Our brain understands our environment from our senses:
- Smell
- Touch
- Taste
- Sight
- Hearing
This is how we collect information that is around us. This is called ‘perception’.
Doing simple activities can be hard if your perception has changed.
Changes in your perception are often difficult to notice as they are not as easily seen as physical changes after stroke. Sometimes people may expect too much from you or get frustrated because you are not doing things the usual way.
What types of perceptual problems are common after a stroke?
Below are types of perception problems a person can experience after a stroke and some strategies that can help to manage these changes in your perception. An Occupational Therapist can work with you to help improve these areas and offer strategies tailored to your specific needs.
Time awareness
What is it?
Time awareness is how you keep track of time passing.
How can it affect you?
Your understanding of how time passes may change. For example, you may expect it to be dinner soon after you finish lunch.
Strategies for you and your caregiver
- Link events to other events and not to specific times. For example, “Your TV program will start after lunch” rather than “Your TV program is in an hour”.
- Keep a consistent daily schedule and review it regularly to become familiar with it
- Use a digital or talking clock
- Use the alarm on your phone to remind you when things need to be done
- Let friends and family know about important appointments. Ask them to provide you with reminders.
- Listen to the person with stroke but let them know the reality. For example, ”I know it seems like you had lunch hours ago but you just finished it 15 minutes ago”.
Spatial awareness
What is it?
Trouble understanding what we see and where the object is in space.
How can it affect you?
- You may misjudge the height of stairs
- You may knock items over when trying to reach for them
- You may bump into things when moving around
- You may trip over loose rugs or uneven pavement
- You may reach too far or too short for objects
- You may miss the edge of the chair when you sit down
- You can be at risk for falls and injury
Strategies for you and your caregiver
- Use visual cues: Place fluorescent or bright-colored tape at the edge of steps and on the lip of the bathtub
- Use non-spill cups/bottles
- Keep your environment free of clutter
Neglect
What is it?
Being less aware of your body and environment on the side affected by the stroke despite having no change in your vision.
How can it affect you?
- You may bump into things on the affected side or may not notice food in front of you on the affected side
- You can be at risk for falls and injury
- You may forget to dress the affected arm or wash the affected side of your face or body
- You may forget to take care of the affected limb and be at risk for injury
Strategies for caregivers
- Arrange the environment to provide stimulation on the side affected by the stroke. This helps the person become more aware of the whole environment.
- Use visual cues: Place fluorescent or bright-colored tape at the edge of a table on the affected side, then encourage the person to scan across to the tape when looking for items on that side of the table.
- Encourage the person to scan their whole environment. For example, use the ’lighthouse’ strategy – imagine the eyes as beams of light slowly sweeping from side to side.
- Approach the person from the unaffected side then move over to the affected side after you get their attention
- Remind the person to look over or turn their head to the affected side
- Decrease stimulation on the unaffected side
- Encourage them to use the affected arm or leg in daily activities as much as possible
- Position the affected arm or leg so that the person can see it
- Encourage the person to help position the affected limb
- Use cues to draw attention to the affected side. For example, ask the person “Where is your arm?”; wear brightly coloured nail polish or a watch on the affected side.
Apraxia (making movements)
What is it?
- Having trouble putting movements together even though you are physically able to and know how to do the task.
- Apraxia happens because messages from the brain to the muscles are not being sorted out properly.
- Apraxia can affect how movement is planned for both sides of the body, not just the affected side.
How can it affect you?
- You may have trouble performing simple, everyday tasks like brushing your hair or getting dressed
- It can appear as clumsiness
- It can also affect a person’s ability to speak
Strategies for caregivers
- Use short and simple instructions when completing tasks
- Break the task into simple steps. Use the same steps every time the task is done.
- Repeat the task to provide more practice and provide hand-over-hand guidance if necessary
- Have family or friends demonstrate the task if you feel like you are getting stuck
Visual problems
What is it?
Changes to your vision after stroke can include double vision, partial or full loss of vision in one or both eyes, and blurred vision.
How can it affect you?
Visual problems change the way we see the things around us and can put a person at risk for falls or injury.
Strategies for caregivers
Encourage the person to use some of the following:
- The lighthouse strategy — imagine the eyes as beams of light slowly sweeping from side to side.
- Visual cues such as a sign on the door saying ‘bathroom’ to help the person find their way
- Use visual reference points or anchors – colored tape on the edge of a table to draw vision to areas the person may not be remembering to look at
For visual field loss, encourage the person to:
- Turn their head to the affected side
- Place items on the affected side to increase their awareness of that space
- Use an eye patch or prism glasses if prescribed