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Frequently Asked Questions About Stroke Rehabilitation

Why is there pain on the affected side?  

Why does the affected side feel tingly or like it's asleep?

Why does my whole arm or leg move when I yawn, sneeze, or try to move only part of the extremity?
In general, what kind of recovery can I expect in the next year?
What physical changes can I expect after a stroke?
Why is there an increase in overall fatigue after a stroke?
What are some tips on transitioning to home and to work following a stroke?
My vision has changed since the stroke. Should I get new glasses?
What are the stages of grieving and is it normal to go through them following a stroke?
How can we help children cope when a parent has a stroke?
What are the signs of depression and how do I alleviate the symptoms?
What are some of the emotional effects of stroke?
How can my family help me be as self-sufficient as possible?
What if my significant other is having role adjustment issues after my stroke?
How do I best deal with the "unseeable" effects of stroke (e.g., speech, cognition, psychological, and memory)?
What's some advice on sexuality and intimacy after a stroke?



Why is there pain on the affected side?

It's common for people to have various aches and pains on either side of their body after a stroke. Pain may be due to:

  • The location of the stroke (if it affected a part of the brain called the thalamus there can be pain), though this is uncommon. Ask your doctor if you're not sure if this applies to you or your loved one.
  • Sore muscles from overworking the stronger side and strengthening the weaker side.
  • Sometimes, when performing exercises, stretching out the arm or just reaching overhead, the upper arm bone can pinch nerves, tendons, or ligaments in the shoulder and cause pain. If there's pain when performing these activities, it's important your therapist or doctor know so he or she can make sure the activity is performed accurately and give suggestions on how to do the task without pain.
  • If the pain is in the affected arm only, it could be due to a process called "shoulder hand syndrome," or RSD.

If the pain is severe or seems similar to shoulder hand syndrome, please be sure to tell your doctor or therapist. [Back to top]

Why does the affected side feel tingly or like it's asleep?

A stroke affects many parts of the body, depending on what part of the brain was damaged. A stroke can affect the part of the brain that controls the muscles in the arm or leg. A stroke can also affect the part of the brain that perceives sensation, which is how the body feels things. Changes in sensation can vary greatly on the affected side, to a very mild decrease in sensation, to no apparent loss of sensation.

If sensation was affected by stroke, it can take a long time to return. It may return in part, in whole, or not at all. No one can predict the amount of healing that will take place. [Back to top]

Why does my whole arm or leg move when I yawn, sneeze, or try to move only part of the extremity?

After a stroke, the muscles are weak. Muscles tend to work together in certain groups, or cliques, called synergies. This is why the whole leg may move when only trying to move the ankle.

Although it's encouraging to see the extremity move, especially if it's early in the healing process, don't reinforce the synergy because then it becomes the only movement pattern available in the extremity. Ask your doctor or therapist for more information if this applies to you.

The muscles in the arm and leg will have a harder time relaxing after a stroke because the whole nervous system is irritated, which increases the tension in the muscles even when they are resting. It's very important to make sure the therapist shows you or your caregiver how to safely stretch your muscles so they won't get tight. Stretching your muscles safely can help prevent other physical problems. [Back to top]

In general, what kind of recovery can I expect in the next year?

People generally see the most healing in the first three to six months after a stroke. A fair amount of healing continues throughout the first year, with plateaus and spurts of healing. After a year, the healing process slows, though healing can slowly continue for years after a stroke. [Back to top]

What physical changes can I expect after a stroke?

Constipation
Medication, decreased activity following a stroke, or reduced fluid intake can cause constipation after a stroke. Typically, constipation is treated by reversing the cause; in other words, increasing activity levels and fluid intake, if possible. Medication may also help alleviate the problem.

Urine Retention or Incontinence
The muscles that control the rectum and the bladder are sometimes affected during a stroke. This can lead to urine retention or incontinence. By following a bladder program of timed voids you can re-train the muscles to prevent incontinence. Kegel exercises help retrain the muscles and may prevent accidents. If bladder retraining isn't effective, medications and catheterization can alleviate the problem or decrease the frequency of accidents.

Pain
Sometimes pain is more of a muscle ache that occurs because the muscles are working hard on the affected side to help with recovery, and the muscles are working hard on the unaffected side to help make up for the weaker side. This can cause muscle soreness. Neurologic base pain can happen because of muscle spasms, irritability in the nervous system following a stroke, or because of the specific area of the brain where the stroke occurred. If pain is ongoing, consult your nurse or doctor.

