Features Of Rehabilitation Of Patients After A Stroke

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Cerebrovascular Accident (CVA) also known as stroke occurs when blood flow to an area of the brain is damaged or destroyed, depriving brain tissue of oxygen and nutrients (Staff, 2019).

Qualities for Caring Patient with CVA

  1. Good communication – Good communication is key to all healthy relationships, and this is especially true when it comes to a carer's relationship with both his patient and the family of the patient. In clear and simple terms, being able to communicate important details about the care of the patient creates understanding and trust. This helps better perform the carer's job. Non-verbal communication is necessary when caring for a patient with CVA, Hand gestures can assist with clarification. Both the caregiver and the stroke patient can benefit. Ask your client to point to what he wants or needs. Because it may be hard for the patient to communicate verbally due to dysphasia.
  2. Empathy – To give the patient the best care possible, it is important for a carer to have a personal understanding of and connection with what his or her patient is going through. Being able to empathize allows the carer to put himself or herself in the patient’s shoes and identify and ease the patient’s fears or discomfort. This also helps the carer to act appropriately and handle the situation properly while considering the patient’s feelings, personal needs, and preferences. Furthermore, empathy enhances the communication and connection between the carer and their patients.
  3. Patient – Patience and flexibility are qualities that every person in the healthcare sector must possess. There’ll be many hardships along the way i.e. the patient is being stubborn and uncooperative, the schedule doesn’t go as planned, or difficult situations arise. A carer who is very rigid will find it challenging to deal with these circumstances in a positive way. The carer must be patient and help patients overcome anxiety (Medical, 2018). The importance of patience is it makes people better, it helps build empathy towards other people, and is very important in the healthcare sector (Medical, 2018). By having patience, it will help the carer accept other people or their patients as the way they are (Medical, 2018).

Activities of Daily Living

  • Mobilizing – The most obvious problem with a patient who had a stroke is their mobility. The type of problem will depend on the size and location of the stroke and the quality of their rehabilitation (AG, 2016). Patients need to be encouraged to continue to exercise both to stimulate the brain and also to try and recover physical fitness. Patients find it difficult to see the point of exercising since there is a limit on developing their physical bodies. However, this is really important, both to allow better recovery of their mobilization, and to reduce the risk of further stroke and heart disease. Exercise can cause pain and may limit how much movement a patient is able to achieve. But in many cases, it is treatable using physiotherapy. Physiotherapy has a better effect on recovering the sensory function, but it is often slower than the recovery of mobility.
  • Eating and Drinking – CVA causes the patient to develop dysphagia. Dysphagia is difficulty in swallowing. Patients who had stroke have problems swallowing certain foods or liquids, while others can’t swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking. bringing food back up, sometimes through the nose (NHS, 2018). Therefore, patients who has dysphagia usually use liquid thickener to be able to swallow the liquid much easier. Patients at home require skilled multidisciplinary working involving the community nurses, dietitian, speech therapist, and GP. Some patients will recover a safe swallow even many months after the stroke so patients should always be kept under review to ensure that oral feeding is started when it's safe. Eating a healthy diet can lower your risk of another stroke. Eating a diet low in fat and salt and high in fruits and vegetables reduces the risk factors for another stroke like high cholesterol, high blood pressure, being overweight, and diabetes (StrokeFoundation, 2018). Foods may also interact with new medicines that you take after a stroke that require you to avoid them
  • Communication – Patients who had a stroke may be challenging to communicate with because they may have aphasia. Aphasia is an impairment of language, affecting the speech and the ability to read and write. Many people with aphasia visit a speech and language therapist following a stroke. Regular sessions are crucial to help individuals regain speaking abilities and learn coping strategies. Stroke causes facial drooping. Speech therapy targets redevelopment of the muscles of the face, mouth, and throat to improve articulation (Cicerchia, 2017). An outburst of uncontrollable crying or laughing (Pseudobulbar Affect or PBA) is a common post-stroke condition (Pioro, 2017). PBA is often mistaken for depression, leading to under-diagnosis, under-treatment and inappropriate treatment at times. Patients should be open about the problem so people are not surprised or confused when you have an episode. When they feel an episode coming on, they should try to distract themselves by counting the number of objects on a shelf or by thinking about something unrelated. Work closely with the speech-language pathologist. Carers can help improve and maintain of their patient’s communication skills by following the instructions of the speech therapist.
  • Elimination – Loss of bladder and bowel control is a common and devastating problem for patients with stroke. A skilled assessment to establish the cause is the first and most important step towards solving the problem. It should never be accepted as an inevitable and untreatable complication of a stroke just to be managed by putting on an incontinence pad (AG, 2016). The carers should empathize with the patients because it is an embarrassing and humiliating experience. In many cases, incontinence is overcome in a relatively short period after a stroke. This can happen as a natural part of the recovery process or as a result of treatment or therapy. There are few treatment options, these include bladder and bowel training, medication, or urinary catheterization.

