Rachel Roberts examines the far-reaching effects that stroke can have, and the challenging journey that awaits its survivors…
Each year in Britain, 150,000 people suffer a stroke. That’s one person every five minutes. It’s a striking and frightening statistic, but although stroke remains the third biggest killer in the western world after heart disease and cancer, thousands of survivors can testify that there is life after stroke – even if it’s a different kind of life to the one that went before.
Put simply, a stroke is a brain attack, caused when the blood supply to part of the brain is cut off. There are two main types of stroke, the most common being ischaemic strokes, which occur when a blockage cuts off the blood supply to the brain. Haemorrhagic strokes are less common, caused by a bleed in or around the brain. A suspected stroke is diagnosed through a brain scan, which can also establish the kind of stroke suffered.
High-profile campaigns, such as the NHS’ FAST, have raised awareness of stroke symptoms and helped to almost halve the mortality rate from stroke over the past decade, although approximately a third of people who have a stroke still die from it, often from a second attack.
Once the initial relief of surviving a stroke has passed, patients and their families often face a long and difficult rehabilitation process. Around half of all survivors are left with severe and permanent disabilities, making stroke one of the biggest causes of disability in the UK. About 20% of strokes occur in people under the age of 40.
Patients are typically moved to a specialist stroke unit as soon as possible after admission to hospital and diagnosis. One there, a team of health professionals, including physiotherapists, psychologists, occupational therapists and speech therapists, will assist with their recovery. The rehabilitation process will be tailored to each patient, according to their symptoms and severity. The damage sustained will partly depend on which side of the brain was attacked, since both have different functions. The left side is utilised more in reading, writing, numeracy, facts and language, whereas the right side is more involved in creativity, emotion, motor skills and rhythm.
The duration of stroke unit stays will vary widely from one person to another, but once discharged, the patient will often need support from community health and social care services, as well as from family members or partners, should they have any.
Charities such as the Stroke Association work to ensure that all recovering stroke patients can access the care they need. The Stroke Association’s Chief Executive, Jon Barrick, says, “It’s an incredibly cruel condition that strikes in an instant, with consequences that can last a lifetime. We are here for everyone whose life has been changed by stroke. Each step towards recovery is a victory.”
One or more cognitive functions, such as speech and writing, can be affected after a stroke to the extent that they may have to be completely relearned. Spatial awareness, memory, concentration, problem solving skills and the ability to carry out everyday tasks such as getting dressed can all be affected by stroke. Techniques such as speech therapy can help to a restore an individual’s cognitive functions, though they may never return to their former level.
Film-maker Lotje Sodderland documented her recovery from a severe stroke she sustained in 2011 in a crowdfunded feature-length documentary, My Beautiful Broken Brain. Aged just 34 at the time of her stroke, Lotje lost her ability to speak, read, write and think coherently. She spent many months in rehabilitation, painstakingly relearning life skills that she previously took for granted.
Lotje has since written about her recovery using the iPhone’s Siri speech-to-text function: “My life is now split into two: before the stroke, and after. Before, I weighed the quality of my life according to how busy I was, both at work and socially. Now I have to be selective about where I focus my attention… While there have been moments of mourning for my old life, my new limitations mean I have been forced to unravel exactly what I was made of. I’ve worked on a new character, becoming more patient, more accepting, kinder to myself and to the people around me.”
Having a stroke can leave someone with weakness, or in some cases paralysis down one side of their body, causing problems with balance and co-ordination. Some people are left unable to walk after a stroke, although they may regain their movement over time. A physiotherapist will develop a programme tailored to the needs of the individual patient that aims to improve their muscle strength, walking and co-ordination. The person’s support package may also see assistance provided by an occupational therapy team, who can adapt the person’s home with the aid of special equipment designed to make daily activities easier to perform.
After the journalist and broadcaster Andrew Marr suffered a widely reported stroke in January 2013, he set about his physical recovery with characteristic determination. Having sustained a right-side haemorrhage, his language and memory skills were unaffected but he was initially unable to walk and was paralysed down his left side.
Marr proceeded to sign up for the extremely vigorous Action for Rehabilitation from Neurosurgery Injury (ARNI) physio regime. Recalling the experience in an interview with The Guardian, he said, “I was determined that I was not going to end up on a scrapheap, determined I was going to go back to work. One day I want to go and sit in a shed and paint all day – but not yet.”
Marr went on to make an excellent recovery, but admits that his stroke altered him – in some ways for the better, having been quoted as saying, “In hospital I remember thinking that I have gobbled too much of life; I have gone racing from one thing to the next and never enjoyed the moment. From now on, I’m going to suck the juice out of life.
“All this has made me, I hope, kinder and nicer. Over the years, I’ve had lots of fights with lots of people but now I’m going to try reconciling myself to them. Life is too short for feuds and battles. I’ll aim to be sweeter all round.”
Those who have suffered a stroke are also often affected by depression and anxiety, as they struggle to adapt to their altered circumstances. Another consequence of stroke can be emotional lability, where a person will quickly switch between emotional highs and lows, and express emotions in socially inappropriate ways – sudden laughing fits, for example, or crying with little prompting. This occurs in about 20% of stroke sufferers.
Now aged 38, Sarah Watts had a stroke when she was just 22. Although she was able to make a physical recovery fairly quickly, she remembers how the psychological scars took longer to heal.
“I was offered some trauma counselling through my GP, but only six hour-long sessions with somebody asking me, ‘So, how do you feel?’ she says. “This didn’t even begin to scratch the surface of the emotional roller coaster I had been on. I was 22, this wasn’t meant to happen to a young woman who’d just got married, a young mum with a daughter, a dancer, a non-smoker! I was confused. Angry, yet relieved, grateful, yet resentful.
“There should be more counselling services out there for anybody who has had a near death experience or major trauma, especially when you’re so young. Even though it was many years ago, there isn’t a day that goes past without me thinking about it. But thanks to a good private counsellor and some great family and friends, I’m able to accept the past and concentrate on enjoying the life I have.”
Although a stroke can have a devastating impact on all areas of a person’s life – affecting their work, family, relationships, sex and finances – many survivors mention having a different perspective on life as a positive long-term outcome.
Peter Groombridge was recently honoured at the Life After Stroke Awards for his work in fundraising and educating others about the dangers of the condition. A 68-year-old former engineer, he had a stroke in 2007 that left him needing to use a wheelchair for a number of months. Regardless, he remained determined to take part in a sponsored walk, and by 2010 had progressed to doing a parachute jump.
He has since formed his own local Stroke Association club in Kent and remarks that, “To me, helping stroke survivors is something that I enjoy. It’s good for people who have recently had a stroke to see what they can still do, and I’m glad I can give something back. I’ve had a second chance at enjoying life, and life is good.”
The Stroke Association
0303 3033 100 (helpline) www.stroke.org.uk
ARNI physio regime
0203 053 0111 www.arni.co.uk
Further information and a trailer for My Beautiful Broken Brain can be seen at mybeautifulbrokenbrain.com