Stroke FAQ > Daily Life and Adaptation

It is important to pace yourself after experiencing a stroke. Post-stroke fatigue is defined as an overwhelming sense of tiredness, lack of energy, and/or difficulties sustaining routine actions in which rest is unrefreshing. While planning your daily activities, focus on the “Three Ps” to manage your post-stroke fatigue: pace, plan, and prioritize. Making a schedule that balances activity and rest during the day can help with post-stroke fatigue management.

You can learn more about managing post-stroke fatigue on our blog.

Improving hand function is a common goal of many stroke survivors. The use of our hands plays a central role in our ability to perform daily activities and engage with the world around us. We need our hands for functional independence, fine motor skills, sensory perception, social engagement, work and productivity, personal fulfillment, and hobbies.

||  Learn about different types of exercises on our blog.

The loss or impairment of hand function can significantly impact a patient’s well-being and quality of life. That’s why hand rehabilitation and restoration of hand function after stroke are critical goals in recovery.

Here are some strategies and exercises that can improve hand function:

1. 1. Range of motion exercises: Engage in gentle range of motion exercises for the fingers, hand, and wrist to maintain or improve flexibility.
   2. Strengthening exercises: Perform hand and finger strengthening exercises to improve muscle strength and coordination. Use functional objects of various resistance to work on grip strength. Additionally, handle common household objects whenever possible, using your hand to gain strength and learn qualities of handling the particular object.
   3. Grasp and release exercises: Try grasping and releasing various objects of different sizes in the hand, like coins, jar tops, jewelry, screws and nails, cell phone, or a computer mouse.
   4. Task-specific training: Engage in activities that simulate real-life tasks while focusing on improving specific hand movements required to handle the objects. This could include handwriting, computer work or video gaming, zipping/use of fasteners, cooking, using utensils, etc. Break down the task into small parts first, then build the sequence of tasks until the entire complex task can be achieved.
   5. Motor priming activities: Motor priming activities stimulate areas of the brain that address planning or rehearsal of movement to eventually translate to carrying out the movement. Mirror therapy, action observation training, and mental practice/motor imagery are included in this category. Learn more about motor priming activities on our blog.
   6. Constraint Movement Therapy (CIMT): CIMT involves restraining the unaffected hand while engaging in intensive training with the affected hand. This therapy helps promote the use and recovery of the affected hand by forcing it to participate in activities and discouraging compensatory strategies.
   7. Functional electrical stimulation (FES): FES involves sending electrical currents to muscles to stimulate movement while the body is engaging in functional tasks. Stimulation is applied at the desired time on the appropriate muscle to activate the movement and promote functional use of the hand.
   8. Brain-Computer Interface (BCI): is an advanced system where an individual’s brain signals are interpreted by a computer to control an output. Essentially, Brain-Computer Interface (BCI) enables direct interaction between the brain and a machine, serving a specific function.
   9. Virtual reality (VR) and gaming: Interactive VR and gaming technologies are incorporated in rehabilitation for the hand after stroke. These tools can hold interest, promote feedback, and aim to improve strength, coordination, dexterity, and hand function.
   10. Occupational therapy: Occupational therapists who specialize in stroke rehabilitation provide customized therapy plans and specific techniques to improve hand function based on individual needs and goals.

For more information, visit How to Get Your Hand Working after Stroke, The 7-Steps to Recuperation from Stroke Arm Paralysis, TENS Machine for Stroke Recovery, Games that Help Stroke Survivors, and The Role of OT after Stroke.

• Physical Therapy: Work with a physical therapist who specializes in stroke rehabilitation. They can assess your balance and coordination abilities and create an individualized exercise program. Physical therapy may include exercises such as weight shifting, standing balance exercises, walking drills, and coordination drills.
• Standing Balance Exercises: Practice various standing balance exercises to improve your stability. This can include exercises like standing on one leg (with support if needed), standing with your feet close together or on an unstable surface like a foam pad, or performing weight shifts from side to side or front to back.
• Core strengthening: A strong core is essential for maintaining balance. Engage in exercises that target your core muscles, such as abdominal crunches, planks, or seated core exercises.
• Tai Chi or Yoga: Consider participating in classes or programs that focus on mind-body exercises like tai chi or yoga. These activities promote balance, coordination, flexibility, and body awareness. They can also help reduce stress and improve your overall well-being.
• Gait Training: Work with a physical therapist to improve your walking pattern and coordination. Gait training exercises may involve practicing different walking techniques, such as heel-to-toe walking (also known as tandem walking) or walking on uneven surfaces.
• Coordination Drills: Engage in exercises that challenge your coordination skills such as catching and throwing a ball, playing table tennis, using hand-eye coordination toys, or using coordination-based video games.
• Assistive Devices: Depending on your level of impairment, your healthcare team may recommend assistive devices such as canes, walkers, or ankle-foot orthoses (AFOs) to provide support and improve stability while you work on your balance and coordination.
• Virtual Reality Training: Virtual reality systems can be used as a therapeutic tool to provide immersive and interactive devices for improving balance and coordination.

