How stroke affects behavior

Pamphlet by: American Heart Association,  Annual, 1994  

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Common Quotes

"I know why my wife has a hard time using her arm and leg after her stroke, but why does she cry so often?"

"My father has learned to walk since his stroke, but why does he keep bumping into things?"

"Mom used to be such a good housekeeper, but since her stroke she's awfully sloppy."

"My husband had a stroke, and now nothing I do pleases him."

Introduction

The quotes on page one reflect the puzzlement of friends and relatives when they see the changes in behavior that stroke can bring. A lot has been written about physical changes that result from strokes. However, relatively little has been written about the intellectual, behavioral and emotional changes that occur.

This booklet will help you understand why stroke survivors behave the way they do. It also gives some guidelines on how to help.

It's important to understand that strokes affect the brain. When a stroke occurs, something has gone wrong with the blood flow to brain cells, and the brain has been injured. If the brain's left hemisphere is affected, the effects will appear on the fight side of the body and vice versa.

A stroke won't affect all areas of the brain -- or all aspects of intelligence -- equally. It's a mistake to think all stroke survivors are alike. They're not. They act differently depending upon what part of the brain was injured, the severity and type of injury, how recently the stroke occurred and their previous personality and behavior.

Some areas of the brain may work normally while others won't. A person may seem as capable as ever when doing one mental task but be totally unable to do another one that seems no more difficult.

Sometimes the pattern of behavior and thinking is inconsistent. There may be good days and bad days, or good hours and bad hours. Despite these inconsistencies, stroke survivors have identifiable patterns of behavior.

This booklet is written primarily about people who've had a stroke in the past. These people are through "healing;" their problems basically have been unchanged for the past several weeks or months. Almost all spontaneous recovery of intellectual abilities occurs in the first three to six months after a stroke.

This booklet doesn't precisely describe every possible problem resulting from a stroke. It's a general guide. Most of the information will be true for most people. It's important to note, however, that it discusses the effects of stroke for right-handed people. Naturally left-handed people manifest effects opposite from those typical of right- and left-brain injuries.

If you have specific questions, ask your doctor.

Right-Side Paralysis

The most visible sign of a stroke is usually paralysis on one side of the body. If the right side is paralyzed (right hemiplegia, pronounced hem e PLEE jee ah), this means the left side of the brain was injured.

Left-brain Injury

People with right hemiplegia who are right-handed are likely to have problems with speech and language. This is called aphasia (ah FAY zeeah). Sometimes they can understand more than they can speak or write. Typically, though, people who have aphasia have some trouble both speaking and understanding.

In our society, speech and communication are very important. And when people can't speak or be understood, there's a tendency to exaggerate the extent of their disability.

Speech and language are two different things. Language is the noises, movements, gestures and expressions we use to communicate with one another. Speech is only a small part of language -- the noises we make with our mouths. Some people have trouble pronouncing words (dysarthria, pronounced dis AR three ah) but their language abilities are normal.

Just because people can't speak and be understood -- or listen and understand -- doesn't mean they can't communicate. Nor does it mean they can't understand a considerable amount of language. Most people who have aphasia also have some trouble reading and writing. With some people, you may be able to communicate better by writing; with others, spoken communication works best.

A lot of normal, day-to-day communication can be carried on without speech.

Some people, especially those who have aphasia, may have trouble with numbers. They may have trouble "calculating" or recognizing and recalling numbers or dates.

Isolating people who have aphasia by not communicating with them because part of their language is gone is a mistake. A lot of normal, day-to-day communication can be carried on without speech. For example, think how often people use their hands when they talk. The game of charades, silent movies and pantomime are all examples of nonverbal communication.

Try communicating using demonstrations or pantomime. Using pantomime is a particularly good idea if language abilities aren't expected to return. In some cases talking may actually interfere with communication. To a person who has aphasia, it may seem like broadcasting static.

Sometimes people who have aphasia use unusual words or sounds to express themselves. For example, one might call a car a "dak." If the person uses the term "dak" consistently, is understood, and language abilities aren't expected to return, why not use it?