The impact of a stroke can be barely noticeable after swift and successful treatment. However, there are some processes which can bring lasting consequences and which represent new challenges for those affected and their relatives.
Stroke is the most common cause of acquired disabilities in adulthood. It can sometimes cause interference in daily life. For example, it can lead to aphasia which does subside gradually, but it can also have more severe effects, like with Detlev Feierband.
A couple of years ago, the now 60 year old was a lively, successful professional. He had set up his own practice for homeopathy and psychotherapy, was involved with environmental protection, and travelled through southern Europe in his free time. “I always had the feeling that I could achieve what I wanted”, Feierabend remembers.
Until a stroke changed his life completely. The left half of his Feierabend’s body remains paralysed. From then on he is in an electric wheelchair most of the time, and is dependent on carers.
The private and professional ramifications
Due to the paralysis and the loss of his left-sided field of vision, Feierabend cannot ride a bike or drive a car. Housework, gardening, and repairs are things of the past. To take part in a discussion or to concentrate on one task for an hour is still difficult for him today. “That’s why I had to give up my practice and with it my professional existence”, says Feierabend.
“Paralysis is a typical impairment after a stroke”, explains Dr. Christian Nolte from the Charité hospital in Berlin. Nolte is a senior physician of a regional stroke unit and also works at the Centre for Stroke Research in Berlin. “Generally, the dexterity of the hands and legs suffers. That leads to the patients no longer being able to walk independently or dress themselves independently”, describes Nolte.
There are many possible consequences of a stroke
“But just as the functions of the brain are diverse, so too are the limitations after a stroke”, explains Nolte. “Common examples are feelings of deafness, speech difficulties, limitations to the field of vision” - as happened to Detlev Feierabend. But a stroke can have not only physical effects.
“Stroke is also commonly associated with personality changes such as apathy, resignation, depression, compulsive crying, or sudden outbursts of rage”, says Prof. Wolf-Rüdiger Schäbitz. He is a senior consultant at the clinic for neurology at the Evangelical Hospital in Bielefeld, Germany, and Regional Commissioner at the German Stroke Aid Foundation.
“Many of the ramifications are temporary and subside after a few weeks or months at the latest. But some deficiencies can last over years or permanently, depending on how severely the brain has been damaged”, says Schäbitz. It is also relevant which area of the brain is damaged by the stroke. “Very minor damages can trigger quite large impairments if they affect important areas. But similarly, greater damages can remain unnoticed if they are localised to less vital brain regions”, explains Nolte.
The other brain regions take over new tasks
If and when the damage subsides depends on the so-called plasticity of the brain. This refers to compensatory mechanisms through which tasks in the brain are redistributed and brain regions take over new roles, i.e. learning new duties. “While plasticity is greater at younger ages, it is still available in older age too”, Nolte adds.
What can those affected do after a stroke to retrieve the abilities they’ve lost or to reduce the effects? “A vital first step is rapid emergency care, ideally at a specialised stroke unit. Because the earlier the treatment is introduced, the fewer the long-term consequences”, says Schäbitz. Extensive rehabilitation measures should also be introduced in the stroke unit, which can be followed by further rehab.