Stroke: Signs, symptoms and care tips

Nisha Andrea Raj has more than 10 years experienced as a nurse. She also has experiences with the Acute Stroke Unit at Singapore and Saudi Arabia. Photo: Homage Malaysia

Stroke can hit anyone, especially those from the older age group. As complications arise, family members and caregivers face the life-changing challenges of caring for their loved ones. Understanding the patients’ need can ensure a smooth quality care.

 Rehabilitation is an important part of recovery

As we get older, one of the medical conditions that we are prone to is stroke. While a stroke can hit any age groups, it affects those who are older more. Approximately three-quarters of all strokes occur in persons above 65 years of age. However, the risk factor of stroke does not only ends with ageing.

Stroke is also more susceptible to those with underlying conditions such as high blood pressure, diabetes, heart and blood vessel diseases, high cholesterol levels, smoking and those with brain aneurysms.

According to Homage Care specialist, Nisha Andrea Raj, a stroke is commonly known as a ‘brain attack’, and there are three different types of strokes that can attack an individual.

“The first one is an ‘ischemic stroke’. It occurs when a blood clot blocks the supply of blood to or in the brain, and that prevents blood from reaching certain parts of the brain.” She also added that when the blood flow is stopped for longer than a few seconds, the brain will not be able to obtain oxygen, and causes brain cells to die.

The second is a ‘hemorrhagic stroke’, caused by the breakage or rupture of a weakened blood vessel in the brain. “This results in internal bleeding that can be very hard to stop.”

The third type of stroke is the ‘Transient ischemic attacks’, which is often called ‘mini-strokes’. Usually, during the attack, the blood flow is temporarily blocked in one part of the brain, causing stroke-like symptoms.

Nisha added that these mini-strokes act as a warning from the body, “Eventually, the chances of getting another stroke are higher for those who had this before without seeking medical attention.”

Taking care of a stroke patient

Understanding the challenges families and caregivers had to face when taking care of a stroke patient, Nisha said that the struggles can be a life-changing process to those affected, either directly or indirectly.

“The most common struggle that the family members or the main caregiver face in caring for a stroke patient is adjusting to the change. The reason being that most of stroke survivors are fully-dependent on their family or main caregiver,” she said.

With more than a decade of experience in nursing, Nisha said that another challenge for caregiver will be when their loved ones are not complying to any treatment, medication or therapy session. This could be very stressful for the emotion, balancing the difficulties and responsibilities.”

Nisha also advised family members to equip themselves with adequate knowledge about stroke. “Providing basic cares such as personal hygiene, diaper change, positioning and dressing are by far the most important and essential thing.”

She then puts an emphasis on precautionary steps to better care for a stroke patient. “As most of the patients mainly struggle with motor impairments post-stroke, the family should pay more attention by encouraging them on daily rehabilitation and exercises to help restructure the brain function.” Through therapy and rehabilitation, Nisha said that the patient’s brain can re-learn, by repairing old pathways or creating new ones.

“Family members also need to be aware that certain lifestyle behaviours can increase the risk of recurrent stroke.” Aside from that, Nisha also urged families to always keep check of the patient’s blood pressure, cholesterol and stress levels. “Because new stroke side effects appear months after discharge, especially during the first year after the original stroke. Be sure to consult a doctor or neurologist as soon as you notice any abnormalities or new signs of a stroke.”

She also mentioned that stroke patients are at high risk of falling due to common balance and gait problems after stroke. “If they fall it can be very difficult for them to get up or families to lift them. Therefore, an occupational therapist is a great resource for seeking help in making home modifications, like installing grab bars and non-slip mats. Families can also consider installing closed-circuit television (CCTV) at home for safety purposes.”

The expert also encourage families to engage a private caregiver or nurse, depending on the patients’ condition. “These could provide more focus care and prevent the main carer from feeling burned-out.”

Understanding a stroke patient

When a patient is first diagnosed with a stroke, it does not stop there. Nisha explained that many families often overlook post-stroke depression. “This condition is common for stroke survivors. It may occur in the early stages or the later phases of post-stroke.”

With her experiences in the Acute Stroke Care unit in Singapore and Saudi Arabia, Nisha explained that the stage is a crucial one, “If a family member fails to identify this, it can significantly affect the patient’s recovery and rehabilitation.”

Further elaborating, she disclosed that stroke survivors often experience a wide range of emotions. “This is known as emotionalism or emotional liability, where they sometimes expressed in a way that is greater than their emotions for no reason at all.” She said that these feelings are normal for survivors during the first six months.

“If they don’t get enough support or help to deal and overcome the situation, it could lead to problems or misunderstanding. Most stroke survivors have a problem controlling their mood,” she said.

Aside from depression and anxiety, stroke survivors also often deal with frustration. This means that they are easily irritated if a situation is not dealt with properly. This may eventually lead to anger or aggressive behaviour.

Nevertheless, Nisha assured that these negative emotions are likely to get better. “Even if the feelings never completely go away, there are many treatment options such as antidepressant medication and therapies that can help deal with the symptoms and make life easier.”

However, she also noted that antidepressants medication does not actually cure emotional problems. Instead, it affects the chemicals in the brain, and create a sensation that can lighten up the mood of the user.

Signs and symptoms of a stroke can vary depending on the area of the brain that is affected.

● Sudden numbness, weakness, or inability to move the face, arm, or leg (especially on one side of the body)
● Confusion or disorientation
● Trouble speaking or understanding speech
● Trouble seeing in one or both eyes
● Dizziness, trouble walking, or loss of balance or coordination
● Sudden, severe headache
● Drooling or difficulty swallowing

Other less obvious symptoms are

● Unusual pain in the face or legs
● Continuous or frequent hiccups
● Feeling weak all over the body
● Sudden chest pain
● Shortness of breath
● Rapid heartbeat

When we learn about stroke, we use the acronym FAST. This way it’s easier for us to remember and detect the sign and symptom of stroke.

1. Face drooping: Ask the person to show their teeth/smile. Is the smile uneven? A classic sign of stroke.
2. Arm weakness: Ask the person to close their eyes and raise both arms. Does one arm drift downward?
3. Speech difficulty: Is speech slurred or hard to understand? Ask the person to repeat a simple sentence like: “How are you / The sky is blue.” Is the sentence repeated correctly without any slurring of speech?
4. Time to call 999: If someone shows any of these symptoms, even if the symptoms go away, call 999. Check the time so you can tell responders when the symptoms first started.

Stroke rehabilitation is an important part of recovery after stroke. The main are 3 therapists and their goal is to help regain independence and improve quality of life.

1. Physiotherapist.

Physical therapists evaluate and treat problems with moving, balance, and coordination. They provide training and exercises to improve walking, getting in and out of a bed or chair, and moving around without losing balance. They teach family members how to help with exercises for the patient and how to help the patient move or walk, if needed.

2. Occupational therapist.

Occupational therapists provide exercises and practice to help patients do things they could do before the stroke such as eating, bathing, dressing, writing, or cooking. The old way of doing an activity sometimes is no longer possible, so the occupational therapist teaches a new technique. They are also a great resource for seeking help in making home modifications.

3. Speech-language pathologist.

Speech-language pathologists help patients get back language skills and learn other ways to communicate. Teaching families how to improve communication is very important. Speech-language pathologists also work with patients who have swallowing problems (dysphagia).