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Recovery doesn't stop when your rehabilitation program ends. Even if rehabilitation goes very well, you may have some lingering disability that lasts for months or longer. The transition from rehabilitation to living on your own can be extremely trying, physically and emotionally. This is a time when the support of relatives and friends can make a tremendous difference in your well-being. Knowing that you're not alone can give you the strength to face this new phase of your life.

The emotional impact of stroke

Given that the brain is the cradle of your emotions and your psyche, it is not surprising that a brain attack can have psychological reverberations. As you recover from your stroke, you may find yourself flooded with feelings that are overpowering or misplaced. It's not uncommon to feel an increased urge to laugh or cry inappropriately, or to get angry easily. You may also experience sexual dysfunction. Although counseling is part of rehabilitation, your need for counseling may last far longer than your need for muscle-strengthening exercises or speech therapy. Psychosocial counseling for you and your family can help you learn to live with the aftershocks of your stroke.

Depression

About 25% of people who've had a stroke develop major depression. (For symptoms of major depression, see "Is it depression?") Left untreated, depression can undermine efforts at rehabilitation and worsen cognitive disabilities, such as difficulty with speech and language. For some people, depression is a reaction to the impairments caused by the stroke. For others, it may stem from injury to certain parts of the brain. If you think you are suffering from depression, talk to your doctor. If you are getting rehabilitation therapy, find out if there is a psychologist affiliated with the rehab program. Psychotherapy, antidepressants, or both may be helpful.

Is it depression?

The following test can help determine whether you are suffering from serious depression after a stroke. (Answer yes or no.)

1. I feel downhearted, blue, and sad.
2. I don't enjoy the things I used to.
3. I've felt so low that I've thought of suicide.
4. I feel that I'm not useful or needed.
5. I notice that I am losing weight.
6. I have trouble sleeping through the night.
7. I am restless and can't keep still.
8. My mind isn't as clear as it used to be.
9. I get tired for no reason.
10. I feel hopeless about the future.

You may be suffering from depression if you answered yes to at least five of these questions, and these symptoms have persisted for at least two weeks. If you answered yes to statement 3, seek professional help immediately regardless of your other responses.

Sex after a stroke

Though there is no medical reason to avoid having sex after a stroke, you may find it difficult to have sexual relations. Neurological damage may interfere with sensation. Men may have difficulty achieving an erection or ejaculating. You may have little or no desire for sex because you feel self-conscious or troubled by the way your body looks, or because you feel tired much of the time.

While it's impossible to overestimate the pain that sexual difficulties can cause a couple, it's important to know that there are solutions to these difficulties. The most constructive thing you and your partner can do is to talk. The trouble you're having is not anyone's fault. Nonsexual physical contact is often a good start. Massage, for example, is a way to bring people together physically. It needn't always be a full-body massage. Try massaging the feet or hands, the back, or even the face. For sexual intercourse, it is sometimes helpful to try different positions to find one that's comfortable. If you get tired in the evening, try making love earlier in the day. If erectile dysfunction is a problem, tell your doctor and find out whether medication or another therapy is appropriate.

Depression and sexual difficulties often go hand in hand. Depression can cause erectile dysfunction or a loss of desire, and these sexual problems can contribute to depression. Antidepressant medication can sometimes cause sexual dysfunction as well. Psychological counseling and medications for erectile dysfunction, either alone or in combination, can be useful.

Returning home

How soon can you go home after being in the hospital or rehab facility? What condition can you realistically expect to be in? The answers depend on the severity of your stroke, the areas of the brain it affected, and other factors.

Some people who've had a stroke can return home after a few days in the hospital. Others will not get home for many weeks if they need treatment in a rehabilitation facility. A few stroke survivors require long-term nursing care. For most people who have had a stroke, living at home is possible only if they can manage activities of daily living, such as dressing, eating, and using the toilet. You also have to follow medical advice and take prescribed medications. But you will probably need help even if you can perform activities of daily living. Don't try to do it alone, at least not right away. Plan on having a relative, friend, or home health aide stay with you for at least the first night that you're home and possibly longer. If you've been in a rehabilitation facility, chances are that someone in charge of discharge planning will visit your home ahead of time to evaluate what equipment and assistance you will need.

Before returning home permanently, it's a good idea for you to visit for a day or a weekend so that relatives or caregivers will have a chance to identify and correct potential problems. If you have trouble getting around the house, for instance, furniture may need to be rearranged, throw rugs removed, and handrails built. If you need a wheelchair, doorways may have to be widened and ramps or lifts installed.

Advice for caregivers

If a relative, spouse, or a close friend has had a stroke, you are affected, too. You miss the person's companionship and worry about his or her well-being. But you have a vital role to play in the person's recovery. You may need to offer practical help with the person's care, and you will certainly need to be supportive when your loved one's spirits fall. Your encouragement can make the crucial difference between rehabilitation results that are mediocre and results that are successful. When you step in to help, keep the following hints in mind:

• Take care of yourself by eating well, getting enough rest, and taking time to do things that you enjoy. Don't be afraid to ask for help from other family members and friends or to hire some help if you can.
• Make everyone's life easier by learning about and using assistive devices that will help your loved one do as much alone as possible.
• Take advantage of support groups and other resources for caregivers.
• Learn as much as you can about stroke and rehabilitation.
• Support your loved one's efforts to participate in decisions about rehabilitation.
• If your loved one has trouble communicating, ask your doctor or a speech therapist for advice. For example, speaking slowly and allowing plenty of time for a response can help. So can using pictures, photographs, gestures, and sounds or computerized communication devices.
• Ask to attend some of the rehabilitation sessions to learn how the program works. Make sure the staff suggests activities that fit your loved one's needs and interests.
• Encourage and help your loved one practice the skills learned in rehabilitation.
• Find out what your loved one can do on his or her own, what he or she needs help with, and what he or she can't do at all. Then try not to do tasks that you know your loved one can do without your help.
• Consider adult day care. A local adult day care program can be a good option if your loved one is living at home but has some degree of mental impairment. Adult day care can help give a few hours respite to a relative who is caring for a stroke patient at home. It would not be suitable for someone who is relatively self-sufficient.

Source: from Harvard Health Publications, Copyright © 2008 Harvard University. All rights reserved. Harvard Medical School does not endorse products.
Used with permission of StayWell.
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