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Stroke Q&As

Published by Bupa's health information team, December 2008.

Answers to questions about stroke

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

If I think someone is having a stroke what should I do?

If you think that someone is having a stroke, you should call for an ambulance straightaway. By getting help quickly you can help to ensure that the person has the best chance of making a full recovery. A simple test to check for weakness in the face and arm and difficultly speaking can help you to spot the symptoms of a stroke.

Explanation

A stroke is a medical emergency, so if you think that someone is having a stroke you need to act quickly. Think of a stroke as a brain attack, as serious and life-threatening as a heart attack. If you thought someone was having heart attack you would call an ambulance or get help straightaway. It's important that you do the same if you think someone is having a stroke.

Having emergency medical treatment within three hours of having a stroke means that you're more likely to make a full recovery. The right treatment early on also helps to prevent the stroke from getting any worse and more brain cells being damaged. For every minute that a stroke goes untreated, your brain loses almost two million of its nerve cells, which are vital for your body to function properly.

Many people find it difficult to recognise when someone is having a stroke. In fact, only around two in five people know the symptoms of a stroke and just one in three would call an ambulance or go to hospital. To help us recognise when someone is having a stroke, a simple test called FAST has been developed. FAST stands for Face, Arms and Speech Test and it can help you to spot the key symptoms of stroke. If you think that someone has had a stroke, test for the three symptoms listed below.

  • Facial weakness - have a look at the person's face to see whether the muscles at the corner of his or her eyes or mouth have drooped. Ask the person to smile so you can see whether there is any weakness in his or her face muscles.
  • Arm weakness - take hold of the person's hands and raise his or her arms up until they are stretched out in front of them. Then ask the person to keep their arms raised while you let go of his or her hands. Look to see whether there is any weakness in one arm or whether either arm drops back down to his or her side.
  • Speech problems - ask the person to speak to you, ask their name, for example, and where they live. Check whether the person's speech is slurred, whether he or she has trouble understanding you or you have difficulty understanding them.
  • Test all three of the symptoms. If the person fails one or more of these tests dial 999 straightaway and ask for an ambulance.

Sometimes people can have the symptoms of a stroke but they only last for a short time. For example, as well as the symptoms listed above you might feel dizzy, have blurred vision or be confused but within a few minutes or hours your symptoms have gone. This is called a transient ischaemic attack, or TIA for short, and is a 'mini stroke'. It's important not to ignore it, as often a mini stroke can lead to a full stroke. See your GP as soon as you can and ask to be referred to a specialist stroke service.

Further information

Sources

  • Suspect a stroke? Act FAST. The Stroke Association. www.stroke.org.uk, accessed 28 May 2008
  • Stroke management. Clinical Evidence. www.clinicalevidence.com, accessed 28 May 2008
  • 10 Things you should know about stroke. The Stroke Association. www.stroke.org.uk, accessed 28 May 2008
  • National stroke strategy. Department of Health. www.dh.gov.uk, accessed 28 May 2008
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After a stroke will I recover and be able to get back to my normal life?

Every stroke is different, which means that everyone's recovery is different. In the first few weeks and months after a stroke many people do recover the functions and abilities that they had lost, and recover completely. However, some people find the process of recovery takes much longer and others may never completely recover. A rehabilitation plan can help you to regain as much of your independence as possible.

Explanation

Recovery from a stroke is different for each person. Around half of people who have a stroke will have some kind of disability six months after the stroke happened. Around two in five people recover from their stroke completely. It's important to remember that stroke isn't just a brain disease - it can affect everything that you do and can also have a major impact on your family and friends. It's also a complicated condition that affects each person differently.

Recovery usually happens in two stages. Straight after a stroke, the cells around the area in the brain where the stroke happened swell and become inflamed. This affects the way your brain cells work and can take a few days to start to heal and improve. As the swelling and inflammation start to go down, you will recover some of the functions you have lost. In some areas of your brain the cells will also start to take over the role of those that have lost their function.

The second stage of recovery is about adapting your day-to-day life so that, as much as is possible, you can get back to your life before your stroke. This may mean re-learning some skills, getting the right support for you and your family and learning some new skills that will help you to become as independent as possible.

On average, recovery from a mild stroke takes about eight weeks, whereas the average length of recovery for a severe stroke is more like 17 weeks. However, there are no hard and fast rules. Many people get back much of the function and abilities that they lost during their stroke within the first weeks and months, but for other people this process can take much longer. Unfortunately some people become permanently affected by their stroke and never get back all of the functions they have lost.

How well you recover from a stroke depends on many things, some of which you have control of and some of which you don't. The main factors are as follows.

