The effects of stroke are the changes that remain once the acute phase is over: most often weakness on one side of the body, tight muscles and poor balance. A stroke is when the blood supply to part of the brain stops, because a blood vessel is blocked or has burst. What the effects are depends on which part of the brain is affected and how large the affected area is. Kaloyan Zarkov works with people after a stroke at the practice in the Lozenets district and at home, including people who are bedridden.
Symptoms
- Weakness or stiffness on one side of the body: in the arm, the leg or both (hemiparesis).
- Muscles that tighten and pull the arm or leg into one position (spasticity). The arm often stays bent and the foot drags.
- Poor balance, more difficulty walking and a fear of falling.
- Shoulder pain, or a feeling that the weak arm is “hanging”.
- Difficulty with fine movements: fastening buttons, writing, holding a cup.
- Numbness or reduced feeling on the affected side.
- Tiring quickly, even after little effort.
Hemiparesis affects the left or right side, depending on which half of the brain is affected. A stroke in the left half weakens the right side of the body, and the other way round. A stroke can also affect speech, swallowing and memory. Kaloyan doesn’t work on speech and swallowing. These are usually treated by a speech and language therapist, so discuss them with the doctor treating you.
Why it happens
The brain controls the movement of each half of the body. When part of it is cut off from its blood supply, the nerve cells there die and the signal to the muscles weakens or stops. The cause is a blocked vessel (ischaemic stroke) or a burst vessel (brain haemorrhage).
The brain can partly adapt. Its healthy areas learn to take over the lost movements, but only when those movements are practised again and again. If the arm or leg isn’t moved, the muscles shorten, the joints stiffen and the weak shoulder starts to hurt. Weakness and poor balance raise the risk of falling, and one fall can set recovery back.
How we treat it
The foundation is stroke rehabilitation, and it is best to continue it straight after you leave hospital. The exercise is carefully dosed and increased gradually. At the first session Kaloyan asks about your stroke and how it progressed, and what you find difficult today. Bring the discharge summary from the hospital and your scans and test results. He checks the strength and tightness of your muscles, your balance, and how you sit, stand up and walk. Then you agree goals together: for example, getting out of bed on your own, walking around the home without help, or holding a spoon again with the weak hand.
Kaloyan uses PNF (exercises in which he guides the movement with his hands) and massage. If you can already move the arm or leg, he adds active movements that you do yourself. Regular sessions are recommended, 4–5 times a week, depending on your condition. If you can’t yet come to the practice, Kaloyan comes to you with home visits and also works with people who are bedridden: exercises in bed and on a chair, standing up, sitting down and walking with a walking frame or a stick. He shows your family how to help and how to make the home safer.
Later, when time has passed and movement stops improving, Kaloyan may add electrical muscle stimulation. It “wakes up” the muscles and reduces spasm. The aim is for slight twitches to appear in the affected arm or leg, to build on. Recovery is different for every person, and rehabilitation usually lasts months, with no fixed end date. Usually the most change comes in the first months. Progress is possible years later too, if the exercises continue, and Kaloyan has seen it in his own patients. That is why you leave with a few exercises for every day, shown to you and your family.
What you can do yourself
- Move every day, in several short bouts rather than one long one.
- When you sit or lie down, support the weak arm on a pillow so the shoulder doesn’t hang.
- Use the weak arm in everyday tasks as much as possible, for example to hold the cup steady.
- Clear rugs and cables out of your path and leave a night light on the way to the bathroom.
- Family can help, but it’s best to let the person do on their own whatever they can. Kaloyan will show you the exercises that suit you.
When to see a doctor first
The signs of a new stroke are easy to remember with four words: face, arm, speech, time (FAST). If you notice any of the first three signs on the list, call 112 straight away, even if they pass quickly:
- Sudden drooping of the face, for example a sagging corner of the mouth.
- Sudden weakness or numbness in the arm or leg.
- Sudden slurred speech or difficulty understanding words.
- A swollen, painful and warm calf, chest pain or shortness of breath. This may be a blood clot (thrombosis), and you need to see a doctor urgently.
- Open pressure sores (bedsores). They must be treated before rehabilitation starts.
- A fall with a blow to the head, or a fall after which you can’t stand on your feet.
If your doctor has said there is a risk of a blood clot, rehabilitation starts only after you have seen a cardiologist.