Daily Routine

  • Physical

Mobilizing – During the time in the hospital, most people were given the opportunity to practice tasks in the kitchen from simply making a cup of tea to preparing a full meal (health talk, 2018). Tasks like this gave people a great sense of achievement particularly when they were able to prepare something for a relative. This will encourage independence for the patients. Patients should have a regular visit from a community occupational therapist or nurse who could help them with planning these tasks. This will help them build up their confidence. They can also d physical exercises such as walking. Physical exercise after a stroke does not have to be complicated. Going for a walk is a good way to get outdoors and improve cardiovascular fitness. Maintaining a garden is not only a good hobby, but it can also provide good exercise and time outdoors. Gardening can help improve stamina, balance, and coordination (Saebo, 2017).

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  • Socially

Communication – Finding ways of connecting to others through immediate and extended family and community organizations such as a church, community center or senior center is important. This will create or improve the relationship between the patient and other people around them. People who feel isolated feel bad about themselves, which makes therapy and recovery more difficult, and it makes it more difficult to accept the life they have now. Social interaction and simply feeling connected to others helps ease the depression and isolation that are common after stroke. It is hard to overcome depression alone and social support is needed to overcome it easier. Other board games also promote social skills. They can also build up relationships with others through music. Language and music are stored in different areas of the brain and someone who struggles with the spoken word may have no difficulty with singing a song (Cicerchia, 2017).

  • Intellectually

Learn something new – By saying this, it doesn’t mean patients have to go back to school, it might be they pick up a hobby like gardening or bird watching. They may also want to acquire a new skill, particularly one that helps with language recovery, like practicing sign language or typing. Stimulating new areas of the brain gets things moving. Family members can also play with them like board games or puzzles. Checkers or Connect Four could serve as excellent cognitive training. Even though these games are simple, they help patients improve their motor skills while cognitive flexibility is required to perform strategic moves and stimulate the brain’s problem-solving skills. (Rehab, 2018). Patients can do some mental heavy lifting and try puzzles, audio books, or even routine activities, such as making to-do lists. The goal is to work on their reasoning, comprehension, and problem-solving skills. Meditation and clearing their mind afterward can be a great way to wrap this type of activity up (Cicerchia, 2017).

  • Emotionally

Self Esteem – After a stroke, changes in your emotions and personality are common. Experiencing strong emotions after stroke is very normal, but with time these emotional reactions usually get better (StrokeFoundation, 2018). Patients may feel disappointed and down after a stroke. But there are ways to raise their self-esteem. The patients should be recommended by them to keep a journal. In this journal, they can write their thoughts and feelings to reduce their stress level. It’s a good way to solve problems and get to know their own selves better. They should also give themselves time to be alone. It’s important to take time every day just to think, read, journal, pray, meditate, depending on what they need. They should make themselves their priority to be able to recover faster. Patients survivors may want to consider making some changes in their daily routine if things really bother them. One-to-one, brief and pleasant activities can be better than trying to handle stressful situations or environments on an ongoing basis in a quiet environment.

  • Spiritually

Spirituality is widely believed to provide a sense of peace and comfort. According to the Very Well Health website, the strength of religious beliefs act as a possible protective factor against emotional distress after a stroke but did not demonstrate significantly improved brain function or better physical recovery after a stroke as a result of spirituality, religion, or faith. (Moawad, 2019). It does appear that the long term effects of spirituality can improve a person's outlook, potentially reducing the severity of stress related medical conditions, such as stroke and some of the risk factors that lead to stroke (Moawad, 2019). Stroke survivors may or may not have connections with a faith community but they could be a means of offering alternative support or practical help that they may not have considered before. In the community, faith groups offer a range of support from practical help to befrienders who volunteer to help in situations of need (stroke4carers, 2017). Meditation can help lower stress, relieve chronic pain, and stave off depression. Medication is easy to do the patient just has to find a peaceful and silent area in their house so that they can meditate.

Conclusion

Stroke can have various effects of all kinds. Many effects are physical and easy to see, but hidden effects can also occur, such as changes in emotion. A stroke survivor may experience fear, anxiety, frustration, anger, sadness, and a sense of loss after a stroke because of the changes they've experienced. It may be impossible to bring back their old selves, but it is possible to relearn skills and improve their wellbeing. Stroke rehabilitation can help stroke survivors regain independence and improve their quality of life. The goal of stroke rehabilitation is to help the patients relearn skills that they lost when a stroke affected part of their brain.

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