Physical effects of stroke
Stroke can cause many different problems including
difficulty with speech, concentration, memory or tiredness.
But the most common effects of stroke are physical ones
such as weakness, numbness and stiffness. This
factsheet describes these effects and their treatments in
more detail.
The brain controls everything we do, including the way we
move. It is divided into two hemispheres, left and right.
The left hand side of the brain is mainly concerned with
language and movement on the right hand side of the
body. The right hand side of the brain controls the left
hand side of the body.
Nerve cells (sometimes called neurons) are stimulated by
the brain and send electrical messages to our muscles to
stimulate them to move. If the brain cells controlling those
nerve cells are damaged by a stroke, the messages can’t
be sent, and muscles can’t move.
What are the physical effects of stroke?
Weakness and paralysis
Weakness of an arm, leg or both is probably the most
common and widely recognised effect caused by stroke,
with 80 per cent of stroke survivors experiencing
problems with movement. Weakness can vary in its
severity. Some people have very mild weakness in one
part of their body, for example their arm, leg or face. But
for many people it affects one whole side of their body.
This is called hemiparesis.
Paralysis differs slightly from weakness as it describes
the loss of the ability to move a part of your body. The
term hemiplegia is used to describe paralysis of one whole
side of the body.
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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Having weak or paralysed muscles can affect your
movement. For example, if you have weakness in your
leg, you may find it difficult to get out of bed, to stand or to
walk. Arm weakness can make it more difficult for you to
do daily tasks such as washing and dressing.
Some people also have problems with balance after a
stroke. For more information, see our factsheet F22,
Balance problems after stroke.
Some people find the physical effects of a stroke painful.
For further information on coping with pain, please see
factsheet F30, Pain after stroke.
Spasticity
Spasticity is a condition that can develop if you have
weakness or paralysis after your stroke. It is a form of
muscle tightness - your muscles become tense and can
contract abnormally.
Muscles need some sort of tightness (called muscle tone)
as without this they would be floppy and not able to work.
Following a stroke, a muscle may have very low tone
when it is very weak, for example you may not be able to
hold your arm up without support. If muscles recover, it is
expected that the tone will increase to normal. However,
some weak and damaged muscles develop high tone.
The muscle feels stiff and tight, and can become painful.
This is called spasticity. It can happen when you are
resting, or might affect you when moving the muscle.
Getting moving early after a stroke is one of the
cornerstones of good stroke rehabilitation on the stroke
unit, and the therapists and nurses will work hard to keep
your muscles moving as much as possible to avoid
spasticity. However, it can develop later, for example
after you are discharged from hospital.
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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If untreated, it can cause pain and discomfort, stiff
muscles and joints, difficulty with walking and other
movements. Rarely, it becomes permanent, in what is
called “contracture”.
If you think your muscles are getting stiff and tight, even if
you have been discharged from hospital, ask to see a
physiotherapist who can assess you and discuss the
best treatment plan for you.
Problems with positioning your feet
‘Drop foot’ describes the inability to lift the toes and feet
properly when walking. As a result of this, your toes may
catch on the ground as your foot is swinging forward. This
can make walking more difficult and may increase the risk
of a trip or a fall occurring.
Sometimes if your calf muscles are tight, poor foot position
can cause the knee to be forced backwards when
standing or walking, and can lead to balance problems
and instability.
The increased effort that you may have to put in can result
in your walking being slow and tiring, with the possibility of
it being unsafe at times due to the increased risk of
tripping or falling. It can also lead to a further increase in
spasticity.
Changes in sensation
There are various ways that stroke can affect your senses.
 You may be less sensitive, for example to touch, so
may not feel something you bump into. This is called
hypoesthesia.
 You may have increased sensitivity. This can affect
a range of senses such as taste, hearing, touch and
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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muscular sensitivity to pain. This is called
hyperesthesia.
 You may experience abnormal and unpleasant
sensations such as the feeling of burning, cutting,
tingling, stinging or numbness. This is called
dysesthesia or paresthesia.
What are the treatments for physical effects of
stroke?
How much recovery you will make after a stroke, and how
long this takes is different for everyone. It depends partly
on the amount of damage done by the stroke, and your
general health before the stroke. Recovery tends to be
fastest in the first few months after a stroke, but many
people continue to notice changes and improvements over
many months and even years.
