By Nancy Meadows

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DAILY CARE AND ACTIVITIES

Have the person who had a stroke do as much routine self care as possible. This may seem very little with one good arm but we have discovered many surprising tasks that our husband and father can do well. Every task he found he could do for himself raised his pride and confidence. He can operate a television remote, secure a towel around his neck before eating, use a spoon to eat most anything, pick up food morsels he has dropped, use a cordless razor to shave and put a cassette in a tape player. His more complicated skills include leafing through a magazine or newspaper, folding towels from the laundry and using the overhead bar to slide himself up in bed.

Vary the day but follow a routine. This piece of advice may seem contradictory but really is no different for the person who lives with a stroke than the family around him. To make the most of the day a schedule provides security and comfort for both the stroke client and the caregiver. For instance, a schedule of getting dressed in the morning, eating breakfast, moving into a comfortable chair and watching favorite television programs gives the patient peace of mind. He also can feel he has some control over his day as he watches the clock knowing certain activities will occur at specific times. Additionally, within the day activities could be varied so that the person who can not move himself does stay in one place, one position for such a length of time that the body and mind become numb. Thus, the assistant must move the client from the bed to the wheel chair to the easy chair and so forth several times in the course of the ordinary day. Staying in one place for hours at a time is neither comfortable physically or mentally. The routine for our stroke patient includes sitting in a recliner in the morning to watch television, moving to the wheel chair and into the kitchen for lunch, return to the bed after lunch for a nap or listening to music. In the afternoon he moves to the recliner again and enjoys watching children coming from school or birds dining at the feeder. Again he moves to the wheelchair and the kitchen for his supper. In the evening he may sit in the recliner again or sit in bed to watch television, read the newspaper or listen to the radio. 

A mechanical ‘lift’ (such as one manufactured by Hoyer) is a necessity. With practice it is easy to use and makes possible the mobility of a person weighing over two hundred pounds by the helper who is five feet tall. A lift could be available in every wing of a nursing home, rehabilitation center, doctor’s office and hospital department. The lift seldom breaks down and takes wear and tear over the years. Every care giver should learn to use this invaluable tool.
Use the stroke patient’s good side. Place a tray or table where the mobile hand can easily reach. Items the patient wants at his access include tissues, cup, spoon, pills and cough drops. The television remote or the nurse call button must be on the side where the patient can handle them. 

Be prepared for normal body functions at all times. If the stroke patient uses a bedpan or underpads, a supply could be kept at the bedside. The patient can’t wait until a nurse or aide walks down the hall and back with the needed items. The same is true for saliva and nasal mucus. Tissues kept at the patient’s hand usually prevent a mess and embarrassment.

INDIVIDUAL NEEDS AND WANTS

Find those special traits that each person maintained in spite of the stroke or developed afterward. For example, our patient can read a clock and point out directions when riding in the car. We also discovered that he can sing and his words are correct for the song and intelligible. At times he will try to sing a word that when spoken is not making sense to his listeners.

The member of the family who has had a stroke can be involved in everyday decisions. This is accomplished by offering choices. The easy tasks such as what to have for dinner can be accommodated by asking, “what do you want, chicken or fish?” More difficult choices can also work in this manner. “What should we give our granddaughter for a wedding gift, money or a clock?”

Be patient and willing to try innovative approaches. One great frustration is learning to eat with one hand, the opposite of the dominant hand. Our patient required many trials before being able to get more food in his mouth than on the tablecloth but eventually his persistence won. In the process we found that a flat dinner plate did not work well. When a pie plate with sides was substituted he could scoop food into a spoon instead of pushing it over the edge. He occasionally requires assistance with cutting food and picking up the last morsels. The person who sits to his right can assist by using his or her fork to push the food onto the spoon. This method allows him to master cleaning up well liked but difficult foods such as peas.