Caregiving After a Stroke (Part 2)

Stroke survivors often feel as though they're lost in an alien landscape. Words can lose their meaning, familiar places and objects can become bewildering, and even the simplest tasks can seem overwhelming. Sufferers may someday return to their old world, but they can't make the trip on their own. For these reasons, stroke survivors need a concerned caregiver who can help ease the way to recovery.

If you're caring for a stroke survivor, you should learn everything you can about the challenges ahead. If your loved one has been seen only by his or her primary care physician, you may want to ask about an appointment with a specialist (such as a neurologist) who can assess the brain damage and tell you what to expect. Even if complete recovery isn't possible, you can take steps to make the survivor's life as pleasant and productive as it can be.

The right-brain stroke

Strokes in the right side of the brain -- the half that governs emotions, spatial perceptions, judgment, concentration, and nonverbal communication -- may cause bewildering changes in behavior and perception.

For example, a stroke survivor may laugh uproariously or burst into a fit of sobbing for no apparent reason. He may not have the attention span to complete simple tasks. Because right-brain damage also clouds judgment, he may push himself too hard or take unnecessary risks. For instance, he may try climbing the stairs when he can barely walk. If he's confused or if his memory is failing, he may wander away.

Survivors with right-brain damage often struggle with perception. The person you're caring for may drop a plate on the floor because he missed the edge of a table. He may even mistake one object for another. "My brother tried to brush his teeth with a pencil," says a caregiver in Marilynn Larkin's book When Someone You Love Has a Stroke. "We had to take all the medicines and cleaning supplies out of the cabinets when he tried to drink the detergent, thinking it was a bottle of soda."

The left-brain stroke

Injuries to the left side of the brain -- the side that controls language -- can be extremely distressing for the survivor and her family. She may have trouble reading, writing, speaking, or understanding the words of others. Some survivors can't speak at all, some can manage only one- or two-word sentences, and some sprinkle their conversations with odd word choices or bits of gibberish. This constellation of speaking and comprehension disorders is called aphasia.

Writing to an Internet forum on aphasia, one woman affected by the disorder describes the dissonance between her thoughts and her words. "I often cannot express the word for an object but can picture it in my mind. For example, 'Put the roast in the square hot box' means 'Put the roast in the oven.'"

Not surprisingly, such problems with basic communication can shake a person's confidence and radically change her personality. "Survivors with left brain damage tend to behave in a cautious, compulsive, or disorganized way and are easily frustrated," writes Larkin.

Fortunately, aphasia is often temporary, especially when a patient receives aggressive speech therapy soon after the stroke. According to a report in the Journal of Internal Medicine, "even patients with severe speech impairment have a considerable potential for recovery, particularly in the first three months after stroke."

The long road back: Tips for caregivers

For any caregiver, safety is always the top priority. It can also be the biggest challenge, especially if your loved one has an injury to the right side of his brain. If his judgment or perception are severely clouded, he shouldn't be left alone. All poisonous substances or dangerous objects will have to be hidden away or put out of reach. And if he's at all inclined to wander, make sure he has an ID bracelet with his name, address, and phone number.

After ensuring his safety, you can take steps to improve his quality of life -- as well as your own. If he starts laughing or sobbing in the middle of a conversation, try to distract him by calling his name or changing the subject. As soon as he stops, continue the conversation as if nothing has happened. If he apologizes, remind him that the fault lies with the brain injury, not with him.

If he has trouble completing a task, try breaking it down into small segments. You can make it easier to stick to the task by turning off the television or eliminating any other distractions. Not only will you cut down on frustration, you'll give him a valuable sense of accomplishment that comes with successfully performing the task.

It takes patience and perseverance to cope with aphasia. Talk to your loved one's speech therapist for advice. Here are some of the tips Larkin offers:

If the stroke survivor cannot comprehend what you're saying, use gestures and facial expressions to communicate as much as possible.

Speak in simple sentences that express one idea, such as "Let's go outside," then "Let's go for a walk," instead of saying, "Let's go outside for a walk."

If the stroke survivor can speak but is impaired, ask questions that take a yes or no response. "My grandfather had such a severe stroke that he couldn't walk and could only say 'yes' and 'no,'" says a woman from Atlanta, Georgia. "But he could put a world of feeling -- from sly humor to exasperation -- into each 'yes' and 'no.' So we would have great conversations playing 20 Questions. He could still smile and frown, too. And sometimes he would cry with frustration, and I'd pat his hand and say, 'It's all right, Granddaddy -- we're here for you. We love you.'"

Find creative ways to help the patient communicate. One caregiver used pictures and labels to help his wife make her choice for dinner.

Talk with your doctor about new technology to help stroke victims. New technologies are being developed that will give stroke victims feedback on which muscles they need to use to, say, pick up a cup or move their hand. Some of the machines can actually recognize and signal someone's people's "intent" to move a particular muscle. Researchers feel these technologies may one day be able to free many stroke and accident victims from paralysis.

Finally, don't hesitate to ask for help. No matter what the impairment you are facing, some caregiver or stroke survivor has already found a way to cope. Join a stroke support group, and ask your loved one's therapists and doctors plenty of questions. It takes compassion and knowledge to help someone overcome a stroke. The first just comes naturally; the second takes work. But as you see your loved one making strides toward recovery, you'll know it was all worth it.

Further Resources

National Stroke Association
800/787-6535
http://www.stroke.org

American Heart Association/Stroke Connection
800/553-6321
http://www.strokeassociation.org

National Aphasia Association
http://www.aphasia.org

References

New device enables stroke victims to recover further. Science Daily. April 13, 2013. https://www.sciencedaily.com/releases/2013/04/130411075457.htm

Larkin, Marilynn. When Someone You Love Has a Stroke.

For stroke victims, promising new technologies. ZDNet. https://www.sciencedaily.com/releases/2013/04/130411075457.htm

Lasska, A.C. and Hellblom, A. "Aphasia in acute stroke and relation to outcome," Journal of Internal Medicine, 249(5):413-422

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