  • Where the stroke is. The left-hand side of your brain controls the right-hand side of your body and the right-hand side of your brain controls the left-hand side of your body. For example, a stroke that happens in the right-hand side of your brain might cause weakness in the left side of your body. Different parts of your brain also control functions such as speech, memory, sight and movement. So, where your stroke is in your brain will decide what kind of symptoms you have. How big the stroke is and the size of the area in your brain that is damaged will also affect how severe the symptoms are and whether or not they are permanent.
  • The kind of stroke you had. Stroke can be caused by a bleed or by a blocked blood vessel. In general, if you have a stroke caused by a small bleed you're more likely to get back your independence than someone who has a stroke caused by a blocked blood vessel.
  • Your treatment. The sooner you have treatment after your stroke, the better your chances of a full recovery. Research now also shows that you're likely to have a better recovery if you're cared for in a ward that is specifically designed for people who have had a stroke. For example, if you're cared for in a specialist stroke unit in hospital, you're more likely to be independent and living at home a year after your stroke than someone who had care in a general medical ward. Many hospitals now have a specialist stroke unit so if you aren't in one, ask if you can be moved.
  • The part you play. Your recovery goes on 24 hours a day, not just when you're having a treatment, such as physiotherapy. You can do a lot to help your recovery by putting into practice what you have learned from your therapy sessions, by doing the exercises and activities you have been asked to do and by putting as much into your rehabilitation as you can.

Further information

Sources

  • Stroke management. Clinical Evidence. www.clinicalevidence.com, accessed 28 May 2008
  • Stroke prognosis. GP notebook. www.gpnotebook.co.uk, accessed 28 May 2008
  • Young J, Forster A. Rehabilitation after stroke. BMJ 2007; 334:86-90
  • Stroke: a guide to your recovery. Chest, Heart & Stroke Scotland. www.chss.org.uk, accessed 28 May 2008
  • Recovery and rehabilitation. The Stroke Association. www.stroke.org.uk, accessed 28 May 2008
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What happens during rehabilitation?

Rehabilitation is the process of overcoming the damage from your stroke, learning to cope with the changes to your life and recovering as much independence as possible. Rehabilitation is different for everyone and is planned around your individual needs. Depending on how you're affected by your stroke, you may need one or more different treatments and therapies, such as physiotherapy and speech and language therapy. As well as having these therapies, there is lots that you can do yourself to help your recovery.

Explanation

Rehabilitation is about overcoming the damage that your stroke has caused and learning to cope with any changes this has made to your life. If your stroke is mild then you may not need rehabilitation, whereas if your stroke is more severe your rehabilitation could take weeks, months or years. Your rehabilitation will start in hospital and carry on when you leave.

Everyone's rehabilitation is different because everyone's stroke is different. What you will need could be very different from what another person may need. Throughout rehabilitation your progress will be continually assessed to make sure you get the right help at the right time. An individual rehabilitation plan will be developed with you and your family with goals that you can work towards.

Your brain controls everything your body and mind does, so when it becomes damaged you may find that the way they function could change. For example, you might have trouble moving or swallowing, or you might find that you have problems understanding or thinking. You're also likely to have more than one problem, for example weakness on your left-hand side and difficultly speaking. Rehabilitation can help you to:

  • regain the abilities you have lost
  • find ways to cope with any new disability
  • manage your day-to-day needs such as washing and eating
  • find the support you need to help you when you go home

Depending on how you're affected by your stroke, you may need one or more different therapies and treatments. These therapies and treatments are usually given by specialists such as physiotherapists, occupational therapists and speech therapists. Therapy often starts while you're in hospital and carries on in the community when you go home. These therapies can help with your physical and mental recovery from your stroke. They can also help you to recover emotionally and socially by putting you in touch with other people who have had a stroke and by helping you to deal with practical problems, such as getting back to work and managing your finances. Not all of the therapies and services are provided by the National Health Service (NHS), some are run by voluntary and community organisations.

Some of the main areas where you might need therapy or treatment are as follows.

  • Speaking, writing and understanding. About one in four people who have a stroke will have problems communicating. This means that you could have problems speaking, reading, writing and understanding. A speech and language therapist can help you to overcome these difficulties.
  • Moving and walking. Stroke can cause problems with movement and walking as well as with balance and coordination. Physiotherapy can start very soon after a stroke and, by using exercises and massage, can help to keep your muscles and joints working properly. Your physiotherapist can help you to sit up, balance and coordinate your muscles. If you're able to, he or she can help you to start standing and walking - working to help you become independent and active again within your limits. This is a gradual process that helps you to build up your strength and confidence.
  • Day-to-day living. Because a stroke can affect movement, coordination and other areas such as your memory and thinking, sometimes day-to-day tasks such as washing, dressing and eating can become difficult. An occupational therapist can help you to get back as much of your life before your stroke as possible. For example, he or she can help you to learn new skills, adapt to your new circumstances and abilities, prepare to go back to work and improve your memory and concentration. An occupational therapist can help you to be safe, for example helping you to shave without cutting yourself. He or she can also arrange for your home to be adapted if you need it.
  • Using the toilet. Having problems controlling your bladder and/or your bowels is quite common after a stroke. You might feel that you want to go to the toilet more often or very urgently, and sometimes you might not manage to get to the toilet on time. Most people find that this gets better after a few weeks. However if it doesn't, you may need help from a specialist continence adviser, physiotherapist or an occupational therapist.
  • Eating and drinking. Finding out whether you can swallow is one of the first tests carried out after you have had a stroke. If you do have problems swallowing, a speech and language therapist can work out what you may be able to eat and drink and can teach you how to swallow food and drink safely. The biggest risk to you if you can't swallow properly is that you will aspirate, which mean that instead of going into your stomach, food or drink goes into your windpipe. This can cause you to choke and cough.
  • Sight and your senses. Stroke can affect your sight. It can cause blurred or double vision and also partial loss of your sight. Some people find that they can only see the left- or right-hand side of objects and people. This can cause problems with balance and coordination. It can also be difficult to recognise familiar objects and people, which can be distressing. An eye specialist can show you exercises that will help and provide you with glasses and other aids if you need them. As well as affecting sight, a stroke can also affect the sensations you feel in your body. For example, you might feel hot and cold or get tingling and pins and needles. Physiotherapy may help to ease these symptoms.
  • Your emotions and feelings. Stroke can have an enormous impact on your mental wellbeing and your emotions. You might feel anxious, upset, frustrated and angry. You might also find that you have sudden and strong mood swings or you go on to develop depression. Almost everyone who has a stroke also feels very tired, and it can take months for your energy levels to return to what they were before your stroke. All of these things can make recovery and rehabilitation even tougher. So it's vital that as part of your treatment, you look after your mental health and wellbeing. Talk to your doctor or nurse about how you're feeling and ask for help and advice when you need it. Your doctor may refer you to a clinical psychologist to help you cope with your recovery.

