Stroke Treatment

[Mike45]

My wonderful mother in law had a stroke last Sunday night and was brought to Saphasit regional hospital in Ubon Ratchathani. She is in the Stroke Unit currently. She appears to have paralysis in her left arm and leg. Initially she was unable to speak and extremely tired. Now she is talking and I noticed that both her eyes blinked normally together. Don't know if that really means anything.

I'm completely unprepared for this situation and don't know what questions to ask, arrangements that I should make, item's I should buy to help her recovery. I'm praying there will be a recovery. I just want to help out and make sure she doesn't fall through the systems possible cracks.

[never me]

Check at the hospital for massage treatment.

[AyG]

I'd suggest you first read about the condition from a reliable site. I'd suggest

http://www.mayoclinic.org/diseases-conditions/stroke/home/ovc-20117264

http://www.nhs.uk/Conditions/Stroke/Pages/Introduction.aspx

That'll help you to get to grips with what has happened and what to expect next. Then, if you've got any specific questions, just ask.

[Sheryl]

Improvement after a stroke can continue for up to 6 months afterwards so it is likely too soon to know how much residual deficit there will be.

Basically care consists of:

- measures to reduce brain swelling in the immediate term (she will be getting this now in the stroke unit

- supportive nursing care while function is impaired (ditto)

- measures to reduce the risk of additional strokes (may include anticoagulants, drugs to reduce elevated lipids if present, and to keep BP in normal range etc)

- longer term physical (and if necessary speech) rehabilitation

The Thai public health system usually does the first 3 fine if one is in a tertiary level facility, which she is. The last one, which mainly occurs just before and then after discharge, is a weak link. Physical therapy services in Thailand tend to be not very proactive or aggressive. How much PT she is going to need, of course, remains to be seen.

I think at this stage there isn't anything for you to do but as time passes and it becomes clearer how much damage there is, and her discharge from the hospital draws near, there may be needs relating to the home environment (possibly: ramps if she has to use a wheelchair or walker; bars to help her navigate in the bathroom, shower chair etc etc- . too soon now to know exactly what as it will depend on her functional state at discharge.)

And she will likely need physical therapy after discharge. What will be available from the health care system may not be much and it might be worth scouting around to see if you can hire someone privately to come in, and also to be sure family members sit in on the sessions at the hospital so that they know what to do/what exercises she should do etc.

It is best to push the patient to do as much for herself as possible during the recovery phase and family members will need to resist the urge to try to do everything for her as this is counterproductive in the long term. The focus should be on helping her do things for herself even though it may be hard for her and take a lot of time and effort on her part. Getting Thais to understand that and adjust their approach accordingly may not be easy as it goes against a number of deeply ingrained cultural beliefs and values: the need to "take care" and show gratitude, as well as a certain amount of fatalism and emphasis on acceptance rather than trying to change things. (There is a time and place for each, of course...but during stroke rehabilitation a more aggressive, try-to-change attitude is better). Doing everything for the patient not only fails to exercise their limbs and support physical rehabilitation, it also conveys an expectation that improvement isn't possible or expected which can lead to depression and lack of trying.

At a certain point, typically 6 months or so after the stroke, future improvement becomes less likely and learning how best to live with whatever lasting disability there may be is an appropriate focus . Prior to that point, however, efforts should focus on working to reduce the disabilities with an optimistic "you can do it" attitude. Again, not always easy to get that in this culture.

[BKKdreaming]

My friend had a small stroke ,

we had him start writing as soon as he could so that he did not "forget" how to, at the beginning it was real bad but in a few weeks much better ,

we also had him walk to get some strength back , at first it was a few houses away , maybe 50 meters , then each time a little more until he could walk 20 minutes

also have her speak , or sing so she remembers the songs and uses her voice.....

thats some of the small things we did, his stroke was not as bad as your mother in law as his arms and legs still worked , he was just tired with slurred speech and easily overwelmed mentally,

He is back 90-95% now , sometimes just a little slower than before

Good luck

[chubby]

try to get a front wheeled walker, and have her on her feet as soon as medically stable, depends on how much paralysis there is, if it is severe, then often you may need to think wheelchair long term.

depends on her age, and motivation, and co-morbities :

https://en.wikipedia.org/wiki/Brunnstrom_Approach

[Mike45]

Thank-you all for the much needed information and specific suggestions

[Mike45]

Improvement after a stroke can continue for up to 6 months afterwards so it is likely too soon to know how much residual deficit there will be.

Basically care consists of:

- measures to reduce brain swelling in the immediate term (she will be getting this now in the stroke unit

- supportive nursing care while function is impaired (ditto)

- measures to reduce the risk of additional strokes (may include anticoagulants, drugs to reduce elevated lipids if present, and to keep BP in normal range etc)

- longer term physical (and if necessary speech) rehabilitation

The Thai public health system usually does the first 3 fine if one is in a tertiary level facility, which she is. The last one, which mainly occurs just before and then after discharge, is a weak link. Physical therapy services in Thailand tend to be not very proactive or aggressive. How much PT she is going to need, of course, remains to be seen.

I think at this stage there isn't anything for you to do but as time passes and it becomes clearer how much damage there is, and her discharge from the hospital draws near, there may be needs relating to the home environment (possibly: ramps if she has to use a wheelchair or walker; bars to help her navigate in the bathroom, shower chair etc etc- . too soon now to know exactly what as it will depend on her functional state at discharge.)

And she will likely need physical therapy after discharge. What will be available from the health care system may not be much and it might be worth scouting around to see if you can hire someone privately to come in, and also to be sure family members sit in on the sessions at the hospital so that they know what to do/what exercises she should do etc.

