The thalamus plays many important roles that help us perform our daily functions; such as memory, emotions, sleep-wake cycle, executive functions, processing sensory inputs, and sensorimotor control. It is responsible for relaying about 98% of all sensory inputs within the body.
Therefore, if a stroke occur in the thalamus it can have unique side effects on survivors. In order to know how a thalamic stroke affects the body, it will be helpful if we first take a look at how stroke occur. Thereafter, we will consider the rehabilitation roadmap and recovery timeline for thalamic stroke.
How stroke Occurs
A stroke occurs if there is a shortage of blood supply to the brain. This can happen when an artery leading to, or within the brain becomes clogged by a blood clot (this is known as ischemic stroke), or when a blood vessel bursts (known as a hemorrhagic stroke).
A stroke is a medical emergency, because if left untreated as soon as it sets in, the brain cells starts to die within minutes of losing blood supply. Blood flow needs to be restored as soon as possible to save the person’s life. It is a known fact that stroke survivors who receive swift, quick and immediate treatment always experience fewer secondary effects and functional difficulties, than those who receive delayed treatment.
To handle issues involving a particular type of stroke, it is important to understand how it affected the area of brain that was injured or damaged.
In the rest parts of this chapter, we will discus how a thalamic stroke can affect an individual, some rehabilitation methods, and the recovery timeline. To begin, let us consider some issues that are common with a Thalamic stroke.
Stroke Within the Thalamus What You Need to Know
The thalamus is located deep within the brain, and a stroke can occur there because of the effect of either a clotted or burst artery. Thalamic strokes are grouped among the category of subcortical strokes, which affect the deeper brain areas under the cerebral cortex, and not in the outer cortical region.
Therefore, to understand the secondary effects of a thalamic stroke on survivors, we need to examine the role and functions of the thalamus in the body. Earlier, we mentioned that it is responsible for relaying about 98% of all sensory inputs within the body.
And that it also plays a vital role in our memory, emotions, sleep-wake cycle, executive functions, processing sensory input, and sensorimotor control. So if a stroke occur in the thalamus, it can disrupt some of these functions — especially those of processing and transmission of sensory information.
As a result, issues with sensation after a thalamic stroke are the most common. Below are some of them:
Impaired sensation:
Numbness or tingling sensations can occur after a thalamic stroke.
Sleep problems or Insomnia:
Thalamic stroke survivors may experience sleep disorders such as insomnia.
Amnesia:
A thalamic stroke may lead to memory loss (vascular thalamic amnesia), and this can affect both long- or short-term memory of a survivor. It can sometimes result in personality change.
Attention and concentration problems:
A stroke in the thalamus can affect an individual’s ability to pay attention and remember things. The main reason is because attention together with memory, are high-level cognitive functions performed by the thalamus.
Language and Speech issues:
A thalamic stroke survivor may experience Language and communication difficulties such as aphasia.
Hemispatial neglect:
This makes an individual to be unaware of the environment on the affected side of their body, opposite to the side of the brain that was damaged. It usually happen when the right hemisphere of the brain is affected. In this case, the right portion of the thalamus will be affected, causing neglect of the opposite side of the body (left neglect).
Vision difficulties:
Some vision difficulties
that may occur after a thalamic stroke, includes: diplopia (double vision) or hemianopia a condition where half of an individual’s visual field is missing.
Balance difficulties:
A stroke in the thalamus can affect functions in the nearby areas such as the brain stem. The brain stem, helps regulate vertical eye position and head posture. When these functions are affected by a stroke, it can lead to poor balance, which can also result in poor gait.
Central post-stroke pain:
Another side effect that thalamic stroke survivors may experience is chronic neuropathic pain, also known as thalamic pain. This pain is a chronic condition that can have delayed onset. Sometimes, it may take months or even years after a thalamic stroke, for pain to develop.
It may start off as sensation loss, and after gradually progress into thermal dysregulation such as, freezing or scalding sensations. In time, it can continue to progress to severe, chronic pain.
In the next section, we will give attention to how rehabilitation can help on the road to recovery from a thalamic stroke.
Rehabilitation and the Road to Recovery from Thalamic Stroke
Compensating for the abilities that were impaired, is the central objective of recovery from a stroke that occurred in the thalamus. Starting intensive rehabilitation early after a stroke, and making consistent efforts to practice skills learned during rehabilitation in daily activities, helps individuals benefit from the process.
It is important to note that not all the post-stroke side effects may be partially, or fully resolved during rehabilitation. Nevertheless, the intensity and consistency of the rehabilitation process will have a significant impact on how much function a person can recover. Below are some important therapies that contribute to recovery:
Massage therapy:
Like in other stroke cases, after a thalamic stroke, it is common for survivors to experience numbness, tingling, pins-and-needles sensations, or pain. One therapy that treats numbness, within the very first few days after a stroke, depending on the severity is massage. No matter how sever, regular massage of the affected areas using oils that stimulates and warm the skin help resolve the issue of numbness and lack of sensation within a few weeks after a stroke occurred. Tingling, pins and needles sensations may linger for awhile after a stroke, however with regular massage it is usually resolve within the first three to six months after a stroke occurred.
When it comes to pains massage plays indispensable role in the treatment regimen.
Physical therapy:
When a thalamic stroke leads to motor impairments, physical therapy can help restore movement in the body. It may help with improving posture, gait training and strengthening. If needed, physical therapists are also able to recommend and train individuals on how to use the appropriate aids(cane, walking- stick or walker) and equipment to improve movement and safety, around the environment.
