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Stroke Rehabilitation Unit

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Questions??


Q.  Is stroke a serious condition?


A.  Strokes vary considerably in their severity, from mild attacks with short-lasting loss of function (TIAs) to severe episodes that may cause unconsciousness and eventually lead to death. However, all strokes must be regarded as potentially serious and even mild symptoms require a visit to the doctor.With the right medical attention at the right time, a more serious attack may be prevented.

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Q.  Does stroke affect everybody in the same way?

A.  No. Stroke is a highly variable condition, ranging from TIA to a severe episode leading to disability. Between these two extremes, there can be almost any type and degree of disability, affecting almost any body function. Recovery is often quite good and many people can resume a near normal life. However, the speed and completeness of recovery will partly depend on the severity and type of stroke, on the age and the overall state of health of the person.

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Q.  Why are strokes so different?

A.  There is nothing wrong with the affected part of the body as such, the problem lies in the area of the brain that controls it. The symptoms are just a manifestation of an injury that has occurred in the brain and which is preventing the right messages being sent to the body. The injury to the brain will vary in each person.

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Q.  Can stress cause stroke?

A.  Stress alone may not cause a stroke and the longterm effects of stress on blood pressure are still unclear. However, becoming aware of the stressors in your life and learning ways of managing stress, can improve your overall sense of wellbeing. Your hospital team or GP may be able to offer you advice on reducing stress.

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Q. Since my stroke I can no longer use the stairs. Will I be able to get financial assistance towards adapting my house?

A.  You may qualify for the Disabled Person's Grant (D.P.G.). This grant covers up to 90% of the cost of alterations needed in the home to accommodate a person with a disability e.g. installation of a stair-lift or a downstairs bathroom.

Information and application forms are available from the housing department of your local authority.

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Q.  Will electrical stimulation help my recovery?

A.  A muscle contraction can be achieved by applying electrical current locally to a muscle. Electrical stimulation may improve movement and help you use the muscle better. There is no strong evidence to support its clinical use(Cochrane Review). Your physiotherapist will best advise you on whether it is suitable for your problems. A trial with it is sometimes recommended. This is not a suitable treatment in certain conditions, for example if you have a pace maker, cancer, infection or peripheral vascular disease.

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Q.  Why is botox used in stroke?


A.  Botox or botulinium toxin is produced by a bacteria (clostridium botulinum). It is a toxin that blocks nerve conduction to muscles (blocks acetylcholine at neuromuscular junction). This makes it a potent muscle relaxant, preventing the muscles from tightening. It is administered by injection directly into the stiff muscle. The toxin starts working within a few days to a week. The effects last 3 – 6 months. It is usually used in stroke to reduce muscle tightness (spasticity), in combination with stretching / splinting / exercise programmes.

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Q.  Why does my foot sometimes shake?

 

A.  Foot shaking is also called clonus. It is the result of a normal reflex which has become overactive due to the stroke. It is neither a good sign nor bad but may be associated with a tight calf muscle. Your therapist can advise you on maintaining muscle length and management strategies.

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Q.  How can I make swallowing easier and safer?


Do's

  • Do sit upright (ideally in a chair) when eating/drinking
  • Do take small mouthfuls at a time
  • Do allow plenty of time to swallow and pause between mouthfuls
  • Do cough if you have a gurgly voice then swallow again
  • Do follow the specific guidelines given to you by your Speech & Language Therapist
  • Do request a review by the SLT if your swallowing becomes more difficult or if you are getting chest infections

Don'ts

  • Don’t eat lying down as this can increase the risk of food/drink going down the wrong way
  • Don’t talk and eat/drink at the same time
  • Don’t eat when you are drowsy
  • Don’t use beakers with lids. These make you tilt your head back which may cause the drink to go down the wrong way
  • Don’t use straws, these make it difficult for your tongue to control the drink before it swallows and could cause the drink to go down the wrong way

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Q.  Will speech come back completely?


