5 Steps To Protect Your Loved One After A Stroke
This information was originally published on QMedic.
1) Recognize the warning signs of a second stroke
Once your loved one has had a first stroke, there is a high likelihood of recurrence. Researchers have found that the likelihood of recurrence within 5 years is 9x higher than that of someone in the general population.
Thus, it’s critical to notice warning signs as fast as possible. The American Stroke Association uses the acronym “FAST” to help caregivers quickly test & monitor for signs of stroke:
“F” – Face Drooping – If one side of the face droops, or your loved one displays signs of facial numbness, do a quick smile test. If you ask your loved one to smile and their smile is uneven or lopsided, this is a sign of stroke.
“A” – Arm Weakness – Ask your loved one to raise both arms to the sides or in front. If one or both arms drift downwards, she could be having a stroke.
“S” – Speech Difficulty – If your loved one has had a previous stroke, she may have partial or full aphasia and/or dysarthria, which are impairments in speech often caused by brain injury. It’s useful to know the differences between the two conditions. The American Stroke Association recommends asking your loved one to repeat a simple sentence like “The sky is blue” or “The fox is red” 3-5 times in a row to determine if she is able to repeat correctly. If speech is more slurred than usual, or incomprehensible, this is a strong warning sign of stroke.
“T” – Time to Call 9-1-1 – If your loved one experiences any of the above, or their symptoms appear worse than usual, call 911 immediately.
During a stroke, the above symptoms are frequently accompanied by others such as numbness, difficulty swallowing, double vision, vertigo and loss of motor control (ataxia). If you notice these symptoms, call 9-1-1 immediately.
2) Get your loved one to quit smoking by reducing related stress factors
The reasons that people smoke are unbelievably complex…unbelievable to the point that people who require oxygen tanks to breathe normally still smoke (and risk death by fire hazard as well). Clearly, education about smoking risks is not enough to convince the most hardcore smokers to stop.
For caregivers, it is helpful to be aware of the urgency here for post-stroke patients. Smoking increases post-stroke death risk by 200%. And even motivated people fail to quit—in a trial featuring over 900 stroke patients who previously smoked, 50% who claimed to be motivated to quit relapsed into smoking within 3 weeks.
One strategy to persuade your loved one to stop smoking is to limit potential causes of stress around her—clutter in the home, toxic family relationships, daily chores, workload, financial hardships, etc.— while making sure she feels supported emotionally along the tough recovery journey. Become an active listener to get to the root of her stress.
In addition to providing steady in-person emotional support, there is convincing evidence that nicotine replacement therapy and electronic cigarettes & vape pens can be effective in reducing smoking.
3) Make physical therapy engaging and easy to comply with
Consistent physical therapy is critical to preventing post-stroke muscle deterioration and falls. Your loved one’s rehabilitation must extend beyond the professional care setting to the home.
Before your loved one is discharged from a skilled nursing facility, consider setting up a dedicated physical therapy area in the home where you can place and use equipment to support recovery. This area must be easily accessible for the user so it makes most sense to put it on the first floor so she can avoid stairs.
Within the home, it’s important for your loved one to keep moving and specifically focus on consistent repetitions of motor movements to activate neuroplasticity and brain healing.
FlintRehab provides an excellent list of affordable equipment that supports stroke recovery through repetitive movement exercises. The equipment list includes:
Exercise peddlers/leg bikes – while it is tempting to buy on the cheap, avoid this temptation—a $100-150 peddler is the right price. Beware of the $20 bike because you get what you pay for.
Balance boards – supports full body coordination through training of legs and core. These should only be used in the presence of a caregiver.
Arm peddlers – by placing your leg peddler on a table, it can double as an arm peddler or you can get a dedicated arm peddler.
Arm skates – supports increased range of motion. Helps support repeat back-and-forth arm motion.
Dumbbells and wrist weights – 5-10 lb weights are sufficient. Again, the focus is on repetitive movement. Weight resistance level should carry low risk of injury.
Therapy putty – Low-cost at $12-15. Squishing the putty in one hand can strengthen fine motor movement and also relieve stress.
Having a dedicated, clean area for this equipment helps ensure that physical therapy can be part of your loved one’s daily routine in the comfort of your home.
Before you make purchases, check with your loved one’s health insurance plan to see if some or all of the special equipment and braces you purchase are eligible for coverage/reimbursement. In the end, much of the expense for discretionary equipment may have to come out-of-pocket but keep in mind that preventative supports/equipment are ultimately less expensive than the costs and health dangers incurred from a subsequent stroke.
4) Prioritize occupational therapy
Occupational therapy plays a central role in the recovery plan. An occupational therapist will likely address the physical, cognitive and emotional challenges that accompany stroke recovery. Based on The American Occupational Therapy Association’s recommendations, therapists are likely to:
Demonstrate one-handed techniques for opening packages, getting dressed, cutting food, using the computer and completing other activities of daily living such as toileting and bathing.
Train your loved one on equipment such as leg and arm peddles.
Conduct a comprehensive home evaluation: eliminating loose rugs and clutter, recommending night lights and grab bars, especially in the shower/bathroom where
your loved one is more likely to fall.
Identify ways to minimize stair usage and fall risks, via rearranging the home or a stair lift system—typically the latter system costs $1,000+. If stair lifts are prohibitively expensive, a more affordable approach would be to rearrange a multi-story home to ensure that your loved one rarely has to go upstairs (e.g. moving bedroom to first floor).
Encourage activities such as gardening, pet care, cooking and household tasks to improve functional movements in arms and legs
Re-evaluate community transportation services to meet your loved ones needs. Recommend mobility aids such as walkers, canes and wheelchairs. Train memory via chunking techniques that break activities and thoughts into smaller, more manageable steps.
5) Learn about novel approaches to stroke-induced aphasia and dysarthria. Almost 1/3rd of stroke patients experience either partial or full aphasia, where speech function and/or comprehension are impaired. Below is an excellent 5-minute TED video from Speech and Language Pathologist Susan Wortman-Jutt explaining the different causes and types of aphasia, as well as how caregivers and therapists can stimulate neuroplasticity to restore speech cognition and formulation.
There are novel therapies in clinical trials that could help your loved one recover speech function and comprehension:
Wortman-Jutt is an advocate for transcranial direct current stimulation, which places non-invasive electrodes directly in neural pathways. This technique is currently in clinical trials to determine efficacy in improving brain neuroplasticity and motor control post-stroke.
Music therapy to improve speech, cognition and recall. There is a great company called SingFit that stimulates cognitive, physical and mood improvements via easy to use singing app-based therapies. Beth Israel Deaconness Medical Center has conducted trials for Melodic Intonation Therapy, “a treatment that uses musical elements of speech (melody & rhythm) to improve expressive language by capitalizing on [singing] and engaging language-capable regions in the undamaged right hemisphere.” While more research is necessary, it is easy to support music therapy at home and evaluate how your loved one responds.