Life after stroke can be challenging. The tips below, can help coping become easier and safer for those impacted by the stroke and those providing care for the stroke survivor.
Increase visibility of task/environment.
Organize: Decrease clutter and create workstations.
Simplify tasks: Eliminate complex tasks requiring vision. For instance, instead of dialing 10-digit phone numbers, consider having your phone set up for one- or two-digit speed dialing.
Mark the edge of the print with contrasting colors, such as red, to help navigate the page to read.
If using bifocals, have a second pair of reading glasses nearby if needed.
Increase the visibility of reading material.
Use appropriate lighting.
Adjust settings for good contrast and bold, enlarged print.
Consider using fonts that are easier to read (sans serif).
Adjust the screen setting for brighter or cooler lighting according to your
preference.
Slow down and write slowly.
Increase the visibility of the writing surface.
Emotional highs and lows and involuntary episodes of excessive crying and/or laughing. These are often manageable with medications.
Short attention spans including distractions and loss of concentration
Poor judgment, especially for his or her own safety and impulsiveness
Confusion and memory loss
Spatial-perceptual issues (neglect of left side/survivor is unaware he or she has a left side)
Cautious or compulsive behavior
Apraxia (difficulty translating ideas or performing function into action)
Aphasia (difficulty speaking [expressive] or understanding what is being said [receptive]
Lack of coordination or swallowing problems
Swallowing problems
Everyone is working very hard to help your loved one recover. Good communication and coordinated rehabilitation are keys to a successful recovery.
Planning should begin as early as possible during the hospital stay. Review rehabilitation options with the team including the physician and case manager.
What options are available for the stroke survivor?
Ask the survivor’s case manager about medical insurance coverage and other help after discharge such as:
Find out the survivor’s current status from each therapist.
Letting therapists know what is important to the survivor and family members helps them focus their efforts to achieve specific goals.
Examples include:
“It is important for my loved one (survivor) to be able to feed himself.”
“My loved one really hopes to be able to hold her grandchild again.”
Return to normal: Rehab frequently improves the survivor’s function but will not return them to normal.
Reasonable expectation of recovery: Make the hand stronger so the survivor can feed himself or herself.
If you or the survivor don’t understand a treatment or therapy, ask why it is being done. It’s very important to understand what the survivor consents to do before agreeing to do it.
Is safety a big issue? What are the major concerns? Ask questions such as, “Can my loved one swallow safely or go to the bathroom without assistance?”
Ask if you can join some therapy sessions to see if you can understand how to correctly assist the survivor.
Therapists will evaluate improvements in the survivor’s balance, gait, transfers, speech and many other patient-focused goals.
Never lose hope. Strokes are life-changing events and require intense rehabilitation to regain function.
Note: If you have foot drop or an inability to walk without dragging your foot, ask your provider or therapist for a brace such as an AFO (ankle foot orthosis).
Factor |
How It Works | What to Do |
Alcohol |
Boosts blood levels of high-density. Reduces the formation of clots. |
Limit beer, wine, mixed drink intake to a daily maximum of one (women) or two (men). One drink = one beer, five ounces of wine or one ounce of liquor. |
B vitamins | Decrease blood homocysteine (amino acid) levels. Lower blood pressure. | Eat dried means, fortified cereals, spinach, broccoli and drink orange juice. Take a daily senior multivitamin with extra Bs. |
Vitamin C |
Strengthens artery walls. Prevents blood platelets from clumping together. Lowers blood pressure. |
Eat citrus fruits, peppers, strawberries and tomatoes; drink fruit juices. |
Omega-3 fats | Combat blood clots. | Eat salmon, sardines, light tuna, walnuts, flaxseed oil, flax meal and dark leafy greens. |
Physical activity |
Improves blood pressure and blood cholesterol. Enhances elasticity of blood vessels. Reduces the likelihood of clots. |
Be moderately active 30 to 60 minutes most days of the week. |
Potassium |
Helps normalize blood pressure. | Eat apricots, bananas, dried beans, lentils, potatoes, prunes and tomatoes; drink orange juice and low-fat milk. |
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Excessive calories |
Contribute to overweight, obesity. | Eat just enough to achieve or maintain a healthy weight. |
Refined carbohydrates | Triggers overproduction of insulin and resistance to insulin. | Eat fewer sugary items like desserts. Eat less white bread, white rice and regular pasta. Drink fewer sweetened sodas. |
Saturated and trans fats | Raise blood levels of low-density lipoprotein (LDL) cholesterol. Lower HDL blood levels. | Eat fewer red and processed meats, fried foods and snacks with hydrogenated oils. |
Sodium | Raises blood pressure. | Limit processed foods, cured meats and pickles. |
Continue the diet used in the hospital until told differently by a speech therapist. Includes thickening of liquids if applicable. All to avoid survivor choking or getting pneumonia from food in lungs.
