Changes in perception after a stroke

When a stroke occurs on the right side of the brain, a person's ability to judge distance, size, position, rate of movement, form, and the way parts relate to the whole is affected (spatial-perceptual problems). People with these problems may have more trouble learning to care for themselves.

Signs of perception problems are often noticed by the caregiver of a person who has had a stroke. These signs may include:

• Not noticing people or things on the affected side and turning his or her head or eyes to the unaffected side. The person may not be able to steer a wheelchair through a large doorway without bumping the door frame.
• Not being aware of body parts on the affected side.
• Having difficulty recalling how to form numbers and letters or confusing similar numbers. The person may not be able to add numbers.
• Having difficulty recalling the written spelling of words. The person may not be able to read the newspaper.
• Confusing the inside and outside of clothing or the right and left sides of clothing.
• Having a hard time knowing when he or she is sitting or standing.

People with perception problems-even minor ones-should not drive a car.

Some tips for working with someone who has perception problems include the following:

• Cut down on clutter to prevent a fall. Also, make sure that rooms are well lit. Install night lights in the bedroom and bathroom.
• Avoid rapid movements around the person. Other people moving around in the room also may be distracting.
• Mark lines on door frames or full-length mirrors so that the person can see what is vertical.
• Do not overestimate the person's abilities. Watch to see what can be done safely rather than taking the person's word for it.
• Tell the person how to do things if he or she has trouble remembering how to do a task. Put your hands in your pockets to keep yourself from gesturing as you talk the person through the steps. It may also be good to have the person talk through the task.
• Break tasks into small steps and give lots of praise. Encourage the person to slow down and check each step carefully. Don't nag. Nagging may cause the person to become angry and upset.