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Table of Contents
Chapter 1 - An Introduction To Life After Stroke ................................................. 4 Who This Guide Is For ............................................................................................. 6 How To Use This Guide ........................................................................................... 7 Chapter 2 - Immediate Aftereffects Of Stroke ..................................................... 10 Most Common Effects Following Stroke............................................................... 10 Statistics On Life After Stroke................................................................................ 13 Goal Setting Following A Stroke............................................................................ 14 What We Learned ................................................................................................... 18 Chapter 3 - Rehabilitation ....................................................................................... 19 Your Mental Health ................................................................................................. 19 Treating Physical Symptoms of Stroke ................................................................. 21 Spasticity and Muscle Pain ................................................................................ 22 ITB Therapy ......................................................................................................... 23 Rehabilitation For Communication ........................................................................ 23 General Management Tips For Recovery ............................................................ 25 Individual Approach To Rehabilitation .................................................................. 28 What We Learned ................................................................................................... 30 Chapter 4 - voiding Future Strokes....................................................................... 32 Dietary Changes ..................................................................................................... 32 Recognize Stroke Risk Factors ............................................................................. 33 What We Learned ................................................................................................... 36 Chapter 5 - Friends, Caregivers and Family ....................................................... 37 Finding Support....................................................................................................... 37 Communication and Family Roles ........................................................................ 38 What We Learned ................................................................................................... 40 Chapter 6 - Hope For The Future ........................................................................... 42 Stroke Resources ..................................................................................................... 44

Chapter 1 - Introduction To Life After Stroke

Congratulations on investing in your health, recovery and ability to find hope in a tunnel of darkness. A Stroke is a debilitating condition affecting millions of people every year. A type of cardiovascular illness, a stroke can affect the arteries and brain. There are many different types of stroke, but most result from a clot that interferes with the passage of blood to the brain or from a ruptured blood vessel, causing the same effect.

According to the National Stroke Association, in conjunction with the American Heart Association, stroke is the #3 cause of death in the United States alone, preceded only by heart disease and cancer
Stroke is unique in the way it affects the quality of life of survivors. While it is a leading cause of death, there are millions of people that have a stroke and DO survive. If reading this guide, you may be a survivor, or friend, family member or caregiver of a survivor. Your goal in reading this guide is likely to find ways to improve your quality of life.

When it comes to quality of life, physicians and doctors have worked for some time to contribute to improved living for survivors of stroke. There are many quality of life studies formally focusing on patient survivors of stroke. Most of these studies focus on assessing and trying to assess ways to improve the quality of life patients experience following a stroke. Why do we repeat this point in this paragraph?

Key to hope, key to survival is the ability of a survivor to maintain an adequate and enjoyable quality of life. Caregivers and family members of stroke survivors must also learn to accept a new life, but one that is worth living. This book will help guide you in that journey. 4

Many of the studies we talk about suggest that survivors of stroke experience declines in their perceived quality of life resulting from multiple factors, including impaired functional ability, psychological factors and ability to communicate or lack of ability to communicate with othersi. One can easily understand this given the detrimental effects a stroke may have on a persons ability to communicate and function.

The quality of life following a stroke is so important to stroke survivors recovery, it is the leading topic and concern of most primary and secondary caregivers. Due to the nature and side effects of strokes however, many caregivers and doctors find it difficult to assess the impact stroke has on quality of life because of physical and functional impairment following stroke, including ones inability to speak or sometimes understand what others are trying to relay to them. For this reason, one of the first focuses of rehabilitation for many survivors is speech and language rehabilitation.

Many doctors will initially rely on reports given by caregivers or family members in the early weeks following a stroke to assess a survivors recoveryii. These reports can have a dramatic impact on ones recovery in the short and the longterm.

Why is this important? A stroke can be one of the most debilitating events that occurs on ones life. For that reason it is important doctors and rehabilitation experts work to improve the perceived quality of life for survivors and their caregivers. Many survivors may find their exclusion in decisions regarding their health frustrating and intolerable. Because stroke often affects ones ability to communicate effectively however, this can be a trying circumstance to overcome. Without hope, many survivors may face rapid decline, little progress and even suffer from a second stroke, one that may prove fatal.

Thanks to much effort and advances in modern technology, as well as treatment protocols and approaches to stroke recovery, survivors are finding they have more and more say in their journey toward recovery. There are more opportunities survivors can look forward to, and more choices healthcare professionals can offer patients looking for hope in light of their disease. Caregivers are also finding new hope in support avenues and education about care giving and addressing the needs of stroke survivors.

Who This Guide Is For

This guide is a practical approach to understanding strokes, its effects on the body and effects on survivors and caregivers. The intent of this book is to help survivors and their family members learn what life may be like following a stroke, and learn what action steps they can take to improve a stroke survivors quality of life following a stroke.

This guide is purposefully designed in a simple-to-follow manner, so survivors and caregivers can quickly and easily find answers to pressing questions or concerns they have about the effects of stroke and its impact on ones quality of life.

This book utilizes as little medical slang as possible, making it easy for anyone to understand and adopt the concepts and tools applied in this book. Written with the intent to help survivors and their families maximize their potential for experiencing a full life, Life After a Stroke really is in many respects, a healing tool for patients and family members.

This book does not go into all of the biological factors leading up to and occurring immediately following a stroke. It does however, include a brief overview of the immediate effects a stroke has on a survivor, and steps survivors and caregivers can take to improve the quality of their lives following a stroke.

Not everyone who experiences a stroke will survive. Those that do suffer a stroke however, often have a good chance to regain much of their ability to communicate, function and improve their quality of life. The mission of this book is to provide survivors and family members with hope, encouragement and information. Information and education are after all, two of the best tools anyone can use to overcome any life challenge.

The authors of this book and publisher are not doctors. The information provided in this guide is meant for informational purposes only. You should always rely on the expertise and guidance of trained and qualified professionals when assessing the best course of rehabilitation and treatment for a stroke survivor. If you are looking for positive encouragement and hope however, as well as valuable resources in your journey toward recovery, youve landed in the right place.

Remember that doctors and rehabilitation experts become a crucial part of your healthcare and wellness team. What stroke survivors need more importantly than anything is a group of caring, supporting and educated people to support them during the challenging road to recovery.

