The effects of stroke can leave one side of your body paralyzed or weakened. This poses challenges to your independence.
Problems with muscles
Stroke can affect muscles in your arms, legs, hands and feet. The muscles can shorten and become very tight. This is called spasticity. Or they might become limp and soft (flaccid).
These muscle changes can cause problems with the joints they support. When there is low muscle tone around the shoulder joint, it can lead to shoulder subluxation — a partial dislocation of the shoulder joint. This can be prevented with proper movement and positioning. You should never force an affected limb to move. Talk to your team about strategies.
Muscle problems can also cause shoulder or hand syndrome — a stiff, swollen and painful shoulder or hand and wrist.
Treatment for muscle problems may involve:
- proper positioning
- using splints or orthotics – special
- devices that help position joints
- injecting botulinum toxin (Botox®, Xeomin®)
Muscle spasticity is increased muscle tone or stiffness, and an increased resistance which may lead to uncontrolled, awkward movements. It may also lead to a tight closed fist. It is important to make sure the hand stays clean and dry, and that the nails are well trimmed. Good hygiene can prevent skin damage. Talk to your healthcare team about the best way to manage your spasticity and take care of your contracted hand.
Where to get support:
The member of your healthcare team who can help may include a:
- physiatrist (rehabilitation doctor)
- occupational therapist
Getting around (mobility)
Getting around your home and community is an important part of your independence. After a stroke, muscle, strength and balance problems may make it hard to get around independently. Some people may need assistive devices such as a walker or wheelchair. No matter how you get around, it is important to keep safe.
A mobility aid is any assistive device that helps you get around. Make sure it meets your needs, both inside and outside of your home. All devices need to be fitted to you. You will also need instructions on how to use them safely. Your physiotherapist or occupational therapist can help with this.
Orthotics and braces
Orthotics or braces can be helpful for people who have weakened or spastic muscles after a stroke. They can support and stabilize the limb to help it function.
Walkers can provide you with support when walking. Some have no wheels, two wheels or four wheels. Your physiotherapist will make sure you get the one that is right for you and will show you the correct posture when using it.
There are different types of canes. Some have a single prong at the end. Some canes are balanced with three prongs. Some have a rubber tip, with a claw you can attach for walking in winter.
There are two types of wheelchairs: manual and electric. A manual chair is fine if you have the strength to wheel it yourself, or if someone will be pushing you. Electric wheelchairs are an option if they fit in your home and you are able to operate one safely.
If you need a wheelchair, you should be fitted by a member of your healthcare team. They will show you how to sit properly and check to see if you need a seat cushion or back rest. Proper positioning prevents injury and pressure sores. You will need to learn to transfer or move safely from your wheelchair to the toilet, bed or another chair.
You will need to plan how to get around your home in a wheelchair. Is there enough room to pass through doorways and turn around?
Make sure that your wheelchair has a seatbelt — and use it. A team member will help you learn how to transfer in and out of the chair safely.
An electric scooter may be an option for you.
Where to get support:
Your occupational therapist and physiotherapist will help you choose and fit your mobility devices. They will train you to use them safely.
Provincial or private insurance plans may fund mobility devices.
Local service groups sometimes lend equipment.
Take a look at the "Everyday Tasks" section for practical tips to adapt your daily activities.