Continue any position of the chin or head given in hospital for eating until changed by speech therapist to prevent choking or getting food or liquid in lungs.
Reintroduce social situations gradually. Watch for signs of survivor getting tired or overstimulated.
Use lots of herbs and spices (rather than salt) to improve taste of food. Feel free to puree their favorite foods, as well as whatever the family is eating.
Caregivers and family members cannot take care of their loved ones if they don’t take care of themselves. Get help from family members, friends, consider hiring help or adult daycare to give caregivers a rest. Don’t feel guilty about wanting or needing to get help or have a rest.
Never lose hope. Research shows it is possible to improve function for many years after stroke. The brain can create new pathways, but constant repetition is required to make these changes.
Physical and occupational therapy operates on the principle of “forced use” – forcing the affected body part to perform more like they did pre-stroke. This technique promotes stimulation of the brain and is the best chance for regaining function. In other words, the more you use your affected side, the better possibility of recovery.
Build in daily “functional exercises” for your upper extremity such as turning doorknobs or faucet handles; lifting empty cup to help with grasping; brushing teeth or hair; putting coins in piggy bank; aim for 3-4 hours/day of “functional exercises” at a minimum. Can be broken into several times/day. Do this with safety in mind and extending the fingers (not just closing the hand to make a fist; this will help reduce spasms in the hand and arm.). These activities should be performed safely with the approval of your physician or therapist.
Build in daily “functional exercises” for your lower extremity such as walking; ascending/descending stairs or curbs; riding a stationary bicycle. These activities should be performed safely with the approval of your physician or therapist.
Depending on your health condition, aim for a minimum of 3-4 hours/day of “functional exercises." This can be broken into several times/day. Try to perform the exercises EVERY DAY (If you skip them, you don’t get the benefit). Do this safely and always check with your physician or therapist before beginning or changing an exercise program.
Being very focused mentally during “functional exercises” brings better results! Research shows that the exercises need to be mentally taxing to do to get reorganization of the brain. As you work on a movement or task, always seek to add repetitions, make it faster, smoother or move on to a more difficult task to continuously challenge your brain.
If you have foot drop or an inability to walk without dragging your foot, ask your physician or therapist about a brace such as an AFO (ankle foot orthosis).
Improvement comes from internal motivation. Therapists can help patients improve and reduce their deficits after stroke, but only if the patient is motivated to do so. Support from family and friends is helpful for this.
Do what your therapist asks you to do at home. Strokes are life-changing events and require intense rehabilitation to regain function. Don’t think that just attending therapy sessions during the week is enough to allow you to meet your goals. It requires consistent effort every day from you!
Communication is KEY! Let your therapist know exactly what YOUR GOALS and NEEDS are – specifically!
Aphasia is the loss or reduction of the ability to speak, read, write, understand or calculate. If you or someone you know has aphasia, share this list with family and friends to help them better understand how to communicate with you.
I WILL |
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I WILL… | Encourage the person to speak and praise all efforts Promote and encourage independence. |
I WILL… | Give the person every opportunity to express him or herself. |
I WILL… | Speak in short, simple sentences, using a natural voice and a slow rate of speech. |
I WILL… | Practice speech exercises during short sessions in the home. |
I WILL… | Carefully place yourself and all objects within the person’s visual range, if there is a cut in the person’s visual field. |
I WILL NOT |
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I WILL NOT | Force the person to speak. |
I WILL NOT | Speak for the person unless absolutely necessary. |
I WILL NOT | Interrupt the person when he or she is speaking. |
I WILL NOT | Anticipate the person’s every need. |
I WILL NOT | Talk about the person in his or her presence; lack of speech does not mean lack of comprehension or lack of intelligence. |
Reprinted from the Stroke Connection Magazine May-June 1996 issue.
Planning for effective rehabilitation and recovery from stroke needs good communication and coordination from the patient, family or caregiver, as well as the physicians and therapists. Everyone is working very hard to do the best they can to help your loved one recover.
Here are some questions to help formulate and understand an effective plan of care, so that all sessions and days spent in rehab make the most of everyone’s efforts for recovery.
WHEN do we start planning for rehab?
Planning should begin as early as possible in the hospital stay to allow for review of options and family’s planning. Rehab stays can be a very limited time, and every day is important. Discuss this with your physician and the case manager.
What types of options are available?
WHAT are realistic goals for this particular person?
WHAT are the specific goals, concerns and expectations for the patient’s Rehab treatments and therapy?
HOW will improvement be measured during Rehab?
If that patient is able to achieve 50% improvement, how does the family or caregiver assist with the other times when they are struggling to help themselves, i.e. assisting with eating or toileting?
PLANNING FOR DISCHARGE after Rehab:
Physical Therapists & Occupational Therapists:
Speech Therapists:
Case Managers:
General: