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The Impact of Stroke upon the Family The Acute Stroke Patient Although strokes are such a common occurrence in our society - some 50,000 in Canada each year - each one comes as a bolt from the blue, nearly always unexpected, often involving a spouse who may not be in the best of health and who by reason of age may have a limited capacity to adjust to such a crisis. For the first few days the main concern is whether the patient will survive. Then, for a few weeks, the question is how much the patient will be able to recover. As the situation becomes clearer, the family must learn to adjust to a loved one who may have trouble understanding them, who may not be able to communicate thoughts and feelings, is often emotionally labile (has a loss of emotional control due to brain injury), who probably has problems getting about, has visual deficits, who needs help even in the simplest activities of daily living, and who tires out so easily. The Importance of Support As the patient begins to recover he or she may become very depressed. To some extent this is a good sign, in that it shows understanding and an awareness of what has happened. This is when the husband or wife, family or friends can play a crucial role in assuring the patient that he or she is still loved and wanted, and there are those who care and want to help. Therapists, nurses, physicians, and volunteers can show they care and can provide technical help and support, but they do not have the time, nor do they have the personal involvement that the stroke survivor needs. Rehabilitation As the patient moves from the active or
acute care area to the rehabilitation area, family members may be confused by
the changes in care that the stroke survivor
Stroke Education When the stroke survivor enters rehabilitation, stroke education for the patient, family and friends is vital. Family members can speak to various health care professionals and can contact the Stroke Recovery Network to find out more about the different elements of stroke and stroke recovery. They may wish to know more about:
The Progression of Care It is common that a stroke patient will spend two to three weeks on the active side (acute care) of the hospital, where the rehabilitation team sees the patient and initiates therapy. Treatment will then continue in a rehabilitation unit where the patient's reactivation is accelerated. Here the patient has one to one sessions with physiotherapists, occupational therapists and speech pathologists as well as group therapy. Some care centers have a recreationist who arranges social events, such as pub night, shopping trips, parties to mark special days, and more. The family is encouraged to see the patient in therapy to receive instructions in transfers and at home care. Family members can be of assistance in areas such as speech therapy. Valerie Eaton Griffith's book, "A Stroke in the Family", has a great deal of valuable advice on how the family can help with language training. After 10 to 12 weeks in a rehabilitation
unit, the patient will usually move into an outpatient clinic, in which the
patient will engage in therapy, group exercise,
Sexual Adjustment after Stroke The stroke survivor may have a diminished self-image after his or her stroke and may doubt whether he or she is still lovable. The love, patience and understanding of the family are all important at this time. Stroke survivors may also face a sexual adjustment following their stroke. Usually stroke does not diminish the libido or potential for orgasm. However, the resumption of sexual intercourse is a major milestone in the rehabilitation process. Dr. Charles Clay Dahlberg, an American psychiatrist, describes his own stroke and recovery in an excellent book entitled, "Stroke", published by Norton and Company. He writes, "One morning about three weeks post-stroke, I woke up with an erection and it was a pleasant sensation. Life was coming back to me, so very shortly after I was cleared by the latest brain scan we decided it was the time for action. I think we were both nervous but all went well and afterward Jane asked me how I felt. I replied, "Good". I asked her the same question and received the same reply." Alex Comfort in his book, "Sexual Consequences of Disability", writes in summary that far too little is known scientifically of sexual dysfunction related to stroke. Some sexual difficulties relate to emotional causes: ongoing anxiety about potential recurring stroke, overwhelming fear after the catastrophic event, anxiety about sexual failure or performance, possible unresolved guilt, or a clinical depression. These difficulties can be managed with an explicit, clear discussion of sexual function, sex counseling or an appropriate antidepressant. Families are encouraged to work through post-stroke challenges together so that the quality of life for both the stroke survivor and his/her loved ones can be maximized. The Long Slow Road People's reaction to a stroke can often
parallel their reaction to death, with the same stages as described by
Elizabeth Kubler-Ross - denial, anger, bargaining, depression, and acceptance.
Family and friends must recognize that these do not necessarily follow each
other in order, however. There are frequent reversals to denial and anger and
depression on the way to eventual acceptance, and then the long slow road to
recovery and readjustment to a different way of life. Family
Many spouses and families faced with the responsibility of caring for and sharing a life with someone who has had a stroke can rise to levels of love, devotion and understanding that they never thought possible. Doctors and nurses alike have said how inspired they felt watching families cope with the effects of stroke, who work together and support each other through recovery and beyond. For more information about stroke recovery, contact: Stroke Recovery Canada This document would not have been possible without the generous support of:
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