Stroke Patients: When Can They Be Safely Left Unattended?

A stroke is a medical emergency that requires immediate treatment. The recovery process can be slow and uncertain, and it is important to start rehabilitation as soon as possible. The typical length of a hospital stay after a stroke is five to seven days, during which the stroke care team will evaluate the effects of the stroke and determine the rehabilitation plan. The long-term effects of a stroke vary from person to person and depend on the severity of the stroke and the area of the brain affected. These effects may include physical, cognitive, and emotional symptoms, as well as heavy fatigue and trouble sleeping.

So, when can a stroke patient be left alone? This depends on several factors, including the patient's mobility, ability to perform daily tasks, and whether they have a strong support system in place. It is important to consider the patient's safety and well-being when making this decision. While some patients may be able to manage their own care and live independently, others may require constant assistance and supervision. In some cases, it may be necessary to have a family member or caregiver stay with the patient or arrange for professional in-home care. Ultimately, the decision to leave a stroke patient alone should be made in consultation with the patient's medical team and should be based on their individual needs and condition.

The importance of rehabilitation and how it can be done at home or in a facility

The importance of rehabilitation after a stroke cannot be overstated. Rehabilitation should start as soon as possible, ideally within 24 hours of the stroke, and can significantly impact the patient's recovery journey. The goal of rehabilitation is to restore the patient's functioning as closely as possible to pre-stroke levels or develop compensation strategies to work around any functional impairments. For example, a patient might need to learn new ways to perform tasks such as holding a toothpaste tube differently so that their strong hand can unscrew the cap.

Rehabilitation can take place in various settings, depending on the patient's needs and preferences. It can be done in an inpatient rehabilitation unit or independent rehabilitation facility, where the patient can be monitored by a physician and can tolerate three hours of therapy per day. For those who require a slower pace, a subacute rehabilitation facility offers one to two hours of daily therapy. Rehabilitation can also be done at home, with visits to an outpatient rehabilitation clinic as needed, especially if the patient has a strong support system of family and friends.

The rehabilitation team typically includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work collaboratively to address the patient's physical, cognitive, and emotional needs. Physical and occupational therapy helps determine which areas of the brain have been affected and assists patients in regaining their ability to perform everyday tasks. Speech-language therapy is crucial for those with swallowing difficulties due to the stroke or the after-effects of a breathing tube.

Additionally, rehabilitation psychologists and neuropsychologists play a vital role in screening for cognitive and emotional challenges. They can create a plan to improve the patient's cognitive function and develop resilience in the face of potential permanent lifestyle changes.

The first three months after a stroke are considered the most crucial for recovery, with most patients making significant progress during this period. However, improvements are still possible after six months, albeit at a much slower pace. Therefore, it is essential to continue following up with the care team, including physicians, therapists, neurologists, and rehabilitation psychologists, to maximize the patient's recovery and adjust goals as needed.

In summary, rehabilitation is a vital component of stroke recovery, and it can be effectively carried out in a suitable facility or at home, depending on the patient's needs and support system. A multidisciplinary team of healthcare professionals works together to address the patient's physical, cognitive, and emotional needs, helping them regain independence and improve their quality of life.

The risk of a second stroke and how to reduce it

The risk of a second stroke is ever-present for stroke survivors. In fact, 1 in 4 stroke survivors will have another stroke, and having a stroke increases the likelihood of having another. Therefore, it is imperative to take steps to reduce the risk of recurrence.

Firstly, it is crucial to understand the factors that may have caused the initial stroke. This knowledge will empower you to make necessary changes to reduce the chances of a second stroke. Speak to your doctor about your risk factors and how to manage them effectively.

• Manage High Blood Pressure and Cholesterol: It is essential to keep high blood pressure and high cholesterol under control. Take prescribed medications as directed and do not discontinue them without medical advice.
• Control Diabetes: If you have diabetes, ensure you take your medication as prescribed. Maintaining stable blood sugar levels is crucial for stroke prevention.
• Healthy Diet: Adopt a healthy diet rich in fruits, vegetables, and whole grains, while reducing the consumption of processed foods. The Mediterranean diet, for example, is associated with a reduced rate of stroke.
• Quit Smoking: Smoking puts a dangerous strain on the blood vessels in your brain and increases the risk of stroke. Quitting smoking is a significant step towards reducing that risk.
• Get Active and Manage Weight: Increasing physical activity and maintaining a healthy weight can lower your chances of having another stroke.
• Healthy Sleep: Getting sufficient, good-quality sleep is essential for overall health and can help reduce the risk of a second stroke.

Additionally, it is important to continue with rehabilitation and therapy to improve your independence and adapt to the effects of the stroke. This can include physical, occupational, and speech therapy, depending on the specific effects of the stroke.

Remember, recovery from a stroke takes time, and it is crucial to be patient and determined. Keep in touch with your support network, including family and friends, as well as healthcare professionals, as they can provide valuable assistance and guidance during your recovery journey.

