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Stroke recovery advice needed.

Leslie E. Packer, PhD lpacker at pipeline.com
Tue Jun 3 14:13:43 EST 1997

>"Bill Walker" <wwalker at public.compusult.nf.ca> wrote:

>We would like to do everything we can to increase my father's chances of
>passing the assessment the next time. Is there anything that a family can
>do to increase the chances of recovery in a stroke patient? 

I think you're already doing a lot  by being involved and letting the
staff at his present hospital know that you are very interested in
your father getting an aggressive rehabilitation program.   And of
course, to the extent that you are visiting with your father, you are
providing him with stimulation, socialization, and helping boost his
spirits.  And _never_ underestimate the importance of the human
spirit.    Keep talking to him, encourage his attempts to communicate
with you,  etc.  Hold his hand as you talk -- his 'paralyzed' hand.
Help him keep the limb in the picture.  And above all, focus on what
he _can_ do and not just on what he _can't_ do.  Whenever possible,
use humor.  These are frustrating times for you all, and a sense of
humor can really help.  

Not, let's get a bit more specific....  

I used to work in a rehab department at a major hospital.  Patients
were not accepted for transfer to our hospital and department unless
they were both medically stable and seemed like they were a candidate
for rehab.  

And here's where money comes in.  In order for hospitals to get
reimbursed under certain programs, the patient has to be able to
participate in a minimum number of rehab modalities each day.  If they
think your father can't do that, they'll be less likely to take him.
And if he has moderate to severe _receptive_ aphasia, that limits the
likelihood of certain therapies being of much help as the therapists
will have difficulty understanding whether _he_ is understanding what
they are saying/instructing.   They're also less likely to take him
for the reason that they honestly outlined to you (and I give them
some credit for being honest):  if he can't care for himself or is
incontinent, that really taxes the staff.  So, talk to the staff and
get more info -- _why_ can't your father feed himself?  He has one
non-affected harm, so theoretically, he can bring the fork/spoon to
his mouth, etc.  What's the problem in that area?  See if you can get
the staff to help you understand what the source of that problem is.
Then ask the same thing about dressing himself.  Is the problem that
he can't do it one-handed (yet)?  Or is there some other reason?  Has
he been evaluated by neuropthalmology for hemianopsia or field cuts,

Depending on the answers you get, there may be some things you can do
to help your father improve and thereby improve his overall chances of
getting more rehab. 

Also:  his chances of getting accepted into a rehab facility are
greater if he is currently in a hospital than if you take him home and
then try to get him admitted from home.  Just take that bit of info
away for future use, if it comes up.

Now that I've given you the bleak side, let me focus on some hopeful

There is a lot of spontaneous recovery that occurs after a stroke --
the bulk of it occurs within the first 6 months, but it doesn't stop
after 6 months.  So your father should be getting a bit better even
without any therapeutic intervention by professionals.  Assuming that
he doesn't go into a severe depression, etc.  Hence, my advice to
always stay 'upbeat' and focus on what he _can_ do or whatever
(little) progress he has made.   

In my professional practice working with post-stroke patients (now
private practice), all too often I hear families being negative around
the patient.  They want so badly to help their relative 'recover' or
get back to what they were, that they are forever offering little
'helpful' suggestions or criticisms. And the patients land up feeling
that they're a mess because they're forever being told what to do or
how to do it.  The whole process and change in relationship
infantilizes them, with further negative psychological consequences.
One of the things I try to teach them is that they are more likely to
be helpful by being essentially a 'cheerleader' for their relative.
Keep the positive mentality, Bill.  

>Are there any
>aternate therapies that conventional hospitals might not try? I'm looking
>for anything that might make his time their beneficial to his recovery.

Ask them about ADL training with an occupational therapist, even
starting at a low level.  ADL is not 'alternative,'  it is primary.
ADL training addresses self-feeding, self-dressing, etc.  

>Presently, I see most of the stroke victims at this hospital just lying
>around with vacant stare when they aren't in their brief physio sessions.
>There must be simple ways that their time can be put to good use at little
>expense to the hospital. For example, when I see Dad in his wheelchair, I
>always position the chair, so that its position encourages my father to
>turn towards his affected side as people enter or leave the room. 

Good for you! (seriously).  Yes, there are ways to arrange the
environment to encourage use of the affected side.  

>I'm not
>sure if this is effective but it causes him to do more exercise with the
>paralysed side of his neck. Anybody have any other simple techniques such
>as this?
>Anybody ever try laughter therapy on a stroke patient? 

See above.  Humor is very helpful, IME.  Indeed, Norman Cousins wrote
a book about it all back in the 70s.  An author search will turn it up
for you.  

>If so, how did it
>work? What did you do? Other therapies???
>It may not be possible to accelerate recovery from a stroke? The stroke
>victim may not be capable of going beyond a certain point regardless of
>what therapies are applied? 

Look, if there's massive brain damage, then there may be some
physiological constraints.  I had one patient who had several
problems.  He was able to get back a lot of use of his arm.  Luckily
for us, we had never seen his MRI or we wouldn't have even tried.  The
biggest problem may be the receptive aphasia, Bill.  

>Timing of therapy may be crucial, similar to
>learning in early childhood development. I don't know the answer to any of
>these questions, but would appreciate any practical advice.
>Yes, we are asking our doctors these questions, too; but would appreciate
>other opinions.
>Thanks in advance for any assistance.


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