What should caregivers take note of when caring for a stroke survivor?

In our previous article, we discussed about the mental and physical changes of a

stroke survivor. In today’s article, we will be discussing the things that can be

done by a caregiver to improve the quality of life after a patient’s discharge

from the hospital.

Bed mobility

Rehabilitation begins with getting the patient out from bed. Once vital signs are stable, physiotherapists proceed to teach patients to move from lying to sitting, sitting to standing as well as walking with assistance.

For patients who are immobile, a changing of position every 2 hourly is important to reduce the risk of getting pressure ulcers or bed sores. It usually happens on bony prominences such as the back of the head, ears, shoulders, elbows, lower back, buttocks, hips and inner knees due to prolong pressure on the skin leading to inadequate blood supply and nutrition to the tissue. This eventually causes tissue necrosis. Bed sores contribute to an increase in the mortality rate of patients as they can develop into life- threatening infections if left untreated. This can be avoided with the help of special mattresses, cushions such as foam filled mattresses, air-filled mattresses and fluid-filled mattresses that can relieve the external pressure on vulnerable areas on the body.

Transferring method

Caregivers should be taught the proper method of transferring a patient. As stroke patients tend to experience shoulder subluxation due to hemiparesis, an improper transfer could worsen the condition and cause dislocation of the shoulder.

Range of motion exercise

Passive movement is required to be done for immobile patients as they have difficulties in moving their limbs. Maintaining available joint range of motion can be done by the caregiver passively moving the limb every day to prevent joint stiffness. If the patient presents with muscle weakness on one side of the body, active assisted exercise is suggested. For example, the unaffected hand may assist the affected hand in moving up and down.

Cardiorespiratory exercise

It is essential for stroke survivors to maintain their optimal cardiorespiratory function in their daily lives. In fact, breathing exercises must be taught to caregivers before the patient is being discharged. Diaphragmatic breathing, active cycle breathing techniques are effective in improving breathing pattern, ventilation and reducing the risk of cough formation that may be caused by prolong immobilization. Moreover, caregivers may apply gentle percussion or vibration on the patient’s chest wall to mobilize the phlegm so that it can be simply removed by coughing.

Home modification

The environment at home can greatly affect a patient’s recovery. Even if is a minor stroke, there will be lingering disabilities such has balance, coordination or cardio fitness. To overcome those challenges, modifying the home environment so that it is suitable for the patient’s safety is important. Installing a toilet railing for patients to assist them in standing up from the toilet bowl is an example. The home environment should have sufficient spaces for them to move around the house. Avoid clutter on the floor so that patient safety is

assured.

Used of walking aids or external appliances

Patients may need different types of external appliances according to their stages of mobility. Hence, the anti-slip rubber and hand grips have to be in good condition. The brake of the wheelchair should be checked regularly to secure the patient’s safety. If the patient is using a wheelchair, caregivers should always check the patient’s posture as prolong improper posture can cause deformities in the long term.

Follow up care

People who have had a stroke have an increased risk of a recurrent stroke, especially during the first year after the first stroke. Patients and families should ask for guidance from their doctor or nurse on how to prevent another stroke. They need to work together to make healthy changes in the patient's daily lifestyle.

Patients and families should also learn the warning signs of a TIA (such as weakness on one side of the body and slurred speech) and see a doctor immediately if these happen.

Reference:

Ulaan Baatar. (2013) Clinical Guideline on Stroke Rehabilitation Management of patients

with stroke: Rehabilitation, prevention and management of complications, and discharge

planning.