Wednesday 4-3 PT Pictures

---------- Forwarded message ----------
From: GRANDPA
Date: April 3, 2013, 8:33:51 PM EDT
Subject: 5 photos therapy mom 4/3/13

Again Mom had kind of a slow start. When I arrived mom was sitting in her chair with that Omnivision machine attached to her right leg. She said they had awakened her from her sleep too early for some kind of a test. Actually I heard later from the personnel that they knew nothing of a test but the speech therapist had been there early, and the speech therapist told me mom had done "marvellous", eating 80% of her oatmeal. Pt's had installed mom in the chair and connected the machine.

Anyway after that machine was disconnected, mom sat in the chair quite listless & unresponsive, but interested in getting back in bed. So I got some nurses to do that. So she rested quietly in bed while I tried to liven her up with some music. Then the two physical therapists returned and were surprised to find mom in bed. They seemed annoyed at that and said things like sitting in the chair for periods of time was all part of the therapy. It seemed allmost reluctantly that they moved Mom back to the chair.

They then rolled mom to the therapy area where they supported mom practicing sitting on a kind of platform like a large bed and also brought in a mirror so she could see herself, and she also practiced grabbing objects like cones and passing those on to the pt. When this was over, they rolled her back to the room.

After sitting there for a while, I convinced mom she might like to be wheeled around various accessible areas, and that's what we did and she enjoyed, even meeting another patient from our community,who was also in a wheel chair.

Yesterday mom had done some of the moving of her chair herself but today she did not feel like doing that. Even so, she enjoyed this roaming around the place very much, but finally she said she wanted to be again put back in bed. So we found two nurses who did that, and soon after, about 12:30 we left and mom agreed to to take a nap.

This pretty well completed mom's activities for the day.

Lizzy & I then went home for lunch & did some chores till we returned to mom sometime after 4:00.

The remainder of our stay was spent chit chatting with her about the events of the day, etc etc, until it was time that we were going home for dinner. Mom seemed very content with the way the day had gone.

Back in her room after PT

Talking to Lizzy

Wednesday Update from Annapolis

Good morning, family:  Here are a few stories from Wenesday and Grandma's progress.

 

HIGHLIGHTS from Wednesday, April 3:

-Speech Therapist made a very early morning visit to Grandma

-Grandma worked with Occupational/Physical Therapists to build control of her "core" and manage her balance

-She visited the hallways in a wheelchair with Grandpa

-Lizzie gave Grandma a foot and leg massage, which she liked

 

Details:

Yesterday, Grandma reports that she was woken very early - as Grandpa wrote in his email - for a "test." We think Grandma may mean the Speech Therapist (Kristen), who came at 7:45 AM ("the middle of the night" according to Grandma) to officially begin her on a puree diet. Like Grandpa reported last night, Grandma did great! She ate 80% of her oatmeal and showed wonderful progress. Grandma needs to strengthen the muscles in her throat to swallow faster. This will allow her to progress in her diet and eat more of her favorite foods.

 

NOTE: To answer your questions, I asked the Head Nurse (Anina) why the sign about "NPO" was posted in her room yesterday. Grandma is beginning this puree diet, but only the Speech Therapist can bring her food for now. She still has some nutrition given to her by IV/tube. Once Grandma is set to eat on her own (right now the Speech Therapist stays with her while she eats), the nurses will bring food instead of only the ST. My understanding is that the NPO sign was simply a warning to the nurses.

 

Grandpa wrote a good summary of the therapy sessions that followed yesterday morning. These include putting the same brain pathway stimulator machine on her right leg/foot as well as getting used to the wheelchair. The nurses took her weight on a fancy scale in the "Bath Room" across from the dining hall. When I arrived to the Rehab Center, Grandma, Grandpa, and two Occupational Therapists (Jess and Annabelle) were working with Grandma in the large therapy room. She was sitting on the edge of a large, padded bed-like bench and looking into a mirror. Jess and Annabelle supported her back and shoulders, but the exercises that followed were truly to help build Grandma's "core" - including her abdomen muscles - and get a feel for her balance while sitting.

 

Jess sat on Grandma's right. She handed Grandma a series of colored plastic cones and asked Grandma to lean and reach with her left hand, grab the cone, then place that cone on her left side - gradually stacking these items. The exercise required a balance of many things simultaneously: Grandma worked on keeping her head up instead of letting it drop down to her chest. She worked on shifting her weight from the right, center, and left while using her core muscles to "ground" herself. She also attempted to maintain a good posture and test out her hand-eye coordination. The mirror helped with all of these movements, and the PT/OT's encouraged her to check herself in the mirror.

 

Grandma seemed a little bewildered and amazed during this activity, and noted it was very difficult. We explained that some of the difficulty was from resting in bed for 1 month. "The muscles in your stomach are sleepy," we said. The PT/OT's also noted that strokes can affect your balance and part of the recovery is working to restore strength in all of the muscles that help you stay balanced. Jess told Grandma that before she can walk, she must first build up strength to sit up tall by herself.

 

After the session, Grandma returned to her chair and her room. Instead of climbing back into bed, we encouraged her to stay in her chair, which she said she liked. The three of us had some good chats together, and Grandma seemed in pretty good spirits. She asked about how everyone was doing - dad, Jerome, my work, etc. and remembered that I was getting married "at the end of the year." Grandma joked, "you and Jerome can try to compete with 65 years." I thought it was very impressive that after all the activity of the morning, she was able to pull those details out. Go Grandma!

 

While on the topic of Grandma's memory, she remembered many other things. She recited her address correctly as well as little phrases in German and Dutch. "Although it seems much of me has been 'shaken up,' somehow the languages remain!" she exclaimed. Given how much joy Grandma gains from knowing and studying languages, this is certainly a blessing. Grandma still says she struggles with short-term memory - particularly with recalling the day's events, especially if they are early in the morning. "I fade in and out," she notes.

 

Next, Grandpa suggested that Grandma take a ride in the hallways in her chair. She agreed, and Grandpa pushed her the length of the entire 1st floor wing of Heritage Harbous Rehab Center. Grandma remarked on the beautiful pictures on the walls, and enjoyed peeking out the windows at the end of each corridor. Still an extrovert and social butterfly, she waved to the nurses and several other patients. Throughout this experience, Grandma did a great job keeping her pretty head up.

 

After visiting in the hallways, Grandma returned to her bed. We returned home for some lunch and when we visited again at the Rehab Center, Grandma said she had tried for a long time to grab her blanket, but that she was having difficulty propping herself up enough to reach for certain items. It seems that helping her to regain strength in her arms and core/abdomen will alleviate some of the frustration she feels. To help her relax, I gave her a foot and leg massage, which really cheered her up.

 

Grandpa and I begin to wonder if a stroke can cause changes in one's eyesight. Grandma looked at some comics in the newspaper toward the end of the day, but she observed that things were blurry. Grandpa read some outloud to her. However, Grandpa said that she usually looks at the paper with a magnifying glass. She still has doubts that the glasses she has are the most recent pair.

 

Some nurses came in to check on Grandma's glucose levels. Her sugar levels are great, and in normal/healthy ranges. I also noticed that Grandma didn't experience a big drop in blood pressure or become unresponsive after all the therapy - but was able to keep herself in good spirits during the majority of the day. The nurses encourage Grandma to push herself to "fight" the drowsiness she feels, saying that she needs to stay awake as long as possible. We will continue to encourage her, because she is making progress everyday.

 

*****

Love to you all!

Tuesday 4-1 PT Photos

---------- Forwarded message ----------
From: Elizabeth
Date: Tue, Apr 2, 2013 at 3:07 PM
Subject: Amazing!!

Grandma did many reps of lifting 1/2 pound on her right arm. Amazing!! The therapist is really sweet

Sent from my iPhone

Tuesday (Apr. 2) Update from Annapolis

Greetings, family!

Here's an update on today's visits with Grandma. Grandpa has been sending additional details throughout the day; please feel free to ask any questions you have! AS AN UPDATE, the "Care Conference" we planned to attend today actually took place yesterday (the visit from April, from social services). The big, official "Care Conference" is scheduled for this Friday, April 5. This meeting will include Grandma's therapists, nurses, etc. who will provide input on Grandma's recovery.
-Elizabeth

***

HIGHLIGHTS from Tuesday, April 2:

• Grandma began the day with some drowsiness, yet worked with the Occupational Therapists to stand using parallel bars as support
• She received a visit from Andrea Lev, an administrator at Heritage Harbour Rehab Center, who gave her some encouragement
• Grandma saw the Physical Therapist/Occupational Therapist and lifted some 1/2-pound and 1-pound weights on both arms!
• Dr. Chopra (spelling?) visited Grandma with the Head Nurse (Anina)
• The "Care Conference" is scheduled for Friday, April 5 -- we misunderstood the date
• Grandma requested we bring magazines and picture books for her to look at

Details:

Today was another day filled with challenges and great recovery milestones. We learned that the Speech Therapist visited early in the morning to begin Grandma on her pureed diet (ie., moving away from the liquid nutrition from a tube). However, Grandma was a little drowsy this morning, or "dopey" as she describes. For this reason, the ST delayed the start of her puree diet. Perhaps related or unrelated, there is a sign above Grandma's bed today (posted April 2) that reads: "Pt. is NPO! No food or drinks please."

Like yesterday, Grandma went with the Physical/Occupational Therapists in a wheelchair again, this time learning to push the wheels along herself. She also gave a go at trying to move herself in the wheelchair using her feet. Once in the therapy room, Grandma was helped up to stand at these new parallel bars - a different set of equipment than yesterday's standing exercise. She did great, but I think she was feeling the effects of drowsiness still and may have appeared a bit bewildered. In either case, she showed big bravery, and Grandpa encouraged her!

After returning to her room and bed, we had a visit from Ms. Andrea Lev, one of the administrators (or perhaps "the" administrator) at Heritage Harbour Rehab Center. She was very nice, and took time to listen to Grandma as she described how she was feeling. She also was very intentional about sharing that Grandma was making big progress. Grandma shared more doubts that she would recover, but Andrea urged her to keep trying. "You have some wonderful support from your family, and the therapists here are great and can get you moving again," she told Grandma.

One observation that Grandpa and I made was that Grandma appears to be able to read just fine. She took a careful look at the cards from some of her friends that arrived this week, which perked her up.

Despite showing short-term memory challenges related to reporting her age, the year, etc., Grandma acknowledges these challenges and recognizes when she might be mistaken. Today, she was under the impression that she was 100 years old. She also has some difficulty remembering conversations from a previous day, or something she sees on TV earlier in the morning.

I notice that Grandma is very close to her normal self when she is feeling perky. She becomes very conversational, asks Grandpa and me questions, nods, points, raises her eyebrows - even cracks some jokes! She has been comfortable listening and speaking Dutch and German. She said "bonne nuit" and "a demain" (good night and see you tomorrow in French) to Grandpa and I when we left this evening. All very impressive!

When chatting about her recovery and healing process today, she told us: "It's difficult, but it's the way it is."  She also said, "I see things I used to do, and now I cannot do them." These include movements like standing on her own and eating her normal meals. She likes to hold Grandpa's hand when she feels discouraged.

We notice she fluctuates between feeling positive/accepting vs. discouraged about her condition.

Indeed, even the smallest interaction during the day can make the difference between these two outlooks. Today, Grandpa gently asked Grandma to repeat the following phrase: "Every day, in every way, I am getting better." With love in her eyes, Grandma sweetly repeated this sentence. When Grandpa described a visit to the Hearing Aid office later this month, Grandma said: "I'll come along with you!" I think a small and emerging part of her is beginning to see her progress.

Speaking of progress, Grandma "wowed" us all when a sweet Physical/Occupational Therapist (Trish) visited Grandma for some weight exercises in bed. First, she lifted a 1-pound pole above her head with her left arm. She did several repetitions. Perhaps the first shocking milestone was that while she was lifting this pole above her head, she lifted her right arm (the weak arm after the stroke) to her nose to itch it!! That was truly impressive to all in the room. Next, Trish strapped a 1/2-pound weight to her right arm and she began to lift that arm as high as she could with the weight on. She did so well! Last, with 2 strap-on weights on each arm, Grandma lifted both arms simultaneously. Trish showed Grandma some resistance exercises that we can help her with - placing our hands on Grandma's right (weaker post-stroke) arm and asking her to push against us - either out, up, backward, or inward. These will make all the difference in helping her regain strength.

Trish gave Grandma a special apparatus to squeeze to rebuild the muscles in her left hand. "Please squeeze it 40 times," Trish said. Grandma did it very quickly, and even showed off a bit by doing more than 40 squeezes! I helped her to count the repetitions. By the end of the session, the therapist was laughing and saying the Grandma was making huge progress. Apparently when Trish first saw Grandma 1 week ago, the most she could do with her right (weaker post-stroke) arm was shrug her shoulders. Go Grandma!

The last activity before leaving Grandma in the evening was a visit from Dr. Chopra (Grandma's doctor) and Anina, the Head Nurse at the Rehab Center. They seemed to be pleased with Grandma's progress, and both expressed a desire to see Grandma's catheter removed soon.

I asked Grandma's nurse for the evening, Fatima, about the white sticker on her left arm. I learned that this is a Clonidine patch for blood pressure which is changed once every week. Tomorrow this patch will be changed and a new one will be placed on her arm.

Grandpa is now visiting (after dinner) with Grandma to bring her some clean t-shirts/laundry and some picture books and magazines to look at. Grandma said she was "bored" occasionally so we are looking forward to providing future entertainment for her! Social services also offers activities. We may look into those.

Monday 4-01 Pictures

Getting out of bed to go into the wheelchair 

Combing her hair

In a device to support her as she re-learns to stand.

Standing up!! Grandma was amazed that she could do that. How awesome it is to see her big smile!

Ate a little bit of everything with the therapist

Drinking from a cup

Start of April Brings New Healing - April 1

Hello, folks - as Christina mentioned, I (Lizzie) am staying with Grandpa for the week and am your humble correspondent from Annapolis, MD. Below are details from yesterday, Monday, April 1st.

HIGHLIGHTS

• Grandma shared that she feels very sad sometimes
• Grandma saw a Physical Therapist, Occupational Therapist, and Speech Therapist
• With help, she sat herself up in bed and shifted into the wheelchair
• In the Occupational Therapy room, Grandma stood up for almost 10 minutes total!
• After a visit with the Speech Therapist, Grandma ate independently
• The Speech Therapist would like to start Grandma on a pureed diet TODAY (Tuesday, April 2)
• Grandma spoke with a representative from social services
• Grandma shared that she is not too impressed with the rehab center nurses

Details:

Yesterday morning, as shared by Grandpa in his emails, we noticed that Grandma was feeling a little down yesterday morning and again in the afternoon. Some of the things Grandma said are that she has trouble believing that she will gain strength in her right leg and right arm; that she sometimes feels that completing this therapy "has no purpose."

"At this age, I need to accept that it is just the way it is," she told us. She also said that many ladies at Heritage Harbour neighborhood do not drive or even walk; she seems accepting that this will now be her lifestyle - however, Grandpa and I gently encouraged her that this is not certain and that she is making miraculous progress! Grandpa is a great encourager.

To ensure that she was perked up for the anticipated therapy visits, Grandpa played some wonderful music, which made Grandma smile. She even sang along softly but also dozed a bit in bed, resting. Grandma knew it was Easter Monday and I asked her what she did on Easter Monday when she was my age. This question seemed to spark some enthusiasm and she explained and remembered happily.

Grandpa tells me that in the morning, the Physical Therapist installed a special machine on Grandma's leg that senses pathways to the brain. Our understanding is that this machine is supposed to stimulate these pathways and muscles to help Grandma move it more easily, and regain mobility in that leg. Grandma did not like this machine very much, and said it was painful.

