After a stroke, persons may show different changes in their thinking. They may display the
Sleepiness and drowsiness are common. Thinking hard makes them tire easily because it uses all
of their energy.
- Tell the person your name when you visit.
- Touch the person lightly and say their name.
- Explain why you are there. Speak in short sentences and allow time in between them.
- Short periods (five to 10 minutes) of working with staff or family followed by the same amount
of rest promotes further progress in the early stages of recovery.
- Too much stimulation or activity does not help the recovery process.
Patients may have a hard time paying attention to anything for more than a few seconds.
Activities that are going on around them distract them. It’s hard for them to pick out what is the
most important thing to pay attention to talk about.
- Make sure the person is looking at you when you are talking to them.
- Keep the sentences short and simple. Focus on one thing at a time.
- Have the person repeat back what you have just said.
- Limit distractions and noise.
Patients may not know what happened to them, where they are, what year it is or who other
people are. This can be very frightening but this is not unusual. A stable environment is important.
Confronting unwanted behavior or disagreeing with the confused person is not helpful.
- Bring pictures and favorite objects to their room.
- Limit activities or changes in surroundings that can increase confusion.
- Reduce extra noise such as television, music or many people talking.
- Frequently repeat correct time, date, place and names of friends and staff. This will help.
- Put a large calendar on the wall.
- Keep a memory book, which is a diary of important events or visitors.
- Suggest something else to do or change the topic if you see the patient is becoming distressed.
- Focus on familiar things.
Difficulties with Abstract Thinking and Judgment
People with stroke can have a hard time solving complex problems. They’re unable to make good
decisions about their job, finances or capabilities. They often want to do activities that they’re
unable to do (go back to work) or are unsafe to do (drive a car). Talking about issues over and
over and getting stuck on a topic often happens.
- Explain the reason the person has to do—or not do—the activity.
- Tell the person why it’s necessary and what would happen if the task is not done—or done.
- If the person is stuck on one thing, gently change the activity or topic.
- Provide a safe environment.
Trouble Planning and Organizing
Communication and daily living skills depend on the ability to plan our time, review our progress
and reach our goals. For people with stroke, this can be difficult. They may have a hard time
saying ideas so that they make sense. They may mix up the order of the ideas or forget to tell you important information. They may be able to say what they want to do but unable to actually carry
out a plan.
- Tell the person that you do not understand what they mean.
- Ask them to communicate one step at a time and to take time to think about what they want to say.
- Explain clearly what activity the person is to complete.
- Go over each step and repeat the steps.
- Start with simple tasks so that the person may succeed.
- Give praise but do not push too hard.
Some people with a stroke will have memory problems. They may remember events from long
ago. However, new information or new learning (short-term memory) is the most common type of
- Have the person write down activities that they have done during the day and review the day’s
- Ask the person to repeat out loud new information to be learned.
- Give hints at first rather than the answer.
- Repeat new information throughout your visit.
- Label and give descriptions of familiar pictures.
Slowed Processing Speed
The ability to think quickly is often reduced after a stroke. This may cause difficulty in
communication, organizing thoughts and solving problems.
- Try to keep conversations short.
- Take time to listen.
- Do not have too many people talking at once.
- Avoid changing topic frequently.
Changes in Emotion and Behavior
Emotional behavior changes in recovery are normal reactions. This can happen due to changes in
a person’s abilities.
For those with stroke, the world can be strange, confusing and scary. It’s hard for them to
understand all the changes that have happened to them. They have trouble understanding why
they need treatment. Angry feelings are often directed toward family and hospital staff. Those
with stroke may no longer be able to make their own choices about what they want to do.
only way to have some control often is refuse to do tasks, such as a treatment.
- Talk in a calm and gentle tone.
- Get the person’s attention away from what caused the anger or frustration.
- Give the person something different to do.
- It’s important for family members to recognize their loved one is not fully responsible for the
anger or behavior.
Many people with stroke have difficulty waiting, act without thinking and are restless. They can
easily become irritable, frustrated and angry. They may also use unacceptable language even if
they had not done so before the injury. These behaviors often happen when the person is trying to
do something that used to be easy, but is now hard.
Those with stroke are often not aware of changes in their physical abilities, thinking or emotions.
These people have trouble with self-awareness. They do not understand the need to work on their
recovery. They feel that they are the same as they were before the injury. They don’t have the
physical and thinking abilities to behave in the same way.
Because they feel the same, they may not understand the need for treatment. They feel others are
forcing them to do activities that they do not need, understand or want to do. This can cause a
great deal of fear. They may lose trust in family and hospital staff. They may make up stories for
times they cannot remember or make up excuses for their actions. Sometimes, they may want their
family there all the time.
Denial is common after a stroke and is a coping response. However, a person who is denying the
present situation and its effects may still have some awareness.
As awareness of their problems increases, people with stroke are likely to become sad. They
begin to see that it’s harder to think, walk and control their actions. They may realize they may
have lasting effect from the stroke. This display of sadness is upsetting especially for the family.
A person’s personality before the stroke plays a role in the recovery. If the person was usually
unhappy, it’s likely that you may see the same behavior, but stroke can sometimes present in
personality change. Sometimes Depression occurs because the stroke can change the balance of
chemicals in the brain or affect areas of the brain involved in emotions or mood. Depression may
be treated either by medication, psychological treatment or both. Psychological treatment helps
the person understand and cope with the changes.
Changes in Cognitive Communication
Damage to the right hemisphere of the brain can lead to cognitive-communication problems,
such as impaired memory, attention problems and poor reasoning. In many cases, the individual
with right brain damage is not aware of the cognitive difficulties or communication problems that
Cognitive-communication problems that can occur from right hemisphere damage include difficulty
with the following:
- Safety awareness
- Left-side visual neglect
- Social judgment, pragmatics
- Processing information
The speech-language pathologist will work with the individual and the rehab team to develop a
treatment plan designed to improve the individual’s cognitive-communication abilities. Strategies
to assist a patient with cognitive deficits are:
- Provide a consistent routine every day.
- Use calendars, clocks and notepads to remind the person of important information.
- Decrease distractions when communicating.
- Stand to the person’s right side and place objects to the person’s right if they’re experiencing
- Break down instructions to small steps and repeat directions as needed.
- Ask questions and use reminders to keep the individual on topic.
- Avoid sarcasm, metaphors and so on when speaking to the individual.
- Provide appropriate supervision to ensure the person’s safety.
Damage to the left hemisphere of the brain can lead to verbal processing problems. Problems can
be seen in language, speech, reading and writing. Problems can also be seen in sequencing and
planning movement, which can interfere with daily living activities.
language and motor planning problems that can occur from left hemisphere damage include difficulty with the following:
- Understanding spoken language
- Identifying pictures
- Correct sequencing
- Planning movement