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When you have had a stroke and you are taken into a hospital there are lots of tests that they have to be looking at. First of all, they really have to look and see what type of stroke it is, because the treatments are also different, they need to look at a brain scan and a lot of the times they do MRI scans, which are a lot more intricate. With an MRI scan, they can pinpoint where the problem is and they can treat with blood-thinning drugs. If you have got a blockage there through a clot, it is because your blood is too thick, they look at treatment. They will always check your blood pressure, they will always check you for your cholesterol, they will always check you for diabetes because they are the contributory factors. Then they will put you on the relevant medications.

If somebody has had a bleed, the majority of people if it does not... If it is really swelling to a point where it is out of control, then they have to look at operating and they take a piece of the skull away to relieve the pressure and wait for that to go down, and then they would replace the skull which they have taken away. So it is a completely different procedure. You would not treat a bleed with blood-thinning drugs because obviously, the blood is, it is flooded and it is not clotting so therefore it is causing that problem.

So there are lots and lots of different treatments, but the scans are the most important things to find out what type of stroke you are having. Once they have established the type of stroke that you have had, then will put you on the medication that is relevant for that, for whatever it is that has caused the stroke. You have to start rehabilitation and a lot of that starts with even just sitting on the side of the bed. But obviously, there are people that are in comas for quite some time because of the nature of the stroke. Sometimes, people are not able to do anything straight away, but what they do try and encourage is to to see what you are able to do and what you are not able to do.

There is a problem, obviously, if somebody has been affected in the area of the brain that affects the speech because the communication is not there. Some people are not able to communicate and things need to calm down. They do start quite slowly, sitting on the edge of the bed or sitting up in bed and all of that, which the occupational therapist and the physio would look at. They would set up a rehabilitation plan.

That does not always happen straight away, because obviously after a stroke, there's quite a trauma and not everybody recovers from that trauma quite so quickly. Once you can establish what the damage is from the stroke, then they start looking at how they are going to rehabilitate people and this does not happen with everybody, some strokes, are very serious and they are not going to be able to. Some people are a bit bound, unfortunately, but if there is any chance that they can get people to sit up, stand, they will do that. Take them to the gym and they will do things with the people. They do a lot of stuff around kitchen tasks and that is not around whether or not they can make a cup of tea, that is around seeing how cognitively which is how the brain functions on day-to-day things. They like to see how people can do things. You may not be able to make a cup of tea, you might not be able to remember.

So, therefore, it could be that the sequence has been affected in the brain. It could be that you just don't remember things. It could be all sorts of things. So they have to do these tests, these tasks to find out exactly what damage has occurred. It can be quite varied and it is individual to each person. People may have a stroke and the damage may be in the same area of the brain, but that does not mean to say they will have the same symptoms. A stroke is as individual as we are as people. So they have to look into that and that is why it can be quite complicated.

With stroke, a lot of people's assumption is it is about the physical side of stroke. If you can't walk or you are weak on one side, it is quite apparent you have had a stroke. But there are a lot of people that don't present with that, but present with speech problems and present with cognitive issues. Now what that is, is how you function, whether you can sequence whether you can make a cup of tea, whether you know what you are doing, your memory. So there are a lot of things that they have to, they look at to see whether or not these are part of what their stroke is.

My experience of working with people with cognitive issues is they may not recognize objects, they may not be able to do things that they could do before. It is not just about whether you can cut up your food and things like that, it is about whether you can recognize objects. Speech is a big issue for a lot of people because you are not able to communicate your needs which is very, very frustrating. People have a tendency to talk for you and when you are walking along and you are walking quite well, people look and think, "Are you sure you have had a stroke?" It is not until you ask them a question or you ask them to do something and you find they cannot answer you.

Obviously, I have had many years of experience working with stroke and I realize that people with speech problems have their difficulties. But it is not apparent for a lot of people, and I think that is probably the worst for anyone who has had a stroke because people haven't got the notion behind the fact that a stroke affects speech, memory, all sorts of things. So I call it, "The hidden problems".  People do not recognize these things which is very, very frustrating for the stroke survivor, because they are able to walk around, they are able to do everything. But the one thing they are not able to do, is to communicate with people.

People need to understand that just because somebody looks well and because they walk okay and because they can do things, that they are okay. People can be watching the television, but do not necessarily understand what is going on. They cannot follow a programme, they cannot read, they cannot write. Some people can read but they can’t do numbers. It affects every aspect of your life.

Stroke is not just about the stroke survivor, it's about the whole family. And I always use an analogy with the pebble and ripple. The pebble was the stroke survivor but all the ripples are everyone around. That is not just family, that is friends, that is everybody. Work colleagues, it affects everybody. A working aged man loses his job because he is not able to work anymore. So the financial and emotional impact that has on children, they may lose their home, it is incredible!

With elderly people, if their partner has had a stroke and they cannot do anything for themselves, that elderly partner is struggling, probably with their own health issues. So it puts a lot of pressure on people. Although the stroke survivor is supported and cared for, it is the carers and families that find it difficult to cope.

Everybody wants to wrap everyone up in cotton wool. So that's when things like frustration comes in. The partner does not want his wife or her husband to go out and do something because they are worried. The stroke survivor feels as if they are being treated like a child and so it snowballs.  It is very, very difficult for the family to be able to continue, because they are never going to be able to continue as they were. So it is a big life change for everybody, not just the person that has had the stroke. And I see that day in and day out. So my role is to support everybody, that includes children, making sure that they are able to deal with children and look after their needs. How do you explain that dad can play rugby one day and the next day, they can’t? And how frustrating for the dad, because he cannot take his kids to rugby. So you can only but imagine the emotional impact that a stroke has.

So although the stroke survivors are said to get all that support, there is all those other people that need to be supported too, because it is horrible, because it is so sudden. You are this person one day, and then you are that person the next day and your life completely changes. As you go through adapting to life after stroke, there are many areas that are difficult to come to terms with. It could be that your house, where you live, and you own is no longer suitable. It could be that you cannot afford to have a stair lift put in, so it means a bed has got to be downstairs which disrupts your whole life really, having somebody that has to sleep, eat, drink, in the living room instead of having the normality of going up to bed, that can be very difficult to deal with. People might need ramps to get in and out with a wheelchair because they are not able to walk. It could be that you have got to have rails at the door. It could be that you have to have the bathroom changed.

Now, there are the facilities and there is not the money out there to get the grants as it was many, many years ago, so people are looking at, "Oh dear, how am I going to do this?" They cannot have a shower. Now, it is a basic need. We are not talking about something outrageously wonderful, it is a basic need. People shower nowadays, they cannot get in the bath. So what happens there? Well, unfortunately, you have to have a strip wash. That is really not very fair. So, it is about looking around to see if you can find grants everywhere and that puts an added stress on people. It could be that you have to move, it could be that you live in a council house or a privately rented accommodation and you are going to have to move because it just is not ideal for the person coming home to. That puts a big stress on people as well.

It is not just about moving house, it is about how it is going to affect the children and their schooling. So there is a lot of pressure and people do not necessarily want their house to become a hospital if you will, but unfortunately, some people have to deal with that and that can be very hard to live with. It is the practicalities of life, that can really encroach on their relationship, on the way they live and it causes a lot of arguments and it causes a lot of pressure. So it is not just about the stroke, it is not just about the physical disabilities, it is about the practicalities of life.