Stroke: Dealing with Life after Stroke

By Virginia Thornley, M.D., Neurologist
February 15, 2018

A stroke occurs when a blood vessel in the brain or neck becomes blocked by a clot which migrated or a plaque that broke interrupting flow to areas in the brain. The neurological symptoms depend on the area involved with the blockage of the artery. A patient who suffered a stroke will often be advised a work-up to determine the etiology of whether the clot came from the heart, aorta or from a large vessel in the neck or brain. Treatment depends on the etiology of the source.

How to manage life after a stroke
Stay healthy
Many risk factors are involved in stroke including diabetes mellitus, hypertension, obesity and high cholesterol. These contribute towards the formation of atherosclerotic plaques in the arteries which can break and block an artery. Ensuring risk factors for stroke are under good control is key. Keep active.

If motor function is involved
If the motor function is involved it is important to have frequent physical therapy to avoid contractions. Contractions occur when a part of your body is not moving, the 19059671_10155427294453841_913446057479861555_nmuscles stay in a contracted state and eventually becomes immobile. Passively moving the limb keeps it supple. Patients can recover function the most in the first 6 months of intense rehabilitation, therefore, the importance of a good physical therapist working cannot be emphasized enough. If large parts of the brain are involved, with intensive physical therapy, sometimes there are other parts of the brain that undergo a process called cortical reorganization where it can overtake the function of the damaged part of the brain. The more intense the therapy the higher the chances of maximal recovery. It is not an exact science but recovery depends on the severity of the stroke.

For many patients, the weakness is persistent even after physical therapy is discontinued. Exercises at home without the physical therapist is still very helpful. Sometimes, the therapist will give a list of exercises to continue at home before services are discontinued. The more therapy is done the chances of meaningful recovery increase. Physical therapy helps with balance and vertiginous (spinning sensations) symptoms as well.

If speech is involved
A good speech pathologist is essential in regaining language. If the problem involves articulation or the motor component of speech, exercises involving the lips, tongue or palate are advised depending on which muscles are affected. With facial muscle involvement, the muscles of the mouth are affected. Exercises with the letter “m” are helpful such as repeating “ma-ma-ma”. Lingual muscles can be strengthened repeating words or sounds with the letter “l” such as “la-la-la”. Palatal muscles are the deeper muscles of the throat. These can be strengthened with guttural sounds such as sounds with the letter “g”, with the hard sound in it such as saying “ga-ga-ga” repetitively.  A speech therapist gives specific exercises to strengthen the weak muscles of articulation.

If verbal output is affected, or the ability to produce sound and words, encouragement to keep speaking even if no sounds occur is important. The more one attempts to speak the more the nerves are engaged and actively firing. With each day, neural connections are strengthened in the brain until eventual language output is achieved. Speech output has the best chances of complete recovery.

If the problem is related to reception or comprehension of language, a speech therapist is helpful in rehabilitation. Other ways to rehabilitate include the following:

1. Have conversations with the patient in order to engage with him or her.
2. Label objects at home will so he or she absorbs, reads, recognizes the word and understand.
3. Speak to patients slowly and enunciate well.
4. Teach the functions of items, for example, ask the patient what does an iron do? Proceed to demonstrate and explain it takes out wrinkles.

5. Have a corkboard with pictures with names and functions written under each picture. Go over them each day.  This can be changed frequently.
6. Point to objects and name them. Explain the functions while out and about or even at home.

The more a patient with language difficulties is engaged, the more the cortex will rewire to form new connections. Early and intense rehabilitation is key.

If the weakness is mild
Sometimes a stroke can affect a small yet vital part of the body with a very important function such as the dominant hand. In cases like these, occupational therapy is very useful.  Exercises that can be done at home include picking up cards, putting small objects in a box and taking them out or squeezing and squeezing a ball. Picking up small coins few times a day in several sets can help.


The best recovery is seen within the first few months of a stroke. However, the brain is still capable of recovering long after a stroke depending on the size and location but starts to slow after longer periods of time. It varies per individual. The motor component for language meaning the ability to say words is easier to recover than the comprehensive function meaning the ability to understand words.

Every stroke is unique and special services depend on the area of the brain involved and the function that is affected. While the brain still has the ability for cortical reorganization, or the ability of some parts of the brain to take over the function of the damaged part of the brain, early and intense rehabilitation is vital.




A Review on “Low Dose Aspirin and Intracranial Hemorrhage, ” by Soriano, L.C.,, Neurology, 2017

Reviewed by Virginia Thornley, M.D., Neurologist

This study asks if low dose aspirin in the 75-300 mg range causes an increase in the risk of intracranial hemorrhage. A national database in the UK was used which identified 199,079 new users of aspirin, each was matched to a patient with no aspirin use.  Patients were taken from the 1st year of general practice. Those who had liver cirrhosis, cancer, esophageal varices were excluded. Ten thousand controls were sampled in the cohort. Cases were divided into intracranial hemorrhage, subdural hematoma, subarachnoid hemorrhage and fatal. Case control methods were used using a confidence interval of 95% with logistic regression. 1611 patients were found with intracranial bleed after following the patients for 5.4 years.

They found that in 400,000 patients followed for 14 years, low dose aspirin showed did not correlate with an increased risk of intracranial hemorrhage or subdural hematoma. Although most used 75mg, at a dose of 80-300mg it is unclear. Using low dose aspirin for at least 1 year showed a protective effect against subarachnoid hemorrhage. This study found that hemodialysis, renal dysfunction and warfarin use increases the risk of intracranial bleeding. Previous intracranial hemorrhage was associated with an 8-fold risk of a rebleed. Other risk factors increasing risk of intracranial bleed include previous ischemic stroke, smoking history, underweight, history of falls and dementia.

In summary, this is a large study concluding that intracranial hemorrhage is not related to low dose aspirin at 75 mg and is, in fact, protective against subarachnoid hemorrhage at greater than 1 year. Further studies, however, are needed for dosages at 80-300mg to determine a correlation.



  1. “Low-dose aspirin and the risk of intracranial bleed, an observational study in UK general practice,” Soriano, L.C.,, Neurology, 2017; 22: 2280-2287