After a Stroke: Tips for Home Caregivers

OK. The unthinkable has happened: your loved one has had a stroke. Luckily they survived. Their color is good. His rehabilitation is going well, and you have learned so much about their care. In fact, there’s talk of this loved one coming home any day now. How do you turn surviving into thriving?

Take a breath. Take two. Then start at the front door, and look around.

"The first thing you do as a caregiver is to prepare your house before your loved one comes home," says Sharon Ostwald, Ph.D., University of Texas Nursing School professor and director of the Center on Aging. Depending on the part of the brain that’s been assaulted, you will need to make your home as user-friendly as possible. If the stroke survivor is wheelchair-bound or using a walker, do you need ramps? Are there rooms where you need to step up or down to enter? Do the bathrooms have bars, and are the doorways wide enough to let a wheelchair pass?

"Make sure your teenagers or grandkids know that shoes can’t be left in the middle of the floor anymore," Ostwald says.

Walk your home as if it is booby-trapped. Do you have throw rugs in traffic areas? Slick floors? Dangling phone cords? Is your carpet so thick that a wheelchair cannot roll?

Different Strokes for Different Folks

Now is the time for customized organization. But you can’t customize until you know everything you can about your loved one’s particular brand of stroke and its unique set of challenges.

For instance, if the patient has what’s known as a field cut (left- or right-sided blindness), put your hand over one eye and take note of what you can’t sense or see in your own home. You might have to turn their dinner plate around for them to realize there is still half a plateful of food to be eaten.

Think about your layout. What your brain takes for granted architecturally, like sharp corners, low-hanging ceilings or walls that jut out, may be "new" information for a stroke patient. They might be relearning the simplest geography of her own house. But learning it again is also part of rehabilitation. And until she does, purchase safety bumpers for those kitchen-counter corners.

If the stroke affected the patient’s motor skills, as in left-sided paralysis, imagine how difficult some tasks may be to perform with only one hand, like decapping and squeezing the toothpaste. So become a drugstore detective. Look for product are easy to dispense, such as pump toothpaste, pump soap, and spray butter. Rediscover the shoe horn. Fall in love with Velcro.

But there is a difference between caring and doing, warns Ostwald. Part of home rehabilitation is fostering your loved one’s own independence in his own world. Replace a few buttons with Velcro, but encourage him to negotiate the sticky strips himself.

"Stroke disrupts every aspect of a survivor’s life and the family’s routine, but routine is critical," Ostwald says. "In those first few months especially, routines help rehabilitate patients mentally and makeit easier for them to get out of bed in the morning."

Run the bath at the same time each day. Plan for the physical therapist to come at specific times. Take a walk with your loved one at designated times, like dusk, or after a meal, so that this newly reorganizing mind can expect it.

Though your universe will feel like it revolves around your loved one, it also will free you to count on certain chunks of time that are just for you. And when those chunks come, take them.

If you’re lucky enough to have extended family, multiple generations living in the same home or a network of caring friends, then blow the whistle and huddle. Plan a family or "team" meeting before your spouse gets home. Divide up daily responsibilities to free you up as the primary caregiver. Expect reluctance, disappointment, and the oddest of family members to rise to the occasion, including the stroke survivor. Your loved one is still a contributing member, so assign him his "tasks."

Bring on the little kids. Children are marvelous at chattering away, often more patiently than adults. They can read the newspaper to their loved one, open mail and entice almost anyone to tune their fine motor skills with a box of crayons and drawing paper. And like children, remember to play.

"Game playing is one of the best rehabilitative tools because it not only stimulates the brain but keeps the patient interactive with the family," Ostwald suggests.

Any game that calls for organizational thought processes, such as checkers, Chinese checkers or dominoes is helpful and fun.

If aphasia (speech/language disruption) is present, steer clear of Scrabble for awhile. But dust off the Monopoly box – it engages just about every aspect of the brain, and it’s a game the whole family can play.

Bottom line: use your familiar surroundings and familiar faces to continue therapy.

"Everyone looks good lying in the hospital bed, or walking around the rehab center. It is only once they come home that the subtle things become overwhelming, like remembering to close the refrigerator door. In the hospital, there was no refrigerator door to remember how to close."

To read the complete series on Stroke Care at Home, go to www.healthleader.uthouston.edu and click on "Stroke Survivor."

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©2006 Texas Medical Center

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URL: http://www.tmc.edu/tmcnews/07_01_02/page_16.html