A.  In some cases people do recover the ability to converse as they did before the stroke. However, in some cases of aphasia a full recovery may not occur. The aim of speech and language therapy is to maximise retained communication abilities while trying to improve speech and language skills in so far as this may be possible. The complicating factors mentioned under the Communication section may affect the recovery of speech and language skills.

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Q.  Can a computer help me to talk?

A.  In some cases communication aids can be helpful. These can be as low tech as a picture or alphabet chart or as high-tech as a computer. How useful these aids are will depend on your needs and abilities as determined by the SLT. Talk to your SLT about what may be suitable before purchasing any equipment.

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Q.  How can I help someone who has communication difficulties?

  • Get the person’s attention by touching their arm or saying their name before you start to talk and make sure you have good eye contact
  • Reduce as far as possible, background noise such as TV or radio
  • Keep your sentences short and uncomplicated but not child-like
  • Keep talking naturally as you would to any other person
  • Allow plenty of time for a response
  • Use all types of communication to help the person follow what you are saying, such as speech, writing, drawing, gesture, and pointing. These strategies can also be used by the person to enable you to follow what they are saying
  • Watch facial expression and body language for clues
  • Repeat important words and write them down to clarify meaning
  • Recap on what you have said to check that the person has understood fully
  • Introduce one idea at a time, using short straightforward sentences
  • Write information down especially important details
  • Don’t interrupt or anticipate what the person is trying to say
  • Encourage the person to ‘talk around’ the word they are looking for, e.g. if the word is ‘pen’, then cues to describe what the object is for, when you use it, size, colour etc. may help word retrieval
  • If you do guess the word or meaning, check back to make sure that you have understood correctly
  • Try to use alternatives or choices to make it easier e.g. Do you want tea or coffee?
  • Sometimes it’s easier to ask questions that just need a Yes/No answer, e.g. Do you want tea?
  • Be encouraging and honest if you don’t understand. Perhaps comments like ‘I know you know what you want to say’
  • Try to get the gist of the message first rather than the particulars
  • Use any communication charts, devices that have been provided by the SLT

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Q. I have aphasia, what helps?

What helps?

  • Take your time
  • Use drawing, gestures, writing as well as speech to communicate
  • Keep a pen and paper with you
  • Reduce distractions such as TV, radio, other noise
  • Ask person to talk slowly so you have time to figure it out
  • Celebrate your achievements in communication no matter how small they may seem
  • Use any aids provided by your Speech & Language Therapist
  • Talk to your Speech & Language Therapist for advice particular to your communication needs

What does not help?

  • Trying to take in too much information at once
  • Worrying about talking perfectly
  • Talking when you are anxious or under pressure
  • Talking when you are tired
  • Persisting with a particular word when a different word might do
  • Being discouraged by bad days, we all have bad days
  • Thinking that you are stupid, you are not stupid, you just have a different way of communicating

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Q.  I have dysarthria, what helps?

What helps

  • Explain to people that you have a speech difficulty
  • Face the person you are talking to
  • Accentuate the movements of your lips and tongue
  • Keep a pen and paper with you to write down what you are trying to say
  • Reduce distractions such as TV, radio, other noise
  • Say the most important information first or the general topic, then fill in the details
  • Place emphasis on the important words in a sentence, as well as on the beginnings and ends of words
  • Watch the listener’s face and repeat yourself if you feel they did not understand
  • Slow down your rate of speech and pause often
  • Use gesture to augment your speech
  • Use any aids provided by your Speech & Language Therapist
  • Talk to your Speech & Language Therapist for advice particular to your communication needs

What does not help

  • Talking at your previous rate of speech, you may need to take more time
  • Worrying about talking perfectly
  • Talking when you are anxious or under pressure
  • Talking when you are tired
  • Persisting with a particular word when a different word might do
  • Ill-fitting dentures, you may need to use special adhesive or else check with your dentist about new ones
  • Being discouraged by bad days, we all have bad days

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