Tips For Caring For A Person Who Has Had A Stroke

WHAT ARE THE SYMPTOMS OF A STROKE?

In 2003 the Canadian Stroke Network conducted a national survey to find out how much Canadians know about the disease. The results were shocking: 50% of those surveyed were unable to correctly describe what a stroke is. Almost half (48%) could not identify a single symptom of a stroke. Reacting fast to signs of a stroke is very important. A stroke, like a heart attack, is a medical emergency. The person with signs of a stroke needs emergency medical assistance at once. Early treatment can often dissolve a clot that is stopping blood flow to the brain. Even a brief delay in getting treatment can decrease the chance of a full recovery.

The warning signs of stroke are outlined below. A person could have several of these signs or just one:

Sudden weakness or numbness in the face, arm or leg, particularly on one side of the body

Sudden difficulty in speaking (i.e. talking or understanding)

Sudden vision problems (i.e. loss of vision in one or both eyes, seeing double)

Sudden loss of balance or coordination

Sudden severe headache with no known cause

LEFT SIDE BRAIN STROKE

When a stroke injures the left side of the brain, the right side of the body is affected. Symptoms such as weakness or paralysis on the right side of the body, difficulties with speech and language, and memory loss may occur. These clients may perform tasks slowly and carefully and have trouble with understanding.

RIGHT SIDE BRAIN STROKE

When a stroke affects the right side of the brain, the left side of the body is involved. Common symptoms are weakness or paralysis on the left side of the body, vision problems, and memory loss. Following a stroke on the right side of the brain, clients may be more impulsive in their actions. They may not be able to recognize the meaning of things that they see, smell, or hear and they may have difficulty with learning.

CARING FOR THE PERSON WITH A STROKE

Many people who’ve suffered strokes need help performing activities of daily living, such as eating, bathing, grooming, using the toilet and, in general, getting around.

Many different health professionals (such as a doctor, nurse, physiotherapist, occupational therapist, speech therapist, recreation therapist or social worker) may be involved in assisting the person to recovery. The person’s family also plays an important part in the process. Recovery involves having the person:

Maintain abilities that are present

Relearn skills that have been lost

Make up for losses that may be temporary or permanent

The goal in recovery is to encourage people to do their best in all aspects of life.

HOW TO HELP

You can assist with activities of daily living while helping the person in your care to become as independent as possible. In many cases, becoming more independent will mean learning how to do things differently.

For example, walking may still be possible but only with the use of a cane or a walker. Dressing may require the use of special Velcro fasteners for clothing, elastic pants, and slip-on shoes. Weighted utensils may help the person to eat independently. A raised toilet seat and safety rail may make toileting alone possible.

If you are caring for someone in her home, changes may have to be made to the home environment. These changes include use of non-slip mats, extra railing in the hallways, grab bars, and widening of the bathroom door.

Family members who are heavily involved in caring for their loved ones should take a break from continuing care. It’s important that caregivers take care of their own physical and emotional health.

Groups that provide support and information for people recovering from stroke and their families are present in many local areas. The section “Other Resources” outlines some of these information sources. The local health authority may also be able to provide information about support group meetings.

POSITIONING AND SKIN CARE

Skin care and proper positioning are very important following a stroke. Without it, the person in your care may be prone to pressure sores and contractures (shortening and tightening of muscles).

You may have to assist with turning and positioning every couple of hours. Injuries to the side affected by the stroke are quite common during transfer and positioning.

You must be very careful when moving the person. Use pillows, rolled blankets, and other devices to support and position the affected side properly while he or she is in bed or in a chair.

Special pressure-reducing mattresses can make the person more comfortable and help prevent skin breakdown.

EMOTIONS

Following a stroke, a person may be very emotional and react in ways that do not ‘fit’ with the situation. He or she may laugh or cry at odd times and act differently than before the stroke occurred. Someone who avoided foul language in the past may now swear often.

These reactions can be very hard on the family. They need to be reminded that the behaviors are a result of the injury and are not within the person’s control. Ignore behaviors that are not appropriate and advise the family to do so as well. As time goes on, your client may have greater command of emotions.

Frustration is a very common emotion following a stroke. Learning how to eat, dress, walk, and toilet again can be very slow and difficult. Offer support and encouragement. If you notice that the person is tired or frustrated while trying to learn a task, suggest taking a break. You can try again later when he or she is rested.

Most people go through a period of sadness as they come to terms with all the losses they have had because of a stroke. Sometimes the sadness develops into a depression that interferes with health and progress. Referral to a psychologist, social worker, or doctor may be necessary. Medication may be needed to offset feelings of depression.

OTHER POSSIBLE EFFECTS OF A STROKE

Other consequences of having a stroke could include:

APHASIA (COMMUNICATING PROBLEMS)

Not being able to communicate well is probably one of the most frustrating challenges that a person can face; yet it is a common problem following a stroke. Aphasia is a type of communication problem that affects the ability to speak, read, write, or understand what others are saying.

Here are several methods that have been found helpful in general when communicating with a person with aphasia:


Speak clearly and slowly.

Keep your sentences short and simple.

Take your time. If the person feels that you are hurried, he/she may not even want to try to communicate with you.

Be supportive and encouraging. A relaxed setting works best.

Remind the person in your care and her family that improvement in communication can sometimes continue for quite some time after the stroke has taken place.

Encourage the person to speak to you. Consider stopping if he becomes very frustrated or tired.

Use gestures and pointing while talking.

Give the person lots of time to understand what you have said and to answer. Although it is generally better not to respond for the person, there may be times when it will be less frustrating for him or her if you do so.

Give one direction at a time.

Name the objects you are using while assisting with bathing, grooming, and other activities of daily living.

Repeat what you have said to ensure understanding.

Try using a picture board or printed materials.

Encourage the person to get lots of rest. People who have had a stroke usually tire easily which makes communication more difficult.

DYSPHAGIA (SWALLOWING PROBLEMS)

Difficulty swallowing, or dysphagia, affects 30-60% of people who have had a stroke. Dysphagia can cause fluid or food to enter the airway, resulting in serious problems such as choking and pneumonia.

Here are several techniques that can be helpful when feeding the person with dysphagia:

Position him in an upright sitting position for meals.

Encourage self-feeding, if possible, so that she has more control while eating.

Avoid the use of straws so that he has more control while drinking.

Avoid bland foods.

Give a soft diet.

Place foods in the unaffected side of the mouth.

Give small bites and encourage the person to chew well.

Offer liquids following, not during, the meal.

Do not serve food or liquids (especially water) at a lukewarm temperature.

Encourage the person to sweep the mouth with a finger after eating if food pocketing occurs.

Keep her sitting for 30-45 minutes after the meal.

INCONTINENCE

Urinary incontinence is the involuntary loss of urine that is sufficient to be considered a problem. It often results in a person being placed into a nursing home. Urinary incontinence is a common condition following a stroke, however, and can often improve with proper treatment. Read more about incontinence here.

OTHER RESOURCES

The following associations can provide information about stroke to patients, families and professionals:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, TX 75231
AHA: 1-800-AHA-USA-1
or 1-800-242-8721
http://www.americanheart.org/
A national voluntary health agency whose mission is to reduce disability and death from cardiovascular diseases and stroke.

American Stroke Association
National Center
7272 Greenville Avenue
Dallas TX 75231
ASA: 1-888-4-STROKE
or 1-888-478-7653
http://www.strokeassociation.org/
Maintains a listing of support groups for stroke survivors, their families, friends and interested professionals. Publishes Stroke Connection magazine, a forum for stroke survivors and their families to share information about coping with strokes.