What is a stroke?
A stroke occurs when blood supply to the brain is interrupted. There are two main causes of stroke – a thrombosis and a haemorrhage.
- A thrombosis is blood clot which blocks an artery (generally in the brain, but sometimes in other areas of the body) and disrupts blood flow to the brain.
- A haemorrhage is when a blood vessel in the brain bursts. This can disrupt blood flow to the brain, but also cause problems when the leaking blood clots.
The brain guzzles large quantities of oxygen and nutrients which are supplied by the blood. An intricate network of blood vessels sends blood to the various parts of the brain. The brain is an extremely delicate organ and the lack of blood flow for just a few minutes can cause brain cells to die. Haemorrhage and thrombosis can cause damage to various parts of the brain depending upon which blood vessel or vessels are damaged or blocked. A stroke can therefore cause a wide range of impairments (depending upon which parts of the brain are damaged).
These impairments can include problems with:
- The production of speech.
- Understanding speech.
- Memory and cognition.
- The function of specific organs.
- Sight and other sensory organs.
The severity of impairments resulting from a stroke can also vary. For example one person who has had a stroke may have a mild weakness in a specific limb, whilst another person may be totally paralysed in one side and unable to talk. Some people who have had strokes make a full recovery, and others remain impaired.
Stroke and Higher Education.
Around 1000 people under 30 have a stroke each year in the UK, making them relatively rare. (http://www.stroke.org.uk). There are however some young students who have had strokes as well as mature students. Difficulties faced by students with stroke damage vary enormously as stroke could potentially affect any part of brain function. It must be noted that after effects of stroke can, and often do improve over time, and with practice.
The more common difficulties likely to be faced by students who have had strokes are, dysphasia, aquired dyslexia, memory problems, mobility problems and depression.
Acquired dysphasia is a more common after effect of stroke and usually results from damage to the left hand side of the brain, which is largely responsible for language and communication.
Dysphasia is an impairment of speech and comprehension of speech, which can manifest itself in several ways.
Dysphasia can include problems with:
- Understanding speech.
- Forming sentences.
- Finding the right word.
- Writing and spelling.
- Following directions and remembering names.
- Selective problems with grammar.
The strength of the indicators of dysphasia can vary. Some people may only have mild communication problems such as inability to read social signals or an occasional difficulty in finding the right word, whilst others my have more severe impairments such as inability to form meaningful sentences.
Staff teaching students with Dysphasia could help by:
- Discretely asking students, if you are unsure of any individual’s needs.
- Providing Handouts ;
- Cover as much of the lecture material as possible.
- Make the handouts clear and concise.
- The use of diagrams and pictures can be very helpful to many students.
- Include references and reading lists.
- Allow students to record lectures, or record them yourself and distribute copies to students on request.
- Face the students when speaking.
- Use plain language - provide a list of any new technical terms or subject-specific abbreviations.
- Allow students time to express themselves.
Stroke can also leave people with less obvious communication problems such as an inability to read social signals, a difficulty in finding the right word , a tendency to tire mentally and perhaps then appear confused or a difficulty with instantaneous decisions.
Acquired dyslexia is another common after effect of stroke. It is usually caused by damage to the left hemisphere of the brain. Singleton (1999) defines acquired dyslexia as a significant loss of literacy skills as a result of some neurological trauma such as a stroke or head injury, illness or brain disease. People with acquired dyslexia may have similar problems to students with developmental dyslexia such as problems with:
- Reading and writing,
- Generating meaning from text,
- Quickly forgetting what they have just read,
- Attaching sounds to letters
- Distinguishing between left and right.
Staff teaching students with acquired dyslexia could:
- Make presentations as diagrammatic as possible
- Encourage the use of sound recording
- Indicate key items on reading lists (and key chapters)
- Provide glossaries of technical terms
- Provide handouts (on disk if possible)
- Use non-book source material (e.g. tapes, videos, CDs) where possible
- Use at least 36 point text size in overhead transparencies (OHTs) and PowerPoint
- If applicable, remind students that they can reserve books via the online public access catalogue, to save them struggling with the Dewey system. In many universities, extended loans are available to dyslexic students.