Much of the information gathered for this manual includes insights provided from The American Heart Association and American Stroke Association. Such organizations are committed to improving the quality of life of patients overcoming stroke and many related disorders.

How To Use This Guide

Whether a survivor or caregiver, this guide will provide you with hope in your journey toward healing and recovering. This guide will provide you with valuable information about the general effects and long-term effects a stroke has on patients and their families. You will also learn of new treatments on the horizon that may dramatically improve the lives of patients suffering from the side-effects of a stroke.

Included in this guide are links to support groups and knowledgeable sources where survivors and caregivers can find even more information about life after a stroke, and links where they can talk with other survivors and family members or caregivers of patients recovering from stroke.

The more you learn about any health condition, the better equipped you become to face the challenges that lie ahead. Centuries have proven that the mind has incredible powers to heal. This book will help you discover how powerful the will to survive and thrive can be in your journey toward healing.

Use this guidebook as your armor when fighting back against the ill-effects of a stroke, so you and/or your loved one can go on to lead the quality of life you deserve following any debilitating illness.

Many doctors and patients alike agree that not knowing is one of the biggest impedances toward greater health. You will avoid this problem however, by reviewing the information in this guide and learning as much as you can about recovering from stroke and improving the quality of your life.

Use this guide to learn as much as you can about stroke and the effects stroke has on a survivors body during the recovery process. Knowledge will make you feel stronger and more powerful, providing you the impetus you need to conquer your fears and overcome anything.

Believe and you will receive the inspiration you need to show courage in the face of hardship and inspire others to do the same

This book will encourage stroke survivors to think of their lives in terms of practical abilities rather than disabilities. Everyone has the power and ability in us to regain a positive outlook on life, from which we may draw strength in the face of adversity.

Keep saying, Yes, I can! and eventually you will create a positive outlook on your life and hasten your recovery. Everyone at some point in their life will face some disability, or inability to accomplish or do things in a way they perceive as normal or ideal. This book will encourage you to view life practically, but also to look past any physical or emotional limitations you may have so you can live life to the fullest and truly learn to enjoy your quality of life, whether a survivor of a stroke, caregiver or other loved one.

So let us now begin our journey by first reviewing some of the more common effects survivors experience following a stroke. Please keep in mind that many patients will experience more dramatic recovery and results depending on the severity of their stroke and the parts of the brain and body affected by the stroke. Once a patient captures or maintains the ability to communicate and understand effectively however, their potential for success is limitless. Remember this as you begin your journey toward better understanding life after stroke. Apply the principles in this guide to everyday life, and find out how, even in the face of adversity, life can become a truly intriguing place to live, filled with potential and the ability to recover from almost anything. IF that is, you are willing to put your faith in your recovery, and your ability to help yourself and others during the recovery process.

Success may not happen overnight, but it will happen if you commit to your life, your quality of life, and your right to enjoy life to the fullest extent possible. Lets begin by gaining a comprehensive understanding of the immediate effects stroke has on ones life.

Chapter 2 - Immediate Aftereffects Of A Stroke

The only way around is through - Robert Frost

Robert Frost had it right. You cant simply walk around a stroke to survive. You cant tiptoe around it. If you suffer from a stroke, you have to learn to walk through your disability to recovery to the best extent possible. To walk through, you must learn what to expect following a stroke.

To understand what life is like after a stroke, it helps to first understand what the more common immediate effects are of a stroke. The effects of a stroke will vary from person to person, depending on the severity of their stroke, and their overall health and ability to heal.

Remember just as each patient will suffer differing effects, each will also recover differently. The faster you understand this, the more accepting you will find you are of your condition and ability to overcome common challenges. It is also helpful for friends, family and caregivers to understand what you are going through following a stroke. By providing them this information, they will have a better understanding of how to help you and better empathize with your situation.

Most Common Effects Following A Stroke

Many organizations, including the National Institute of Neurological Disorders and Stroke (also called the NIN) and the American Stroke Association, agree that some effects are common among most stroke victims. These effects are listed below.

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Paralysis that may affect a part of the body (like an arm or a leg) or a whole side of the body, including the face. This paralysis may be permanent, though some patients recover full or partial mobility in parts of the body affected by stroke.

Weakness in part of the body, on the whole side of a body or in a limb. Sometimes physical therapists can help strengthen the body through specific treatments to help reduce the effects weakness has on ones quality of life.

Painful spasms and stiffness of the muscles, or frequent aching and twitching of these muscles. This is one of the most difficult long-term effects of stroke many patients must overcome.

Difficulty speaking or enunciating or difficulty understanding speech. For example, a patient may know what the right words are and want to communicate, but may not have the ability to do so vocally or in writing.

Transient or constant feelings of numbness, tingling or pain in different locations throughout the body. A survivor may experience this for a short time, or for years following their stroke.

Difficulty swallowing or eating. Sometimes this can lead to fatal circumstances including malnutrition. Often doctors will try to address this by providing an alternative source of nutrition if there is a good chance for recovery.

Urinary or bowel incontinence. This may be transient or permanent.

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Emotional distress, including anxiety and depression. This will often manifest immediately following a stroke, and may also manifest among people caring for a stroke survivor. It is important doctors treat depression and anxiety as well as the physical side-effects stroke has on a survivor.

Excessive fatigue. This can result from the constant tightening of muscles in the body, or attempts at healing and recovery.

Difficulty balancing, which may lead to trouble walking or falls (which can lead to further injury). Physical therapy is a commonly used approach to address this side-effect of stroke.

A condition called claw toe where the toe curls resulting from muscle imbalances in the body. This condition may become permanent or difficult to recover from.

Constant pain throughout the body, which can be difficult to address or understand. A patient may not have the ability to vocalize or articulate their pain in the early weeks following stroke, so efforts should be made to ascertain a survivors level of pain and establish appropriate treatments to reduce discomfort.

Fine motor skill deterioration, to the point where one may have trouble picking up small (or even larger) items. These effects can sometimes be reduced through routine rehabilitation and therapy, but may take some time to recover from.

Limited ability to communicate because of damage to learning centers or communication centers of the brain. Some patients may permanently lose the ability to learn new information or communicate at varying levels of complexity.

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Sensation that noises and actions are overwhelming, which can lead to greater depression or anxiety. Doctors may treat this with various medications to try to improve a survivors comfort and ability to heal.