It's natural to feel depressed and frustrated after your stroke and it's easy to give into negative thoughts. Remember though that you're the most important person in your recovery. The more you put into it, the better your chances of a good recovery.

Here are some suggestions that may help:

  • think positive and focus on what you want
  • be realistic about your goals and what you think you can achieve
  • do practise the exercises and the tasks you have been given, but don't overdo it - a few short periods of exercise each day are better than one long one
  • keep in mind that your recovery may be gradual and be persistent
  • get help when you need it but try to do as much as you can for yourself - some tasks may seem like they are taking forever, but the more you can for yourself the more independent you will become
  • understand why you have been asked to do certain exercises and tasks - it will help you to stay motivated

Further information

Sources

  • Care after stroke and transient ischaemic attack: information for patients and their carers. Royal College of Physicians/The Stroke Association. www.rcplondon.ac.uk, accessed 30 May 2008
  • Stroke: a guide to your recovery. Chest, Heart & Stroke Scotland. www.chss.org.uk, accessed 30 May 2008
  • National Stroke Strategy. Department of Health. www.dh.gov.uk, accessed 28 May 2008
  • Helping rehabilitation. The Stroke Association. www.stroke.org.uk, accessed 30 May 2008
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Why does a stroke usually only affect one side of the body?

Common symptoms of a stroke are numbness, weakness or paralysis on only one side of your body. Which side of your body is affected depends on which side of your brain has been damaged by the stroke.

Explanation

Different parts of your brain control different parts of your body. The right-hand side of your brain controls the left side of your body and the left-hand side of your brain controls the right side of your body. So, a stroke which affects the blood supply to the left-hand side of your brain will cause symptoms such as weakness on the right side of your body. A stroke affecting the blood supply to the right side of your brain will cause symptoms on the left side of your body.

If the only symptom you have after a stroke is weakness on one side of your body, the stroke has probably only affected a small area of your brain that controls movement. If the stroke has damaged a different area of your brain, other things such as your language and perception skills may be affected.

Further information

Sources

  • What is a stroke? Common symptoms. The Stroke Association. www.stroke.org.uk, accessed 11 August 2008
  • What is a stroke? Damage to the brain. The Stroke Association. www.stroke.org.uk, accessed 11 August 2008
  • Lindley DR. Understanding stroke. Family Doctor Publications in association with the British Medical Association, 2002: 6, 7, 59, 60
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Will I be able to drive after having a stroke?

You won't be allowed to drive for one month after you have had a stroke. After one month has passed your doctor will decide whether or not it's safe for you to start driving again.

Explanation

Having a stroke can affect your vision, coordination, concentration and the way that you move. For these reasons it may not be safe for you to drive. You won't be allowed to drive for one month after you have had a stroke or a transient ischaemic attack (TIA). After one month your doctor will decide whether your symptoms have improved enough to make it safe for you to start driving again.

If your symptoms have lasted for over a month, your doctor may decide that it's still unsafe for you to drive. If this is the case then you will need to inform the Driver and Vehicle Licensing Agency (DVLA). The DVLA will make a final decision as to whether or not it's safe for you to start driving again. You will usually be asked to fill in a questionnaire and your doctor may be asked for further information about your condition.

The DVLA may take several months to make a decision. If they decide that it's unsafe for you to drive, you may still be allowed to start again sometime in the future. If your condition improves then you can re-apply for your licence, but you shouldn't begin driving again until your licence has been re-issued.

You must always inform your insurance company of your condition and let them know of the decision that the DVLA have made.

Further information

Sources

  • Lindley DR. Understanding stroke. Family Doctor Publications in association with the British Medical Association, 2002: 6, 7, 59, 60
  • Driving after stroke. The Stroke Association. www.stroke.org.uk
    • , accessed 11 August 2008
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: December 2008

 

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