Emotional and Behavioural Changes After Stroke

Emotional Factors in Recovery

Following a stroke, the patient's anxiety, fear, and frustration are enormous. Many stroke survivors initially suffer confusion that makes 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 survivor's limitations and allow an 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 behaviour should be pointed out, nagging tends to upset and anger stroke survivors, and discourages rather than encourages effort.

Determination is essential in overcoming the effects of a stroke. Patients must be willing to adapt to the disability and be convinced 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 survivors return home, the following guidelines will encourage a positive recovery.

Set attainable goals the road to recovery is built 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.

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 behavioural 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 Liability

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 behaviour 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-a radio playing softly or a soft light left on may help.

Quality Control

Even minor brain damage affects a memory related area of behaviour called quality control. This refers to how well individuals check and control their own behaviour. 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.