Stroke: Impact of Stroke

Physical Changes and Activities of Daily Living

Stroke commonly results in neurological impairments that significantly impact functional independence. Approximately 80% of stroke survivors experience weakness on one side of the body, whilst more than half develop balance and coordination deficits. Visual field defects are common after stroke, and many patients experience changes in sensation such as reduced feeling or altered touch. Post-stroke pain syndromes, including central pain and shoulder pain, frequently develop in survivors. These impairments create substantial barriers to performing activities of daily living, with many stroke survivors requiring assistance with basic self-care tasks (e.g. eating or dressing), especially during the early recovery phase.

There are ways to cope with the changes that occur after stroke:

• Physiotherapy is highly effective for stroke recovery. Exercises can improve movement, balance, and walking speed. Specific training exercises help enhance mobility and reduce disability.
• In Occupational Therapy, training focuses on improving cognitive skills, movement, and sensory changes, which are particularly helpful for returning to meaningful activities.
• Staying physically active is crucial for ongoing stroke recovery and preventing further health complications. Regular physical activity reduces the risk of another stroke and improves overall cardiovascular health. Even light activities like walking or gentle exercises can make a meaningful difference in long-term recovery.
• Assistive devices and home modifications can enhance safety and independence. Appropriate mobility aids can reduce falls and improve daily function. Professional home assessments and modifications lead to better quality of life.
• Fall prevention is essential as stroke survivors have a much higher risk of falling than others. Effective strategies include removing home hazards, wearing proper footwear, and learning to use mobility aids correctly.

Refer to the Physical Therapy and Occupational Therapy fact sheets for more information.

Nutrition and Difficulty Swallowing

You may experience difficulties swallowing food and/or liquids (dysphagia). Dysphagia makes it difficult for you to eat or drink safely as food or liquids may enter your airway, which can cause a lung infection known as aspiration pneumonia. Some patients benefit from modifications to their diet and liquid textures. Some may also be recommended to use an alternative mode of feeding such as nasogastric tube (NGT) feeding if the risk of choking or malnutrition is high.

Changes in appetite are common following a stroke, but good nutrition is important for recovery and to prevent further complications. Some ways to cope with these changes are to:

• Speak to a Speech Language Therapist (SLT) about the changes you are experiencing, especially if you are coughing or choking when eating or drinking.
• Consult a dietitian on how to supplement or make changes to your diet and habits to reduce dietary risk factors for another stroke.

Refer to the Swallowing Difficulties fact sheet for more information.

Communication Difficulties

Stroke can sometimes cause difficulties in communication. It is common for some individuals to develop one or more of the following communication challenges post-stroke:

• Dysarthria, which means slurred or unclear speech due to issues with the muscles controlling speech.
• Aphasia, a language impairment affecting language comprehension and/or expression.
• Apraxia of speech, which is a deficit in the sequencing of accurate sounds needed for speech production.
• Cognitive Communication Disorder, which is a deficit in communication due to cognitive changes, like issues with attention and memory.

The exact nature of these difficulties would have been determined by your Speech Language Therapist (SLT) before or shortly after discharge.

Not being able to communicate easily can be distressing, but there are ways to bridge that gap. The SLT will determine and establish a rehabilitation plan to set tailored goals whilst helping you and your loved ones to understand what communication strategies best suit you. You may also explore the following general strategies to aid communication:

• Consider using gestures, writing, or a pictorial book to communicate daily needs.
• As much as possible, communicate with others in quieter environments (e.g. rooms without TV or radio distractions) for more successful interactions.

Refer to the Speech Therapy for Communication Difficulties fact sheet for more information.

Cognition

As a result of stroke, you may experience changes in your memory, attention, thinking, and/or reasoning skills. These changes may make it harder to concentrate on the things that you are doing (e.g. reading, watching TV). You may also find that you misplace things more often, or face more difficulty doing the complex tasks that you used to do such as cooking or managing finances.

There are ways to improve and work around these changes:

• Work with your Occupational Therapist (OT) or psychologist to find new ways to complete your daily activities.
• Write down or record notes about things that you need to remember.
• Reduce distractions in your environment and do one thing at a time (e.g. turn off your TV when you are trying to read).
• Maintain a regular schedule to make it easier to complete your daily activities.

