Medical Concerns

Monitor your habits for health

• Alcohol: Drinking more than one or two alcoholic drinks each day can increase your stroke risk and lead to other medical problems, including heart and liver disease and possibly brain damage. Studies have shown that drinking too much alcohol has been negatively linked to stroke. If you drink more than 2 drinks per day you may be increasing your risk for stroke by 50 percent.
• Cholesterol: Monitor and maintain healthy cholesterol levels. High cholesterol or plaque build-up in the arteries can block normal blood flow to the brain and cause a stroke. It may also increase the risk of heart disease and atherosclerosis (hardening of the arteries), which are both risk factors for stroke. Saturated fat can raise your blood cholesterol more than anything else in your diet. Being overweight or obese can also raise your risk for high cholesterol.
• Diabetes: People with diabetes have health problems that can increase the risk for stroke. If you have diabetes, follow your physician’s recommendations for managing diabetes, which can
  reduce your risk of stroke.
• Heart disease: Atrial fibrillation (AFib), a type of irregular heartbeat, increases your risk for stroke by 5 times. Work with your doctor to control this heart condition.
• High blood pressure: Talk to your doctor about what your blood pressure range should be. Learn how to take your blood pressure and keep a chart. Make sure you take your blood pressure medication regularly. Modify salt intake.
• Smoking: Smoking increases the risk for stroke when compared to nonsmokers. The more cigarettes a day you smoke, the higher the risk according to several studies. Smoking reduces the amount of oxygen in the blood, causing the heart to work harder and allowing blood clots to form more easily. Smoking increases the amount of build-up in the arteries, which may block the flow of blood to the brain, causing a stroke. Smoking-induced strokes and overall stroke risk can be greatly reduced by quitting smoking. Talk to your medical team for support.

Managing pain symptoms

Experiencing pain within days, weeks, or months after a stroke is very common. Pain can slow your recovery, interfere with your daily activities, and lower your quality of life. Each person feels pain differently. Sometimes stroke damage to the brain can cause a normal touch feel painful.

Patients recovering from stroke generally experience two types of pain:

• Local pain often results from the unusual positioning of a joint due to spasticity, paralysis, or muscle tightness. The shoulder joint is most commonly involved.
• Central pain is constant, moderate, or severe pain caused by damage to the brain. After a stroke, the brain may not correctly interpret the messages sent from the body in response to touch, warmth, cold, and other stimuli. Instead, the brain registers even slight sensations in the skin as painful. This type of pain typically occurs more than one month after the stroke, and may seem to be unrelated. Less than one in 10 stroke patients experience central pain.

Symptoms

• Constant, often chronic
• Comes and goes
• Pain in one side of the body affected by stroke
• Aching, burning, sharp, stabbing, itching
• Feel more pain with emotional stress, cold, or movement
• Experience normal touch as unpleasant and painful

Treatment

Medical professionals who can treat stroke-related pain include general physicians, neurologists, physiatrists, physical and occupational therapists, and psychologists.

Report symptoms of pain to your healthcare provider. Keeping a pain dairy is helpful so that your healthcare provider understands the type of pain you are experiencing. Make note of what part of your body is the pain felt, what triggered the pain, what made it better, how often it occurs, and how long it lasts.

Your treatment may include medications along with complementary medicine such as massage or physical therapy. Standard over-the-counter treatments and prescription pain relief drugs have limited success in relieving stroke-related pain. Medications used to treat stroke-related pain may include antidepressant, anti-seizure, and anti-spasticity medications.

Patients can take several actions to try to avoid pain:

• Avoid activities that cause pain, such as temperature changes and tight clothing.
• Correctly position affected extremities to reduce discomfort.
• While sitting or lying down, use an armrest or pillow under weakened arm to relieve shoulder pain.
• Use heat treatment.
• Perform exercises as prescribed by your therapist. Stay active.
• Try relaxation or meditation techniques.
• If the pain persists and/or affects your daily activities, call your doctor.

Maintaining muscle tone after stroke

Following a stroke, the person recovering from injury or their caretaker may experience changes in muscle tone, which is a state of tension that gives muscles their shape, even at rest. Several different types of changes in muscle tone can occur.