Again, it is important to note that not everyone will experience all of the effects listed above. The extent to which a survivor experiences effects of stroke depend largely on the severity of their stroke, their genetics, their individual health status and other important factors.

Statistics On Life After A Stroke

The symptoms and effects of stroke listed in the previous section do not affect all people the same. Remember that some people, as much as 10 percent of all patients will experience a full or almost full recovery following a minor strokeiii.

Still others will experience moderate to serious impairment that lasts indefinitely, up to 40 percent according to the NIN. There is behavioral, physical and emotional rehabilitation however, that can help patients and caregivers cope with these effects. We will talk more about rehabilitation in the next section.

Roughly one quarter of stroke victims will experience minor problems, which may include muscle weakness or some speech difficulty. Some people are affected so severely they may need long-term care in a designated facility.

The NIN reports roughly 15 percent of patients may die from stroke, or be at risk for a second or third stroke, which is why prevention of recurrent strokes is very important. Rehabilitation will depend on many factors, including how severe the stroke is and what areas of the body are affected. The more damage to the brain, the more likely an individual is to suffer from physical and communication or behavioral symptoms.

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Goal Setting Following A Stroke

Everyday people set goals for their life. These goals may focus on their desired career path, their desire to change something about their health, their desire to learn the list goes on. Following a stroke, caregivers and stroke patients may find it helpful to set goals for recovery and rehabilitation. Their goals may also center on improving their quality of life or regaining function in certain areas of the body damaged by the stroke.

If a full recovery is not possible, the first goal a caregiver should have is making this clear to the patient, so no false hopes are set. All goals set should be realistic based on the patients illness and potential for recovery.

The primary and most important goal a patient should have is to live the best quality of life they can, and live as independently as they can. Goal setting may also include deciding on the best type of treatment and rehabilitation plan for a patient, and follow through to make sure a stroke victim receives the care and loving support he or she deserves.

If you are working with a loved one to establish goals for recovery, here are some great suggestions to help get you started in the right direction:

1. To be as independent as possible. Many patients suffering milder strokes will find they feel eager to regain full independence as soon as they are comfortable and able.

2. To live a life as full as possible given ones abilities and limitations following a stroke. If one experiences a severe stroke, they may have to reevaluate their definition of a full life and find new ways to enjoy life given the changes their body experienced resulting from the stroke.

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3. To learn how to live life in a new and interesting way, despite the effects a stroke has on ones physical or emotional body. This goal is also helpful for caregivers and supportive friends and family members.

4. To support caregivers in a manner that allows them to offer well-informed, guided and supportive care for themselves and their loved one.

5. To learn how a stroke affects a person individually, so a survivor can set realistic expectations for recovery. A healthcare professional should work closely with a stroke survivor when setting realistic goals. If it is clear a survivor will have a permanent disability in some part of the body, but may be able to regain near to full function in another, it is important this information is shared with the patient so realistic goal setting can occur.

Hope
Having and maintaining HOPE after a stroke may seem impossible at first, especially if a survivor is struggling to communicate. However, HOPE is one of the most important factors in ones ability to overcome stroke and the effects it has on the body.

Many people assume that following a stroke, ones life is damaged forever in a negative way. While a stroke may have many debilitating effects on ones body, patients who maintain an optimistic outlook are much more likely to experience a positive quality of life following their illness than those that feel hopeless.

To establish and maintain hope, all people working with a stroke survivor should feel comfortable being honest about their

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expectations of ones recovery, but also remain optimistic and HOPE for the best.

There are incredible stories throughout life of patients recovering from seemingly devastating or life-threatening illnesses. Stories of patients that lived and enjoyed a better quality of life even if at one point during their life they experienced near-death.

Consider for example, the case of Lance Armstrong. Lance Armstrong is a well-known personality. But, in case you didnt know, here is his story. Armstrong is one of the best known bicycle racers of all time. He won the Sports Illustrated and Associated Press Sportsman and Athlete of the Year respectively in 2002.

Interestingly, just a few years prior, a doctor diagnosed Armstrong with testicular cancer, which rapidly metastasized, or spread throughout his body, including to his lungs and his brain. Most doctors predicted Lance had a 60 percent or less chance to survive, much less recover fully.

One year following his diagnosis however, Armstrongs doctors claimed he had fully recovered, and conquered cancer. Armstrong has gone on to live a very full and rewarding life, and to inspire others to do the same, by having hope and faith.

Since this time he has gone on to win the Tour de France a record 7 straight times. While Armstrong isnt a stroke survivor, he is a model of how powerful the mind can be when facing recovery from a life-changing or debilitating condition.

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The more in control you become of your disease or illness, the better able you will be to tap into your ability to heal, survive and conquer.

The key to a stroke survivors ability to recover well includes their ability to look past the damaging effects a stroke has on their body, and instead focus on their ability to regain their self-esteem about their new body, their new image and lifes new potential and possibilities.

There are as many amazing survival tales of patients with stroke as there are patients overcoming diseases like cancer. To help inspire you and give you hope, read about some:

strokecenter.org/pat/survivors.htm

stroke.lotsahelpinghands.com

www.caregiver.org/caregiver/jsp/home.jsp

www.strokecenter.org

Hope is available to anyone willing to reach out and embrace a new way of thinking about their life and a new way to approaching life.

If you invest in hope, you will find those around you also become more optimistic and that creates positive energy, energy you need to recover to the best of our ability and feel as good as you can.

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What We Learned
Ever person experiencing a stroke will experience different physical, emotional and psychological effects. These effects may be minimized depending on the severity of the stroke, ones willingness to overcome any physical damages to their body and ones commitment to rehabilitation.

Recognizing the effects of a stroke is the first step on ones journey toward recovery. Another step is goal setting. Through active and reflective goal setting, a patient and his or her caregivers can dramatically improve the quality of life experienced by patients of stroke. In the next section, we will talk more about rehabilitation and how rehabilitation affects the wellness and quality of life of stroke victims.

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Chapter 3 - Rehabilitation
Rehabilitation is an important part of recovery for stroke victims. Some patients will endure a lengthy hospital stay before they fully recover from their stroke. Life following a stroke may prove very challenging for the stroke survivor and the family members of those affected by the stroke. Rehabilitation may start in a hospital, and continue on an out-patient basis for the duration of ones life.

Rehabilitation focuses on many different effects of a stroke, including the mental and emotional effects, the physical effects and any neurological effects. Some of the more challenging effects rehabilitation focuses on include communication difficulties.

