The Impact of Stroke on the Family
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 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 recovery will occur. Gradually the situation becomes clearer while the family is learning 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 unstable (has a loss of emotional control due to brain injury), who probably has problems getting about, has visual deficits, 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 depressed. To some extent this is a good sign, in that it shows understanding and an awareness of what has happened. Here is where the husband or wife, family and friends are so important in assuring the patient that he or she is still loved and wanted, and that there are those who care and want to help. We - therapists, nurses, physicians, and volunteers can show we care and can provide technical help and support, but we do not have the time nor the personal involvement which our patient needs. Anti-depressants have not been found very helpful in reversing the depression which follows stroke - all too often they add to the confusion and fatigue from which the patient is already suffering.
As the patient moves from the acute care area to the rehabilitation area, there is a change in the care of the patient which may be confusing to the family. Family members may interpret as poor nursing care the efforts of the team to get the patient to do more for himself or herself and to be more independent. We often have to insist that the wife not feed her husband - and it doesn't help a nurse's morale to be asked, "Why don't you feed my husband? That is what you are paid for". The family may object to the therapist or orderly who stands by as the patient struggles to propel his wheelchair down the corridor, but this is done for a reason.
The Progression of Care
A common progression in care for a stroke patient is two to three weeks on the acute care side of the hospital where the rehabilitation team sees the patient and initiates therapy, then treatment continues in the rehabilitation unit where the patient's reactivation is accelerated. Here the patient has one to one sessions with physiotherapist, occupational therapist and speech pathologist as well as group therapy. There may be a recreationist who arranges social events, such as a pub night, shopping trips, parties to mark special days, pet days, and more.
The family is encouraged to see the patient in therapy to receive instructions in transfers, etc.. The speech therapist in particular can use a great deal of help by the family. 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.
The Long Slow Road
we have seen husbands and wives faced with the responsibility of caring for and sharing life with a spouse who has had a stroke, who is aphasic and hemiplegic, rise to levels of love, devotion and sacrifice which makes us humble to observe and which restores our faith in the essential goodness and nobility of human nature.