Refer to the Cognitive Issues and Coping with Cognitive Issues fact sheets for more information.

Continence

You may have trouble controlling your bladder or bowel movements. This may be due to damage in the areas of the brain that control continence, or reduced mobility that prevents you from passing motion as needed.

In many cases, incontinence can be improved.

• Follow the advice of your stroke team, such as by doing prescribed pelvic floor exercises and improving accessibility to the bathroom.
• Maintain a toileting routine.
• Make sure you stay hydrated as incontinence can lead to dehydration.
• When leaving the house, check the location of toilets at your destination for ease of access.

Refer to the Bladder and Bowel Issues fact sheet for more information.

Emotional Changes

Feelings of frustration, anxiety, anger, grief, or depression are common after stroke. These are normal reactions to a serious medical event and may also be related to the changes in the brain caused by stroke. You may also experience rapid mood changes which were not present before the stroke. In some cases, your emotional symptoms may require specific treatment. Do inform your stroke care team if you are experiencing any concerning symptoms.

There are ways to manage your emotional changes:

• Share how you are feeling with your loved ones and support one another.
• Try not to shame or blame yourself for the changes you are experiencing after the stroke.
• Find healthy ways to express and vent your emotions, such as journalling or mindfulness.
• Do not be afraid to seek professional help from a therapist or psychologist.

If you are currently feeling overwhelmed by your emotions or have thoughts of self-harm or suicide, please call the 24-hour Samaritans of Singapore hotline at 1-767 or send them a message/Whatsapp at 9151 1767. You can also contact the 24-hour National Mindline by calling 1-711, messaging them on Whatsapp at 6669 1711, or accessing an online chat at https://mindline.sg/fsmh

Refer to the Emotional Changes and Coping with Emotional Changes fact sheets for more information.

Sleep, Tiredness, and Fatigue

It is common to experience difficulties with sleep after suffering a stroke. These can range from insomnia (difficulty falling and/or staying asleep) to sleep-related breathing disorders such as sleep apnoea (abnormal breathing whilst asleep). Poor nighttime sleep can result in daytime sleepiness and tiredness, which may negatively affect your daytime activities including work and leisure activities. 

Some ways to cope with sleep issues, tiredness, and fatigue include:

• Improve your sleep hygiene, for example by sleeping and waking up at the same time every day and reducing caffeine and nicotine intake later in the day.
• Plan and schedule your activities so that you have sufficient time to rest.
• Eat a wide range of nutritious food to keep up your energy levels.

Seek the advice of your stroke care team for ways to improve your energy levels.

Behaviour and Personality

Stroke may cause behavioural and personality changes due to the damage to the part of the brain which regulates emotions, decision-making, and judgement. This can lead to aggression, apathy, disinhibition, emotional lability, irritability, and impulsivity.

These changes may or may not go away, but you can do things to support your best recovery.

• Give yourself the time and space to come to terms with the stroke.
• Speak with your loved ones and reach an understanding that things may not be the same as before.

Do not be afraid to seek professional help to better manage the changes you are experiencing.

Sexual Intimacy

You may feel worried about engaging in physical intimacy or have a physical impairment that affects intimacy. Being a caregiver can also take a toll on your partner, affecting physical intimacy. This can sometimes lead to stress and tension in the relationship.

Over time, with mutual understanding and patience, it is possible to re-establish intimacy with your partner. 

• Open communication plays an important role in strengthening your connection.
• Being mindful of physical changes can also help. Consider planning moments of closeness during times when you feel more energized.

Refer to the Sexual Intimacy fact sheet for more information.

Social

​The consequences of stroke may restrict your ability to engage in your usual social activities. You may need time to return to work, travelling, and typical physical and social activities. This can sometimes lead to feelings of isolation. 

It is important to work with your doctor and stroke care team to determine the appropriate time to begin these activities again.

• Consider reaching out to stroke associations such as Stroke Support Station (S3) and Singapore National Stroke Association (SNSA) to join activities and social events catered for stroke survivors.
• Be patient with yourself and set goals with your Physiotherapists (PT) and Occupational Therapists (OT).
• Seek clarification from your doctor for individualised advice based on your health status.
• Staying connected with your family, friends, and community can support recovery.

Refer to the Social and Leisure Matters after Stroke fact sheets for more information.