Module 5: Deficits and health problems after a stroke

Introduction

In Module 4, we discussed the brain’s recovery attempts after a stroke. However hard the brain attempts reverting to its pre-stroke functional level, it cannot regain everything lost; some of them will, however, reappear with time – mostly within the first six months post-stroke. Regaining the lost functions with time follows a non-linear trajectory as we learned in module 4. The rest will persist – as deficits – sometimes permanently.

And, new health problems such as pain and depression will also arise.

This module will look at the pre-stroke functions that may lose – called deficits hereafter – and the new health problems that are likely to develop. At the end of this module, you will be able to describe what those are and explain its relationship with the stroke attack.

The deficits directly related to the damaged brain locations.

brain lobes (Image source: University of Utah); link: https://library.med.utah.edu/kw/hyperbrain/figures/2a.htm
Brain lobes

5.1. Deficits that occur due to the Frontal lobe damage

When the ischemic stroke attacks occur due to a block in the middle cerebral artery, one of the commonest sites, cells of the motor homunculus dies. As a result, it will not be able to do its job; sending commands to muscles that move body parts starting from the eyelid, facial and mouth muscles, arm, and leg. As we now know that mostly, but not always, a stroke strikes one side of the brain, the deficit appears on the opposite side of the body. Depending on the extent of the damage, deficits can range from mild weakness to complete paralysis of one side of the body. Consequently, those affected will face the following difficulties.

  • Movement difficulties
  • Swallowing difficulties
  • Speech difficulties
Movement difficulties

Movement problems are one of the most visible deficits that occur due to a stroke. The deficit could range from mild weakness to complete paralysis of one side of the body – from one side of the face, mouth, arm, or leg. For example, if the weakness is on the right side, the damage is on the left precentral gyrus in the brain and vice versa.

If the parietal lobe involves, the movement difficulties that may arise from the Frontal lobe damage, it can result in difficulties in maintaining posture and balance also. In a combination with these difficulties, walking becomes the greatest challenge.

Swallowing difficulties

This is also a common as well as serious problem since the affected individual can get choked with food.

Speech difficulties

The speech difficulties that occur due to the Frontal lobe damage will be discussed under 5.4. – language deficits.

5.2. Deficits that occur due to the Parietal lobe damage

Sensory disturbances

When the Parietal lobe’s post-central gyrus is affected, the affected person cannot feel touch, pain, as well as temperature. Following are the difficulties they face.

  • Inability to feel touch, pain, and temperature
  • inability to sense how the body is positioned
  • Inability to recognize objects that they are holding
  • Pain, numbness, and altered – tingling or tickling – sensation on the affected side, arm, or leg
  • neuropathic pain – due to damage to the thalamus
  • The heaviness of the affected arm or leg

5.3. Deficits that occur due to the Temporal lobe damage

The prominent deficit due to the Temporal lobe damage is to verbalizing thoughts through either speaking or writing. This occurs due to the damage in the Wernicke’s area of the lobe.

5.4. Language deficits (impairments)

Language deficits range from mild impairment to complete loss. The nature of deficit/s depends on the damaged area/s. The common language deficits are Broca’s aphasia, Wernicke’s aphasia, etc.

Broca’s aphasia

As the name itself implies, this language deficit results from the death of neurons in Broca’s area that situates on the Frontal lobe. It impairs expression either by speaking or writing; hence the name, “expressive aphasia”. However, if the Wernicke’s area is not affected, they can understand concepts but are unable to formulate grammatically correct sentences according to the National Institute of Neurological Disorders and Stroke.

Wernicke’s aphasia

As its name implies, this language deficit results from the death of neurons in the Wernicke’s area that situates in the Temporal lobe. In this type, those affected cannot understand the concepts, which others express either by writing or talking. Their communication is incoherent. The National Institute of Neurological Disorders and Stroke says that their expressions, although grammatically correct, have no meaning.

Speech problems
  • Loss of expressing thoughts and feelings: they lose the ability to translate their thoughts and feelings into speech or writing language
  • Difficulty in understanding spoken or written language and incoherent speech; they can make grammatically correct sentences but no meaning.
  • Some can have the above difficulties together.

5.4. Mental, psychological, and cognitive deficits

After a stroke, a range of mental, psychological, and cognitive deficits may persist after initial recovery. It includes the following elements;

Difficulties in thinking and memory
  • Deficits in short-term memory
  • Difficulty in following instructions (apraxia)
  • Loss of ability to respond to objects or sensory stimuli on the affected side
Emotional problems
  • Fear, anxiety, sadness, anger, frustration
  • Personality changes

5.5. Loss of bladder and bowel control

Another distressing problem is the loss of bladder control. However, the good news is that it can successfully be managed with proper knowledge and an easily acquired skill set. This will be discussed in a later module.

5.6. Pain

Researchers report pain as one of the commonest but under-recognized post-stroke problems. Those who live with a stroke report pain referring to any part of the body from head to toe.

Pain’s origin seems to be manifold; it can occur due to a stroke damage to the Parietal lobe, brain structures deep inside the brain – thalamus and pons, and due to “frozen” joints.

Pain as a result of “frozen” joints

The National Institute of Neurological Disorders and Stroke describes this pain occurs due to the non-use of joints for some time. This non-use leads to freezing tendons, ligaments, and muscles that assist in moving that particular joint.

Neuropathic pain

According to the experts in this field, those who experience this type of pain describe it as using these words: lacerating, aching, freezing, burning, and squeezing. They also may complain of pain even to just touching.

Although less common, this type of pain occurs as a result of the damage to structures deep inside the brain such as the thalamus and pons. Therefore, it is also called “thalamic pain syndrome”. Our sensory information from body parts to the brain transmit via the thalamus.

Spasticity-related pain

After a stroke, some develop spasticity in which the affected exhibit uncontrolled exaggerated movements. Experts say that two-third of them complain of pain and the majority of those who do not develop spasticity do not complain of pain.

Shoulder pain

Research reveals that shoulder pain is a common problem after stroke and may occur due to more than one reason including muscle weakness around the shoulder joint; however, pain most often appears with the development of spasticity. Prevention is the key. Experts advocate beginning physiotherapy “as soon as the patient is medically stable”.

This is only an introduction.

Please help us to fill the gaps in this post; add yours in the comments section.

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Author: Prasantha De Silva

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