One of the most challenging side effects of a stroke is spasticity, where a survivor experiences uncontrolled muscle tightness resulting in pain and muscle cramping in the body. The good news is as a stroke survivor you can learn to control this side-effect and regain much of your normal muscle control with time and proper rehabilitation.

Your Mental Health

Rehabilitation starts in the mind. If you prepare yourself for recovery, and know what to expect during recovery, you will dramatically improve the results. I once worked in a physical therapists office as a young adult. A woman used to come in regularly for physical therapy. She had a very severe stroke that left her with much spasticity, pain, inability to talk clearly and an inability to walk.

Being so young, I thought the entire experience must be horrible to endure. The funny thing was, this remarkable woman was usually the most upbeat person we saw at the clinic. She was always trying to make us laugh, she laughed when she couldnt do something, and she laughed when things went awry.

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Sure there were times during her rehabilitation she got frustrated, and had a right to. Every now and again she felt too tired to practice. But nine times out of ten in her mind she knew what she wanted and was happy. And this joy was infectious. And her physical therapists always commented on how quickly she made progress, despite the severity of her condition.

To succeed in rehabilitation, you have to prepare your mind. You may have to endure a lot of hard work, and the road ahead may first appear gloomy. But remember, every step you take in rehabilitation is one towards a happier, more content and improved quality of life.

Rehabilitation And The Mind

Many people fail to acknowledge the impact the mind has on ones ability to heal. The mind is one of the most powerful structures in the body. Even when damaged physically, the brain has the capacity to restore itself in remarkable ways.

To prepare for rehabilitation, whether a survivor or caregiver, cherished friend or loved one, a person must first begin by addressing their mind.

They must look at all the thoughts they have about their disability and transform them into thinking patterns that center on their ability to overcome stressful obstacles and physical limitations.

Life is challenging, especially for those surviving stroke. However, with the right mindset, a survivor is more likely to confront any challenges associated with a stroke head on.

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Prepare your mind by thinking positively. Spend some time visualizing the journey toward recovery. Imagine what your life might be like if you were able to communicate clearly. Imagine yourself walking. Even if you do not know exactly how you will get there, the mere power of thinking can help you overcome obstacles to your success and help you achieve greatness in the face of adversity.

Your life may never be the same as it was before your stroke, but you can learn to enjoy life in new and different ways. Much of it has to do with the mental conditioning you do ahead of time. Sometimes therapy and counseling can help you overcome the feelings of loss and grief you experience following a stroke. A trained counselor, one familiar with working with stroke survivors, can help you overcome the limitations you now perceive in your life as a stroke survivor. They can also help you affirm your ability to improve the quality of your life through education and proper treatment.

Treating Physical Symptoms of A Stroke

There are many rehabilitation programs and physical treatments available for stroke survivors. Many of these target specific difficulties stroke survivors experience following their stroke. For example, speech and language therapists may work with a stroke survivor to help them learn to communicate clearly with others.

A physical therapist may work with a stroke survivor to help restore some control of muscle spasticity and function. Lets look at some specific physical treatments for some of the more common symptoms and side effects of stroke.

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Spasticity and Muscle Pain

Spasticity and muscle pain or uncontrollable movements of the limbs, arms and muscles is a common effect following a stroke. There are various treatment choices available to patients who engage in rehabilitations. Spasticity typically results from an injury to the patients brain that prevents them from tightening and relaxing their muscles properly.

This condition specifically is one of the more challenging side-effects for stroke patients to overcome. It is also one side-effect of strokes that modern science has created new and innovated rehabilitative treatments for, to improve the quality of life of patients following a stroke.

Examples of this condition may include the inability to unclench ones hand, or someone experiencing abnormal postures or difficulty walking because their legs tighten and cross one another or spasm. With time, this condition may cause pain because the muscles are in constant motion.

Traditionally, many doctors offer patients oral medications that help relax the muscles so pain becomes less of a problem in stroke survivors. Examples may include Zanaflex or Diazapam. The problem with these medications is for many patients they often bring on lethargy or fatigue. With time in some patients these side effects may dissipate iv.

Doctors often use these medications to treat generalized spasticity, where multiple muscles in the body are affected. For some patients, they will experience more localized spasticity, meaning a tightening of the muscles in specific areas of the body, as in the limbs. There are new treatments available that can help reduce this problem in patients.

Many doctors, for example, now prescribe Botox for patients who experience spasticity in small, localized areasv. A doctor may inject this substance into the

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muscle offering relief for extended periods of time, though this practice is not widely accepted yet as a traditional treatment alternative for stroke patients.

Still, new treatments like this are often offered to patients with other conditions including migraines. One of the reasons Botox helps is because it acts to relax the muscles in the area surrounding the injection sight. This can lead to reduced spasticity.

ITB Therapy
Other treatment choices for patients with generalized muscle tightening include a treatment called ITB therapy (short for intrathecal baclofen therapy). Using this treatment, a doctor implants a pump under a survivors skin connected to an area surrounding the patients spinal cord. This pump allows delivery of continuous medication to the patients body, thus relieving muscle tightening in larger areas for extended periods of time.

Many doctors see dramatic results using this treatment. The best part about this treatment is the doctor or patient can control the amount of medication needed and the time the medication is delivered in the system to achieve optimal results.

Baclofen isnt a new medication in itself. Many doctors prescribe this medication to stroke patients orally. The benefits of using a pump to deliver medication include reduced sedation and less need for high dosing. Patients using ITB therapy generally experience better results using less medicationvi.

Rehabilitation For Communication

Another debilitating side-effect of a stroke is the impact it has on ones ability to communicate well. Many times a patient experiencing a stroke is unable to communicate because they have difficulty finding the right words to use to express their thoughts.

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Their brains may also have some difficulty interpreting information, leading to confusion and frustration. Fortunately, there are treatments that also improve the quality of life for stroke patients by helping patients recover much of their ability to communicate with others and understand others with relative ease.

Many times the most difficult problem for a patient to face is knowing what they need to say but not being able to tap into the areas of the brain that hold the right information or words they need to express their thoughts. Some physicians refer to this trouble as a language problem, while other patients have articulation problems. These doctors more commonly refer to it as motor problems, where a patient can access the words they want to say, but have difficulty speaking clearly.