Always remember to consult with your healthcare team, including a physical therapist or occupational therapist, to design a comprehensive rehabilitation program that is safe for your abilities and can help monitor your progress over time. For additional information, read Balance & Coordination Training After Stroke.

You may need a period of recovery, rehabilitation, and evaluation prior to returning behind the wheel. Assessments may include tests of vision, reaction time, motor skills, and judgment. Sometimes this is done in a vehicle on the road, while other times the assessment is clinically based and may or may not involve a driving simulator. Your healthcare provider will be able to provide guidance on when it may be appropriate for you to consider driving again.

It is important to prioritize safety for yourself and others on the road before you resume driving. If you do return to driving and you notice any changes in your condition that warrant concern, such as decreased reaction time, difficulty controlling the vehicle, getting lost, or impaired vision, stop driving immediately and consult your physician. You can learn more about driving after a stroke on our blog.

Emotional Changes:

Strokes can affect the brain’s emotional regulation centers and lead to mood swings, depression, anxiety, or emotional lability (rapid and unpredictable shifts in emotions).

Apathy:

Some stroke survivors may become more apathetic, showing a lack of interest or motivation in activities they once enjoyed.

Impulsivity:

Damage to the frontal lobes of the brain can lead to impulsivity, causing individuals to make hasty decisions without considering the consequences.

Aggression or Irritability:

In some cases, stroke survivors may exhibit increased irritability, anger, or even aggression. This can be related to changes in brain regions responsible for emotional control.

Changes in Social Behavior:

Stroke survivors may have difficulty with social interactions, including decreased empathy, or changes in social judgment.

Reduced Inhibition:

Damage to the brain can lead to reduced inhibitions, causing individuals to say or do things that they might not have done before the stroke. It is important to note that personality changes may not occur because of the damage caused by the stroke itself, but as a consequence of having to cope with the consequences of stroke symptoms. For example, an individual may become depressed and withdrawn because they cannot walk or talk to engage in their favorite pastimes, such as cheering on their favorite team at a baseball game.

Physical Recovery:

Depending on the severity and location of the stroke, physical impairments such as muscle weakness, coordination difficulties, or sensory changes may affect sexual function. Working with a physical therapist or occupational therapist can help address these challenges and explore strategies to adapt or modify sexual activities as needed.

Communication With Your Healthcare Team:

It’s important to discuss your questions and concerns about sexual activity with your healthcare team. They can provide guidance, address any specific medical considerations, and offer recommendations or referrals to specialists who can provide further support.

Emotional and Psychological Factors:

Stroke can impact emotional well-being, self-esteem, and body image, which can influence sexual desire and intimacy. It may be helpful to discuss these concerns with a mental health professional who can provide guidance and support.

Medications:

Some medications prescribed after a stroke can affect sexual function. If you experience any sexual side effects from your medications, discuss this with your healthcare provider, as adjustments to your medication regimen may be possible.

Support and Education:

Seek out resources and support groups that focus on sexual health after stroke. These resources can provide information, strategies, and emotional support from individuals who have gone through similar experiences. Remember, every individual’s recovery and experience with sexual activity after a stroke is unique. It’s essential to have open and honest communication with your healthcare team, partner, or other trusted individuals who can provide support and guidance. They can help you navigate any physical or emotional challenges and assist you in finding strategies to resume or adapt sexual activity based on your specific situation. For an in-depth discussion on this important topic, visit Common Questions Surrounding Intimacy and Sexuality Following A Stroke.

What Happens If I Cannot Return to Work After Stroke?

If you are unable to return to work after a stroke, there are several opportunities to make the most of your situation:

1. 1. Understand your strengths and weaknesses to help you advocate for your current situation while identifying what areas still need improvement
   2. Seek vocational rehabilitation services
   3. Explore alternative work options
   4. Consider skill development and retraining
   5. Seek emotional and social support
   6. Prioritize hobbies, self-care, and rehabilitation efforts

Financial support and assistance resources are available. They include:

• Social Security Disability Insurance (SSDI): SSDI provides financial assistance to individuals who cannot work due to stroke-related disabilities. You can apply for SSDI benefits through the Social Security Administration or by contacting your local SSA office.
• Supplemental Security Income (SSI): SSI is a needs-based program that provides financial assistance to individuals with limited income and resources who are disabled and unable to work.
• Non-Profit Organizations: Various non-profit organizations provide support and resources for stroke survivors. These organizations may offer assistance with job training, employment placement, financial counseling, and support groups.
• Local Financial Assistance Programs: Explore other financial assistance programs that may be available in your region. These can include programs offering housing assistance, utility bill relief, food assistance, or healthcare subsidies.

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