The role of the stroke team
The earlier the rehabilitation process begins the more
likely you are to regain lost skills and abilities. Recovery
from a stroke depends on undamaged parts of the brain
learning to take over the functions of the damaged parts.
Early treatment on a stroke unit makes a big difference to
your recovery. Everyone admitted to a stroke unit will have
an early assessment by the nursing and therapy teams.
This will include an assessment by the physiotherapist
and occupational therapist, as well as other members of
the team as necessary (for example a speech and
language therapist).
Weakness and paralysis
Stroke rehabilitation aims to help you to recover as much
as possible and enable you to learn how to manage with
any remaining difficulties, using exercises appropriate
for you. Nurses, doctors and therapists work together on
The Stroke Association April 2012
Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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the stroke unit to assess the degree of muscle weakness
you have, and how best to improve it.
Anyone with physical effects after a stroke should be
assessed by a physiotherapist as soon as possible.
Physiotherapy aims to help you to regain as much
movement as possible and enable you to learn how to
manage with any difficulties, using appropriate exercises.
Occupational therapy aims to help you to carry out daily
activities and maintain your independence. Therapists
may also be involved in providing you with specialist
equipment when you go home.
Occupational therapists and physiotherapists will often
assess you at the same time, to look at the amount of
weakness and how it affects your daily activities, and to
plan a programme of exercises.
The therapy team will work with the nursing staff to ensure
that you can get out of bed as soon as it is safe to do so,
and to start a programme of early mobilisation as soon as
you are ready. They will also make sure that your weak
limbs are in the best possible position to remain
comfortable and to avoid problems, for example
supporting a weak arm on a pillow to avoid shoulder pain.
The stroke team will talk to you about how best to keep
your muscles supple, even when they are not working
very well.
In the early stages of stroke, the team will often focus on
helping you to sit up safely, and then move on to helping
you to stand and then start to walk safely, perhaps with a
walking aid. They may also look at other tasks such as
dressing, eating, bathing and using the toilet.
You may also be given exercises to practise between
therapy sessions, or your family can be given ideas as to
how to keep your muscles supple. The occupational
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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therapist will encourage you to carry out daily activities
and maintain your independence. Initially they will do a
detailed assessment of any problems you may have,
assessing both movement problems and taking into
account any additional problems that may affect your
recovery, for example memory problems. The stroke team
will help you to devise strategies to manage all the
activities that you need to carry out after you leave
hospital. They will work alongside you and your family to
ensure you get the right equipment and support.
For further information please see our factsheets F16,
Physiotherapy after stroke and F17, Occupational therapy
after stroke.
Treatments for spasticity
There are several treatments for spasticity and early
intervention by trained specialists can, in many cases,
avoid spasticity developing.
If you think your muscles are getting stiff, talk to your
physiotherapist (even if you have left hospital) about how
to avoid spasticity. He or she may suggest how best to
position your limb to reduce muscle tone, and may
suggest some exercises. If more treatment is needed,
sometimes an assessment from a specialist
physiotherapist or a consultant in neurorehabilitation may
be useful.
There are some drugs that can be useful to reduce muscle
tone in spasticity, but these need to be prescribed by a
specialist who understands all their effects and how they
might help. These drugs include:
 Baclofen - this drug belongs to a group of medicines
known as muscle relaxants. Baclofen also works on
the central nervous system to relax the muscles.
 Gabapentin - an anti-convulsant drug which acts on
the brain cells and dampens down electrical activity.
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 Tizanidine - is used to decrease spasticity similarly
by working on the central nervous system. It is
suggested that these drugs cause less muscle
weakness than Baclofen, which can be important for
patients who are trying to regain physical strength.
Botulinum toxin (commonly known as ‘botox’) can help
spasticity that affects only one or two joints (called
focal spasticity). It works inside the nerve pathways by
blocking the release of the chemical that stimulates
muscle contraction. This can then help create temporary
muscle weakness. In England, Northern Ireland and
Wales this can be used as a treatment for spasticity.
Botox is not currently recommended for use within the
NHS Scotland for the treatment of spasticity.
The botox is injected directly into the specifically selected
muscles and generates temporary relaxation and
weakness of the muscles. You will gradually see effects
from this treatment over the following 4-7 days, however in
some cases this may be longer. The weakness in the
muscles can last for about 3-4 months before the muscles
recover their activity and the process will need to be
repeated. It is suggested that the benefit from this type of
treatment can continue for many months, particularly
when it is accompanied by physiotherapy, however the
effects then gradually wear off.
