When someone you know has a stroke, life can change in an instant. For them, for you—a stroke can affect more than just the stroke victim. Family and caregivers are often surprised at how the person’s behaviour or personality—or both—changes.
Dealing with the changes in behaviour and personality that may occur in stroke victims requires patience and understanding that the patient may not be able to control their emotions and actions. With appropriate therapy and time, many of these changes can be resolved.
Are you in the difficult situation of walking alongside someone as they go through the aftermath of a stroke? You may be unsure of how to deal with the changes they’re experiencing or how they now interact with others. This article offers practical ideas to navigate the post-stroke path with your loved one.
Common Behavioural and Personality Changes After Strokes
A stroke occurs when there is a blocked blood vessel or bleeding somewhere in the brain, which results in neural damage. Because the brain is the control center for behaviour and emotions, these two critical aspects of who you are as a person can be affected in various ways.
Each side of our brain controls different functions. So, depending on which side of the brain the stroke occurs, a stroke victim will be affected differently. According to Stroke.org, issues break down in this way:
- Left Side: speech and language issues, slower and cautious behaviour
- Right Side: vision loss, quicker and inquisitive behaviour
- Either Side: paralysis, memory loss
A stroke can leave its victim with altered behaviour, emotions, and personality. Sometimes these changes are significant, affecting the victim in a way that drastically alters their quality of life. Other times, the effects are mild and have only a minor impact on their post-stroke life.
In some cases, the injury to the brain is itself the direct cause of these behaviour and personality changes. In others, the victim struggles to cope with the way life has been transformed by the stroke, which results in behaviour and personality shifts. Regardless of the reason or severity of these behaviors or emotions, the consequences can be difficult for the stroke victim and their family to accept and deal with.
The good news is that time is on your side. Many stroke victims regain much of what had been lost after the stroke with the appropriate intervention and therapy. In the meantime, life must go on for the patient, family and friends, and caregivers. Dealing with these changes is a daily struggle felt by all involved. But there are things that you can do to ease the impact on everyone and make progress on a return to normalcy.
The different scenarios described in this case study show that, with targeted effort, patience, and time, stroke survivors can regain feelings of self-worth, a zest for living, and improve relationships with their friends and family. It’s helpful to learn ways to navigate the uncharted waters of the post-stroke world so that everyone feels like there is hope for a return to normal once more.
Dealing with Behaviour and Personality Changes After Strokes
Treatments for the behavioural and emotional after-effects of a stroke depend on how these changes manifest themselves in the patient.
Unfortunately, there is no “one size fits all” answer. Not every idea works with every person or behaviour. Patience and understanding, along with trial and error, are vital in helping the patient move forward.
Often, it takes some time and a combination of different therapies or tactics to address persistent or multiple issues.
A stroke can cause brain injury that prevents the patient from having any positive emotions, which leads to depression. Some patients become depressed as they realize that they cannot live life as they used to and wonder if they’ll ever be able to again.
Some signs of depression include:
- Ongoing sadness
- Lack of interest in others and activities that previously gave pleasure
- Lack of energy
- Changes in sleep routine
- Changes in appetite
If depression is evident, seek out a medical diagnosis to determine if there is a physical reason caused by the stroke itself or if it results from feeling down about how different life is.
Dealing with Depression
If you are a family member or caregiver for a stroke victim with depression, offer compassion and empathy for their situation. Interactions with a depressed patient should be positive and upbeat, expressing hope that the situation will get better.Psychotherapy, or talk therapy, can help both the patient and family members living with the aftermath of the stroke and its impact on their quality of life. Talking about feelings of sadness and self-worth with a trained professional often allows everyone involved to put the situation in perspective.
Medication is another option if the depression is severe and persistent. You’ll need a doctor’s opinion if this is the route you wish to take.
It can be helpful to encourage the stroke victim to get up and be more physically active if possible. Heading outside for fresh air and sunshine can be a mood-brightener too.
If they will agree, have the stroke patient participate in a support group for stroke victims. This is a good way for them to put their feelings in perspective. Support groups can be beneficial for family members and caregivers, as well.
