Paralyzed shoulder muscles are not able to help tendons keep the upper end of the arm in the shoulder joint. As a result the arm drops from the joint which is very painful and can prevent rehabilitation of the hand and arm.
Depression after stroke, as after any severe illness, is very common, often goes without diagnosis, reduces the patient's capacity for rehabilitation, and impairs his/her quality of life. Furthermore this affects not only stroke survivors but also their spouses or next-of-kin who take care of the patients. For many of the patients, their spouses and their children, this burden is long-standing.
Stroke can lead to cognitive decline, and it is even more common after a recurrent stroke. This is also the case after recurrent subclinical strokes which are often not diagnosed due to missing classical symptoms of stroke. Yet, they cause more and more damage and reduce the mental capacity of patients.
Spasticity is like a "wicked charley horse." Brain injury from stroke sometimes causes paralyzed muscles to involuntarily contract (shorten or flex) after trying to move a limb. This creates stiffness and tightness. The contracted muscles often freeze the joints of the hand and arm permanently into an abnormal and often painful position. When a muscle can't complete its full range of motion, the tendons and soft tissue surrounding it can become tight. This makes stretching the muscle much more difficult.
Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest. This can seriously interfere with a stroke survivor's ability to perform daily activities such as dressing. Spasticity in the leg may cause a stiff knee, pointed foot and curling toes.
All of these disorders can be diagnosed and there are treatments available for most of them.