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Stroke happens more and more often, with ever younger ones. Fortunately, we are also getting better at treating strokes, and rehabilitation after a stroke can also do wonders. But what to do when the patient lacks space in the neurological rehabilitation unit or has to leave it too soon?

Stroke rehabilitationcan be very effective, but as long as the caregiver knows what to look for and how to help to minimize losses after a stroke and not harm your behavior sick.

It is estimated that approximately 30 percent of stroke patients should be referred to a neurological rehabilitation unit immediately after treatment. In practice, only 15 percent go there. The rest are sent home.

Of course, every patient has the right to rehabilitation at home, but the main burden of care falls on the relatives.

Beware of pressure ulcers in people after a stroke - lying in one position for a long time is one of the main causes of their formation.

When caring for a stroke patient, remember that the paresis to a greater or lesser extent usually affects half of the entire body: face, esophagus, palate, tongue, trunk, shoulder joint. This can cause not only mobility problems, but also problems with swallowing, drinking and speaking.

Eating problems after stroke

The cause of problems with biting and swallowing food is the paresis of the muscles of the tongue, palate and throat. It may also happen that with excessive muscle tension, the trachea and esophagus are shifted to the side and the patient cannot easily swallow even mushy food. This ailment will be eliminated by a massage performed by a therapist visiting the patient at home.

  • Advice for the caregiver : watch if the patient eats the correct amount, does not have trouble swallowing, or if he or she complains of constant pressure in the throat.

Post-Stroke Repulsion Syndrome

Some people after a stroke (approx. 15%) are unable to keep their bodies in an upright position. They tilt the body to one side (to one side) because they perceive the tilt as the correct vertical position, both when sitting and standing.

It happens that when the guardian wants to sit the mentee upright, he or she stayspushed back (hence the name of this condition "repulsion syndrome"). Such tilting of the figure can lead to accidents, but the dysfunction self-resolves over time.

  • Tip for the caregiver : you can speed up the rehabilitation process, e.g. by painting or sticking vertical stripes on the walls.

Linguistic improvement after stroke

The effect of a stroke may be problems with speaking, understanding, reading, writing, and counting. Rehabilitation in this area is provided by neuropsychologists and neurologopedists.

Appropriate exercises are selected depending on the type and severity of language disorders. They are run by neuropsychological rehabilitation clinics. The therapist may also come to the patient's home. Usually there are 3 visits a week, lasting 45-60 minutes.

With mild aphasia, improvement is seen after 2 weeks, with an average of 6, and severe aphasia after six months. The therapist's task is also to teach the caregiver and the patient to communicate with simple messages: "You want to eat - yes. You want to drink - no". The spoken words should be accompanied by a gesture that will make it easier to understand the question. Encouraging word completion is also helpful. The guardian says: "you want wo …" and points to a glass of water. The patient ends: "water". The stimulation method is recommendable. Teaching the patient words, sentences, statements, asking a question, we tap the rhythm on the patient's sick hand and sing the words "do you - want to eat". A good exercise for patients with aphasia is to connect the dots drawn on a piece of paper with lines, from which they create pictures or geometric shapes.

  • Tip for the caregiver : you can borrow a computer program for the rehabilitation of cognitive functions from a rehabilitation clinic for a fee (PLN 200 per month). Just like in computer games, you move on to the next, higher stages, so also here you move on to more advanced tasks. The decision about it is made by therapists from the rehabilitation center after assessing the patient's progress. This type of therapy for people after stroke has an attractive form of play, which increases its effectiveness.

Dyzartia and post-stroke aphasia

Inability to communicate with the environment, loss of the ability to translate thoughts into words is an extremely difficult experience for the patient and his relatives. It often leads to the isolation of the sick person. To prevent this from happening, we need to know a bit about the mechanism of these dysfunctions. A post-stroke patient may have dysarthria or aphasia. Dysartia is a speech disorder resulting from damage to the speech apparatus, i.e. the tongue, pharynx, larynx and palate. As a result of muscle paralysis, the patient cannot make any sound, but understands everything andcan write what he needs.

In aphasia, language disorders are associated with brain damage. The patient is not able to combine syllables into words, words into sentences, and sentences into a logical statement. The sick person finds himself in reality, he knows that he is in the hospital or at home, he can distinguish whether someone is nice, helpful or not, but he is unable to communicate using words.

There are many types of aphasia. For example, in motor aphasia, the patient understands what is said to him, but he himself speaks in a telegraphic shortcut: "I go to the hospital, I eat". When he suffers from sensory aphasia, he speaks fluently and a lot, but the words do not make sense, he says, for example, "nogobut, spine, falohalopikalo". He doesn't understand the commands because he doesn't know the meaning of the words. Characterized by amnestic aphasia, the patient understands simple commands, speaks but cannot name objects. Instead of saying "chair", it will say "something to sit on."