Most doctors begin speech and language rehabilitation very shortly following a stroke, so a patient has the ability to regain some control over their life and their communication immediately. This often is among the primary concerns of patients, and can lead to better communication and understanding between the survivor and caregiver in the months and weeks to follow.

For some patients improvement in language and communication develops slowly, while others realize much quicker recovery. Remember, every patient is different as is every patients experience of a stroke.

One of the goals of language and speech therapy is to establish goals with the patient that are realistic, so a patient can know what to expect two, six, twelve months down the road and beyond. Some patients may experience gradual improvements over a matter of years.

The good news is most patients will also experience some recovery in the first few weeks and months following rehabilitation.

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General Management Tips For Recovery

Much of rehabilitation for stroke patients focuses not simply on reducing pain and discomfort and restoring speech and mobility, but more importantly preventing future strokes from happening. In the next section we talk comprehensively about active steps stroke survivors can take to help reduce their risk for a second stroke following the first.

Some other problems that place stroke survivors under risk following a stroke include vii:

Increased risk for deep vein thrombosis, a condition where blood clots form in the deep veins of the body, which, if left untreated, may be fatal. Treatment and rehabilitation objectives will include encouraging mobility and movement in the legs and muscles to reduce the risk for clotting. Some doctors may also recommend blood thinning agents to help reduce coagulation of blood or pooling of blood which may contribute to this condition.

A pulmonary embolism, where a blood clot forms and then dislodges from its location (usually in the leg or another limb) and lodges in the lung. This is a severe complication that may lead again to fatality.

Pneumonia due to decreasing immune function and added stress placed on the respiratory system.

Additional heart or cardiovascular complications.

Urinary tract or kidney infections associated with decreased ability or muscle spasticity in the pelvic area.

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Fortunately, rehabilitation specialists engage in a wide array of tools and techniques to help alleviate and control a survivors risk factor for these effects following a stroke. Such actions can dramatically improve their odds of survival and their perceived quality of life.

Is Everyone A Candidate For Rehabilitation?

Not everyone is a candidate for all the rehabilitation programs available to stroke survivors. Caregivers and survivors will work closely with trained specialists to assess their suitability for certain procedures.

How do you know if you are well-suited to a procedure? There are many elements or factors a healthcare team looks at and reviews when considering rehabilitation treatment choices.

With time and recovery, as well as individual response to rehabilitation, these treatment choices may change. Some common considerations when evaluating a patients candidacy for rehabilitation include:

1. How severe a patients stroke is; intense or vigorous training and rehabilitation is not often an option or feasible choice for patients experiencing severe strokes. In this case, the patients may be a candidate for in-house care at an appropriate facility.

2. How mild a stroke is; patients with mild strokes often realize the quickest and most startling recovery and improvements in quality of life by taking advantage of rehabilitation alternatives.

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3. Whether a survivor can sit up, understand and become aware of their surroundings. When a patient is able to do this, they are better prepared for more rigorous rehabilitation and will likely experience more positive results.

4. The extent of spasticity. While a patient may not enjoy these tight constrictions of the muscles in the body, often muscle spasticity is a sign that live nerve ability still exists in the body, improving ones odds for effective responses from rigorous intervention and rehabilitation.

5. Patients recovery within the first week or two following a stroke. Those patients and survivors that can start moving appendages or limbs in the short weeks following their stroke are good candidates for intensive rehabilitation.

6. An active and willing support structure that may include loved ones and family members.

Some patients, including those with certain complications from a stroke are less likely to benefit from traditional rehabilitation. For example, many patients experience an increased risk for mortality because they lose their ability to swallow resulting from a stroke, a side-effect that may lead to malnutrition.

Other patients, including those experiencing severe seizures consistently following their stroke, may not represent good candidates for positive outcomes following even strict rehabilitation.

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Individual Approach To Rehabilitation

Stroke survivors and family members working with their loved ones should recognize that each doctor and rehabilitation specialist will take an individualized approach to rehabilitation. This approach will include evaluating several factors related to the patients health and wellness.

Strokes can affect different parts of a victims brain, so the approach toward rehabilitation may vary depending on which centers of the brain are most severely affected.

Some common approaches to general rehabilitation for most stroke patients with a good expected outcome include: Muscle rehabilitation - this will typically include reducing spasticity and tightening of the muscles and training other muscles in the body to perform tasks that impaired muscles can no longer carry out, whether on a short-term or permanent basis. For example, patients experiencing paralysis or decreased mobility on one side of their body, such as the right side, may learn how to use the left side of their body and retrain their muscles accordingly. This is a very common approach to rehabilitation, as many people are either left or right handed, which leads to greater control on the side of the body the person was used to using preceding the stroke.

Attention and focusing training this type of rehabilitation focuses on helping survivors learn to refocus their attention so they can perform daily tasks following a stroke. Some patients will have to relearn very common skills including eating, talking, using the bathroom or communicating and listening to others.

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 Speech and communication therapy which focuses on restoring ones ability to communicate, whether nonverbally or verbally. Other forms or tools a survivor can learn to use include using a computer or pen and paper to communicate with others. Some patients will have to relearn the alphabet and learn how to communicate and read again. If the stroke is very severe, it is similar to a doctor or rehabilitation specialist teaching a student in elementary school.

Medication therapy - this is a common approach for relieving side effects including pain associated with treatment following a stroke. There are also some medications currently available that may help patients improve their ability to articulate words correctly. Other drugs may help improve unusual side-effects, including uncontrollable hiccups, an often unmentioned side-effect affecting many patients that have survived a serious stroke.

Emotional rehabilitation - this rehabilitation focuses on helping survivors regain their self-esteem, confidence, independence and ability to fight for a better quality of life. It is very common for stroke survivors to undergo periods of depression. It is important that doctors recognize this and respond to it accordingly. The American Stroke Association indicates that failure to address symptoms of depression my lead to prolonged therapy or a less than ideal response to rehabilitation efforts.

Neurological emotionalism - this is a term often given to stroke survivors that describes certain emotional features a patient may exhibit following stroke, including uncontrollable crying. It is neurological, however, rather than a psychological disorder, meaning

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it is not directly tied to the emotions necessarily, but rather changes that occur in the brain following stroke.

