Physical changes

Stroke usually affects one side of the brain. Movement and sensation for one side of the body is controlled by the opposite side of the brain.

This means that if your stroke affected the left side of your brain, you will have problems with the right side of your body. If your stroke affected the right side of your brain, you will have problems with the left side of your body.

Changes that may happen after a stroke on either side of the brain include the following.

Abnormal muscle tone

This is a nerve problem that can make your movements slow and jerky. There are different stages of muscle tone recovery.

• Your arm, leg or joint may be limp and floppy.
• Your arm, leg or joint may move on its own when your muscle tone starts to return. It does not always do what your brain tells it to do.
• Your arm, leg or joint begins to respond to your brain.

Bladder changes

You may have problems urinating or controlling your urine ( incontinence). You might also have a bladder infection.

Bowel changes

Constipation is the most common problem after a stroke. This may be caused by lack of liquids or limited physical activity. Your doctor or nurse can help you regain your regular bowel pattern.

Cognitive problems

You may have problems with memory, thinking, attention or learning. For example, you may have trouble:

• concentrating
• following directions
• interacting with other people
• organizing or prioritizing your day
• making decisions
• understanding what is safe
• problem-solving such as:
  • thinking of all the steps needed to solve problems
  • coming up with other solutions if the first does not work
• doing everyday activities when a routine is changed or stopped
• remembering information or events such as:
  • what someone just told you
  • the current time and date
  • what you have read
  • if you took your medicine

Coordination problems

You may have reduced hand-eye coordination. When reaching for an object, your arm may waver or your hand may overshoot the object.

Dysarthria (dis-AR-three-a)

Dysarthria is a motor speech problem. This means you are not able to coordinate the movement of your mouth to form words or sounds.

It is caused by weakness, lack of coordination, or loss of feeling in your lips, tongue and mouth muscles. You know the right words, but you have problems saying them. Dysarthria may affect your:

• word pronunciation
• voice
• speech rate
• rhythm
• resonance (how deep and clear your voice sounds)
• breath control for speaking

Dysphagia is a swallowing problem usually caused by weakness or loss of feeling in your tongue, lips, throat or palate (roof of the mouth).

It may cause problems with:

• moving food around your mouth
• having food stick in your throat
• coughing or choking on liquids or solids (aspiration)

If you have swallowing problems, you may need to have a video swallow study. 

A member of your health care team will recommend the correct diet for you. He or she may recommend some ways to help your swallowing. These include:

• correct body and head positions
  • Stay as upright as you can.
  • If you are in bed, make sure the head of the bed is as high as it can go.
  • Bend your knees so you will not slide.
  • Put pillows behind your back.
  • Keep your head slightly bent downward. This will keep food and liquid from going into your lungs (aspiration).
• correct food texture
• correct food quantity
• correct feeding utensils and containers 

If you cannot eat or drink by mouth, you will need to get your nutrients by a tube. This will keep food and liquids from getting into your lungs.

• A nasogastric feeding tube is passed through your nose and esophagus to your stomach. This will be used for short-term tube feedings.
• A gastrostomy tube is put through your abdominal wall into your stomach. This will be used for long-term tube feedings when your recovery is slow.

The dietitian will suggest which tube feeding product will fit your schedule. Members of your health care team will closely watch your tube feeding for any problems or adjustments.

Your ability to swallow may return during recovery.

You will receive updates on your progress.

To reduce your risk of choking during your recovery:

• Check with your doctor if you cough when you swallow.
• Do not try to stop a cough. A cough is your body's natural protection against choking.
• Stop eating if you cannot stop coughing or if you cannot clear your airway. Call 911 right away.
• Drink thickened liquids to slow down coughing or choking. Gelatin, pudding powder or potato flakes can thicken liquids. The texture of food and the utensils you use will affect your ability to swallow.
  

Emotional changes

Please see the section on emotional effects.

Endurance problem

You may find you are unable to do a task or activity for a long period of time. This should get better as you get stronger.

Fatigue

Fatigue is a feeling of tiredness that can keep you from doing the things you normally do or want to do. It is common to feel tired more quickly after a brain injury. You may need more sleep or rest.

Fatigue may cause you to:

• be unable to do a task or activity for a long period of time
• need more concentration or effort to do things
• feel more tired when you are stressed or anxious

You may also have more trouble with coordination, vision, speech, movement, controlling your emotions or other problems when you are tired.

Hemiparesis (hem-ee-par-Ee-sis) or Hemiplegia (hem-ee-PLEE-ja)

You may have weakness, partial or complete paralysis of one side of your body or just one arm or one leg.

• If the stroke was on the left side of your brain, the right side of your body will be affected.
• If the stroke was on the right side of your brain, the left side of your body will be affected.
  

Impulsivity

You may act without planning ahead.

Judgment

You may not know your own limits. You may act without thinking about the consequences of your actions. You may misinterpret situations. You may be unable to judge, problem-solve, organize, use "abstract" reasoning skills or all of these.

Memory problems

You may have poor memory. This may lead to problems retaining, blending and recalling information.

Sensation changes

You may have numbness or loss of feeling in different parts of your body. This may cause you to have trouble knowing where you place or how you position a part of your body (such as your hand or foot).

Sexuality concerns

It is rare that a medical concern would keep you from sexual activity. Fear may keep you from being intimate with your partner. You may feel anxiety about:

• how you look
• changes in your relationship
• rejection

Talk with your partner about how you feel. Talk about how the two of you can become close and tender again. Talk with your doctor if you are having intimacy concerns.

Vision changes

You may ignore or not be able to see anything toward your right. You may only eat from the left side of your plate or read from the left side of a page.