One of the most unnerving after-effects of stroke is PBA, or Pseudobulbar Affect. PBA, also known as Emotional Lability, is when the patient has an uncontrollable outburst of emotion—usually crying or laughing—that is not the appropriate response at that particular moment.
PBA can be triggered by certain situations like crowds or settings of silence, such as a church service. This can cause the stroke victim to withdraw from life out of fear of these uncontrollable outbursts. However, with targeted effort, this doesn’t have to be the case.
Dealing with Mood Swings
One stroke survivor offers several tips on coping with PBA until it (hopefully) improves or resolves with time:
- Determine what triggers the PBA episodes.
- Avoid trigger situations if possible.
- Create a distraction for yourself.
- Move or reposition your body to get your mind focused on that effort.
- Use deep breathing exercises to calm the mind.
- Reducing unnecessary stress, practicing relaxation techniques like yoga, and getting plenty of rest may also work to lessen the frequency of PBA outbursts.
- If the lability is severe enough to have an extremely negative impact on quality of life, medication is available to address the condition. Contact your doctor if PBA continues to cause problems.
Some stroke victims decide it’s best to talk during an episode about what’s happening and let others know the best way to help them through it. Others choose to ignore the PBA and carry on with whatever they’re doing; this usually gives those nearby permission to do the same.
Agitation, Anger, and Aggression
Agitation is a common side effect of a stroke. The person may not be able to handle too much at once. Too many questions, too much bright light, too many visitors, or too much contact with medical personnel can all create an agitated state.
Stroke patients often show increased anger due to frustration at their slow recovery. It can be painstaking to learn how to do the simplest things again—tasks that could once be done without a second thought.
This American Academy of Neurology study, among others, has shown that anger and aggression are a direct result of the physical injury to the brain caused by the stroke, meaning the patient truly cannot control their behaviour.
Sometimes, anger can lead to violent behaviour and aggression, even in someone who was completely mild-tempered before the stroke. It’s important to manage this aggression so that the home stays a safe place for the patient and their family.
Dealing with Agitation
Since too much of a good thing is the impetus for agitation, it’s best to avoid that trigger. Refrain from asking too many questions, limit the number and frequency of visitors, and be sure your loved one gets enough rest and downtime.
Dealing with Anger and Aggression
To maintain a safe environment, it’s essential to tread carefully when the stroke victim begins to show signs of anger and aggressive behaviour. A Stroke Network newsletter offers these tips:
- Remember that your loved one cannot control their behaviour.
- Stay calm.
- Speak slowly and quietly until they settle down.
- Avoid arguing with your loved one.
- Try distracting your loved one with another topic or activity.
- Find what triggers the behaviour and try to avoid those situations.
- If aggression occurs, back away and keep the other family at a distance until the behaviour subsides.
- Seek help if the violent behaviour persists.
For caregivers and family members, it’s important to recognize when your anger level begins to rise so you can take a step back. Take deep breaths and get a grip on your emotions before trying to help your loved one.
Someone who has experienced the loss of a former self that often comes with a stroke can be understandably anxious. Not knowing if their current condition is permanent or not is worrisome to even the most optimistic person.
Symptoms of anxiety can include:
- Lack of restful sleep
- Muscle tension
- Inability to concentrate
Dealing with Anxiety
Offer compassion and understanding to the patient when they show signs of anxiety. Put yourself in their shoes to get a sense of what it’s like to deal with the physical effects of a stroke and also be unable to control your behaviours and emotions.
Seek out anxiety medication from a doctor if the condition persists and the person can’t seem to move past their feelings of loss and worry.
Neglectfulness is attributed to impaired cognitive function. One-sided neglect, as it is known, is when a stroke patient is unaware and inattentive of what’s happening on one side of their body.
A stroke patient typically exhibits neglectfulness on the same side that the stroke occurred on. They may not notice anything that happens to them or in the environment around them when it occurs on the affected side of their body.
Neglectfulness can lead to a lack of independence since the stroke patient will neglect important tasks or warnings from the affected side. It also is potentially a safety issue (think about trying to cross the street without looking for traffic in one direction). It can result in physical injury if not dealt with.
