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Discharged from the hospital after a stroke, what next?

Summary: All patients with stroke need high-quality primary care to manage new needs, prevent a recurrence, remediate complications, optimize quality of life, and facilitate prompt access to specialists as needed. By the time they are ready to be discharged from the hospital, the patient should be able to provide reliable yes and no responses to questions and express himself or herself in short phrases, use the unaffected hand much more effectively for self-care, and walk 50 m slowly with hands-on supervision, aided by a cane and ankle–foot orthosis; he or she would be expected to need some physical help for self-care. (3) The ways to move forward are to implement what we do know and to develop optimal implementation strategies and policies. We also need to implement home or community-based rehabilitation programs for those who can and will engage and benefit. We need to identify this group early and provide resources, so they can optimize their outcomes. We need to develop solutions for the challenging patients, which may mean institution-based, not home-based rehabilitation, or closer follow-up with home care. We need to address apathy post-stroke and use advancing knowledge of neuroscience to develop interventions. Those that show promise, an emphasis on goal setting, and the development of problem-solving skills could be achieved through self-management programs, which are now delivered through media. (4) Physical, occupational, and speech therapy after discharge should be focused on training in tasks needed to increase independence for activities at home and in the community.

What is a Stroke?

A stroke occurs when the blood supply to a part of the brain is cut off. Some of the signs and symptoms of a stroke are sudden loss or blurring of vision, dizziness, confusion, a sudden and very severe headache resulting in a blinding pain unlike anything experienced before, difficulty swallowing (dysphagia), loss of consciousness, complete paralysis of one side of the body. Strokes are a medical emergency and urgent treatment is essential. The sooner a person receives treatment for a stroke, the lesser the damage.

Impact of Stroke on caregivers

A stroke can have a detrimental impact on not just the person suffering from it, but also on their family. A drastic change in their living conditions, a sudden transition to caregiving responsibilities, potential loss of income, and emotional distress are some of the stresses a stroke survivor’s family has to deal with Feelings of uncertainty are reported among many caregivers and family members of stroke patients. Setting aside their feelings and challenges to focus on the recovery of their loved ones can be extremely taxing for the caregiver. In such situations, where the family needs support to care for the stroke survivor, palliative care may be considered.

Why consider Palliative Care?

Stroke recovery calls for a caring approach that focuses on improving holistic well-being and quality of life, which is the core principle of palliative care. In addition to relieving physical symptoms, the palliative team helps to address the mental, spiritual, and social care needs of stroke patients, thereby elevating the patient’s overall well-being. Research shows that stroke patients who receive palliative care early on report better quality of life. Their family members also benefit from having the palliative care team to guide them with necessary medical knowledge, and consulting when they have to make decisions with, or for their loved one. Social workers, who are a part of the palliative team, also lend a helping hand to both patients and families. (1)

How can Family members take care of a stroke survivor at home?

  • Providing support

Aiding stroke patients with rehabilitation exercises is crucial to recovering physical mobility. In addition to giving physical assistance, providing emotional support and reassurance is key since some patients may have a tendency to focus on the worst-case scenario, which could hinder their healing process. Setting short and long-term goals for patients motivates them to engage in practices like physiotherapy that lead them to recovery.

  • Adapting to their behavioral changes

troke is known to cause unexpected emotional and behavioral changes in some patients. Stroke survivors may develop resentful feelings for no apparent reason. This can be very frustrating or overwhelming for families and close friends, causing them distress along the way.

However, it is important to remember that these changes are often temporary, and stroke survivors will likely revert to their old selves as the rehabilitation sessions progress. Seeking help from support groups and palliative care teams can be of great help when a loved one may be going through difficult times. This would also allow caregivers to take time off and focus on their physical and psychological needs whenever required. (1)

Some more tips for at-home stroke caregivers in short:

  • Encourage daily rehabilitation exercises

  • Talk with social workers or case managers for tips

  • Talk with an Occupational Therapist for house modification recommendations

  • Keep a record of side effects from medication

  • Be on the lookout for new stroke side effects

  • Beware of extra supplements because they could cause another stroke

  • Join support groups






Author: Mr.Nikhil Sharma

Editor: Dr.Manognya Chekragari

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