Caring for a person after a Stroke

Description
Strokes can occur in different parts of the brain which will result in different physical, emotional, and/or cognitive (mental) deficits. Caregivers will face different challenges based upon that person's specific set of needs for comfort and safety.

Challenges to be Addressed: Mobility, Swallowing, Activities of Daily Living, Communication

Mobility
Ambulation/ Walking
Strokes can result in a person being bedbound or unable to walk independently for a variety of reasons. Those reasons include: weakness of one side of the body, impaired balance, impaired sight, loss of vision in one eye resulting in difficulty with depth perception or loss of peripheral vision, and loss of coordination. Loss of independence is not purely a physical issue, but results in emotional and psychological distress for the person as well as the caregiver.

Tips

  1. Caregivers should support and encourage participation of the person in their own care as much as safely able. The caregiver will need to look for ways in which participation is possible.
  2. Talk to the medical provider regarding physical therapy for flexibility and strengthening exercises as well as their recommendations regarding assistive devices such as canes, walkers, wheelchairs and motorized scooters, etc.
  3. Discuss with the medical provider the need for equipment such as bedside commode, over bed tables or hospital bed.
  4. See eye doctor for evaluation and treatment of visual impairments. Remember to discuss depth perception difficulties.
  5. Caregivers will need to encourage or perform range of motion and strengthening exercises to maintain flexibility and strength on a regular basis.
  6. People who are no longer able to ambulate independently may "automatically" try to get up to do normal activities such as going to the bathroom. Prevention of falls and injury is the ultimate goal. Depending on the person's ability to participate and process information, caregivers will have to be creative. Strategies include: creating an "activity alarm" by arranging furniture around the bed so that when it is moved by the person trying to get up, the caregiver will be alerted, setting up a schedule of daily activities including toileting times, and providing reassurance that the caregiver is readily available.
  7. Caregivers must evaluate the ability and safety of those needing assistance with transfers and ambulation. If the person is able to transfer with just assistive devices, make sure those devices are within their reach. See appropriate topics under bedside care.
  8. Losing the ability to walk and becoming dependent on someone else for mobility can be emotionally devastating for all involved. Caregivers need to recognize this loss of independence and assist with adapting and coming to terms of this new reality. Denial, anger, anxiety and depression may all be part of this process. Seek advice and guidance of medical professionals. Medications may be necessary. Support groups may be helpful.
  9. For those people who maintain the ability to ambulate/walk but who are cognitively impaired after a stroke, safety will be the primary issue. Strategies for safety include: Putting locks high on door, installation of door and window alarm systems, taking knobs off oven and stove, turn down hot water temperature, secure knives, guns, medications, cleaning supplies, or any object that may inadvertently cause harm, and secure pools with fencing/alarms. Explore the community resources for caregiver relief/respite.

Swallowing
Eating and Drinking
Strokes can alter a person's ability to swallow. Protection of the person's airway will prevent problems such as aspiration pneumonia. Often times people will find it more difficult to swallow liquids than solid foods. Caregivers must learn safe feeding techniques. Eating is more than just fulfilling nutritional needs. It has spiritual, emotional, social and psychological components.

Tips

  1. If a person has dentures, they may not fit as before. Consult a Dentist or leave dentures out.
  2. Drooping of the mouth and drooling of saliva may make it difficult to keep food in the mouth and to be able to chew adequately before swallowing. This is a frustrating problem for both the caregiver and the person being fed. Tipping back the head is not the solution as this opens the airway and results in aspiration! See Safe Feeding Techniques under the Bedside Care Tab for further instructions.
  3. Use commercial liquid thickeners when there is an inability to swallow fluids safely.
  4. Caloric intake needs will be less for people who are not as mobile.
  5. Mouth care after each meal and at bedtime will contribute to comfort and help to maintain swallowing ability.
  6. Apply barrier cream to protect skin from irritation from constant drooling. Place a soft towel or washcloth under the person's chin to protect clothing/linen from drool.
  7. Enjoyment should be part of the eating process. Textures, smells and preparation of food matters. Share meals together. Honor religious traditions and participate in family gatherings.
  8. If swallowing difficulties are severe, swallow evaluation and speech therapy should be considered. Contact your medical provider.

Activities of Daily Living
Depending on the severity of the stroke, independent performance of daily activities such as brushing teeth, taking a bath or shower, dressing or using the toilet may be impaired. This may be embarrassing and uncomfortable for the person with the deficits as well as the caregiver.

Tips

  1. Caregivers need a clear understanding of what help is needed to perform daily activities.
  2. Setting up routines gives a structure and rhythm to the day so that expectations are already defined.
  3. Making sure that you have the equipment and supplies to complete these tasks (ie shower chair or bedside commode).
  4. Recognize the need and provide for additional caregivers when necessary.
  5. Provide compassionate care giving and maintain dignity.
  6. Urinary leg bags can be easily concealed under trousers for family gatherings, etc.
  7. Honor personal preferences.
  8. Talk with the medical provider regarding bowel protocols.
  9. Loss of the ability to care for ones self can lead to understandable anxiety, anger, frustration, and embarrassment. Likewise these emotions are often found in caregivers who must provide personal care. Acknowledging these emotions is the first step in dealing with them. Look for community resources and communicate emotional issues with medical providers.
  10. Consider occupational therapy for evaluation and provision of adaptive devices to assist in self performance of activities of daily living.

Communication
The area of the brain involved in the stroke will determine if and to what degree communication will be affected. The most common deficits involve the inability to express oneself verbally (expressive aphasia). Less common is the inability to understand what is being said (receptive aphasia). After having multiple strokes, some people will end up with the loss of both the ability to speak and understand what is being said (global aphasia). Due to muscle weakness most people post stoke will have difficulty forming words clearly enough to be understood (dysarthria). These difficulties in communication make care giving difficult and exasperating to both the care giver and the person receiving care.

Tips

  1. Don't forget the obvious-is the person hard of hearing and needs to be evaluated for hearing aids.
  2. It is important to understand how this stroke has affected the person's ability to communicate. Speaking more slowly and loudly may not help!
  3. Nonverbal communication (hand gestures/nodding or shaking head, etc.) may be helpful.
  4. Consider talking with the medical provider regarding speech therapy for message boards, picture boards, or alphabet boards.
  5. Humor may help to alleviate the understandable challenge that this presents.
  6. People with strokes may end up with expletives as their only vocabulary. This is a result of the stroke and not of their own choosing.
  7. Try to anticipate needs and set up routines to eliminate the barriers of effective communication.
  8. Support any effort to communicate. Do not be in a hurry!

Important Points to Consider

  • Advance directives such as financial power of attorney, health care surrogacy, living will and Do Not Resuscitate status if not already completed, need to be considered and addressed after a stroke. Decision making capacity will need to be determined by a physician.
  • Writing checks and paying bills may not be physically possible after a Stroke even though their mental ability may remain intact-arrangements with financial institutions will need to be set up.
  • Multiple strokes may result in Vascular (or Multi-Infarct) Dementia. Adhering to the treatment plan developed by the medical provider will diminish the risk of Vascular Dementia.

Related topics

Recognizing Signs and Symptoms of a Stroke
Preparing a Bed for Comfort and Convenience
Turning and repositioning a bedbound person
Making an Occupied Bed
Bathing and Skin Care
Mouth Care
Moving from a wheelchair to a bed
Moving from a bed to a wheelchair
Safe Feeding Techniques
Incontinence Care
Managing Dementia
Discussing Dementia