Physical effects of stroke

You might find that there are some physical effects of stroke such as weakness, changes in muscle tension, loss of sensation and limb awareness.

Impact of physical effects

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

• Sitting without support
• Moving from sitting to standing
• Getting from bed to chair or toilet
• Walking
• Getting in or out of bed or turning over in bed
• Reaching and grasping with the affected arm
• Feeding
• Managing personal care
• Pain.

Intimacy following a stroke

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.

Good seating after stroke

Tips on good sitting techniques after stroke:

• Bottom well back in chair and body upright.
• Head in midline
• Hips and knees bent at 90 degrees
• Affected arm supported on a pillow
• Feet flat on floor or footplates of a wheelchair

A good sitting technique:

• Allows adequate trunk support and comfort at rest
• Allows movement to enable functions
• Helps avoid pressure problems
• Supports joints
• Reduces the risk of shortening in the muscles
• Helps with eye contact and communication
• Helps improve eating and drinking

Moving and Handling

Managing the hemiplegic arm and shoulder

• 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, for example on a pillow or arm of chair
• Regularly change the position of the arm
• Never pull on the arm
• Use adequate pain relief/medication for pain 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

• 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

Spasticity

Walking after stroke

Vision problems

Ask if:

• A person can see – especially to their affected side
• They need reading/distance glasses
• They need sunglasses because sensitivity to light (photophobia) is common after stroke

Depth perception may be affected, for example 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.

Incontinence

Incontinence (loss of bladder control) after stroke

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
• 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

Incontinence 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.
• Make sure 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 incontinence assessment and provision of continence pads if required.

More resources

The following links provide further training on the effects and management of arm and leg weakness after stroke:

• Effects of leg weakness – CHSS eLearning
• Management of leg weakness – CHSS eLearning
• Effects of arm weakness – CHSS eLearning
• Management of arm weakness – CHSS eLearning
• Stroke Recovery Exercises – Different Strokes: Please seek advice from your therapists prior to commencing any training or exercise programme

Find out more information about sex and relationships following a stroke:

• Stroke Association – Sex and relationships
• Headway – Relationships after brain injury
• Different Strokes

You can contact your local community stroke team.