Professional advice
General Advice Q1: Will I have another stroke?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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People often ask whether I’ll have another stroke. So after a stroke, you are at slightly higher risk of further stroke. But it’s important to remember that most people don’t go on to have a further stroke. The risk of reoccurrence is highest in the first few weeks after a stroke, and the risk reduces with time. Overall, around 1 in 4 stroke survivors will have another stroke in the first 5 years after their stroke. But again, I think it’s important to emphasise that most people won’t go on to have a further stroke.
General Advice Q2: How can I prevent another stroke?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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What are the things that people can do to prevent another stroke? Really, everybody probably knows these things. It’s living a health lifestyle. It’s reducing what we call your vascular risk factors. So things like smoking, high blood pressure, if you have diabetes – making sure it’s well controlled, making sure your cholesterol is good, exercising regularly and eating a healthy diet
General Advice Q3: Will I get back to normal?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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Will I get back to normal again, after my stroke? Recovery after stroke can be variable. It depends on many factors, including your age, your medical history, and of course the type, size and location of your stroke. You should talk to your own Doctor or Stroke Team about your individual prognosis. In my experience, many people do make a good recovery after stroke. Some people can get back to normal after a few days. In others the the recovery process can take weeks and even months. But most people do make a good recovery after stroke.
General Advice Q4: Will I get all my recovery in the first 6 months after stroke?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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People have said I’ll get all my recovery n the first 6 months. Is that right? While many people do improve over the course of the first 6 months after stroke, just because you haven’t got back to normal after 6 months doesn’t mean that improvement will not continue to come. Improvement after a stroke can continue for a long period of time. I’ve seen people continue to improve after 1 year, 2 years – I’ve even had a man who got back to walking after 3 years. The more effort that you put into it, if you continue to try and improve, there’s always potential for improvement no matter what the timeframe is after a stroke.
General Advice Q5: I feel tired all the time - is this normal?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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I feel tired all the time – is this normal? Fatigue after stroke is a very, very common finding. It can occur after any type of stroke; large or small. It can have many causes and contributing factors. So it’s a good idea to talk to your Doctor or Therapist to see if any specific cause can be identified and treated. Fatigue often will improve with time. It is slow to lift, but should lift after a period of weeks and months. A minority of patients will have fatigue after one year. Gentle exercise and slowly building up the amount of activity that you do can help the fatigue to lift. Again, I’d emphasise that with most patients, fatigue does lift with time.
General Advice Q6: I feel quite low after my stroke - is that normal?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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I feel quite low after my stroke – is that normal? Feeling down after a stroke is quite common. It’s important that you speak to your Doctor, your Stroke Team and also your friends and family about that. Certainly talking about these issues can be quite helpful. It’s important to focus on the positive things about your recovery after a stroke and to maintain your motivation to try and improve.
General Advice Q7: I have issues with continence - who can I speak to?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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I have issues with continence – who can I speak to about this? Ok so bladder and bowel problems are very common after stroke. Often they will improve after the first few weeks after stroke, but some people may experience problems in the longer term. The most important thing to do is to seek help – don’t keep it to yourself – because there are effective treatments available. Talk to the Stroke Team who can advise you. Stroke Teams often have a nurse who is a specialist in continence and there are other services that you can potentially be referred to; a continence advisor or continence service, where they can do further tests to try and identify exactly the type of problem you have and then advise on what treatments may be available.
General Advice Q8: Should I be monitoring my blood pressure?
David Wilson is a Consultant Stroke Physician working at the South Eastern HSC Trust.
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Do I need to check my blood pressure regularly now that I’ve had a stroke? High blood pressure is the biggest, modifiable risk factor for stroke, so it’s really, really important that you get your blood pressure checked regularly. After a stroke, your Doctor should tell you what your target blood pressure is. For a lot of patients the target blood pressure is 130 over 80. but it may vary for various reasons. I often advise my patients to buy a home blood pressure monitor if they can. You don’t need to be too obsessed with checking your blood pressure; maybe check it once every few months if it’s generally on target. Or more frequently, if you’re readings are above your target. You should keep a diary of your readings if you can as this will help your Doctor make more informed decisions around your treatment. It’s important to remember that treating blood pressure is more than just medications – diet, lifestyle and exercise can all help your blood pressure.
Speech and Language Q1: Is it common to have swallowing problems following a stroke?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Yes, it is common. About half of everyone who has a stroke will have some swallowing difficulties in the first few weeks of their recovery.
