The effects of a stroke on a patient can be extensive and long-lasting. How exactly a person will be affected, to what extent, and how long the consequences will last, differs from patient to patient. Additionally, there are even differences between the right and left side stroke.
Stroke is, unfortunately, one of the most common medical emergencies. Each year in the US, around 800 000 people suffer a stroke. Out of those, some 60 percent survive. Most of the survivors require rehabilitation, and some of them continue living with long-term or even permanent disabilities.
It is the job of the caregiver to provide the best quality of care for their clients. For stroke patients, this might mean providing a lot of physical support, while also supporting the client with the mental and emotional aftermath.
Here are some practical tips on how to provide the best care for clients after a stroke.
Be Mindful of Your Words
The aftermath of a stroke is a scary and confusing time for a client. Their world has turned upside down and they have to get used to a new reality and the new limitations of their body.
This can be extremely difficult to accept, and it’s important for the caregiver to be careful about the way they speak about the event and the way it has affected the person’s body.
When caring for an individual in recovery from a stroke, do not call the weaker side the "bad side," or talk about the "bad" leg or arm. Use the term, “weaker” or “involved” to refer to the side with paralysis or weakness. Even if the client themselves refer to the “bad” side, you can try to re-frame it as just a limitation.
While it’s important to be soothing and encouraging, never talk to your client as if they were a child. They may have to learn basic skills from the very beginning, and they deserve just as much respect and collaboration as they did before the stroke.
Encourage Independence and Self-Esteem
It’s important to encourage and allow your client to gain as much independence as possible. Let them do things for themselves as much as they can or want to, even if you could do a better or faster job. You can help make tasks easier to do if they need help, but let them try things on their own first.
Even when they don’t succeed, show appreciation and acknowledge the person’s efforts to do things for themself. Be patient with them and encourage them to be patient with themselves. Stroke recovery can be a very difficult process; support, patience, and encouragement will go a long way.
Positive reinforcement can make a world of difference, so make sure to praise even the smallest successes to build confidence.
Be Ready for the Emotional And Behavioral Changes
Because the physical effects of a stroke can be so serious and overwhelming, the emotional, mental, and behavioral changes don’t get talked about as much. Sometimes these changes are a psychological effect of adapting to the new situation, but a lot of changes are actually based on physiology, leading to a range of different effects.
Where the stroke happened in the brain makes a big difference in the physical effects because each side of the brain controls different body functions.
Strokes in the right side of the brain can cause memory loss, either short-term or permanent. The client could also suddenly act impulsively or not be aware of their limitations. On the left side of the brain, the opposite effects tend to be shown.
They might move or think slower and become overly cautious. These are just a few examples; strokes can create a wide range of symptoms on either side of the brain.
Experiencing confusion or memory loss is upsetting. People often cry for no apparent reason after suffering a stroke. As a caregiver, you should be patient and understanding. Your positive, supportive attitude will be important. Keeping a routine may help clients feel more secure.
These emotional or behavioral outbursts can sometimes be challenging, but try to always be compassionate, and remember that they are even more upsetting and confusing for the client. Be prepared for the challenging behavior of your client and learn how to manage it.
Keep Them Safe and Comfortable
A stroke patient might not know or be able to tell you when something is wrong. Sometimes they can’t speak or don’t have access to all of their language or lose feeling in certain body parts. Pay special attention to skincare and observe for changes in the skin if a person is unable to move.
Clients who aren’t able to move much on their own can easily develop pressure ulcers, also known as bedsores.
Help the client to move and reposition their body regularly to keep circulation flowing and hopefully prevent these painful sounds. Make sure to always check their body alignment and positioning. Sometimes an arm or leg can be pinched or stuck and the client can’t feel it, so it’s important to watch out for this.
If your client has a loss of touch or sensation, check for potentially harmful situations. Diminished sensation or paralysis causes lack of awareness about such things as water temperature and sharpness of razors. Take care so that injury does not occur.
Handle Bowel and Bladder Retraining Delicately
Bowel and bladder retraining can be particularly sensitive and cause the client to feel embarrassed or ashamed. Treat them with dignity always, but especially if they have to deal with this aspect.
Follow bowel and bladder retraining schedules as ordered. You can offer positive words for successes or for attempts to control bowel or bladder, but don’t be over the top about it, or talk to your client as if they were a baby. Keep your voice low and do not draw attention to any aspect of retraining. Finally, whatever happens, no matter how many setbacks occur, never show frustration or anger with retraining efforts.
Encourage Them to Use the Affected Side
One of the biggest challenges a person faces after a stroke is to regain mobility if one side of the body is affected severely. This can be a long and extremely frustrating process. Your job is to encourage them to use the affected side, without making them feel powerless and hopeless.
You can do this by placing items they use regularly within reach on the neglected side, such as eyeglasses, tissues, phone, and other items. You can also approach clients on the weaker side to improve awareness around what movements might be limited and need strengthening.
Try talking to your client from that side, and their instinct will make them attempt to turn or follow your movements with their eyes. You can also touch that side of the body if the client agrees, by holding their hand on the weaker side, for example.
If you engage the parts of the body that have been affected by the stroke, they will naturally try to use those parts more often, which will improve the recovery process and speed.
Provide Physical Assistance
Mobility issues are a very common problem for people recovering from a stroke. Sometimes this is isolated to one part of the body, like an arm, hand, or leg. Other times it will affect half of the client’s entire body, or their whole body completely. Understanding their limitations and capabilities is important for the best caregiving support.
When assisting with transfers or walking, stand on the weaker side. You should always support the weaker side and lead with the stronger side.
When assisting with dressing, dress the weaker side first. Place the weaker arm or leg into the clothing first. When you help them undress, do it the opposite way: undress the stronger side first.
Find a Way to Communicate
When a stroke happens in the left hemisphere of the brain, it can negatively affect the ability to speak or communicate. This condition is called aphasia.
Even if they do not have aphasia, talking for a long time or about complicated topics might be challenging for the client. Effective communication is definitely still possible in this situation, it just might require some creative thinking.
To facilitate more involved communication, you can use pictures, gestures, pointing, or even communication boards or special cards. This helps them communicate their needs and feel more in control of what is happening to them as they recover.
Help Them Eat Safely
After a stroke, one of the common, challenging conditions a client may have is difficulty swallowing. This is called dysphagia.
Although dysphagia often improves after a few weeks, at first it affects around 50 percent of stroke survivors.
Dysphagia poses a significant risk of choking even when a person is doing something as simple as drinking a sip of water. If you are helping your client eat or drink, this is something that you should keep in mind.
When assisting with eating, you should always have the client sit upright at a 90 degree angle, and watch for signs of choking.
It’s best to serve soft foods and thickened liquids. Solid foods not only pose a greater choking risk, but also the chewing motions may be difficult and cause problems.
Always place food in the unaffected or non-paralyzed side of the mouth and make sure all food is swallowed before offering more bites. This is not a good time to encourage use of the weaker side, because that will increase the risk of choking and potential for harm.
Taking care of a stroke patient can be challenging, but the key is to be aware of your client’s symptoms and limitations and to approach them calmly, with patience. Since their independence will likely be affected, you are a very important resource to help them maintain their quality of life and recover with grace and dignity.