Occupational therapy:
To regain mobility and to perform activities of daily living after a thalamic stroke, occupational therapy is needed. Occupational therapists can help teach survivors how to use adaptive equipments, and compensation techniques to minimize difficulties with daily tasks. The benefits of this therapy, can become visible through repetitive experience and practice. The brain strives to become efficient, by creating and strengthening neural pathways, for tasks that are frequently experienced. This is known as neuroplasticity.
Home therapy:
For effective and successful recovery, it is important to make adequate arrangement to continue your therapy exercises at home.
Sensory retraining therapy:
As stated earlier, after a thalamic stroke, it is a common feature for survivors to experience sensory issues such as numbness, tingling, pins-and-needles sensations, or pain. Sometimes, the brain can adapt, and regain the ability to process sensory information, through a therapy called sensory retraining. It is most times used by occupational therapists. Sensory retraining involves practicing various exercises, that involve sensation to encourage the brain to adapt, and improve its ability to interpret sensation.
For instance, you can alternate placing hot and cold towels on your arm to stimulate the brain’s sensory processing. Be sure to have your caregiver, or someone else check that the towel is not too hot, before placing it on your affected arm.
The key is to do these exercises regularly, to provide the brain sufficient consistent stimulation to activate neuroplasticity.
Vision Therapy:
Vision therapy involves various eye exercises, to retrain the brain on how to control the eye muscles. It may also involve, learning different techniques to compensate for visual field deficits or inattention, such as the lighthouse strategy, which focuses on visually scanning side to side like a lighthouse to see an entire area.
To recover, individuals must actively, and consistently participate in the therapy exercises. However, it is equally important to note that not all vision issues after a stroke can be resolved.
Speech and Cognitive therapy:
Some possible aftereffects of a thalamic stroke include, speech difficulties and changes in executive functions, such as working memory loss, or changes in attention span. If a thalamic stroke survivor have such experience, a Speech-Language Pathologist or therapist will be required. An SLP knows how to identify, and treat speech and cognitive issues, in people with neurological injuries like stroke.
For best results, it is good to start therapy with an SLP, and continue it at home with the guidance of the therapist. Learn to practice at home, and follow whatever recommendations from your therapist.
Pain Management:
If you struggle with central post-stroke pain, then early treatment is very important. It is best to begin the treatment of post – stroke pains with massage therapy.
If it is started earlier, possibly immediately after the hospital interventions, the result is usually incredible. However, stroke massage is quite different from other forms of massage. It is more rigorous, and requires a therapist who understand stroke treatment.
This does not mean that where such a therapist is not available, you cannot do something on your own, your caregiver or someone else can also help. The truth is that a half massage done regularly is better than none.
Other stroke survivors may find relief through medication, or alternative medicine. When nonsurgical pain treatment options fail to provide relief, talk with your doctor about surgical options such as a permanent spinal cord simulator implant.
It is also important to both seek social support, and medical treatment for your overall wellness and to reduce the feeling of depression and other potential psychological effects of living with chronic pain.
How Long, can it Take to Recover from a Thalamic Stroke?
The length of time it may take to recover from the effects of a thalamic stroke, will differ from one individual to another. This is because every stroke is different, and every recovery response is equally different.
As a result, it is not possible to predict the exact recovery time for any single person. It is worth restating that the intensity, and consistency of rehabilitation has a great impact on recovery.
Other factors such as age, the individual’s endurance level and other underlying health conditions can also influence recovery time.
However, if stroke survivors consistently continue with their rehabilitation programs after discharge from inpatient therapy, they see better results than individuals who discontinued along the way.
It is recommended, that individuals continue their therapies at home, through the assistance of therapists and caregivers. Whether it has been months, or years since you had a stroke, do not fail to continue your therapy until you recover.
Do whatever is possible within your reach to complete the processes. It requires patience, hard work and commitment, the good news is that, your brain will respond if you did not stop.
Recovering from a Stroke in the Thalamus
Finally as stated earlier, recovery from a thalamic stroke will require hard work and dedication from survivors. In the early stages of a thalamic stroke recovery, the medical team will assess the condition, and any secondary side effects that were suffered.
These may include changes in sensation or balance. After that, it is very important for the survivors, and caregivers to work with the therapists who will together address the issues that arise.
The success of a thalamic stroke recovery, will largely depend upon the consistency of the rehabilitation program, and the active participation of survivors. To accomplish the best results, it is necessary for therapists to tailor their treatment to suit individuals, their needs and circumstances.
The Summary
The thalamus plays a vital role in our memory, emotions, sleep-wake cycle, executive functions, processing sensory inputs, and sensorimotor control. It is responsible for relaying about, 98% of all sensory inputs within the body.
So if a stroke occur in the thalamus, it can disrupt some of these functions — especially those of processing and transmission of sensory information. Thalamic strokes are grouped among the category of subcortical strokes, which affect the deeper brain areas under the cerebral cortex, and not in the outer cortical region.
Therefore, a stroke in the thalamus, can produce unique side effects that may include sensory, physical and cognitive difficulties. To recover functions impaired by a Thalamic stroke effective rehabilitation must be pursued.
Rehabilitation for Thalamic stroke survivors, must be consistent, with the active participation of the survivor. Several therapeutic approaches can be used, depending on the side effects sustained.
Although, the timeline for recovery is not exact, as is the case with strokes in other brain areas, recovery is possible. The recovery outlook for thalamic stroke is bright, especially if rehabilitation is started early, and survivors continue with their therapy, even after inpatient and outpatient therapies. At-home therapy, can be very helpful in enhancing the overall recovery outcomes.
Book to link: “Stroke and Your Brain- eleven regions that should matter to you.” Part one and two.