fourth of all stroke survivors experience language impairments involving the ability to speak, write, and understand spoken and written language. A stroke-induced injury to any of the brain's language-control centers can severely impair verbal communication. Damage to a language center located on the dominant side of the brain, known as Broca's area, causes expressive aphasia.
People with this type of aphasia have difficulty conveying their thoughts through words or writing. They lose the ability to speak the words they are thinking and to put words together in coherent, grammatically correct sentences.
In contrast, damage to a language center located in a rear portion of the brain, called Wernicke's area, results in receptive aphasia. People with this condition have difficulty understanding spoken or written language and often have incoherent speech. Although they can form grammatically correct sentences, their utterances are often devoid of meaning.
The most severe form of aphasia, global aphasia, is caused by extensive damage to several areas involved in language function. People with global aphasia lose nearly all their linguistic abilities; they can neither understand language nor use it to convey thought. A less severe form of aphasia, called anomic or amnesic aphasia, occurs when there is only a minimal amount of brain damage; its effects are often quite subtle. People with anomic aphasia may simply selectively forget interrelated groups of words, such as the names of people or particular kinds of objects.
Stroke can cause damage to parts of the brain responsible for memory, learning, and awareness. Stroke survivors may have dramatically shortened attention spans or may experience deficits in short-term memory. Individuals also may lose their ability to make plans, comprehend meaning, learn new tasks, or engage in other complex mental activities. Two fairly common deficits resulting from stroke are anosognosia, an inability to acknowledge the reality of the physical impairments resulting from stroke, and neglect, the loss of the ability to respond to objects or sensory stimuli located on one side of the body, usually the stroke-impaired side. Stroke survivors who develop apraxia lose their ability to plan the steps involved in a complex task and to carry the steps out in the proper sequence. Stroke survivors with apraxia may also have problems following a set of instructions. Apraxia appears to be caused by a disruption of the subtle connections that exist between thought and action.
Many people who survive a stroke feel fear, anxiety, frustration, anger, sadness, and a sense of grief for their physical and mental losses. These feelings are a natural response to the psychological trauma of stroke. Some emotional disturbances and personality changes are caused by the physical effects of brain damage. Clinical depression, which is a sense of hopelessness that disrupts an individual's ability to function, appears to be the emotional disorder most commonly experienced by stroke survivors. Signs of clinical depression include sleep disturbances, a radical change in eating patterns that may lead to sudden weight loss or gain, lethargy, social withdrawal, irritability, fatigue, self-loathing, and suicidal thoughts. Post-stroke depression can be treated with antidepressant medications and psychological counseling.