Emotional, Behavioral and Mental Health Issues Following a Stroke

A stroke is a catastrophic injury of major proportion. It is sometimes called a “brain attack” and is a traumatic brain injury (TBI) in every sense. At its most basic, it involves the breakage or clogging of an artery that carries oxygenated blood from the heart to other parts of the body, notably, to the brain.

There are two main kinds of stroke:

• Ischemic: There is a blockage of a blood vessel that provides blood to the brain. If the artery is already narrow when the blockage occurs, the stroke is called a “thrombotic stroke.” An “embolic stroke” is within the general category of ischemic strokes, but the term is used when a clot breaks off from another area within the blood vessels of the brain. Ischemic strokes may also result from the collection of plaque resulting in clogging of arteries. The plaque can break off, travel to the brain and prevent the free flow of blood throughout it.
• Hemorrhagic: A weakening of the blood vessels in the brain and a burst of one or more of them. If blood leaks into the brain and fills the space between it and the skull, the term that is generally used to describe the stroke is a “subarachnoid hemorrhage.” If a defective artery in the brain bursts and fills the surrounding tissue with blood, the term that is generally used to describe the condition is “cerebral hemorrhage.”

Regardless of the type, a stroke requires clinically relevant services from a multidisciplinary team of professionals. While a stroke can have many physical implications that vary depending upon the parts of the brain affected, a stroke may also be accompanied by cognitive changes. These changes also depend upon the parts of the brain that were affected by the stroke because different parts of the brain control different functions[1]. Specifically, if blood stops flowing for more than a few seconds, the brain is unable to obtain the oxygenated blood that it needs to function. As a result, cells die.  Based upon where in the brain the cell death occurs, a stroke can affect movement, speech, vision and the range of functions the brain controls, including cognitive functions. This is because different locations within the brain control different aspects of movement and cognition.

When an individual who has suffered a stroke becomes a client of NeuLife in Mount Dora, Florida, he or she undergoes an independent functional evaluation, comprehensive testing and behavioral analysis. The results of the evaluation are used by a multi-disciplinary team to develop an individualized Client Goal Plan. Depending upon the findings of the evaluation and the specific needs of the client, the team can include, but is not limited to, the following specialists:

• Board Certified Neurologist
• Board Certifies Psychiatrist
• Neuropsychologists
• Speech-Language Pathologist/Cognitive Therapist
• Physical Therapists
• Board Certified Behavior Analyst
• RNs
• Occupational therapists
• Vocational therapists

A multitude of physical, behavioral, emotional and mental health issues can arise from a stroke, all of which require post-acute rehabilitation. In general, there are five main types of disabilities that can result and each may have an element of mental health involvement. They are:

• Paralysis or other problems with motor control;
• Sensory disturbance, including pain;
• Problems with using and understanding language. Broadly, this disability is called “aphasia.” It can include the inability to speak, write or to understand spoken or written language. A stroke that occurs in the left side of the brain where language control is located (for right-handed individuals and for some left-handed individuals) impairs an individual’s verbal communication ability. Damage to a language center located on the dominant side of the brain, known as “Broca’s area,” causes “expressive aphasia.” Individuals with this type of aphasia have difficulty conveying their thoughts through words or writing. They lose the ability to speak the words they are thinking and to put words together in coherent, grammatically correct sentences. In contrast, damage to a language center located in a rear portion of the brain, called “Wernicke’s area,” results in “receptive aphasia.” Individuals with this condition have difficulty understanding spoken or written language and often have incoherent speech. Although they can form grammatically correct sentences, what they say often does not make sense and therefore, they cannot be understood by others. Individuals who have the most severe form of aphasia, “global aphasia,” lose nearly all language function and cannot understand language or use it coherently;
• Problems with thinking and memory; and/or
• Emotional disturbances[2];

The first three implications of a stroke can cause great frustration for the client because of his or her inability to attend to his or her needs, including communication. Cognitive dysfunction, suggested by the fourth, can be a particularly difficult consequence of stroke, especially for previously high-functioning individuals. It may require specialized rehabilitation and speech-language therapy provided at NeuLife through its multidisciplinary team of professionals consisting of psychiatrists, psychologists, speech-language therapists and others.

With specific reference to emotional disturbances, many stroke survivors experience fear, anxiety, frustration, anger, sadness and a sense of grief about the physical and mental changes that a stroke may cause. Some of these may result from the physical effects of the traumatic brain damage itself. The emotional disturbance can progress to “clinical depression” which is a major level of depression characterized by:

• Depressed mood, such as feeling sad, empty or tearful;
• Significantly reduced interest or feeling no pleasure in most activities;
• Significant weight loss;
• Either insomnia or increased desire to sleep;
• Either restlessness or slowed behavior that can be observed by others;
• Fatigue or loss of energy;
• Feelings of worthlessness or inappropriate guilt; and/or
• Trouble making decisions, thinking or concentrating.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” — the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best achieved in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to achieve function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757

[1]What is a Stroke? National Stroke Association, http://www.stroke.org/site/PageServer?pagename=stroke (2014)

[2] National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm (2014)