The Social, Emotional, Financial, and Physical Effects of a Stroke
The aim of this article is to investigate some of the effects a stroke may have on an individual, and the impact it may have on the person's life. Having worked within care settings for a number of years, I feel that I am familiar with some of the difficulties encountered by stroke patients.
What is a stroke? What are the effects of the stroke on the individual? What kind of aids and equipment are available to help the person maintain independence?
What Is a Stroke?
A stroke (the medical term is "cerebrovascular accident," or CVA) is an illness in which part of the brain is suddenly severely damaged or destroyed. The result is loss of function of the affected area of the brain. It usually causes weakness, paralysis of the arm and leg on either the left or right side of the body, twisting of the face, and in some cases other effects which may include loss of balance, disturbance of vision, disturbance of speech, loss of control of the bladder and bowels, and difficulty in swallowing. In very severe cases, there is a loss of consciousness or confusion of thought. A blood clot or haemorrhage causes the damage in the brain. If the clot is very big or if it affects a vital part of the brain, the person may die. In less severe cases partial or complete recovery occurs.
Effects of a Stroke
The social, emotional, financial and physical effects of this particular disability are often inter-related, and it is difficult to categorise them.
The social effects of suffering a stroke are that the person’s whole life may have to be changed, not only for them but also for their partner/spouse. The partner may have to perform tasks that were once done by the individual, because they are no longer able to do certain things.
The person who has had the stroke may cease to show interest in anything, she may no longer want to do the things she used to enjoy. This may be because she finds it harder to concentrate, or because she may feel unable to make decisions for herself and so quickly loses interest in what is going on. She may also become more easily fatigued, which leads to tasks being left unfinished or never started. Also it is more difficult for her to withstand stress.
The physical effects of the disability may sometimes affect the social aspects such as movement/speech/visual problems. The person may not be able to move in the same social circles as she once did, so she would have to find a whole new way of life.
When someone has had a stroke, quite often her self-confidence deteriorates causing her to feel less sociable, and more withdrawn. The longer someone is withdrawn the harder it is for her to regain self-confidence, which in effect causes a viscious circle.
Quite often the person requires a lot of help from relatives or carers especially within the first few months, this can often cause a barrier to social relationships made before the stroke occurred. The person often feels dependent on other people and doesn’t like to ask for help, especially when socialising.
The initial hospitalisation affects everyone emotionally due to the strange environment, the different routine and not being able to take in exactly what is happening to them.
The individual is likely to show signs of depression. Sometimes this is the direct result of the stroke and the damage she has suffered. In other cases it may be reaction caused by a sense of helplessness at her present condition.
Other common emotional reactions are extreme changes of mood, which more often than not take the form of outbursts of weeping and occasionally uncontrolled laughing. A few people have outbreaks of swearing, which are often associated with speech and language problems. This may be extremely disturbing to carers but it must be remembered that she has no control over these outbursts. She is likely to be irritable, distressed, frightened and uncertain of what the future may offer, and may express this by bursts of anger which sometimes result in physical violence. Carers must try to realise the acute frustration the individual is facing, and see that this may be her means of communicating.
A newly found restriction in movement/speech/vision is likely to cause feelings of helplessness, frustration, aggressiveness, confusion, distress, depression and eventually personality changes. These feelings may also occur during rehabilitation. Some forms of medication have been known to cause emotional disturbances with their side effects.
Whilst the person is in hospital, immediately after the stroke has occurred, people in employment may only receive sick pay for a certain length of time, other people may not receive any payment at all from employers. This can have devastating financial effects on the individual. She may never be able to return to work even after rehabilitation. She may not be able to keep up payments for loans/mortgages and other credit accounts. This could lead to the person becoming more and more in debt.
If the person lived alone before the stroke, they may have to leave their home and move into a residential accommodation or even a nursing home. This can be very costly to someone who is only entitled to certain state benefits.
There is no specific allowance for stroke illness, but sufferers of strokes and their carers are entitled to the same wide range of benefits as other people with disabilities.
Click on the following link for more information relating to benefits claims and claim forms.
At the onset of a stroke the muscles of the face, trunk, arm and leg on one side of the body are weak and lax. In most cases the power gradually returns, first to the leg and then to the arm. However, unless the limbs are placed in the correct position and are frequently put through a range of movements, there is a danger that they may stiffen so that even if the power returns the limbs could be practically useless. This is why so much importance is attached to maintaining the limbs in the correct position and allowing recovery to take place in the best way. The simple rule is to let the leg bend but to keep the arm straight. It is also vital to treat the body as a whole, not just the paralysed limbs in isolation.
Speech is affected in two ways. In some people it is slurred and indistinct or even completely absent, but the person can read, write, and understand perfectly what is said. This condition is called ‘dysarthria’. The other condition is much more complex. It is called ‘dysphasia’ or ‘aphasia’ and is due to damage to the part of the brain, which controls all language processes. This can affect the person’s ability to speak, understand speech, read and write.
In most cases vision is not affected at all, and even in those people who complain of visual difficulty the fault is not in the eyesight itself, but the interpretation by the brain of what the eye sees. When the part of the brain, which forms one of the ‘normal’ half-pictures, is damaged by a stroke, the person sees one half of the world, depending on which side of the brain is affected. This can be perplexing for the individual and relatives and very disabling, but recovery although slow usually occurs.
Signs of a Stroke and What To Do
On discharge from hospital, a person who has suffered a stroke will often require a wheelchair, as they are usually unable to walk distances, if at all. If there is a one-sided paralysis, the person will be unable to manoeuvre the wheelchair themselves, so their carer would be required to push the wheelchair. A sheepskin or pressure cushion would be of benefit, to help prevent pressure sores developing.
Occasionally, after rehabilitation, the individual may be able to walk short distances alone using a walking stick. A zimmer-frame would be unsuitable due to the fact that they only have the use of one arm, and they would not be able to lift the zimmer easily. Some people may prefer a tripod or quad walking stick (three or four legged) for more security.
If the person were returning home to a house with stairs, a stair lift would be very useful for safe transfer from floor to floor, especially if the bathroom facilities and bedroom are upstairs. Alternatively, they could have their bed moved to the ground floor, and be provided with a commode. A raised toilet seat could also be beneficial.
Disabled shower facilities are often provided in certain social services dwellings, which accommodate a wheel-in seat under the shower. Otherwise, a bath seat or hydraulic bath chair could be fitted.
Non-slip table mats or mats with ‘sides’ are useful to someone with only the use of one arm. These prevent the meal plate slipping off the table.
There are also ‘sided’ boards available, for preparing foods such as spreading butter on bread without it slipping off the work surface, and non-slip mats for preparing hot drinks.
If the person was very independent and rational of thought, a motorised buggy could be useful for taking trips to go shopping, visiting places, etc.
Click on the link below for current information about what equipment is available to assist in enabling independence.