A few hours later, 2 occupational therapists came and helped Grandma up in bed. They encouraged her to straighten her shoulders and back and lift up her pretty head. Grandma seemed a little doubtful that she could get out of bed and into the chair, but she did it with help. I saw her support herself with her right arm and her left leg helped her to swing into the chair. Grandpa and I cheered her on!

She seemed pretty happy in the chair, and we continued to encourage her to keep her head up. In the occupational therapy room, she saw many other people at different stages of recovery rebuilding their strength. Grandpa and I both think this was a good thing for her to see.

These therapists rolled her to the far side of the room in the chair to an apparatus used to help her stand. They extended a strap on her bottom and across her hips and with help and encouragement, she stood. These therapists took her blood pressure while she was standing up and it was in good shape (I think it was something like 138/80). They had her stand with her arms supporting her for 5 minutes, then sat her down in the chair. Then they repeated this process. Grandma did great - she began apprehensively, and repeated "I just cannot believe it," a few times. Returning to the chair, she seemed perked up. We helped to push her back in the room.

Grandma shared many times yesterday that she notices that her brain and body are almost severed - Her brain knows what it wants her body to do, yet her body isn't listening and doesn't have strength. I shared my experiences with my foot surgery and how atrophied and weak my foot and leg were after 1 month of not getting out of bed. She seemed surprised and encouraged by this.

Grandma and I talked while she remained in the chair in her room for a few minutes. Grandpa got a drink. During this time, Grandma shared a lot of her fears and said that she didn't feel positive that she would regain her strength, repeating "this has no purpose." I told her that we all loved her so much and that it was normal to feel scared - but that we would be with her every single step of the way. Grandma said she's almost glad to have had this stroke at 90 years old, because to have had one earlier would have been more difficult to adjust to a new lifestyle, and that she would have had to forgo a lot of activities much earlier.

I held her hand and brushed her hair, and then she became exhausted and had some trouble holding her head up. I called some nurses to help her back into bed before Speech Therapy.

The Speech Therapist brought a big tray of food - pureed chicken pot pie, water, juice, and milk with a honey-like consistency, mashed potatoes, and pureed peaches. She fed Grandma 1 or 2 times and then Grandma began eating independently. The therapist put 2 fingers against her throat to be sure the muscles were working to help her swallow. The reason why Grandma cannot drink more watery things is that those liquids move more quickly in the mouth, and particularly to the back of the mouth. This increases the risk that it will go down her airway.

The therapist noted that Grandma continues to build the muscle in the back of her throat that helps her to swallow quickly. "It takes me 3 swallows to get a bite of food down," she said. Grandma did really great, and she seemed proud of herself at the end. We were so impressed. The ST would like to start Grandma on a pureed diet TODAY, working her up to a soft diet perhaps by next week!

Grandpa and I left for lunch shortly after while Grandma began to doze off.  In the afternoon when we visited again, Grandma seemed a sad. She shared that the nurses are not too responsive, and that this is particularly true overnight. We encouraged her to press the red button at night to call the nurses that way. Grandma did not seem too hopeful that this would solve the problem, and said she had tried this before. She also said that the television has no stations that she can relate to (I believe many of the stations are from Baltimore instead of Washington DC or Annapolis), and this is frustrating.

I ran out to the nurses station and asked who was on duty now, and who would be on duty overnight. Apparently 5 nurses are on duty in the daytime. Their names are listed on the white board near the nurses station. Their shift ends in the evening around 11:00 pm. I asked how patients can contact the nurses, and if the nurses routinely check in on them. The head nurse affirmed this, and said they make regular rounds. When Grandpa and I shared this with Grandma, she seemed doubtful. She shared that she was not too impressed with the rehab center. Grandpa responded that this was good motivation to get better and get home as soon as possible!

We left Grandma around 6:00 pm as she settled in for a nap. We agreed that the day had been filled with both accomplishments and challenges, and that it was very important to help Grandma stay positive.