Also important to address during recovery and rehabilitation is the emotional and physical ability and strength of the stroke survivors primary caregiver. Many will require support and guidance. Some caregivers may also undergo bouts of depression, especially if they are coping with the loss of a loved ones ability to communicate and interact with them intimately.

Fortunately, rehabilitation can also work to help caregivers respond and address the physical and emotional impacts a loved ones stroke can have on them as well. Rehabilitation and counseling is often an important consideration for caregivers whos loved one may experience abnormal neurological behaviors following a stroke, including dementia or aggressive behavior.

Remember, sometimes it is difficult to determine at first glance how a stroke will manifest in a survivor physically and emotionally. A caregiver should work closely with a qualified team of healthcare professionals to help the stroke survivor decide on the best course of treatment and rehabilitation for a patient.

What We Learned
A stroke affects survivors in various ways, depending on the severity of the stroke and the areas of the brain that are damaged or impacted by a stroke. Recovery is critical to ones success and ability to improve their quality of life, and often starts with prompt, immediate and active rehabilitation.

Depending on the severity of a survivors stroke, a patient may begin speech and language rehabilitation within the first 48 hours following a

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stroke. Many believe communication is the most important ability to recover following a stroke, allowing a survivor to better communicate and share their needs and their impressions of treatment.

Depending on the patient, the caregiver and resources available to them, a rehabilitation team is likely to develop a moderate to aggressive approach to rehabilitation depending on a survivors state of mind, condition and willingness or desire to enter therapy. Often, medication intervention, including treatment for anxiety or depression, may initiate rehabilitative efforts to help provide stroke survivors with hope for a recovery that will improve their quality of life and long-term wellness.

Because many patients suffering a stroke are at risk for another one, it is important to know what steps are necessary to help reduce the odds a patient will experience recurring strokes. In the next section, we will discuss various risk factors and treatments for patients that may be at risk for experiencing a subsequent stroke. The more attention one gives to their overall health and wellness following a stroke, the more likely they are to regain better control over and improve the quality of their lives.

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Chapter 4 - Avoiding Future Strokes

The American Stroke Association, an organization working with the American Heart Association, emphasizes that once one has a stroke their risk of having another is higher than someone who has not suffered a stroke. This may seem scary, but the good news is you can control many risk factors and make lifestyle changes that will reduce the odds you will suffer from another debilitating stroke.

Much like a person that has a heart attack survives and recovers so too can a person who suffers a stroke. They can also limit their odds of experiencing future disability. This section will focus on ways stroke survivors can reduce their chances of suffering another stroke. The information provided contains guidelines provided by the American Stroke Association and American Heart Association, as well as other organizations committed to improving the quality of life of individuals following stroke.

Dietary Changes
One simple way anyone can reduce their chances of succumbing to a second stroke is by eating well. Healthy food choices are important for maintaining your hearts health and reducing your risk of heart disease and stroke, high blood pressure and other conditions that can contribute to stroke.

Good nutrition will also provide you with more energy, something you will find very important in the months and years following your stroke. If you suffered a stroke and have comorbid conditions, like heart disease or diabetes, it is more important than ever you eat well to nourish your body.

Here are some tips for eating well that will help reduce your risk of recurring strokes: Make sure you invest in lean protein like fish and poultry.

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 Incorporate many whole grains, fruits and vegetables into your diet. Aim for a serving of each during each meal of the day. Try baking, grilling or broiling foods instead of frying them. Use olive oil in place of butter for seasoning, dressings and flavor, as olive oil has heart healthy ingredients. Avoid foods that are highly processed and foods that contain too much saturated fat (including red meat). Eat these in moderation. The majority of your diet should include wholesome, nutritious and energy producing foods. Try using egg whites when making egg products including omelets. Look at label ingredients when shopping and avoid products containing high fructose corn syrup and products containing lots of sugar.

Just as anyone will benefit by eating a diet containing more wholesome, unprocessed foods, so too will a stroke survivor benefit by paying more attention to their diet, and physical activity, which ultimately serves to improve the life and quality of life of anyone willing to put effort into these critical success factors.

Recognize Stroke Risk Factors

If you recognize physical risk factors of a stroke, you are more likely to take preventive action.

Just by becoming more aware of stroke risk factors, you can help reduce your risk of future strokes. Here are some common physical health factors that may increase your risk of stroke or recurrent stroke:

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1. High Blood Pressure One of the leading risk factors for strokes and heart disease alike is high blood pressure. High blood pressure is often a sign of other health problems. A majority of stroke patients have high blood pressure before experiencing their first stroke. Any blood pressure with a systolic reading greater than 130 or diastolic reading greater than 80 may suggest you are at risk for pre-high blood pressure. If you notice your blood pressure creeping up, consult with your doctor and take action to correct it.

There are many ways to treat high blood pressure.

1. Exercise is one of the best ways to help lower blood pressure. It will also help restore your energy and can help promote weight loss. 2. Lose weight if you are overweight. Many times simply being overweight increases your odds of high blood pressure or hypertension. 3. Reduce your consumption of alcohol, which can increase your risk for high blood pressure if you are prone to hypertension. 4. See your doctor about blood pressure lowering medications if your blood pressure is very high. 5. Limit or reduce your intake of salt. 6. Increase the amount of fluid or water you drink so you do not retain water, because interestingly this can raise your blood pressure. 2. Atrial Fibrillation In this condition the atria or top chambers of the heart do not beat properly. Instead of actively pulsing, they quiver so blood does not move into the ventricles properly. Many patients, up to 20 percent according to conservative estimates, have atrial fibrillation before experiencing a stroke. This is because this condition slows down the flow

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of blood, increasing the likelihood that blood will pool in the body and clot. This increases your risk for a stroke and recurring strokes.

The good news is your doctor has many treatments available to help keep blood from clotting, including the use of anticoagulants. Many survivors are offered these medications or antiplatelets, to reduce their odds of having another stroke. Some studies, including those by the American Heart Association, also suggest that taking aspirin may reduce the risk of a first time stroke, or reduce the severity of a stroke if taken within the first two days or few hours of a stroke.

3. Atherosclerosis High blood cholesterol or other risk factors increase ones risk of high blood pressure, heart disease and stroke. Often high cholesterol can be controlled through diet alone. If your condition is hereditary, you may have to seek the advice of a doctor who may prescribe a cholesterol lowering drug temporarily to reduce your risk of a stroke or recurring stroke. A diet that increases levels of HDL, or good cholesterol, can decrease your risk of atherosclerosis.

