How to care for someone after a stroke

Stroke is a sudden neurological deficit in the body occurring due to   blood supply being cut off in part of the brain and causing damage to that part. 

Blood supply is cut off due to either a clot blocking the cerebral artery or arteries (blood vessels of brain) or due to bleeding occurring in one of the vessels.

Hypertension, diabetes, high cholesterol levels, smoking and alcohol are some of the risk factors for stroke.

This is manifested in the form of sudden onset of paralysis of part of face and one or both limbs with or without loss of consciousness.  Medicines given at that time retard the progress of the attack but the neurological deficits persist.  

Complete recovery of the paralysed limbs occurs over a period of weeks to months depending on a number of factors like the underlying cause, blood vessel affected, alternate blood supply to brain by tributary vessels among others.

It is challenging for the care givers to take care of a person affected by stroke. Majority of the people affected remain conscious and alert but find it difficult to speak clearly due to weakness of one half of the face. They cannot move due to the paralysed limbs, cannot feed, wash or dress themselves.

Depending on one’s temperament, many times these people may be agitated or depressed. They may not be very cooperative and refuse to eat or take medicines. The attendant needs to be very patient. He should be able to counsel and convince the person that he shall surely recover, but that will take some time. For good recovery, it is important that he takes medicines and meals regularly.

Due attention to the nutritional status of the affected person is vital.  Because the patient is mostly unable to chew and swallow food normally, he should be given food in liquid or semi liquid form. Feeding him/her in small spoonfuls needs much patience.

Unless there is diabetes / hypertension needing some special diet plans, a person should be fed the quantity of food he was taking before falling sick. It should be balanced containing all nutrients, which will help him regain physical strength.

Another aspect needing attention is the prevention of bed sores. When a person is bed ridden for a long time, scars and wounds tend to form on dependant parts of the body like buttocks and back due to dampness. Once formed, they become a source of pain and infection.

The best way to prevent them is to change the position of the patient passively after 3 to 4 hours.  The entire back portion of the body should be kept dry by using some dusting powder.

Most of the bed ridden patients including those suffering from stroke are catheterised as they pass urine involuntarily. This is also a potential source of infection. If the care takers have the time, strength and patience, a urinary catheter can be avoided. One can use pampers or thick old cotton clothes in the form of diapers as used for children. This can be changed every 3 to 4 hours. If urinary catheter is necessary, it should be changed every 3 to 4 days.

Passive exercises form integral part of rehabilitation of a patient recovering from stroke. One who has access to professional physiotherapy can make use of this service. Regular massage and passive exercise of the paralysed limbs helps in improving the power of the limbs.

But in case of a person who lives far from a physiotherapy centre, the family members can learn to do passive exercises from a professional before discharge and continue to do so at home.  This includes slow movement of the limb without jerks, in all possible range of movement. The number and time of movements done has to be increased gradually.

Keeping the patient happy and optimistic helps a lot in ensuring recovery from a stroke.  Many patients do recover completely after a stroke and start walking normally again. Thus the patient and his family need to be optimistic while undergoing treatment.

 Dr Rachna Pande, Specialist, internal medicine

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