• Flaccidity: Complete loss of muscle tone. The person is not able to start any movements with a flaccid muscle group.
• Hypertonicty: Increased muscle tone or tension. The person is unable to stop increased muscle activity.
• Hypotonicity: Less than normal muscle tone or tension. The person is not able to start or maintain enough muscle activity for the time it takes to complete an activity.
• Spasticity: Increased muscle tone or tension which increases with increased speed during stretching. The person notices there is less increase in muscle tone when trying to stretch slowly as compared to stretching quickly.

What causes these changes?

Changes in muscle tone are caused by an illness or injury involving the brain, brainstem, or spinal cord, which make up the central nervous system. The central nervous system works as a network of nerves connected to the muscles to communicate complex information back and forth between the brain and the muscles.

Normally, this information follows easily allowing the body to move easily and adjust quickly without a person’s having to think about it. After an injury, this relay system can be disrupted and the brain may not be able to process this information in the right way. This causes the balance of the system to be disturbed, which results in changes in muscle tone.

Changes can range from mild to severe and can happen in any of the muscles of the body, from the tongue to the toes, and on one or both sides of the body.

Symptoms

Changes in muscle tone affect everyone differently. Symptoms may be mild, such as the feeling of tightness in a muscle, or more severe, producing painful, uncontrollable spasms. Make sure to communicate with the medial team about how muscles are functioning.

Symptoms can interfere with mobility, self-care, and positioning. When changes limit activity, it can cause additional medical problems, including pain, sleep disturbance, joint problems, pressure sores, and pneumonia. Loss of muscle length and joint motion can lead to contractures, making joints difficult or impossible to move and performing daily care more difficult. Additionally, decreased muscle tone can lead to increased and unwanted movement in a joint, which can lead to painful positioning.

Treatment options

In order to help the healthcare team make the best decisions about treatment options, track changes in muscle tone over time. Keep in mind that some treatments are more appropriate for certain individuals, depending on the underlying cause, severity, time since injury, medical stability, location, extent, prognosis, and speed of complication development.

Rehabilitation therapies

Physical, occupational, and speech therapy are designed to maintain or improve joint range of motion and mobility, increase strength and coordination, and improve comfort. These interventions may include:

• Stretching and strengthening exercises
• Weight-bearing exercises
• Splinting
• Casting
• Positioning
• Applying hot or cold packs
• Electrical stimulation
• Taping
• Instruction and training for effective movement strategies
• Instruction and training on use of assistive devices to improve safety and stability

Medications

The use of medications for treating changes in muscle tone should be discussed with your physician. Medications can be given by mouth or feeding tube, intramuscularly (injected) and/or intrathecally (delivered directly in to the fluid surrounding the spinal cord). Medications used to treat spasticity may have side effects that can arise even after long use, including dizziness, sleepiness, weakness, fatigue, bowel and bladder issues, respiratory issues, and low blood pressure. Tell your doctor of any side effects.

Ongoing monitoring

Individuals with changes in muscle tone should be monitored on an ongoing basis to assess changes that might indicate problems. If the person is not able to communicate pain, be aware that increased spasticity can be the result of underlying medical issues such as infections, increased fluid in the brain, or other medical complications.

Call the doctor

Call the doctor if you note any of these issues:

• Problems taking medications
• New problems with moving around or getting out of bed or chair
• Skin sores or redness
• Pain that is not controlled or worsened
• Recent falls
• Coughing or choking when eating
• Signs of bladder infection (fever, burning when you urinate, or frequent urination)

Call 911 if any of these symptoms develop suddenly or are new:

• Numbness or weakness of face arm or leg
• Blurry or decreased vision
• Inability to speak or understand
• Dizziness, loss of balance, or falling
• Severe headache

Questions for your doctor

• What should my blood pressure range be?
• How much salt can I have in my diet?
• What is my cholesterol range?
• What is a good weight for me?
• What blood thinner medication am I taking?
• If diabetic, what should my blood sugar range be?

• American Diabetes Association
• American Heart Association
• Cholesterol | U.S. Centers for Disease Control and Prevention
• DASH Eating Plan | National Institutes of Health
• Diabetes | U.S. Centers for Disease Control and Prevention
• Heart Disease | U.S. Centers for Disease Control and Prevention
• High Blood Pressure | U.S. Centers for Disease Control and Prevention
• Quit Smoking | American Lung Association
• Smokefree | National Institutes of Health