By Nancy Meadows

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Life for the Jack Meadows family changed forever in December 1989 when this husband and father suffered a stroke. The massive incident in his brain left him with no use of his right side. Months of rehabilitation restored strength and balance but could not return him independence in daily routines of self-care. He has a strong left arm and weak left leg to provide limited mobility. In addition, frustrating his life even greater is the lack of communication. He definitely has cognitive processes as is evident when following conversations and watching television quiz shows. But, thoughts have difficulty connecting to words and words in the brain do not translate to speech. 

His family has chosen over the past twelve years to assist him at home. While visiting nurses and aides have contributed valuable services over the years, the major day-to day attention to his needs has been and continues to be given by his wife. A son, daughter and a few good friends frequently assist. We have learned tremendous lessons about the skills our stroke patient has retained or developed. We have also acquired extensive knowledge and mastered many competencies in our twenty-four hour a day, seven days a week responsibility. As others make decisions about the care of their family member who has incurred a physical or communication limitation, they could benefit from our experience. When arranging care for a family member guardians may inquire and observe to ascertain if the kind of care we are giving in the home will be given in the long-term care facility or hospital. 

Over the years Mr. Meadows has required services in several hospitals and many doctors’ offices. Most doctors and nurses do not know readily how to meet his needs. We can only surmise that they learned about stroke patients and other handicapped individuals in their schooling and on-the-job training but have not had the amount of direct experience as when a family provides care at home. Our intention is to share the wisdom we have attained and to contribute to the quality of care accorded to all persons with physical restrictions.  

COMMUNICATION

First, be sure you have the full attention of your patient. While eye contact is important the individual who has had a stroke may look you square in the eyes but not have focus on the conversation. Position yourself in front of your patient and tune out all other sights and sounds in the room. Turn down the volume of the television, radio and block the talk of any other people in the area. Make contact by touching the hand, chin or cheek, an area not affected by the stroke. Sometimes our family member is helped by directing him to look at the speaker. Saying, “look at my face,” does not offend him and gains his concentration. Use a normal volume and speak clearly.

Express one idea at a time in simple terms and repeat if needed to assure yourself that the two of you understood each other. For example, “do you want coffee?” and then follow up with “coffee?” More complex thoughts can also be conveyed in this manner. Ask, “were you on Omaha Beach?”… “Omaha Beach?”… “you were there during World War II?”

Hand gestures can assist with clarification. Both the care giver and the stroke patient can benefit. Ask your client to point to what he wants or needs. He will develop a repertoire of pointing for such daily items as the television remote, newspaper, eyeglasses, radio, drapes, an uncomfortable foot or arm or headache. When going through complicated maneuvers such as using the mechanical lift to get in and out of bed the patient can work in coordination with the attendant. Instruct him to place his hand on the release lever of the lift and push in. Point to the lever or guide his hand to the lever. Demonstrate a pushing motion at the same time as saying, “push.”

At times when communication is not working, give it a rest. Take time out and try again later. Sometimes the family or friend has exhausted the twenty questions and both parties are becoming frustrated. Tell the patient, “we will think about it,” or “we can try again later.”