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The burden of stroke is on the rise in India and is now the fourth leading cause of death and the fifth leading cause of disability. Almost 40 per cent of stroke patients have a moderate disability, and 15-30 per cent have a severe disability when discharged from the hospital. A stroke happens when blood flow to any part of the brain is blocked. Each patient has a different recovery time and may need long-term care. Stroke patients may experience problems with moving, thinking, speech, and performing regular activities. Nearly half of the post-stroke patients are dependent on others for their day-to-day life activities. Some patients improve in the first few weeks or months after a stroke, while others take months or years to recover after a stroke.
Home care of stroke patients aims to improve the quality of patients' life and their inabilities to do their daily activities. The key to effective home care is person-centered care with a humanistic and holistic approach.
Stroke rehabilitation is a crucial aspect of caring for stroke survivors. Stroke rehabilitation includes speech therapy, physical therapy, and occupational therapy. Speech therapy is needed for those who have difficulty in speaking or understanding speech. Physical therapy helps the patient relearn movement and coordination skills through exercise, which may have been lost due to stroke. Occupational therapy emphasizes improving daily activities like eating, drinking, dressing, bathing, reading, and writing.
At home, specific changes in the setup may be needed to keep the patient safe from falls in the house and bathroom, avoid unnecessary wandering and make the home easier to use. For example, the bed and bathroom should be within easy reach. In addition, family counseling and support, visiting nurses, or aides help improve the patient's quality of life.
A stroke patient may experience muscle, joint, and nerve problems. Muscles on one side of the body may be weaker or may not move at all; different joints and muscles may become hard to move. In such cases, physical therapists, occupational therapists, and rehabilitation doctors may visit and help the patient relearn how to -
Another issue faced by stroke patients is a problem with bladder or bowel control. This may result in loss of bowel or bladder control, diarrhea or constipation, urge to urinate frequently, or difficulty in emptying the bladder. At home, the caregiver can work out a bladder or bowel schedule. A commode chair may be kept close to where the patient sits most of the day. The caregiver may also help prevent skin or pressure sores by cleaning up after incontinence, frequent change in position, and watching out for sores.
Problems with swallowing may arise due to lack of attention when eating or damage caused to the nerves that help in swallowing. As mentioned earlier, a speech therapist may help with swallowing and eating problems after a stroke. In addition, diet changes, such as thickening liquids or eating pureed foods, may be helpful. High-calorie foods or supplements containing vitamins or minerals can also prevent weight loss and keep the patient healthy. Once the stroke survivor is at home, a team effort is needed to help improve the patient's quality of life. The patient's physician, nurse (sometimes specialized stroke nurses may be required), family members, home caregivers, and special therapists have to work together to help patients perform everyday tasks, rehabilitation exercises, and assist in speech, swallowing, and eating.
(This article is authored by Dr Vishal Sehgal, President, Medical Services, Portea Medical)
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