The emotional and behavioural changes that can occur

A stroke can cause a wide range of emotional and behavioural changes. The brain controls our behaviour and emotions, so it is no surprise that stroke survivors often experience feelings of irritability, forgetfulness, carelessness, inattention or confusion. They may also experience fear, frustration, anger, grief, sadness, anxiety and depression.

One of the most common emotional changes after a stroke is grief and loss. Stroke is a major life event that can lead to sudden changes at home, work and in relationships. Many people report a loss of confidence after a stroke.

Another common emotional change is anxiety. Around one in four people who have a stroke will experience anxiety within the first five years. Many worries are natural after a stroke, such as worrying about having another stroke, getting around on your own, money or family.

Frustration is also common after a stroke, as so many things change. This can lead to irritability or anger. Some people feel they get angry for no reason, or that they get angry about things that didn't bother them before.

Depression is also common, with around one in three stroke survivors experiencing some form of depression within the first year. Signs of depression include feeling sad or down most of the time, feeling worthless, helpless or guilty, feeling hopeless or desperate, losing interest in things you used to enjoy, lacking energy or motivation, and sleeping or eating too much or too little.

Emotionalism, or emotional lability, is also common after a stroke, affecting about one in five people in the early stages. This can involve crying or laughing more, or for no reason, or even swearing when you didn't before your stroke.

The good news is that many emotional and behavioural changes tend to improve over time.

The physical limitations and how to adapt the home

A stroke can cause a range of physical limitations, including problems with physical activities such as walking and using the hands and arms, and even swallowing. These limitations can vary from person to person, depending on the severity and location of the stroke in the brain. It is important to assess the patient's specific limitations and make necessary adaptations to their home environment.

• Mobility and Walking: If the patient has difficulty walking or requires a walker, ensure that the home is free of clutter and tripping hazards. Install handrails and grab bars in hallways and bathrooms to provide support and assist with balance. Consider widening doorways to accommodate a walker or wheelchair if necessary.
• Stair Climbing: Stairs can be challenging for stroke patients. Consider installing a stairlift or ramp to provide an alternative means of accessing different levels of the home. If this is not possible, ensure that handrails are securely attached and easy to grip.
• Transferring and Getting Up: For patients who have difficulty getting up from a seated or lying position, provide sturdy furniture with arms that can be used for support. Place chairs or benches in the shower or bathtub to assist with bathing. Adaptive equipment such as transfer belts or boards may also be useful.
• Daily Activities: Encourage independence by adapting the home to make daily activities easier. For example, lower shelves and storage areas to make it easier to reach items. Install lever-style door handles and faucets, which are easier to use than round knobs. Provide adaptive utensils and plates for eating, and place frequently used items at eye level to reduce the need for reaching.
• Communication: If the stroke has affected the patient's speech or language abilities, ensure that they have alternative means of communication. This could include writing boards, picture cards, or speech-generating devices. Keep a phone within easy reach in case of emergencies.
• Safety: Install motion-sensor lights to illuminate dark areas and reduce the risk of falls. Remove loose rugs or secure them with double-sided tape to prevent slipping. Consider installing a personal emergency response system that the patient can activate in case of a fall or other emergency.

It is important to work with the patient, their care team, and, if possible, an occupational therapist to identify specific limitations and make tailored recommendations for adapting the home environment. The goal is to promote independence, safety, and comfort for the stroke patient while living at home.

The role of the caregiver and how to look after themselves

The role of the caregiver is crucial in the recovery process of a stroke patient. Caregivers are responsible for meeting the patient's basic needs, such as feeding, bathing, and grooming. They also assist with mobility, help with rehabilitation exercises, and provide emotional support. Caregivers act as a bridge between the patient, medical professionals, and the patient's family, keeping everyone informed about the patient's condition and needs.

Caring for a stroke patient can be physically and emotionally demanding, and it is important for caregivers to prioritise their own well-being. Here are some strategies for caregivers to look after themselves:

• Seek support: Caregiving can be isolating, so it is important to stay connected with friends and family. Join support groups or seek counselling if needed.
• Practise self-care: Make time for your own physical and mental health. Eat well, exercise, and get enough rest. Practise stress management techniques like meditation or deep breathing.
• Educate yourself: Learn about stroke, its effects, and how to provide the best care. This will help you feel more confident and empowered in your caregiving role.
• Ask for help: Don't be afraid to ask for assistance from family, friends, or community resources. Caregiving is a team effort, and it's okay to delegate tasks or take breaks when needed.
• Set realistic goals: Work with the patient's healthcare team to set achievable goals for the patient's recovery. This will help you measure progress and adjust your caregiving strategies as needed.
• Take care of your own health: Don't neglect your own health needs. See your doctor regularly and address any concerns or issues promptly. Remember, your health is important too!

Frequently asked questions