In the evening, I think both Grandpa and I were feeling a little worn out and deep in thought. Jerome made a special surprise visit around dinnertime and we enjoyed a good meal together at home. I think this cheered us up!

Easter 3-30 Pictures

My mom made Grandma another "sweater" out of a sweatshirt. She loved it!

Grandma immediately rolled up the ends of both sleeves, by herself! :)

We were short on chairs so Grandpa sat in Grandma's wheelchair. He thought it was kind of nice to wheel around... :)

Listening to YouTube videos of Heino and André Rieu...

In the later afternoon Grandma was complaining about being restless, so we got Grandma sitting up for a little while and had her work on holding her head up and stretching her arms.  She did great despite being pretty tired and it was fun to do a little "family rehab" together. :)

A Happy Easter!

I went out to Annapolis with my mom and sister today; Joyce and Andrei joined us soon after. 

First impressions: I had not seen Grandma in two weeks and I was IMPRESSED.

• Grandma was supporting her head, turning her neck and speaking much better (helped that she had her teeth in)
• She was much more alert and was alert for a longer period of time than last I saw her.
• Grandma followed and joined in conversations much more like her "normal."
• She seemed to have much better control of her arms and legs, but she did complain that it was difficult on the right side, comparing it to when your arm is very asleep; you can move it, but you don't have as much control or feeling.
• She cannot yet sit up on her own, but she is able to push her torso up from the bed a little if someone is trying to help with a pillow or the bed. And she can hold herself up in a seated position (with some assistance, once you've turned her on the side of the bed and helped her up). Two weeks ago, she was not doing this; now they're talking about having her try (supported) standing!

Some challenges I still noticed:

• While Grandma was much more alert on Sunday, she did tucker out after a couple hours of lots of stimulation throughout (6 guests in the room, YouTube music videos, "dancing," conversations, etc.) When she was tired, she was a little more "mumbley" like she was when I saw her two weeks ago, but she was a bit more "with it" until she started to fall asleep. So even her "good days" seem to be improving gradually. :)
• Grandma acknowledges that she seems to have memory and alertness issues.  
• She says she only remembers "episodes" of the last month and I'm not sure how far back she can remember since the stroke. I don't think she remembers the stroke at all; sometimes she can't remember why she's in the rehab place. I'm pretty sure she can't remember much if any of her time in the hospital.
• Grandma realizes that she seems to go in and out with her alertness. She says that she doesn't always know it is happening, though, but she is quite aware of the fact that she is sometimes "off the map" as she says.
• While she has very good memory of things from her past, childhood, even before the stroke, she has some confusion from time to time about details of the present - the year, her age, etc. When you tell her the correct information she'll hesitate with it, even after you've walked through the math (2013 - 1923 = 90 years old).
• She has some trouble reading smaller print that she didn't have issues with before.  She may need a new prescription, but it could also be a little neurological. 
• Grandma wasn't sure why the nurse came in to check her blood sugar at some point and didn't realize she was being tube fed ("I haven't been eating anything in days, I don't know why they do that").  Upon explaining that to her, she understood the whole thing, but I'm not sure how much of it she would remember a day or even a few hours later.

Grandma's mood:

• Grandma says she's kind of lonely in the rehab place.  I'm sure this is a combination of not remembering family visits (as I've discussed before, she doesn't always remember when people visit, even later the same day) and not having really anyone to talk to when family leaves; she can't exactly call in a nurse to chitchat with her when she's bored, and you know Grandma likes to talk, so this is surely difficult.
• She says the rehab place is ok, but that she "might have only another year to live and it's kind of a sad way to live it out."  When we tell her that she's making great progress and eventually will be able to go home, she seems encouraged by this, but she doesn't always remember on her own that is the goal, thinking that this is it, this is all she'll get better.  Thus the importance of constantly reminding Grandma how she is doing.
• Grandma says she misses outside.  Again, we just tried to focus on the positive and remind her that once she is capable of sitting in a wheelchair for awhile on her own and supporting herself, perhaps she can be taken outside in the wheelchair, and she seemed to like that idea.

