Physical effects of stroke - Newcastle Hospitals NHS Foundation Trust

Common physical effects

Common physical effects following a stroke include:

Weakness or loss of ability to produce movement of a limb (often known as hemiplegia)
Changes in muscle tension – the limb may feel heavy, floppy or stiff
Loss of sensation or changes in sensation
Loss of awareness of a limb position
Reduced balance when sitting or standing
Visual problems
Shoulder pain or other pain

Having a stroke can impact movement and functions, and lead to having physical difficulty with:

For many reasons this can be daunting to people.
It could be communication difficulties, physical difficulties or cognitive changes.
Sexual intimacy is important to many people and understandably questions can arise which people can feel embarrassed about.
If there are difficulties within this area it is recommended to speak to your partner first and foremost as they may be able to support through this.
If you don’t feel comfortable discussing it with a partner but you do with a professional, speak with your therapy team or GP

Tips on good sitting techniques after stroke:

A good sitting technique:

Tips on moving and handling a person with stroke:

Maintain your safety when moving a person with stroke
Keep close to the person you are supporting
Support the person – don’t restrict – think about your handling
Consider extra support for patients with reduced eyesight or sensation
Be aware of communication/language difficulties – use gestures or visual prompts
Involve the person you are moving and handling – what can they do for themselves?
Take your time – allow the patient time to move
Is everyone ready? Have a lead person giving the instructions
If you have been supplied with moving and handling equipment, use it – if you are unsure, ask for training

Be aware of changes to muscle tone e.g. floppy muscles or tight muscles can lead to loss of joint range
Be aware of changes to sensation which can cause the person to be unsure of where their arm is
Use careful handling, shoulder supports and wrist splints to manage joint stiffness – as directed by therapist
Support the arm e.g. on a pillow or arm of chair
Regularly change the position of the arm
NEVER pull on the arm
Use adequate pain relief / analgesia if necessary
Educate the patient- Promote self care and maintenance of arm during tasks with family and carers
Looking after the upper limb is a joint approach from all the team including patient and family/carer

Shoulder subluxation is a partial slipping of the joint surfaces of the shoulder joint – It is not a shoulder ‘dislocation’
It is often caused by weakness and loss of muscle tone (floppy muscles) in the shoulder and arm
This can cause the arm to feel heavy and often ‘hang’ down by the person’s side
You may feel or see a gap at the top of the shoulder in the joint space
Shoulder pain varies from 5-84% and 39% can still experience pain at 12 months post stroke
Shoulder pain can be a result of poor moving and handling which is associated with poor recovery of movement and function

Two thirds of people will have visual problems after stroke
Ask if a person can see – especially to their affected side
Ask if they need reading/distance glasses
Ask if they need sunglasses because sensitivity to light (photophobia) is common after stroke
Depth perception may be affected –e.g. when going up or down steps
Poor vision increases risk of falls
Poor vision reduces ability to take part in everyday activities
Some people may not notice any visual loss
Scanning exercises to the affected side can support with natural movement and recognition of the visual loss
This can cause some people to trip or bump into objects
Brightly coloured crockery or cups can support with finding objects
Some people may see unusual shapes or objects that aren’t there, this is the brain filling in the missing gaps

Continence after stroke:

40-60% of patients experience urinary incontinence after stroke with 25% still having urinary incontinence at discharge
Stroke-related urinary incontinence is linked to greater dependence and severity of disability, poorer rehabilitation outcomes, discharge destination and even death
If poorly managed secondary problems may arise including dehydration, skin breakdown and urinary tract infection
Incontinence of faeces is associated with more severe stroke and is more difficult to manage
Incontinence has a detrimental effect on mood, confidence, self-image and participation in rehabilitation and is associated with carer stress

Other factors affecting continence include:

Functional – decreased movement, poor eyesight, difficulty adjusting clothing, lack of awareness of need to void, balance problems, environmental
Cognitive factors – level of consciousness, Confusion/disorientation, Perceptual problems
Mood and emotions – anxiety, depression, embarrassment, beliefs
Communication difficulties – receptive and expressive dysphasia, dysarthria and visual disturbances

Continence management:

Try and get into a routine. Go to the toilet at regular times during the day, even if you’ve had episodes of incontinence. You could consider going to the toilet when you first get up, shortly after each meal and before going to bed.
Ensure you drink enough. Reducing the amount you drink can irritate your bladder and increase the risk of infection.
See a district nurse or continence nurse for a continence assessment and provision of continence pads if required.