4. Inactivity A simple lack of activity can increase your risk of a recurrent stroke. While it may seem counterintuitive, it actually benefits you to exercise following a stroke. People who are in better shape before a stroke will suffer fewer long-term consequences and often recover faster than their inactive counterparts. You dont have to start running marathons, but you should consult with your doctor for a recommended activity program that will help keep you safe and physically active.

There are many other risk factors that may heighten ones susceptibility to future strokes, including ones family history and overall wellness and attention to rehabilitation. Remember, all survivors are individuals. The more a survivor

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understands their risk for recurrence, the more likely they are to take proactive steps to reduce their odds for another stroke and hasten their recovery.

What We Learned
Once a person suffers from a stroke they automatically are at an increased risk for another stroke. The good news is simple awareness of this can dramatically improve ones odds for survival and decrease their chances of having subsequent strokes.

In this chapter you learned how to improve your overall health and lifestyle habits, which can dramatically improve your odds for surviving a stroke and reduce your odds for experiencing a secondary stroke.

In the next section, well talk more about the impact a stroke has on friends and family, who often become primary caregivers or emotional support figures in the lives of stroke survivors. A stroke survivors ability to recover well often hinges on the willingness of those around him or her to help support them in their often difficult journey to healing.

This next section will also help caregivers learn ways they can better care for their own health and emotional wellness while grieving for loved ones whove suffered from a stroke.

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Chapter 5 - Friends, Caregivers and Family

Friends and family members are often involved in taking care of and helping someone recover following a stroke. Many times family members or friends and other caregivers look for support, so they know best how to help their loved one.

If you are a stroke victim, and can communicate, the best way to help family members is to be honest about your feelings, wants and needs. It never helps to keep things bottled inside. That said, if you havent suffered a stroke, it is hard to understand what having a stroke is like, and how it changes your life.

Friends and family will benefit by learning as much as they can about strokes and how it affects ones life. There are many resources and support groups online for stroke victims, but also for the friends, family and caregivers of people that have suffered a stroke.

Finding Support
Many times a stroke victim feels as if he or she is alone. Family members can also feel this way as they struggle to find ways to help. One way to find support is by reading about others experiences with strokes and others experiences helping loved ones overcome the difficulties presented following a stroke.

For victims, friends and family members, a wonderful resource to find information about support groups is the American Stroke Association. You can access them here:

www.strokeassociation.org

Here you will find personal stories of recovery and care, and support groups for patients and family members. You can also learn more about recovering from a stroke and what you can expect from life following a stroke. This site also offers

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caregivers, including family members, special offers including daily journals they can use to log important information, and provides links to various resources specifically designed to provide caregivers and family members the proper knowledge and information they need to care for a stroke victim.

The American Heart Association also offers a board and forum offering familial support for families caring for a loved one, and for individuals that have suffered from a stroke who are looking for advice and support. Visit:

http://my.americanheart.org/jiveforum/index.jspa

In the resources section of this guidebook you will find links to many other support groups and forums you can rely on for guidance and additional information during your journey. One thing many family members and caregivers often forget is to care for themselves while caring for a loved one. It is easy to fall into the trap of spending so much time caring for your loved one that you forget to care for yourself. The good news is you can prevent frustration and burnout by remembering that you are important.

If you burn out, you wont be any help to your loved one or to yourself. So start by taking some time out of each day just for you. Take some time to exercise to help relieve the stresses associated with caring for a loved one.

Communication and Family Roles

Most importantly, make sure you communicate your needs to your loved one. Just because someone has a stroke, doesnt mean they cant empathize and understand that you too must feel stress. When you communicate about your fears, anxieties and desires, you open the door to better communication and a warmer relationship. This will improve the quality of life for you and the person you care for.

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Tips For Caregivers & Stroke Victims

When someone has a stroke, their life changes dramatically, as does the lives of the people living with the person who has had a stroke. Lets say for example, the head of a household has a stroke. The stroke results in a disability.

What does this do to a family dynamic? It changes it completely. The first step toward recovery is recognizing how the stroke has affected the family dynamic, and the role each member of the family has to take on.

Someone else may now step up and act as head of the house. You may need to hire additional care or someone to provide in-home, full-time care depending on the severity of the stroke. You may find you need to take more time to care for yourself as you tire working diligently to attend to the rehabilitative needs of a cherished loved one.

One way to go about structuring your life and improving the quality of your life, whether a family member or a stroke patient, is to sit down and communicate with each other. Map out who is responsible for what. Responsibilities might be as simple as communicating daily or taking five minutes alone to relieve stress. Every person in the home should have their own role and their own schedule, including the stroke patient.

Remember, someone that has a stroke is still an important part of the family, and will want to play a role in the planning and execution of family affairs. Disabled doesnt mean incompetent. Keep that in mind. Consider each family members skills, abilities, talents and capabilities, and work to consolidate them to improve the quality of everyones life.

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Your life may change dramatically, but many times it may be for the better. Once the initial chaos and confusion wears off, you can pull together as a team to overcome just about anything.

What We Learned
When someone has a stroke, it changes the entire dynamic of a family. The good news is this change may seem at first like something bad, but eventually with proper support, communication and understanding, everyone can pull together to create a loving, supportive and nurturing environment.

Every member of the family, including a primary caregiver, needs support following a stroke. If you or a loved one suffers from a stroke, seek help and guidance. Dont go it alone. This will help reduce the chaos and fears that often accompany a dynamic change in ones routine and living environment.

For more information and family support, for caregivers and family, try contacting the Stroke Family Support Network. They can help you clarify each persons role in the family, and direct you to local resources and help when needed. There number is 1-888-4-STROKE.

Here are some additional resources for family members:

National Association of Area Agencies on Aging o Visit them at www.aoa.dhhs.gov/elderpage/locator.html

National Family Caregivers Association provides direct links to people and access to resources for family caregivers caring for victims of stroke and other diseases. o Visit them at www.nfcacares.org

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National Easter Seal Society offers many programs and rehabilitation services for adults with disabilities including stroke. o Visit them at www.easter-seals.org

Most hospitals and healthcare facilities also offer links to local and community organizations and support groups that can help caregivers find support and help stroke survivors find support following their illness.