As with other stroke effects, neglectfulness and forgetfulness should improve over time and with targeted practice.
Dealing with Neglectfulness
Addressing neglectfulness begins with helping the stroke patient be more aware of their tendency to only use or turn to one side of their body. Including family members and caregivers in this awareness allows them to part of the solution as they interact with the patient.
Practically speaking, the best way to slowly overcome this issue is to force the patient in a gentle way to use the neglected side. Try doing the following on their neglected side to encourage them to turn or move that way (You may need to calmly assist them in focusing on that direction.):
- Approach and speak to them.
- Put objects within reach.
- Gently remind them to look on that side for forgotten items.
- If necessary, take their hand or chin and guide it towards the neglected side.
With time and consistency, it is possible to gradually overcome the neglectfulness left behind after a stroke.
Inappropriate or Childlike Behaviour
One problematic result of a stroke can be exhibiting inappropriate or childlike behaviour. For both the patient and family members, it can be embarrassing, frustrating, and, in some cases, dangerous.
Whether the behaviour is a coping mechanism born out of the frustration of overcoming a stroke or caused by actual physical damage to the brain, it is a common experience among stroke survivors.
If your loved one is having emotional outbursts, episodes of impulsiveness, or showing a lack of inhibition, they may be sending out a cry for help and attention.
Dealing with Inappropriate or Childlike Behaviour
You may prefer to try and deal with inappropriate behaviour without intervention as the first course of action.
Keeping the stroke survivor in familiar surroundings and free from unnecessary stress may help alleviate the incidences. Encourage the stroke patient to listen to family members who have their best interests at heart and are trying to gently guide them into more social awareness of their actions.
Other ways you and your loved ones can deal with inappropriate or childlike behaviour include:
- Stroke survivors who act in socially inappropriate ways or revert to acting like a child will often benefit from psychotherapy. Therapy can help them realize what triggers the episodes and offer resources to cope in more acceptable ways.
- Meditation is another option as it teaches the patient how to calm their mind and emotions. With a focus on self-awareness of trigger points and the onset of such behaviours, the patient can use meditative techniques to pull themselves back from the edge.
- As in other after-effects we’ve discussed here, medication is also possible after a mental health evaluation and prescription from a doctor.
Therapy to Address Changes in Behaviour and Personality
Changes in behaviour and personality after a stroke are common. That doesn’t mean the patient or family members have to accept them unequivocally.
In addition to the methods we’ve discussed that require no outside intervention, there are several types of therapy that may provide the treatment needed by the stroke survivor.
Music therapy can involve singing, playing an instrument, or simply listening to mood music. Music affects our moods and emotions with the power to calm, uplift, or even excite or rally us into activity.
Studies have shown that music therapy for stroke survivors can affect brain function and emotional moods, as well as improve motor skills if an instrument is played. For stroke survivors who exhibit neglectfulness, music therapy can be a catalyst for them to focus their attention on the musical sounds, which can increase cognitive function.
Music can make rehabilitation times fun and upbeat. It can inspire and motivate patients to keep working on the after-effects of a stroke. Think “Rocky’s Theme” and how that driving beat makes you feel like you can really do it!
Recreational therapy is all about getting the stroke survivor back into the game, so to speak, and doing the activities they love to do. From board games to dancing or painting, this form of therapy strives to get the patient up and active.
As they feel like progress is being made and normalcy is within reach, their mood should improve, and their behaviour and personality issues may recede. In doing something they enjoy, they will focus more on being successful and spending less time using other coping mechanisms.
Recreational therapists will work with patients who need extra assistance or encouragement. If the stroke survivor is able, there are plenty of activities that can be done at home without outside intervention; a few examples include:
- Board games
- Crossword puzzles or Sudoku
Art therapy is based on the idea that artistic self-expression is therapeutic and offers healing for the mind and emotions. It benefits both sides of the brain: the right side for visual and spatial awareness and the left side for analysis and verbal communication.
Henry Hoffman writes for Saebo that “art therapy stimulates the brain, activating neuroplasticity —the ability of the brain to repair or rewire itself to restore functions damaged by a stroke.”
