By Marianne J. Legato, M.D., F.A.C.P.

Going home after a moderate to severe stroke can be a frightening prospect for the survivor, the caregiver, and the family due to fears that a stroke could happen again, fears that the survivor might not be able to accept his/her disabilities, or fears that the responsibilities of caring for the survivor might be daunting. This is a time when it’s important to recognize there are professionals, organizations, and friends all able to support the caregiver as well as your loved one.

Support Teams

After a stroke, your loved one’s rehabilitation team includes the nurses, the physical therapists, occupational therapists, speech pathologists, neuropsychologists, others who consult about continuing care, and perhaps most important, you. If you are caring for someone who suffered a stroke, seek training in things such as transferring your loved one from a wheelchair to the bed, how to get your loved one up after a fall, helping your loved one learn how to speak, or physical therapy.  Caregiver and patient support groups are valuable resources. Organizations such as the National Stroke Association will have local chapters that can assist you. Hospital and rehab facilities often have their own support groups.

Memory Loss

Memory loss after a stroke can be subtle and may not be noticeable at first. Stroke survivors may have difficulty with numbers, or may need reminders about something they’ve begun and not finished.  Keeping daily schedules routine, keeping items in the same place, and talking about what your loved one likes to do on a daily basis can help.

Erratic Behavior

Confused behavior, poor judgement, and apathy are all possible with the stroke survivor. Be aware that your loved one’s behavior may be due to depression.  A depressed person may be irritable, neglect medications, or refuse to exercise. Patience on the part of all family members is critical, as is keeping the survivor active, engaged, and interacting socially.  If chronic depression persists, try individual counseling, group therapy or antidepressant drugs.

Many stroke survivors experience sudden laughing or crying for no apparent reason and difficulty controlling emotional responses affects many stroke survivors. The emotional display may end as quickly as it started and isn’t necessarily related to being happy or sad.

Left- or Right- Sided Neglect

Left- or right- sided neglect means that a survivor will ignore things corresponding to the same side of the brain that was injured because they don’t perceive things. For example, on a plate’s left side, food may be ignored.   Rotating the plate will help.

Language and Mobility

Language and comprehension difficulties can be very frightening after a stroke for both the survivor and the caregiver.  In more severe cases, you will want to seek professional help about how to handle communications.

Impairedmobility and impaired ability to complete everyday tasks may require adaptive devices or techniques specially designed for stroke survivors. These devices and new ways of doing things may give the survivor a feeling of independence and safety.  Even accomplishing something as seemingly simple as dressing oneself is a form of independence, and maintaining good grooming habits will enhance a stroke survivor’s self-esteem.

Diet and Weight Control

A low-salt, low-fat, low-cholesterol diet can help prevent a recurrent stroke. Nutritional recommendations from your physician or nutritionist can enhance the benefits of the drugs a survivor may be using for the stroke or other conditions.  Weight control is crucial if your loved one is following a more sedentary routine.  Some stroke survivors may have trouble swallowing, so be mindful of choking possibilities.  Memory loss may cause some to forget to chew or to swallow.

Pain

Staying in one position for a lengthy time can also cause muscles and joints to ache. A stroke survivor may suffer pain from nerve damage, bed sores, or from general lack of mobility. Check with your healthcare professional, ideally a physical therapist, for tips on how to prevent or relieve certain types of pain. A paralyzed limb can cause pain in the connecting joints.  Your loved one may need physical therapy to help relieve this.

Intimacy

Couples may find changes in their sex lives, but it is important to remember that sexual satisfaction is achieved in many different ways.  Find healthy ways to satisfy yourself sexually. The emotional and physical challenges of caregivers and their families in caring for a stroke survivor are demanding.  Don’t hesitate to ask for support after your loved one has a stroke, because it’s all around you.