In the next section, we will wrap up our discussion of rehabilitation and life after a stroke by offering survivors and their families hope for the future. No matter how debilitating any illness, it is important that caregivers, patients and loved ones recognize that there is always hope for the future.

Technology and modern medicine continue to bring new and interesting techniques and strategies for hastening recovery and restoring ones ability to live a full and rewarding life following stroke. Lets take some time to look at what the future has to offer stroke survivors and their families.

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Chapter 6 - Hope For The Future

Hope is the single most important thing one must hold onto during their recovery from a stroke

Unless one is a victim of a stroke, one can never really understand what a stroke survivor will undergo during the recovery process. As frustrating as recovery may sometimes feel for caregivers, it is equally if not more frustrating for patients. Patients may want nothing more than to restore their life to the state it was in before their stroke.

Most patients suffering a stroke however, will have to learn a new way to adapt to their life. They will have to learn new ways of coping with new disabilities, and new ways of thinking about their bodys and their minds.

As technology and modern medicine continue to converge they will open the door for new possibilities for stroke victims and their families. A key to a stroke survivors recovery is their ability to recognize the physical changes a stroke will have on their body. The more knowledge one has of an illness, the better able one is to recover from it.

The same holds true for caregivers. The life of a caregiver for any patient with a disability can be challenging. Caregivers have a duty to themselves to take care of their own physical and emotional health as they do to care for others. Some survivors will suffer severe physical and emotional damage requiring permanent in-house care in a competent and caring facility.

If this is the case, a loved one will often need to seek support from other families and perhaps even counseling to learn how to cope with the changes in life brought on by a stroke. This is often the case when a patient permanently losses the ability to communicate clearly or understand others.

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The good news is many patients will recover from their stroke. They may not live the same life they did before having a stroke. They do however, have the ability to learn and discover a new way of living life. Medical treatments can help reduce pain and discomfort. Speech and language therapy can help an individual regain their capacity to communicate well with others.

Emotional and psychological rehabilitation and counseling can help stroke survivors learn to look at their lives in new and challenging ways. Remember, with proper support and a positive outlook, anything is possible. If you keep the hope alive, you will have the best chances for success, happiness and comfort as you learn to life with life after a stroke.

We hope you found this guide helpful to you in your journey toward recovery. Remember that life is constantly evolving and changing, as are all people as individuals. A stroke will represent a dramatic change in the way you live your life, but can also present you with new challenges and opportunities to live a healthier, better and more rewarding life.

Many blessings to you on your journey toward health and wellness

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Stroke Resources
There are many resources available to patients, professionals and caregivers of survivors of stroke. Many of them are listed throughout this guide. To help you find information quickly and easily, a list of resources is provided below you can use anytime.

American Heart Association http://www.americanheart.org 1-800-242-8721 This site provides information for patients, healthcare providers, caregivers and family members looking for information about rehabilitation, stroke, recovery and support. Many feel this is the best starting point to find information about health and recovery. You can also find detailed information about what stroke is and how it affects the body using this website. American Stroke Association http://www.americanheart.org 1-888-478-7653 Like the American Heart Association, the American Stroke Association commits itself to providing ongoing support, education and information to patients, family members, caregivers and professionals interested in learning more about stroke. This site is a division of the American Heart Association, so you will find many references linking the two together. You can also find links for online risk assessment for stroke and other heart related health problems.

Congestive Heart Failure http://www.americanheart.org/chf As part of the American Stroke Association, this site targets patients and their caregivers specifically. You can find information and many free tools

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that assess your risk for stroke and keys to prevention for recurrent infections or illnesses.

Nutrition Information http://www.deliciousdecisions.org As you know, good health starts with good nutrition. Patients can reduce their risk of recurrent stroke by adopting a heart healthy diet. This site, recommended by the American Stroke Association, is a non-profit entity providing recipes and nutrition advice for adopting a healthy and nutritious lifestyle.

Brain Basics http://www.ninds.nih.gov/health_and_medical/pubs/preventing_stroke.htm Part of the National Institutes of Health, this informative article provides information on preventing stroke in healthy individuals. You can also link to other articles and resources about cardiovascular and heart health for men and women, as well as children. Generation S: Young Stroke Survivors http://www.orgsites.com/pa/generation-s Stroke is not an illness that affects young and old alike. Young people, including children, can fall victim to stroke and survive. This innovative young and hip website targets young people affected by stroke, offering support and guidance. Stroke Information Directory http://www.stroke-info.com/ This site offers even more links to centers and organizations providing information, articles and support details for patients, caregivers and providers interested in learning more about stroke.

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National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/ A government funded site, part of the National Institutes of Health, providing resources and information on various neurological disorders including stroke. Also provides links to resources for primary caregivers. National Stroke Association http://www.stroke.org Like the American Stroke Association, provides national support for patients, caregivers and family members seeking more information about stroke and recovery. For links to local support groups in your area you can visit for support, whether a survivor or caregiver, visit http://www.strok.org/supportsearch.cfm The National Rehabilitation Information Center http://www.naric.com This site provides details about rehabilitation and new treatment alternatives for patients facing many illnesses and acute diseases including stroke. Here you can find detailed information about specific therapies you may have an interest in learning more about that center on prevention and recovery. Stroke Network http://www.strokenetwork.org The Stroke Network is an online community committed to providing caregivers and survivors support and guidance during their journey toward recovery. You can buy stroke awareness gifts to help increase the publics knowledge and awareness of heart health and stroke. This site is rated a topnotch website in 2007 for stroke survivors and health providers by Dorlands. Health professionals are also invited to take part in discussions. A non-profit organization, the Stroke Network is a support group whose members and directors include survivors of stroke or those whose lives have been affected

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by a family members suffering and joyous recovery or painful loss. Many consider this truly unique organization a blossoming addition to the family of support networks available to stroke survivors, caregivers, health professionals and family.

Haan, D.R., Limburg, M. Van Der Meulen, J., et. Al. (1995). Quality of life after stroke: impact of stroke type and lesion location. Stroke, 26: 402-408; Sneeuw, K.C., Aaronson, R., Haan, J., Limburg, M. (1997). Assessing Quality of Life After Stroke. Stroke, 28: 1541-1549. ii Op Cit Ibid; iii American Heart Association. iv National Stroke Association. v American Stroke Association. vi Op.Cit.Ibid; ASA; http://www.poststrokehelp.com/ vii http://www.nym.org/

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