ARTICLES / General / Care and
Comfort for the Stroke Patient /
By Nancy Meadows
Life for the Jack Meadows family changed forever
in December 1989 when this husband and father
suffered a stroke. The massive incident in his brain
left him with no use of his right side. Months of
rehabilitation restored strength and balance but
could not return him independence in daily routines
of self-care. He has a strong left arm and weak left
leg to provide limited mobility. In addition,
frustrating his life even greater is the lack of
communication. He definitely has cognitive processes
as is evident when following conversations and
watching television quiz shows. But, thoughts have
difficulty connecting to words and words in the
brain do not translate to speech.
His family has chosen over the past twelve years
to assist him at home. While visiting nurses and
aides have contributed valuable services over the
years, the major day-to day attention to his needs
has been and continues to be given by his wife. A
son, daughter and a few good friends frequently
assist. We have learned tremendous lessons about the
skills our stroke patient has retained or developed.
We have also acquired extensive knowledge and
mastered many competencies in our twenty-four hour a
day, seven days a week responsibility. As others
make decisions about the care of their family member
who has incurred a physical or communication
limitation, they could benefit from our experience.
When arranging care for a family member guardians
may inquire and observe to ascertain if the kind of
care we are giving in the home will be given in the
long-term care facility or hospital.
Over the years Mr. Meadows has required services
in several hospitals and many doctors’ offices. Most
doctors and nurses do not know readily how to meet
his needs. We can only surmise that they learned
about stroke patients and other handicapped
individuals in their schooling and on-the-job
training but have not had the amount of direct
experience as when a family provides care at home.
Our intention is to share the wisdom we have
attained and to contribute to the quality of care
accorded to all persons with physical restrictions.
First, be sure you have the full attention of
your patient. While eye contact is important the
individual who has had a stroke may look you square
in the eyes but not have focus on the conversation.
Position yourself in front of your patient and tune
out all other sights and sounds in the room. Turn
down the volume of the television, radio and block
the talk of any other people in the area. Make
contact by touching the hand, chin or cheek, an area
not affected by the stroke. Sometimes our family
member is helped by directing him to look at the
speaker. Saying, “look at my face,” does not offend
him and gains his concentration. Use a normal volume
and speak clearly.
Express one idea at a time in simple terms and
repeat if needed to assure yourself that the two of
you understood each other. For example, “do you want
coffee?” and then follow up with “coffee?” More
complex thoughts can also be conveyed in this
manner. Ask, “were you on Omaha Beach?”… “Omaha
Beach?”… “you were there during World War II?”
Hand gestures can assist with clarification. Both
the care giver and the stroke patient can benefit.
Ask your client to point to what he wants or needs.
He will develop a repertoire of pointing for such
daily items as the television remote, newspaper,
eyeglasses, radio, drapes, an uncomfortable foot or
arm or headache. When going through complicated
maneuvers such as using the mechanical lift to get
in and out of bed the patient can work in
coordination with the attendant. Instruct him to
place his hand on the release lever of the lift and
push in. Point to the lever or guide his hand to the
lever. Demonstrate a pushing motion at the same time
as saying, “push.”
At times when communication is not working, give
it a rest. Take time out and try again later.
Sometimes the family or friend has exhausted the
twenty questions and both parties are becoming
frustrated. Tell the patient, “we will think about
it,” or “we can try again later.”