Vision and visual perception is how your brain tells your body about what is going on in the space around you. Here are some areas of perception that may be affected by stroke and some tips for dealing with them.
Areas of perception that can be affected by stroke
Vision
There are different ways that your vision may be affected.
- double vision
- partial loss of vision in one or both eyes
- blurred vision
- loss of ability to see contrasts (contrast sensitivity)
- loss of visual field (blind spots).
Tips and strategies
- Lighthouse strategy: This means that you turn your head from side to side using the visual field you still have, in a sweeping motion to look at the whole room. This makes up for the loss of visual field.
- Put signs on the doors, such as “bathroom” to help you find your way.
- Use tools such as prism glasses and patches as recommended by your healthcare team.
Sensation
Feeling may be affected, limited or lost on the side of your body affected by stroke. This can put you at risk for injury. You may not be aware of a shoe rubbing or hot liquid in a cup.
Tips and strategies
- Use a silicone glove when handling hot pans.
- Adjust the water heater to a safe temperature.
- Look at your body carefully to make sure that it is positioned safely.
- Check the skin on the affected side for red marks.
Spatial relations
Estimating or judging the space between things around you. You might:
- misjudge the height of steps or bathtubs.
- trip over rugs, steps or uneven pavement.
- miss the chair when sitting down.
Tips and strategies
- Understand and identify safety issues in your environment.
- Tape the edges of tables and stairs to provide a point of reference.
- Always make sure you can feel the seat of the chair you are about to sit on.
Time awareness
The recognition of time passing. You may feel that time is passing more slowly or quickly than it really is. For instance, you may think it is time for lunch soon after breakfast.
Tips and strategies
- Keep clocks and calendars handy.
Unilateral body neglect
A decreased awareness of one side of your body and the area surrounding that side of your body. If you are unaware or less aware of the side of your body affected by stroke, it can become more challenging to take care of it. You might put only one arm into a shirt, shave only half of your face, or leave your affected arm dangling out of your bed or wheelchair. You might not notice the remote sitting next to you on the affected side of your body.
Tips and strategies
- Learn to look carefully at the neglected side of your body to make sure that it is positioned safely (visual scanning). Or use a mirror to remind yourself of the affected side.
- Include your affected side in any task.
- Rub the affected arm and leg. Post reminders such as, “Rub your left arm.”
- Have people approach you from your neglected side to increase awareness.
- Place things you use frequently such as your phone or remote on your neglected side.
Visual neglect
Seeing only part of what is in front of you. You may only recognize or perceive part of the table or plate.
Tips and strategies
- Have people approach you from your neglected side to increase awareness.
- Place articles you use frequently such as phone or remote on your neglected side.
Pain
After a stroke, gravity, improper handling and positioning may pull the top of the humerus down and overstretch weakened muscles and ligaments. This can cause the shoulder to move out of position and cause a painful condition called shoulder subluxation. Damage from a stroke can also cause painful sensations in an arm or leg. They can be made worse by touch or cold temperature.
Tips and strategies
- Be careful when you handle and move your affected shoulder and arm.
- Always lie, sit and walk in recommended positions. Change positions often. Avoid long periods of time in one position.
- Monitor and track your daily pain levels.
- Follow your plan for pain control.
- Sometimes physiotherapy, massage or pain medication can help.
Apraxia
Stroke can also cause apraxia which affects movement on both sides of the body. Apraxia can cause problems planning and completing movements needed to do a task – even if a person understands what they have been asked to do. Even if the person has good sensation and movement. Apraxia can make daily activities such as brushing your teeth, dressing, writing, speaking or walking more challenging.
Tips and strategies
- There are different types of apraxia. An occupational therapist or physiotherapist can work with you on strategies to manage your challenges.
Where to get support
Talk about your perception problems with your healthcare team and find out who can provide the best support for each problem. Make sure your care partner, family and friends understand where you are having challenges, so they can support you.
