What You Should Know about Strokes

By  Jeffrey Walden, Psy.D.

Strokes are the leading cause of long-term disability, according to the National Institute of Neurological Disorders and Stroke. Experts estimate that four million Americans and their families are living with the effects of stroke.


What is a stroke?

A stroke is an interruption or disruption of blood flow to the brain. There are two general categories of stroke. An Ischemic Stroke occurs when a clot obstructs blood flow in a blood vessel in the brain. Ischemic strokes account for around 87 percent of strokes. A Hemorrhagic Stroke occurs when a blood vessel in the brain ruptures or bleeds. Hemorrhagic strokes typically occur due to weakened areas in blood vessels in the brain.   It is also possible to have a Transient Ischemic Attack or mini stroke. These occur when a clot temporarily blocks a blood vessel in the brain. Although the symptoms of transient ischemic attacks resolve quickly, they are considered a warning sign of potential future ischemic stroke and should be evaluated immediately by a medical professional.


What are the warning signs of a stroke?

There are some warning signs that a person may be having a stroke. The acronym FAST can help you remember the warning signs to recognize. If you observe any of these symptoms in yourself or a loved one, you should seek immediate medical attention


F- Face droop: Is one side of the face drooping or numb? When the person smiles, does only one side of the mouth rise?


A- Arm weakness: Has one arm become weak or numb? When attempting to raise both arms, does one arm drift downwards or fail to respond?


S- Speech problems: Does the person’s speech sound slurred or garbled? Is the person unable to speak or understand what others say? Can he or she repeat a simple phrase or sentence?


T- Time to call 9-1-1: If you observe any of these symptoms, even if they go away, you should call 9-1-1 and get to a hospital immediately.


Other warning signs of stroke include sudden confusion, difficulty walking, sudden blurring of vision in one or both eyes, dizziness, and rapidly developing severe headache.

What are the effects of a stroke?

Sometimes the damage from a stroke is temporary, with the gradual recovery of function over time, but at other times, the person may experiencing permanent changes.  According to the National Stroke Association, 35% of stroke survivors will recover either all (10%) or most of their ability (25%). An additional 40% might have moderate to severe impairments and can require special care.

Two-thirds of stroke survivors experience problems with thinking skills after the event. They may also experience changes in motor skills and sensory functioning. Finally, survivors of stroke may experience symptoms of emotional distress,  including feelings of depression, anxiety, and trouble sleeping. These effects can impact the patient’s ability to participate in rehabilitation and may require treatment from mental health professionals

There are multiple potential behavioral health issues following a stroke, which may include:

  • Lack of restraint in controlling behavior, lack of inhibitions
  • Impulsive decision-making
  • Agitation or feeling over stimulated, e.g. being wound up or fidgeting
  • Loss of appetite
  • Insomnia
  • Dementia symptoms

There are often cognitive difficulties after a stroke, which may include:


  • Lack of follow through on a task, i.e. starting and stopping different activities
  • Troubles with attention and concentration
  • Complications with decision-making and problem-solving
  • Decreases in processing speed, i.e., slower thinking
  • Difficulties with learning and memory
  • Challenges with coordination of movement and visual perception
  • Problems with organization and planning

In some cases, the stroke patient may not realize the extent to which the stroke has affected his or her thinking skills.

Rehabilitation after stroke

Stroke survivors have the best outcomes when they begin rehabilitation as soon as possible after the stroke. This effort starts in the hospital. Subsequent therapy may take place in a rehabilitation unit, home treatment, or a long-term care facility. Most patients receive speech therapy, occupational therapy, and physical therapy. Treatment may also include psychotherapy and psychiatric care to address mood, thinking, and behavior. The patient and his or her family may also receive education to reduce the risk of future strokes by managing risk factors such as blood pressure, cholesterol, blood sugar levels, obesity, and alcohol and tobacco use.

For stroke patients with impaired thinking skills, the treatment process may include cognitive rehabilitation. Cognitive rehabilitation seeks to assist the stroke patient to recover cognitive skills by using exercises designed to retrain the brain, as well as the development of compensatory strategies or “workarounds” to utilize intact thinking skills to compensate for those affected by the stroke. Cognitive rehabilitation includes the monitoring of the patient by a professional to adjust the treatment to target the individual’s deficits.  Because of the close monitoring by the professional, the patient gets timely feedback on their progress.

To read more about Cognitive Rehabilitation after a stroke, please download this PDF from Neuropsychologist Dr. Rimma Danov, P.C.

Neuropsychologists often play a significant role in assisting patients to recover from a stroke. Neuropsychologists assess the impact of strokes on thinking skills, as well as evaluating the patient’s emotional responses, understanding of the impact of the stroke on functioning, and potential changes in personality or behavior, and the results of the assessment help to guide the rehabilitation process. Neuropsychologists may provide a  formal cognitive assessment, as well as a mental capacity assessment to assist in determining what activities are suitable for the patient. Their expertise can also be useful in helping the stroke patient adjust to any long-term changes stemming from the event.

It is important that patients and their families work closely with their neuropsychologist and other treating clinicians to determine realistic rehabilitation goals consistent with the priorities of the patient and his or her loved ones. Treatment aligned with patient priorities based on realistic goals and expectations can do much to maximize recovery, foster satisfaction with the rehabilitation process, and facilitate improved adjustment to their life after their stroke.

For a helpful overview of the role Neuropsychology makes in stroke rehabilitation, please download this PDF from the South London Cardiac and Stroke Network.

Jeffrey Walden, Psy.D., MBA

Dr. Walden has over a decade of experience in neuropsychological assessment and treatment of adults and children. He has extensive experience in the evaluation and treatment of chronic and acute mental and behavioral health concerns. Dr. Walden provides neuropsychological assessment, psychological testing, and psychotherapeutic services at Achieve Wellness Group. He is presently accepting new patients.



Sources :


“Stroke Rehabilitation Information.” www.ninds.nih.gov. Web. 14 January 2016. <https://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm >.

“Rehabilitation Therapy after a Stroke.” www.stroke.org. Web. 14 January 2016. <https://www.stroke.org/we-can-help/stroke-survivors/just-experienced-stroke/rehab>.

“Neuropsychology within Acute Stroke Services.” www.slcsn.nhs.uk. 6 October 2010. Web. 14 January 2016. < https://www.slcsn.nhs.uk/files/stroke/events/061010-mdt/hans.pdf>.

“Neuropsychology Today.” www.neuropsychnyc.com. Web. 14 January 2016. < https://www.neuropsychnyc.com/files/Newsletter-Cognitive_Rehab_after_Stroke_CVA_.pdf>.