Speech and Language Q2: I'm having problems swallowing and I've been told that I need to be on a puree diet and thickened fluids. Will this always be the case?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Hopefully not! Usually, people’s swallowing recovers quite quickly after a stroke and having modified food or fluids such as a puree diet or some thickened fluids is most often a temporary measure to compensate for those difficulties as your swallow recovers. There are factors that might mean that your swallowing takes a bit longer to get better, or doesn’t get better at all. That depends on where the stroke has happened in your brain and any other symptoms you might have, for example – cognitive difficulties – so things to do with your awareness and understanding.
Speech and Language Q3: Are there exercises I can do to improve my swallowing in the same way that I can do exercises to improve my leg or arms?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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The best therapy for swallowing is to swallow. So if you are having something to eat and drink – even if its only small amounts, even if it is puree and thickened fluids – that is the best exercise for your swallow. But sometimes a Speech and Language Therapist might prescribe specific exercises for your swallowing muscles in the same way that you might be prescribed something like that for your arm or leg, and these are usually done after an x-ray of your swallowing to really identify exactly where the difficulties are, so those exercises can be targeted appropriately.
Speech and Language Q4: If I think that I might be struggling with my swallowing, are there better food or drinks for me to have?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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I think that if you think your’e struggling with your swallow, then it’s probably a very good idea to get an assessment from a Speech and Language Therapist. But you can have a go and have a think about what you might think is easier because probably when the Speech and Language Therapist when they come, will ask you what you’ve tried and what has helped and what hasn’t helped. In general, softer, moister foods are easier but it’s always a good idea if you think you’re struggling with your swallowing to get the Speech and Language Therapist around to have a look.
Speech and Language Q5: I understand everything that somebody says to me, but when I try to respond I have problems expressing my words properly. Is this common after a stroke?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Yes, it is common after a stroke. About one third of people who have a stroke will have difficulty expressing what they want to say, especially if their stroke is on the left side – and that’s very common. It can get better; so as your brain heals from the stroke on the inside, the symptoms you have on the outside – you’ll notice improvement there. Lots and lots of practice helps and day-by-day expressing yourself can get easier and easier as you learn new ways around your difficulties as well. So, just finding different ways to communicate, such as using gesture or mime, writing things down if that’s easier, doing some drawings – just finding any other way you can get your message out or indicating to your listener or conversation partner what it is you want to say.
Speech and Language Q6: I have problems understanding what people say to me. Is this common and will it get better?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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So it is common to have difficulties in understanding what others say to you after a stroke. Difficulties understanding can make getting better after a stroke a bit more challenging, because ti makes it more difficult to follow instructions and understand what people are telling you about this new condition that you have. But Speech and Language Therapists have a very important role in helping others communicate better with you and helping others make it easier for you to understand. I think it’s important to remember that communication is everybody’s responsibility.
Speech and Language Q7: I'm having problems with writing following a stroke. Is this common and will it get better?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Problems with writing, again are very common after a stroke. You may have difficulties writing because the hand that you use to write with has been affected by your stroke and you have to learn to use your other hand, which is difficult. But then there are problems with writing that are similar to the problems you can experience with talking and that’s got to do with how the stroke has affected the part of your brain that helps process language. You might notice when you go to write something that you get your letters mixed up, or you write something that you didn’t mean to write or an unrecognisable word. As with everything after stroke, this can get better – especially with lots and lots of practice. Also, some people find regular software programs – things like spellcheck or predictive text – useful.
Speech and Language Q8: People have said that I speak very quietly. Is this common and is there anything I can do to fix this?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Yes, this is common. There are some simple things that you can think about when you’re speaking with other people. Some simple environmental changes like removing background distractions, turning off TV/radio and making sure that you’re face to face with the person that you’re speaking to. Sometimes it’s about asking the other person to put their hearing aid in if they use one, for example. There can be specific things that your Speech and Language Therapist might suggest for you to do, such as maybe talking in shorter chunks/shorter phrases. Sometimes they might even suggest specific exercises to strengthen your vocal chords as well. They may even suggest using some kind of amplification device if it’s particularly challenging, say on the telephone.
Speech and Language Q9: My speech sounds slurred and when I'm out and about, people often think I'm drunk. Is this common and is there anything I can do to help this?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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It is common and lots of people say actually that if you’re meeting somebody new or somebody for the first time then it’s really, really helpful just to let them know straight away that you’ve had a stroke and that your speech sounds a bit different. Most people say they get very positive responses from the other person who tends to just ‘turn their ears on’ a little bit more and that might mean that you don’t have to actually change anything about the way you speak, because your listener is just being a bit more attentive. There are some changes that you can make to help your speech sound a bit more clear and that can be things like just slowing down or exaggerating your mouth movements a little bit more.
