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Aspiration Pneumonia

Dysphagia (swallowing problems) is common after stroke, as the event damages a person’s ability to coordinate movement in the throat. Swallowing food or liquid down the “wrong pipe” (the trachea that leads to the lung) is known as aspiration and can lead to aspiration pneumonia. Silent aspiration means the stroke patient does not cough, gag, choke, or have any other outward signs of difficulty. Much of this can be addressed durring speech language therapy and utilizing swallowing technology like FEES (flexible endoscopic evaluation of swallowing).

Infections

Infections, like bladder infections and IV line infections (when the bloodstream is infected with germs that enter the body through an intravenous tube), are also common, though usually quite simple to treat with antibiotics. A urinary tract infection (UTI) is the most common type of infection.

Recurrent Stroke

Most people worry about having another stroke but the probability of a second stroke is about 10 percent within three years.  However, stroke risk does increase with age.

Deep Vein Thrombosis & Pulmonary Emboli

When one or more body parts is paralyzed due to inactivity of the limb, blood is more likely to start pooling inside the veins and form clots called deep vein thrombosis.  If deep vein thrombosis occurs, the clots can break off, travel through the bloodstream, and get caught in the lungs, which is called a pulmonary embolism. This is rare but may be life-threatening.

Neuropathic Pain

This occurs when your brain interprets normal everyday sensations as pain without any injury to the skin. Neuropathic pain can feel like a numb, tingly sensation, similar to a wire brush touching the skin, or, in extreme cases, broken glass rubbing on the skin.

Most people who experience neuropathic pain begin to feel mild sensory changes about two to four weeks after a stroke. The good news is medications and methods exist for alleviating this pain.

Shoulder Pain

The shoulder on the weak, hemiplegic (one-sided paralysis) side typically experiences this type of pain. Most people avoid using their weak arm because their shoulder is in too much pain. This can limit participation in rehabilitative activities and impair function.

Shoulder subluxation (dropping) is initially present because the whole shoulder is weakened by the stroke. A few weeks later, spasticity (muscle over-activity) develops and overtightened muscles may further limit normal movement.  

Ideally, management should begin with careful efforts to prevent shoulder pain from occurring in the first place. Poor handling of the affected limb is thought to play a role in contributing to later shoulder pain. Care should be taken in transferring (from bed to chair, etc.) and handling the weak arm and shoulder.

Treatment options to alleviate this shoulder pain and increase range of motion include:

• over-the-counter pain medications,
• joint injections with corticosteroids,
• botulinum toxin injections to relax tight, spastic muscles,
• neuromuscular electrical stimulation of the shoulder muscles, and
• stretching and strengthening program with a physical therapist.

Mood Disorders

It is important to recognize and monitor your mood and emotions. If needed, seek help from your family, friends, or doctor.  Effective treatment typically includes:

• medication,
• counseling,
• exercise, and
• support groups.

Spasticity & Hypertonia

The muscles on the weak, hemiplegic (one-sided paralysis) side may start to get tight around two to four weeks after a stroke. If you don’t address symptoms of spasticity (muscle over-activity) or hypertonia (too much muscle tone that makes it stiff or difficult to move) with your rehabilitation team, your muscles will continue to tighten up and further restrict your ease of movement.

At U of U Health, we offer a spasticity management program with an array of treatment options to explore.