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How to effectively care for someone who has had a stroke?

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"A stroke, sometimes called a "brain attack", can steal one's ability to understand or to locate words." -Richard D. Zorowitz, MD


According to the John Hopkins Medicine(2006), every year 700,000 people in the United States have a stroke. Since stroke is the number one cause of disability, it's important for everyone to be well informed about effective care that every stroke victim needs.

Helpful Tips For Care-givers
  1. Be as positive as possible at all times.
  2. Don't be overprotective.
  3. Be patient.                          
  4. Set up a daily routine that meets both of your needs. http://www.stroke.org.uk/information/after_a_stroke/factsheets/stroke_a.html

Money Matters
(extra expenses that go along with effective care)
 
The Stroke Association Website states that when it comes to effective care for your patient or loved one, money is often a big issue. You are often paying for someone to take care of the person, along with larger heating bills, extra equipment, and support services if necessary. If you are a full-time carer then you may be entitled to some financial benefits, which will help with the extra costs. However, the benefits system is always changing, so be sure to check into it well and often.http://www.stroke.org.uk/information/after_a_stroke/factsheets/stroke_a.html

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What are common disabilities after a stroke?
  1. Mobility problems are common during the acute stroke period, but a large majority of survivors are able to with with or without assistance six months to a year later.
  2. Basic activities of daily self-care functions, such as dressing, bathing, feeding, tolieting, and grooming that a person must perform to be independent become impossible.
  3. Communication often becomes a challenge for stroke victims. It's common to experience some spontaneous improvement though.
  4. Balance and Coordination become problems that can be demonstrated by doing finger-to-nose, heel-to-shin, and alternating movement tests. Numbness, tingling, abnormal sensations, and excessive reactuions to sensory stimuli are common.
  5. Visual Defecits are very common, especially homonyous hemianopsia.
  6. Unilateral Neglect is when the patient lacks awareness of a specific part of the body. This usually occurs on the less dominant side, usually right hemisphere. In these patients, sensory stimuli in the left half of the enviroement are muted and ignored.
  7. Speech & Language Defecits effect verbal expression, reading and writing. It becomes very difficult to name objects, and fluency and adequacy of content.
  8. Pain such as headache, neck pain, or face pain can result from a stroke.(Post Stroke Rehibilitation Guideline Panel, Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1995)

Rehabilitation
Unfortunately, all of the disabilities mentioned above could get in the way of effective rehabilitation.However, most patients will have a rehabiltation team to help them overcome their personal challenges. The rehabilitation physician is the leader that oversees it all, including the medical attention, managing medication, and supervising the other therapists. He/She is usually a neurologist specializing in stroke disorders or a phychiatrist who specializes in rehabillitation. Rehabillitation for speech problems should begin immediately, because it's important for the patient to be able to express their wants/and needs, and be able to play a role in what is going on around them. Most hospitals will have speech therapists who will see the patient quite early, not just for the speech problem, but also because speech problems lead to problems with swallowing. The patient should see a speech therapist within 24-36 hours to determine whether the patient will be able to eat food, or will need other types of feeding, such as tubes. The neuropsychologist is the doctor that studies the special relationship between the brain and behavior. They will perform diagnostic tests and cognitive abilities, behavioral problems and psychological structures. They also provide individual, family and group therapies. The physical therapist concentrates on motor function. They will work with walking, balance, coordination, wheelchair use, strength, endurance and posture. The occupational therapist will supervise the practical routines that re-create a normal life. They will also provide excercises for finger and hand control, eye-hand coordination, and more. The respiratory therapist is only present at the onset of a stroke, and provides care if the patient has difficulty breathing. The clinical dietitan helps to control the patient's weight problems, and helps them maintain their bowel problems. They also provide special instructions for swallowing difficulties. The rehibilitation nurse tends to the patient's general medical needs. They help the patient reach rehibilitation goals while therapy is not in session. They help with personal hygiene and bladder/bowel control. The job of a rehibilitation nurse varies in different situations. (Senelick, Richard C., M.D>, Peter W.Rossi, M.D., and Karla Gougherty. Living With Stroke. Chicago, Illinois: COntemporary Books, Inc. , 1994.)

Medication can be very effective when trying to prevent a stroke from causing diabilties. Anticoagulants are known to create less clot formation. However, Coumadin(which is a type of anticoagulant) is actually a rat poison, so therfore comes with its risks. Aspirin can improve circulation for those with sluggish, thick blood. It also reduces the clot formation in blood. It can decrease platelet stickiness, and aid in prevention as effectively as more dangerous prescription drugs such as Coumadin. Antiplatelet Agents have been used in conjunction with aspirin for supposedly more efficient results. Nimodipine can reduce the severity and subsequent disability of a stroke already under way. It must be given within six to twelve hours after the onset of a stroke and it must continue to be administered for three weeks. It's side effects may include possible hypotension and migraine headaches. Antidepressants are used not only to help depression and also enhance physical and cognitive rehabilitaion. Tranquilizers can help ease the pain and these fears but, as with antidepressants, they must be closely monitored. They can interfere with cognition. Anticonvulsants will control seizures if a stroke victime does experience a seizure. Activase has been known to give major improvement in treatment of strokes also. It is the only medication that can halt a stroke caused by a blood clot, and must be administered soon after the stroke begins.(Senelick, Richard C., M.D., Peter W. Rossi, M.D., and Karla Dougherty. Living With Stroke. Chicago, Illinois: Contemporary Books, Inc., 1994.)

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A Closer Look
As a caregiver of a stroke victim, my best advice would be to get as close to your patient as possible, and try to understand them the best way you can.  It's important to realize that every stroke patient is going to have different needs. The key to effective care is not necessarily the medications or ways of effective care that you read about in books/articles. However, from personal experience I've found that the most effective care comes from compassion, and patience, and a personal understanding of your patient. It's important to remember that although your patient's life has been changed permanently, you need to be optimistic. It's also important to realize the you don't know what it's like to go through a stroke, and how it feels to be the burden of others. Life is not always fair, and those who deserve good don't always recieve good. But there is life after stroke. Nothing is impossible, however life has just changed. Dignity is a very important word when dealing with a stroke victim. Treat the person with the same dignity you would want given to you. There is more than hope after a stroke, there is life, and this is my personal advice for effective care of your stroke victim.

Please get in touch and let me know what you think of this site. Also feel free to contribute to this site with your own tips.