  • Caregiver's Tip : Rehabilitation of aphasia takes time, but even partial resolution brings great relief to the patient and the family. Patients are often frustrated by the course of rehabilitation because they are aware that simple activities, such as arranging pictures, are difficult for them. Still, they need to be encouraged to exercise.

Protect your hand with paresis after a stroke

You can't measure the pressure on it, you can't inject it. During hygienic procedures or dressing the patient, the paralyzed arm must not be pulled, because it is very easy to damage the shallow shoulder joint, where the bones only stick to each other. The shoulder may also be injured by the weight of the inertly drooping arm. Therefore, when the patient is sitting, the hand should rest on the table or desk top. If the patient uses a wheelchair, it should have a table top on which to support the arm. In the supine position for the arm, you need to put a pillow. While walking, the hand must not hang down - you can put your hand in a trouser pocket or by a belt, but it is best to put your hand in the orthosis on the shoulder and shoulder, because it allows you to move the hand, and therefore also its rehabilitation. It is better to avoid placing the arm on a classic sling, because the patient is so comfortable that he forgets about it.

  • Advice for the caregiver : The patient often performs all activities with the he althy hand. In order to activate the sick, you can put a thick oven mitt on the he althy one and thus force the performance of various activities (opening the door, getting dressed, washing) with an infected hand. A gloved hand will then be helpful, e.g. to support oneself in case of imbalances.

Mirror therapy after stroke

Mirror box therapy, or mirror therapy,helps to improve an inadequate hand. It is perfect for home rehabilitation. You will need a box large enough to fit your forearm. We make a hole in it, through which the patient will be able to insert the sick hand inside. Glue the mirror to the side of the box from the outside - if the right hand is not correct, attach the mirror to the left side, looking from the side of the hand opening. The patient sits down at the table and puts the sick hand in the box. He places his he althy hand on the table next to him. She cannot see the sick woman, because she is hidden in a box, but she can see the he althy one, as well as her reflection in the mirror. It looks as if he can see both his hands. Its task is to move the he althy one and observe her in the mirror. This helps convince the brain that the affected arm is moving. It will indeed happen in time. Why? Around the paralyzed part of the brain there is a so-called penumbra zone with living but inactive neurons. The eye registers the illusion of diseased hand movements and sends a signal to the brain. Dormant neurons wake up, which triggers movement.

  • Tip for the caregiver : Practice 2 hours a day in series of 15 minutes, once in silence, once with music. The effects of such exercises come surprisingly quickly.

Post-stroke neglect syndrome

It is a state in which the stroke patient does not perceive ( although he can see!) The affected part of the body with his senses, e.g. he does not want to wash the sick hand because he thinks it belongs to someone else. The same applies to the space around the patient - he sees only half of it, e.g. he does not see us if we stand on his left side. How do I know if I am suffering from Neglect Syndrome? It is enough to divide the sheet of paper with a vertical line into two parts, draw the same short vertical lines on both of them and ask the patient to cross them out. If he does this with only dashes on one side of the page, he has a malpractice syndrome.

  • Caregiver's Tip : The most common mistake caregivers make is stimulating the side of the body that the patient does not notice. Meanwhile, it should be the other way around. If the patient neglects the left side, then everything that happens around him should be on the right side. This is where we put the radio on, this is where we talk to it, and this is where we go to the bed. Gradually, under the influence of the plastic abilities of the brain, the area of ​​the patient's perception of the world will begin to expand.

Paralysis of the leg

Patients who have suffered leg paralysis show a characteristic gait. They throw their leg on, which is called by physiotherapists mowing the floor or mowing the pavement. This is because the leg does not bend and is as if too long. If we don't improve our legs, it will happen after a few yearsserious degenerative changes in the lumbar spine and in the hip joint.

  • Caregiver's tip : The STEP device for electrostimulation (FES) of the peroneal nerve (can be borrowed from the rehabilitation clinic) is helpful. This small device (fits in a trouser pocket) has an electrode that attaches to the calf muscle and a sensor that should be placed under the heel in a shoe or on a heel. When the foot leaves the ground, the sensor sends a pulse that causes the muscle to contract. This makes the leg slightly bend at the knee, the foot does not descend and the gait becomes more natural. Also disappears the fear that the patient will catch his foot on the ground and fall.

Post-stroke bladder training

Many stroke survivors are discharged home with a catheter in their bladder. This often applies not only to people who are lying, but also people who are walking. A normally functioning bladder can contract and stretch when filled with urine. A long catheterized bladder loses this property. It becomes lazy - it does not have to contract and stretch because urine constantly flows from it into the container. If the bladder "forgets" how it is emptied, the catheter cannot be removed because urine will flow back into the urinary tract, which can cause infection and pain. First you need to restore the bladder to its former efficiency.

  • Caregiver's Tip : For the first few days at home, if allowed by your doctor, clamp the catheter tube for 15 minutes and then release. This operation should be repeated several times. We gradually extend the time of clamping the catheter - by half an hour, an hour, etc. The bladder will "remember" how it should behave, and then the catheter can be removed permanently.

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