Tremors
Tremors occur because of muscle weakness, fatigue, neurologic causes, or metabolic causes. Let your doctor know if you're experiencing tremors.

Dry Skin
Skin can become drier after a stroke because of decreased fluid intake and medication. Take care that there isn't a build up of pressure in susceptible areas (e.g., under bracing or in boney areas). Use lotion to help alleviate discomfort. [Back to top]

Why is there an increase in overall fatigue after a stroke?

Many people are deconditioned after a stroke because of a sedentary lifestyle before the stroke or because of increased time in bed after the stroke. It also takes more energy to perform even the simplest task after a stroke, which makes people fatigue more easily. This can be a long-lasting effect of a stroke. Depression can also cause fatigue. If you're depressed, let your doctor know. [Back to top]

What are some tips on transitioning to home and to work following a stroke?

Work closely with your therapists and discuss your deficits and how to overcome them. Build on your strengths and make modifications, as needed. Occasionally, people will consult Michigan Rehabilitative Services to help with vocational rehabilitation or job training. [Back to top]

My vision has changed since the stroke. Should I get new glasses?

If you could see well with your glasses before your stroke, don't get new glasses. Your vision problems may resolve on their own or with therapy. Generally, wait at least six months after a stroke before getting a new prescription. If your glasses weren't working well for you before the stroke and your vision has gotten worse, you should still wait six months before getting a new prescription. [Back to top]

What are the stages of grieving and is it normal to go through them following a stroke?

While there's no set series of stages of grief that someone goes through following a stroke, it can be an emotional time. However, the grieving process often involves denial, anger, bargaining, depression, and acceptance. [Back to top]

How can we help children cope when a parent has a stroke?

The most important thing you can do to help a child deal with a parent's stroke is to give them accurate information about what's happened and what to expect. Learn all you can via the Internet, books, and support groups. Work closely with your Mary Free Bed social worker for resources regarding talking with children. [Back to top]

What are the signs of depression and how do I alleviate the symptoms?

Depression takes several forms. Sleeping too little or too much, appetite changes, loss of interest in things once enjoyed, and feelings of hopelessness are among the symptoms of depression. Or, you may exhibit an agitated form of depression. Watch for symptoms such as: inability to sleep; easily annoyed; or having too much energy, but not really able to accomplish much. Talk to your doctor if you experience these symptoms.

Activity is one of the best ways to fight depression – get moving; go for walks, if possible; get outside; go to the local mall; and plan activities. If symptoms persist, your doctor may recommend medication and/or psychotherapy with a rehabilitation psychologist. [Back to top]

What are some of the emotional effects of stroke?

Emotional effects of a stroke vary tremendously depending on the location of the stroke as well as your personality. Emotions may include depression, mood swings, anger, and self-esteem issues, among others. Depression, anger, and crying easily are all common. If you continue to demonstrate symptoms of emotional distress or depression for more than a few weeks, medication may be appropriate. Seeing a rehab psychologist can also help. [Back to top]

How can my family help me be as self-sufficient as possible?

It's important for your family to remember that you're a person first – not a "stroke victim." If you can no longer do certain things, have your family help you try new ways of doing those same activities. Have your family modify the environment, the technique, or the task to help you experience success in these areas. Mary Free Bed's therapists are excellent resources in this area. [Back to top]

What if my significant other is having role adjustment issues after my stroke?

It truly depends on the specifics of your situation. If you're unable to figure out how to deal with the changes, talk to your doctor about seeing a rehab psychologist for help. [Back to top]

How do I best deal with the "unseeable" effects of stroke (e.g., speech, cognition, psychological, and memory)?

Work closely with the therapists to help tailor the specifics for you. You'll want to use any and every compensatory strategy that's helpful. [Back to top]

What's some advice on sexuality and intimacy after a stroke?

Experiment to see what works for you and your partner. Try different approaches toward intimacy and different positions. Try to relax during the process of experimentation. Your Mary Free Bed social worker, psychologist, doctor, and physical therapists are good resources during this process. If you're unhappy with the results of your experimentation, seek advice from your doctor. [Back to top]

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