In severe cases of contractures, surgery to release
tendons may be carried out, but this is rare.
Treatments for walking problems
An Ankle-Foot Orthosis (AFO) is a type of foot brace,
usually made of plastic that can help with standing and
walking. AFOs are designed to compensate for muscle
weakness and spasticity and can improve the function and
alignment of your whole leg, by controlling the position of
your foot and ankle. They can improve your walking
speed, stability and balance.
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Some AFOs are ready made, but these are not suitable
for more complex walking problems. In these cases an
individually made AFO is necessary.
You may be referred to an orthotist who is a qualified
rehabilitation professional, for advice on whether an AFO
may be appropriate for you, and to provide you with the
most suitable type. However this treatment is not suitable
for everyone, so alternative solutions may need to be
considered.
Functional Electrical Stimulation (FES) is another
method of treating drop foot. FES uses small electrical
signals to replace the nerve impulses that have been
interrupted by damage to the brain. Electrical stimulation
is applied either to the skin by surface electrodes or
alternatively by implanted electrodes.
A specialist physiotherapist or consultant in
neurorehabilitation will be able to refer you to an
appropriate specialist in FES although it is not suitable for
everyone. This will be determined by a physical
examination that takes place in your initial assessment. If
you are suitable for this treatment you will then be asked
to attend again for two days to learn how to use the
device. After this you will then be asked to return to the
clinic for follow-up assessments, at regular intervals.
Treatment for changes in sensation
There is very little research into changes in sensation after
a stroke. Unfortunately it is unlikely that any treatment will
help to improve any changes in sensation, however often
these sensations improve in time. This can take longer
than recovery from other effects such as problems with
movement. If you have any changes in sensation, but your
movement is good, you should be taught how to take care
of your limb to avoid any accidents or injury.
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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Useful organisations
All organisations are UK wide unless otherwise stated.
Stroke Association
Stroke Helpline: 0303 3033 100
Website: www.stroke.org.uk
Email: info@stroke.org.uk
Contact us for information about stroke, emotional support
and details of local services and support groups.
The British Association and College of Occupational
Therapists (BAOT or COT)
Tel: 020 7357 6480
Website: www.cot.co.uk
The professional body for occupational therapy.
The professional body for Prosthetists and Orthotists in
the UK.
The British Association of Prosthetists and Orthotists
Tel: 0845 166 8490
Website: www.bapo.org
Chartered Society of Physiotherapy
Tel: 020 7306 6666
Website: www.csp.org.uk
Has a register of therapists who are members of the
Association of Chartered Physiotherapists interested in
Neurology (ACPIN).
HemiHelp
Helpline: 0845 123 2372 (open from 10am to 1pm, MonFri during term time)
Website: www.hemihelp.org.uk
Supports children and young people with hemiplegia, and
their families.
National Clinical Centre for FES
Website: www.odstockmedical.com
Offers more information about FES.
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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Physio First
Tel: 01604 684 960
Website: www.physiofirst.org.uk
Offers details of private therapists specialising in
neurology.
Disclaimer: The Stroke Association provides the details of
other organisations for information only. Inclusion in this
factsheet does not constitute a recommendation or
endorsement.
Glossary of terms
AFO = Ankle-Foot Orthosis
Contracture = abnormal shortening of a muscle that
results in deformity
Drop foot = the inability to lift the toes and feet properly
when walking
Dysesthesia or paresthesia = abnormal and unpleasant
sensations
FES = functional electrical stimulation
Hemiparesis = weakness of one part of the body
Hemiplegia = paralysis of one part of the body
Hyperesthesia = an increased sensitivity that can affect a
range of senses
Hypoesthesia = a dulled sensitivity to touch
Spasticity = a form of muscle tightening
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Stroke Helpline 0303 30 33 100 website www.stroke.org.uk
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Produced by the Stroke Association’s
Information Service. For sources used,
visit stroke.org.uk
© Stroke Association
Factsheet 33, version 05, published
December 2010, updated April 2012 (next
revision due March 2013).
Stroke Association is a Company Limited by Guarantee, registered in England and Wales (No
61274). Registered office: Stroke Association House, 240 City Road, London EC1V 2PR. Registered
as a Charity in England and Wales (No 211015) and in Scotland (SC037789). Also registered in Isle
of Man (No 945), Jersey (NPO 369) and serving Northern Ireland.
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