In addition to the physical benefit of art therapy, artistic exercises like drawing, painting, kneading, and moulding clay can offer the patient a sense of control, relieve stress, and promote calm. Completing an art project successfully can also give the patient a sense of fulfilment and achievement.
With their medium of choice, stroke survivors can express their thoughts and feelings using creativity, colour, and form. It often gives caregivers and family members insight into deeply held emotions and behaviours that have manifested after a stroke.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy, or CBT, is also known as psychotherapy or talk therapy. It involves attending sessions with a licensed professional to deal with these alterations in behaviour and personality.
Working with a therapist to learn how their thoughts connect to emotions and actions can help a stroke survivor. They can then recognize triggers and work to handle their responses to situations, feelings, or negative thoughts.
Cognitive Behavioural Therapy can provide coping mechanisms for the patient to try when they feel themselves losing control.
Solution-Focused Therapy (SFT) is just what its name implies. Guiding the patient to set goals and develop solutions to the challenges they face is its primary role. This therapy encourages the patient to not dwell on the negative aspects of their current situation.
Sometimes looking back at the past and how the patient used to deal with issues is the first step in turning their focus to what’s ahead and how they can get there. Stroke survivors then need to look ahead and plan for a future where they can do what they love and feel like their old selves again.
Healing into Possibility defines mindfulness as “the capacity to pay relaxed, openhearted, non-judgmental attention to what is happening right now, in this present moment.”
For stroke patients who suffer from depression and feelings of despair, mindfulness therapy can help them become more aware of their mental state to learn to deal with their emotions.
It is a blend of cognitive therapy and can involve mediation practices and breathing techniques, as well as group therapy sessions. The idea is for the stroke patient to not necessarily dispel the negative emotions but to change how they are seen and handled.
Learning to interact with others in more productive, socially acceptable ways is the basic tenet of Interpersonal therapy, or IPT. It is a short-term treatment for depression and the patient’s inability to maintain close and effective personal relationships.
Stroke survivors may try to isolate themselves from others because of depression or uncontrollable behaviours. With IPT, the patient learns strategies for changing the way they interact with others.
Self-Care for the Caregiver
Your loved one has had a stroke and has begun the recovery process. Where the person was once mild-mannered or fun-loving, they may now be angry or depressed. They may lash out at you, their caregiver, or other family members—with ugly words that hurt or even violence.
The resulting upheaval of their altered behaviour and emotions can take a toll on those providing care. Therefore, it’s critical that family members and caregivers take time for self-care along the way.
You may think it’s selfish to spend time on yourself and your needs. It isn’t selfish at all. Your loved one needs you to be on your best game because you provide stability and the encouraging environment they need to focus on getting better.
Self-care can include the following:
- Understand and accept that your loved one has been through a traumatic event. They are not the same as they used to be, and their behaviours and emotions reflect that.
- Go easy on yourself. You’re doing the best you can to deal with a difficult situation, and that’s all you can do on a daily basis.
- Take care of your physical, mental, and emotional needs . Eat right, exercise, and get some rest. If you get run down, you won’t be able to fully care for your stroke patient.
- Take time away from the situation. Enlist a neighbour, co-worker, or extended family member to provide care for a few hours or a few days so you can get away and rejuvenate your mind and body.
- Avoid comparisons. Looking at social media often makes it seem that everyone else has a perfect life. They don’t. Comparing your current situation with that of others or with what you had before can leave you feeling empty and dissatisfied. Don’t do it.
- Join a support group for caregivers. Simply talking and sharing with others who are in the same situation can lighten your load and provide encouragement to keep going. The American Stroke Association offers resources to assist you in finding the support you need.
According to Caregiver.org, strokes happen to nearly 800,000 Americans every year. Death occurs in over 135,000 of the cases. Those who survive face a challenging road to recovery physically, mentally, and emotionally.
Dealing with the side effects of altered behaviour and personality from the traumatic brain injury of a stroke is a slow and ongoing process. But, with time and a concerted effort by the stroke survivor, the family members, and caregivers, it is possible to adapt to or overcome these changes and live a full life.
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