In 1996, Jill Bolte Taylor, PhD, a 37-year-old brain scientist, had a severe hemorrhagic L(bleeding) stroke in the left hemisphere of her brain.
Taylor's cognitive abilities degenerated rapidly in the hours following the stroke. Bleeding affected the motor cortex (paralyzing her right arm)...the sensory cortex (making it difficult for her to see or hear).. and the brain's language centers (making it difficult for her to speak).
After struggling to call for help, she was taken to the hospital, where she underwent surgery two-and-a-half weeks later to remove a golf ball-sized blood clot in her brain.
Today, Taylor is completely recovered-all of her physical, cognitive and emotional abilities are intact. Her eight-year recovery refutes the widely held belief that if a stroke survivor doesn't regain a particular ability within six months, it will never be regained.
We recently spoke with Taylor, a neuroanatomist (a scientist specializing in the anatomy of the brain) who lectures widely, about her stroke recovery. The strategies she shared also can be used by all those who have had a debilitating ischemic stroke (in which a blood clot stops blood supply to an area of the brain) or any severe brain injury…
Step 1: Move To Recover
People who survive a stroke often experience crushing fatigue due to the damage that occurs to brain cells (neurons)—this affects their energy levels and abilities to process information. Simple tasks, such as changing the position of your body or even opening your eyes, are extraordinarily difficult. But the same activities that restore physical strength also force individual neurons to reconnect and communicate with one another-a process that is essential for post-stroke neurological recovery.
Helpful: Any physical activity is beneficial even basic movements, such as standing up or sitting down.
Important: When you feel rested and capable of expending the necessary energy, you should push yourself to do more and more physically each day. As I gained strength, I progressed to trying more difficult activities, such as standing at the sink and doing dishes.
Step 2: Escape The Mental Noise
Neurons that are damaged by a stroke are unable to process normal stimuli, such as bright lights or the sound of a television. As a result, visual or auditory distractions may be interpreted by the brain as mental "noise" Saturating the brain with such stimuli may make it much harder for the neurons to recover and may impede the retention of new information.
Helpful: After any kind of stroke or other brain trauma, alternate periods of sleep with briefer periods (about 20 minutes) of learning and cognitive challenges (such as those described below). Periods of sleep (as much as needed until waking up naturally) allow the brain to assimilate information that is gleaned during periods of wakefulness.
Step 3: Work The Mind
The brain has remarkable "plasticity" (the ability to form new connections between the surviving neurons). After a stroke, if there is damage to the brain areas that control movement, sensory perceptions and cognition, you need to challenge these areas.
Examples…
- Multiple-choice questions. My mother, who was my primary caregiver, understood that asking "yes" or "no" questions didn't force me to think hard enough. That's why she asked me multiple-choice questions-for example, did I want minestrone soup or a grilled cheese sandwich? Each question forced me to relearn words.
- Simple puzzles. If you've had a serious stroke, putting together a simple jigsaw puzzle may be a huge challenge. You might not recognize shapes or colors. You might not have the dexterity to put the pieces together. But doing such a puzzle is a superb exercise because it forces you to work different parts of the brain at the same time.
- Reading. It's among the hardest tasks because, for many stroke patients, the entire concept of letters and words is lost-temporarily for some stroke survivors, but permanently for others. I had to relearn everything from scratch-that the squiggles that make up letters have names...that combinations of letters make sounds and also that combinations of sounds make words.
Helpful: I started with children's picture books, which would be appropriate for most stroke patients who are relearning to read.
Step 4: The Simplest Steps
Healthy people can't begin to comprehend how complicated things seem after a stroke When I first started walking, for example, I didn't understand the concept of sidewalk cracks. Each time I saw one, I had to stop and analyze whether it was important.
Helpful: Caregivers need to break down tasks to the simplest levels. For example, a stroke patient might not understand how to sit up in bed. He/she might need to spend days just learning how to shift body weight. In my case, I had to learn to simply hold an eating utensil before I could imagine raising it to my mouth.
Step 5: Focus On Abilities
When you've had a stroke, the extent of your disabilities can be overwhelming. It took me eight years before I was fully recovered. Patients can easily get frustrated and quit trying. At that point, if a patient is not aware of what recovery step needs to be taken next, he may never actually take that next step. It's normal for a stroke survivor to reach a recovery plateau, to continue to learn, then hit another plateau. There are many plateaus along the way.
Helpful: Even if progress seems exceptionally slow, remind a person who has had a stroke of the smallest successes it may be something as simple as once again being able to hold a fork securely.
If you are the stroke survivor, use small triumphs as inspiration. In my case, it was embarrassing to drool in front of strangers, but I reminded myself that I had managed to swallow.
After my stroke, I never imagined that I would regain enough of my abilities to return to a career as a scientist and teacher. I've managed to do both-in fact, at the same level and intensity. My stroke recovery gave me an opportunity to start my life again.
Aggressive Blood Pressure Control Helps Stroke Patients
Hemorrhagic strokes affect about 60,000 Il people in the US every year and up to 50% of these strokes are fatal. In a recent study of 404 stroke patients, half the stroke victims had systolic pressure (the top number) lowered to 180 by intravenous drugs—and half had it reduced to 140. Patients whose blood pressure was treated more aggressively had about one-third less bleeding, and the treatment caused no major side effects. Further research is needed.
Exercise and Diet Better Than Surgery
In a study of patients with carotid stenosis (a I narrowing of one of the main arteries that supply blood to the brain, but no symptoms of the disease, 90% of the patients had only a 1% risk for stroke (as determined by ultrasound probes that detect small blood clots or plaque that may break loose).
Implication: Because carotid surgery or stenting (use of a tube to prop open an artery) carries a 5% risk for stroke or death, most patients fare better with exercise, a healthful diet and medication.
Secondhand Smoke Danger
In a new study of 1,209 women, those who I had never smoked but had been exposed to secondhand smoke at least one day a week (15 minutes daily) during a 10-year period were 67% more likely to develop peripheral artery disease (PAD-narrowing of the peripheral arteries, commonly in the legs—than those who were never exposed. Secondhand smoke is likely to have a similar effect on men.
Theory: Carbon monoxide, nicotine, as well as other harmful substances produced by cigarette smoke can cause atherosclerosis (fatty deposits in the arteries).
