Emotional
and Behavioral Changes after Stroke
Emotional
Factors in Recovery
Following
a stroke, a stroke survivor's anxiety, fear, and frustration can be enormous.
Many people who have had a stroke initially suffer confusions that make it
impossible to do the simplest mental tasks. They often feel helpless and
dependent, and their sense of self-worth is diminished. It is important to
understand the emotion and physical changes that the survivor is dealing with
and allow appropriate time for recovery. Self-worth, confidence and enjoyment
of life will gradually return.
Encouragement is an extremely important
motivating factor for stroke survivors. Caregivers should avoid being critical.
While inappropriate behavior should be pointed out, nagging tends to upset and
anger stroke survivors and can be discouraging, rather than encouraging, for
them.
Determination is essential in overcoming
the effects of a stroke. Survivors must be willing to adapt to the disability
and be confident that by therapy they will improve. It has to be stressed that
the will to recover does pay off. Nothing helps raise the body and spirit of
the survivor of a recent stroke like seeing how their own hard work helps their
recovery.
On a survivor's return home, the following
guidelines will encourage a positive recovery.
-
Set attainable goals -the road to
recovery is build of simple achievements.
-
Involve the survivor in daily activities
and routines
-
Encourage independent activities, while
recognizing the survivor's
limitations.
-
Try to maintain social contacts within
the family and community.
The Effects of Stroke
Different sides of the brain deal with
different areas of human intellectual functioning. Generally speaking, brain
damage due to a stroke causes the kinds of problems noted below. However, it is
important to note that brain injury in left-handed individuals results in
effects that are exactly the opposite of those explained below.
Left Brain Injury (right-sided weakness -
hemiplegia)
Those with left-brain injury and a paralyzed right side are more likely to have
problems with speech and language. Apart from language problems, these
individuals tend to be cautious, hesitant, anxious and disorganized when faced
with an unfamiliar problem. Many of those with right hemiplegia need frequent
assurance that they are doing okay, with lots of immediate positive feedback.
Breaking tasks down into steps and practicing often will aid learning.
(For more information on language problems see SRA pamphlet "Aphasia,
Communication and Stroke").
Right Brain Injury (left
hemiplegia)
People often assume that if a stroke has not affected language and speech, a
stroke survivor is not impaired. This is not true! Left hemiplegia may result
in problems with spatial-perceptual tasks - the ability to judge distance,
size, position, rate of movement, form and how parts relate to wholes. People
with severe spatial-perceptual deficits may have more trouble with self-care
than those with equally severe language deficits. They may not be able to read
a paper - not because they can't read, but because they lose their place on the
page. They tend to have a behavioral style that is too quick and impulsive and
behave in a way that makes overestimating their abilities easy. They are often
unaware of their deficits and may think themselves capable of tasks they are
not - driving, for instance, which even with minor spatial-perceptual
disabilities can be dangerous.
One-side neglect
Many stroke survivors have visual field defects - up to half their visual field
(what they can see with both eyes) is, in simplest terms, not there. This is
usually compensated for by turning the head. However, some individuals, usually
those with left hemiplegia, have what ranges from a reduced to no sense that
their left side exists, or that anything or anybody approaching from that side
exists. This is called neglect, and is potentially isolating for these
individuals.
Depression
Depression resulting from a stroke is one of the most difficult factors for a
spouse and family to deal with. A certain amount of crying, though upsetting to
the family,
may be a natural and normal emotional response to the stroke survivor's greatly
changed circumstances. However, chemical changes caused by stroke may result in
deeper depression and apathy, with the survivor appearing passive and detached,
a state that will usually improve with time.
Emotional Lability
Often, excessive crying seems to have little relationship to sadness or what is
happening around the survivor. This loss of emotional control due to brain
injury is
called emotional lability. Someone who is emotionally labile may not be sad
when crying, happy when laughing, or angry when appearing hostile. If possible,
interrupting the emotional behavior of such a person (by clapping hands or
snapping fingers) is usually a good idea, saving them embarrassment and
fatigue.
Change in Personality
Changes in personality and emotional response are common after a stroke. The
type, size and location of a stroke, as well as the individual's previous
personality all have a bearing on what these changes will be. The stroke
survivor may seem a different person, showing feelings of anger, caution or
anxiety that are completely out of character. The affected individual may also
feel this - and feel less of a person.
Memory Deficits
Almost any brain injury, however slight, may cause memory problems,
contributing to language, spatial-perceptual and retention span difficulties.
For most stroke survivors, remembering old information (from before the stroke)
remains easy, while new learning is difficult.
Generalization
Some stroke survivors are capable of learning new information, but are
unable to apply that learning to other similar situations (generalization). For
instance, they may make safe transfers to and from a wheelchair while in the
hospital, but are unable to once at home. They may become very sensitive to and
often fearful of changes in their environment, and will thus benefit from and
be comforted by an effectively established routine.
Sensory deprivation and
over-stimulation
Many recent stroke survivors are overwhelmed by too much stimulation. When
visiting, go singly or in small, quiet groups, and speak one at a time.
Conversely, some stroke survivors may have diminished sensations of touch,
pressure, sight or pain, causing them to suffer a constant level of sensory
deprivation, leading to psychological stress. The quiet of night may compound
this, and a radio playing softly or a soft light left on may help.
Quality Control
Even minor brain damage affects a memory related area of behavior called
quality control. This refers to how well individuals check and control their
own behavior. A previously fastidious person may fail to bathe or zip his fly,
or a formerly polite person may become rude and profane. Caregivers need to be
aware of these deficits, and praise appropriate efforts to compensate for them.
For more information on stroke recovery,
please contact:
Stroke Recovery Canada
Ontario March of Dimes
10 Overlea Blvd.
Toronto, ON M4H 1A4
Tel. 1-888-540-6666 or 416-425-4209
www.strokerecoverycanada.com
info@strokerecoverycanada.com
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