Speech and Language Q10: I'm feeling anxious about my communication. Is there anything I can do to help with this?
Lucy Maran is a Speech and Language Therapist, who has worked in Acute and Community Stroke Services. A Speech and Language Therapist is someone that helps people with their speech, language and general communication following a stroke, as well as swallowing.
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Absolutely. Firstly, just be aware that it’s entirely normal to feel anxious if you have a communication difficulty and everybody feels anxious. I think it’s about taking very small steps and setting yourself little, smaller targets to challenge yourself and it might be making a phonemail to somebody you know well, if phonically are difficult. It might be encouraging yourself to actually talk to the shopkeeper when you go into a shop for example. But it’s about taking those small steps and building them up and reflecting on your successes really and what went well – because most people have a tendency to do the opposite. But it’s about feeling proud of yourself because living with a communication difficulty is a tall order and every time you communicate with somebody you should give yourself a good pat on the back!
Occupational Therapy Q1: I'm having issues getting washed and dressed after my stroke. Is this something you can help with?
Sha Vawda is an Occupational Therapist specialising in Stroke Rehabilitation; predominantly in the community setting. Occupational Therapists looks at your activities of daily living and how you manage them. They work to encourage independence and support people to be as functional as possible.
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Absolutely. Firstly, just be aware that it’s entirely normal to feel anxious if you have a communication difficulty and everybody feels anxious. I think it’s about taking very small steps and setting yourself little, smaller targets to challenge yourself and it might be making a phonemail to somebody you know well, if phonically are difficult. It might be encouraging yourself to actually talk to the shopkeeper when you go into a shop for example. But it’s about taking those small steps and building them up and reflecting on your successes really and what went well – because most people have a tendency to do the opposite. But it’s about feeling proud of yourself because living with a communication difficulty is a tall order and every time you communicate with somebody you should give yourself a good pat on the back!
Occupational Therapy Q2: I'm worried about how I'm going to prepare food for my family. Is this something you can help with?
Sha Vawda is an Occupational Therapist specialising in Stroke Rehabilitation; predominantly in the community setting. Occupational Therapists looks at your activities of daily living and how you manage them. They work to encourage independence and support people to be as functional as possible.
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Absolutely. Again, it’s one of the areas of your activity of daily living. So whether it’s breakfast, lunch or supper, it might be that you’re a very social person who loved preparing and having friends over and creating huge meals. As I said, it might be that you have one upper limb that’s not as functional as it was before or it might not have no movement at all, or it might be that you have problems with balancing and standing because your lower limbs are affected. Again, we can work on ways together. So for example, if your hand or upper limb is affected, we can look at getting a specialist type of knife that could change the grip and facilitate you holding that a bit better. We could look at a different type of chopping board; one which maybe has built up edges that allows the contents of the food the you’re chopping to remain on the board, or even something – a board – with spike that you can skewer your onion on whilst you chop it. Different bits and pieces that sort of are quite logical and easy to fix, but people don’t often think about it. So it’s not rocket science, but it’s just those little tweaks that make things easier – we look at lots of adaptive equipment.
Occupational Therapy Q3: Will I be able to return to work after my stroke?
Sha Vawda is an Occupational Therapist specialising in Stroke Rehabilitation; predominantly in the community setting. Occupational Therapists looks at your activities of daily living and how you manage them. They work to encourage independence and support people to be as functional as possible.
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Yes! Often people want to return to work, it’s a really important part of what we do. But it might be that the type of work you return to is not the same type of work, or the way that you did the work isn’t going to be done in the same way as before. And so what we would look at is what type of work it is – and it might be that some work you aren’t able to do because it’s too physical. It might be that you can work in the same work environment but not actually do the same job. Or it might be that you go back to the same job, but you just do it in a way that has some assisted technology – for example if you have a visual impairment and you need a screen with bigger writing. Or it might be that you have something that turns your voice into text, or it might be that your work environment needs to change. I think with Coronavirus we’ve found that we’ve all had to adapt to different environments and we know that we can do that quote easily. So it’s really again, having the discussion with your Occupational Therapist about what your work was and they will break that down in terms of the components required to do that job, in terms of memory, processing, your ability to attend and concentrate, your ability to be able to physically move around the space, the ability to access that work environment. So they would look at all those things with you and the together you can liaise with your employer and have discussions around returning to work. And it might be, as I said, that you don’t return to doing exactly the same job you were doing before.