It is best to push the patient to do as much for herself as possible during the recovery phase and family members will need to resist the urge to try to do everything for her as this is counterproductive in the long term. The focus should be on helping her do things for herself even though it may be hard for her and take a lot of time and effort on her part. Getting Thais to understand that and adjust their approach accordingly may not be easy as it goes against a number of deeply ingrained cultural beliefs and values: the need to "take care" and show gratitude, as well as a certain amount of fatalism and emphasis on acceptance rather than trying to change things. (There is a time and place for each, of course...but during stroke rehabilitation a more aggressive, try-to-change attitude is better). Doing everything for the patient not only fails to exercise their limbs and support physical rehabilitation, it also conveys an expectation that improvement isn't possible or expected which can lead to depression and lack of trying.

At a certain point, typically 6 months or so after the stroke, future improvement becomes less likely and learning how best to live with whatever lasting disability there may be is an appropriate focus . Prior to that point, however, efforts should focus on working to reduce the disabilities with an optimistic "you can do it" attitude. Again, not always easy to get that in this culture.

I witnessed some of her physical and speech therapy at the hospital. They appear to be very professional and pushed her to do her therapy. They told me that therapy at the hospital was available after discharge. They also believed that therapy was available at the community hospital ten minutes from my MIL house. So we are hopeful that this may be coming together.

[Sheryl]

Make sure as many family members as possible sit in on the therapy sessions to get the idea.

I wouldn't count on the quality of the PT/ST being at all the same at the community hospital. So it may need the family to step in. Also, they need to reinforce the therapy at every aspect of her daily life.

[chubby]

can she walk with a walker yet? if so how far ? is her hemi/stroke hand have a grip?

Improvement after a stroke can continue for up to 6 months afterwards so it is likely too soon to know how much residual deficit there will be.

Basically care consists of:

- measures to reduce brain swelling in the immediate term (she will be getting this now in the stroke unit
- supportive nursing care while function is impaired (ditto)
- measures to reduce the risk of additional strokes (may include anticoagulants, drugs to reduce elevated lipids if present, and to keep BP in normal range etc)
- longer term physical (and if necessary speech) rehabilitation

The Thai public health system usually does the first 3 fine if one is in a tertiary level facility, which she is. The last one, which mainly occurs just before and then after discharge, is a weak link. Physical therapy services in Thailand tend to be not very proactive or aggressive. How much PT she is going to need, of course, remains to be seen.

I think at this stage there isn't anything for you to do but as time passes and it becomes clearer how much damage there is, and her discharge from the hospital draws near, there may be needs relating to the home environment (possibly: ramps if she has to use a wheelchair or walker; bars to help her navigate in the bathroom, shower chair etc etc- . too soon now to know exactly what as it will depend on her functional state at discharge.)

And she will likely need physical therapy after discharge. What will be available from the health care system may not be much and it might be worth scouting around to see if you can hire someone privately to come in, and also to be sure family members sit in on the sessions at the hospital so that they know what to do/what exercises she should do etc.

It is best to push the patient to do as much for herself as possible during the recovery phase and family members will need to resist the urge to try to do everything for her as this is counterproductive in the long term. The focus should be on helping her do things for herself even though it may be hard for her and take a lot of time and effort on her part. Getting Thais to understand that and adjust their approach accordingly may not be easy as it goes against a number of deeply ingrained cultural beliefs and values: the need to "take care" and show gratitude, as well as a certain amount of fatalism and emphasis on acceptance rather than trying to change things. (There is a time and place for each, of course...but during stroke rehabilitation a more aggressive, try-to-change attitude is better). Doing everything for the patient not only fails to exercise their limbs and support physical rehabilitation, it also conveys an expectation that improvement isn't possible or expected which can lead to depression and lack of trying.

At a certain point, typically 6 months or so after the stroke, future improvement becomes less likely and learning how best to live with whatever lasting disability there may be is an appropriate focus . Prior to that point, however, efforts should focus on working to reduce the disabilities with an optimistic "you can do it" attitude. Again, not always easy to get that in this culture.

I witnessed some of her physical and speech therapy at the hospital. They appear to be very professional and pushed her to do her therapy. They told me that therapy at the hospital was available after discharge. They also believed that therapy was available at the community hospital ten minutes from my MIL house. So we are hopeful that this may be coming together.

[BKKdreaming]

can she walk with a walker yet? if so how far ? is her hemi/stroke hand have a grip?

We also got a rubber squeeze ball to get the fingers stronger

if she is real weak some foam rubber might be a good place to start......

and maybe count as she uses each finger , make a little game out of it and change the order of fingers she uses....

Edited September 10, 2015 by BKKdreaming

[Mike45]

can she walk with a walker yet? if so how far ? is her hemi/stroke hand have a grip?

There is no movement in her left arm or leg.

No grip.

[chubby]

if it is that severe, that a swallow ?barium xray test, may be in order , and you probably want to do "positioning" like this : if her shoulder is sublux'd > 2 finger width get a sling, otherwise don't in general, try to get her to attend to the involved side my seting up the TV on that side , get a decent w/c cushion, reposition her every 2 hours in supine, and 30 minutes while up to prevent pressure ulcers /"bed sores"

if she coughs on water "thin liquids" thicken her fluids till a ST tell you not to, or they do the swallow test, assuming they do those there .......

http://img.docstoccdn.com/thumb/orig/38612092.png

these is a generic big document, both maybe something to review, as 1 stroke often means another one is more likely .......

https://www.stroke.org/sites/default/files/resources/NSA-Hope-Guide.pdf