How to Manage Behavioral, Mood and Communication Disorders After A Stroke

One in four stroke survivors report experiencing moderate to severe anxiety around two to eight weeks after their stroke. Depression affects between one-third and two-thirds of stroke survivors. Hormone regulation can change after a stroke raising cortisol levels, which can lead to quick, frequent, and exaggerated changes in mood. Some strategies to deal with the emotions and communications struggles that result from a stroke are identified below.

Along with receiving physical rehabilitation, your stroke recovery team will educate you about the emotional and psychological effects of your stroke. This team will work with you on the difference between depression and anxiety. You’ll be able to air your feelings, and cry if you need to. Their goal is to have you recover, so they will suggest activities that are enjoyable and rewarding, and work toward your return to independence.

Research has shown that even four weeks of exercise could have a positive effect on mood. Set small, daily goals like walking every day for 15 to 20 minutes, rather than engaging in a walking marathon over the weekend.

It’s also good to stay socially involved by considering group activities, such as a support group, exercise class, book club, or group focusing on an interest of yours in order to interact with loved ones or to meet new people.

Participate in mindfulness activities. Relaxation techniques, deep breathing, yoga, tai chi, or mild stretching can help reduce mental fatigue and stress.

Common disorders after a stroke

Pseudobulbar affect (PBA) occurs when emotional responses seem out of character or out of context, like having a laughing spell when you are not amused.

Up to 500,00 people in the US with a stroke have PBA, while seven million people with a neurologic insult of any type have symptoms that suggest they also have it.

This disorder features sudden and frequent crying and laughing spells, which are uncontrollable and may last for several seconds to minutes.

If you know someone who has had a stroke and has pseudobulbar affect, here are some ways to help them manage:

  • Do not tell them not to cry or laugh. It won’t do any good.
  • Ask them how they want to be treated during an episode. Many people prefer it to be treated as a reflex like hiccups that will go away, and conversation can continue. Some may want to be removed from the situation.
  • Distract them.
  • Avoid or minimize triggers like fatigue, stress, noise, overcrowding or being overwhelmed.
  • Have them change their body position (ie: go from sitting to standing), as it is distracting to the body and preoccupies the mind.
  • Provide calming activities to reduce tension.
  • Have them explain their inappropriate responses to family, friends, and other people in their life.

Impulsivity is more frequently seen in the frontal lobe or a right-sided stroke. It is characterized by the inability to think ahead or understand the consequences of their action. Here are ways to cope with impulsivity:

  • Use visual or visual or verbal cues to remind them to slow down.
  • If recommended, make sure they are wearing a lap belt in their wheelchair so that they can’t just jump up.
  • Don’t take the person’s behavior personally.
  • Give them examples of what they have done that may not be appropriate and why.
  • Go for a walk with the person to help control their urges.
  • Encourage them to think about their behavior before jumping into action.
  • Encourage and remind them to think about what they are to say before saying it.
  • Encourage them to attend a support group for those with impulse control issues.
  • Deal with safety concerns in the home and outside.
  • Encourage the person to solve a problem before completing the action.

Communication problems can stem from a weakness or lack of muscle control in the mouth and facial muscles (dysarthria), expressive and receptive speech loss (aphasia), and difficulty coordinating speech muscles (dyspraxia). It may take up to two years for someone who has had a stroke to recover their ability to speak.

When you are conversing with someone who has trouble speaking, remember to be patient, positive and encouraging. Remember to slow your speech, and enunciate well. Be close to them, make eye contact, and if appropriate, use touch to make that connection. And above all, celebrate every tiny step achieved.

Here are some tips for communicating:

  • Try to ask questions that have a yes/no or very simple answer. Simple multiple choice questions work, so give two options to make it easier to respond.
  • Give the person sufficient time to respond or answer questions.
  • Speak slowly, but in a normal voice and at a normal volume.
  • Use short, simple sentences and questions.
  • Speak one sentence or command or ask one question at a time.
  • Have a pen and paper ready if they can write or draw what they need.
  • Talking may become tiring, so try doing activities that avoid talking.
  • Be prepared to paraphrase what you are saying many times and in different ways.
  • Do not pretend to understand what the person is saying if you do not.
  • Keep the environment quiet while talking, so turn off the TV and radio and minimize extraneous noises.
  • Face each other, so you both can observe gestures, other body language or facial expressions that can make communication more effective.
  • Have them try to think of the image of a word or its first letter. Encourage thinking of the first letter of a word by going through the alphabet letter by letter.
  • Have them think of the physical features of an object whose word they are trying to come up with, such as its size, shape, texture, color.
  • Have the person say sounds and words repeatedly. Frequent practice is key.
  • Use aids such as a communication board or picture dictionary, as provided by the speech therapist.
  • Demonstrate how to perform a task.
  • Break all actions down into smaller steps and clarify the next step.
  • Repeat something you are saying, approaching the 20th time as if it were the first.
  • Do not finish sentences unless asked to.

There are many simple strategies that can be used to manage behavioral, mood and communication disorders that can accompany a stroke. It is a difficult time for the patient. These strategies, counseling, and medications can help with their struggle to adapt to a new way of living.

Key take-aways

Stroke survivors often become anxious and depressed, and may have behavioral and communication difficulties.

The stroke recovery healthcare team will work with the person to learn to cope with these difficulties.

However, if you know and are caring for someone who has had a stroke, there are ways to help them cope with their emotions, impulsivity or communication difficulties at home.

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