Memory is often divided into 2 distinct types, based upon duration. These are:
- Short term memory (STM) – A working memory which stores information about things that have just happened and are currently happening. STM is limited to approximately 7 bits of information and has a duration ranging from just a few seconds up to about a minute.
- Long term memory (LTM) – A large memory store of almost unlimited size. LTM stores many types of information including autobiographical information, language, acquired knowledge and much more.
Stroke can cause problems with LTM and STM which often improve over time.
Staff teaching students with memory difficulties could:
- Provide hard copies of any information presented, e.g. handouts or data on disks.
- When presenting information, keep it as short and concise as possible.
- Try to make lectures flow and do not jump from one point to another too quickly.
- Present the same information in different ways to encourage deeper processing.
Motor impairments and problems with mobility often result from stroke. Usually these problems are confined to the side of the body opposite the side of the brain which has been damaged by the stroke. Occasionally stroke damage is widely spread across the brain and both sides can be affected. The severity of motor impairments can vary from a one sided weakness in a single limb (hemiplegia), to a full left or right side paralysis.
Motor problems may cause the person difficulty with everyday activities such as walking or grasping objects. Fortunately there are many assistive products available to people with mobility problems ranging from wheel chairs to voice recognition software.
Staff can help students with mobility problems by:
- Ensuring that all rooms are easily accessible and walk ways are not obstructed.
- Ensuring that desk and seating spaces are of adequate size.
- Allowing the use of any assistive products necessary.
- Prioritising seats for these students
- Offering assistance for any field trips or excursions.
Depression is a very common after-effect of stroke. There are two main reasons for this:
- The emotional impact of a stroke on one’s life can often result in depression.
- The alteration of brain function due to brain damage may cause depression.
Depression is often categorised as the experience of low mood which continues for more than two weeks. Depression can have detrimental effects on living. It can cause:
- A loss in the ability to concentrate.
- Poor motivation.
- Reduced memory capabilities.
- Low self-esteem.
- A tendency to avoid social interactions.
- Low energy levels - People with depression often report tiredness.
- Decreased personal hygiene.
- Self harm and a tendency to turn self-defeating behaviours such as drug abuse and alcoholism.
Depression is rarely permanent, although relapse is quite common. The effects of depression can often be improved by anti-depressant medications, regular exercise and psychological therapies.
Staff can help students with depression by:
- Allowing extensions to coursework deadlines.
- Allowing absences and supplying students with the resources to catch up.
- Allowing the student to work from home if necessary.
- Providing detailed lecture handouts and reading materials.
- Providing positive feedback when deserved.
- Talking to students about their impairments.
- Encouraging the use of audio and/or video recording.
Bergquist, W.H., McLean, R., Kobylinski, B. A. (1994) Stroke Survivors. San Francisco, California: Jossey-Bass Inc. Publishers.
Burkman, K. (1998)Stroke Recovery Book: A Guide for Patients and Families. Addicus Books.
Davis, G.A. (1983) A Survey of Adult Aphasia. Englewood Cliffs, New Jersey: Prentice Hall.
Doyle, J. (1996) Dyslexia: An Introductory Guide. London: Whurr.
Hales, G. (1994) Dyslexia Matters. London: Whurr.
Josephs, Arthur. (1992) The Invaluable Guide to Life after Stroke: An Owner's Manual. Long Beach, California: Amadeus Press.
Hinds, D.M. (2000) After Stroke. Harper Collins.
Parkin, A.J. (1996) Explorations in cognitive neuropsychology. Blackwell.
Pinel, J.P.J. (2005) Biopsychology (6th Edition) Pearson Higher Education.
Websites and Pages
American Stroke Association - www.strokeassociation.org
NHS Direct Online Health Encyclopaedia - www.nhsdirect.nhs.uk/en.asp?TopicID=433&AreaID=3633&LinkID=2708
The Stroke Association - www.stroke.org.uk
Wikipedia - www.wikipedia.org/wiki/Stroke