So all in all, a great Easter Sunday.  I was really glad to see Grandma having a "good day."

Elizabeth is staying with Grandpa this week and will probably be reporting on the blog a bit while she's there.  There is also a "Care Conference" with the doctor on Tuesday that Elizabeth should attend so it will be interesting to see what comes out of that.

Saturday 3-30 and Pictures

• Grandma was kind of sleepy on Saturday.
• Shelley and Sally visited for a couple hours in the afternoon which Grandma enjoyed, but Grandpa reports that she kind of dozed off several times during their visit.
• The Easter Bunny came to visit! (See photos below.) Sally also brought Grandma a really cute stuffed animal bunny.
• Physical Therapy came in the late afternoon, around 5 PM.  This was a really nice guy named Jonathan; Grandma seemed to really like him and enjoyed talking with and working with him. He had her turn her weight from right to left, and even helped her sit up for awhile. Grandpa thought she did really well even though it wore her out.
• Grandpa discussed the boot on Grandma's foot with Jonathan.  He said it was the best solution, but did not elaborate on what else could be done. Maybe the weekday therapists will have some information on this.  
• Since Grandma was tired from her therapy, Grandpa left around 6, and a nurse got Grandma ready for bed.

Great Website on Stroke Recovery

My mom/Rosemary shared this website on stroke recovery, especially the section about left brain injury patients (that exhibit the right-side weakness that Grandma has).

"Emotional and Behavioural Changes After Stroke"
by Stroke Recovery Burlington, a stroke support organization in Canada.

I found some of it to be so spot-on that I think it's worth quoting directly here:


______________

Following a stroke, the patient's anxiety, fear, and frustration are enormous. Many stroke survivors initially suffer confusion that makes it impossible to do the simplest mental tasks. They often feel helpless and dependent, and their sense of self-worth is diminished. It is important to understand the survivor's limitations and allow an appropriate time for recovery. Self-worth, confidence and enjoyment of life will gradually return.


Encouragement is an extremely important motivating factor for stroke survivors. Caregivers should avoid being critical. While inappropriate behaviour should be pointed out, nagging tends to upset and anger stroke survivors, and discourages rather than encourages effort.


Determination is essential in overcoming the effects of a stroke. Patients must be willing to adapt to the disability and be convinced that by therapy they will improve. It has to be stressed that the will to recover does pay off. Nothing helps raise the body and spirit of the survivor of a recent stroke like seeing how their own hard work helps their recovery.


On a survivors return home, the following guidelines will encourage a positive recovery.
- Set attainable goals ­ the road to recovery is built of simple achievements.
- Involve the survivor in daily activities and routines.
- Encourage independent activities, while recognizing the survivor's limitations.
- Try to maintain social contacts within the family and community.

______________

Left Brain Injury (right-sided weakness (hemiplegia) )
Those with left brain injury and a paralyzed right side are more likely to have problems with speech and language. Apart from language problems, these individuals tend to be cautious, hesitant, anxious and disorganized when faced with an unfamiliar problem. Many of those with right hemiplegia need frequent assurance that they are doing okay, with lots of immediate positive feedback. Breaking tasks down into steps and practicing often will aid learning.
______________

Depression
Depression resulting from a stroke is one of the most difficult factors for a spouse and family to deal with. A certain amount of crying, though upsetting to the family, may be a natural and normal emotional response to the stroke survivor's greatly changed circumstances. However, chemical changes caused by stroke may result in deeper depression and apathy, with the survivor appearing passive and detached, a state that will usually improve with time.

______________

Memory Deficits
Almost any brain injury, however slight, may cause memory problems, contributing to language, spatial-perceptual and retention span difficulties. For most stroke survivors, remembering old information (from before the stroke) remains easy, while new learning is difficult.

______________

Generalization
Some stroke survivors are capable of learning new information, but are unable to apply that learning to other similar situations (generalization). For instance, they may make safe transfers to and from a wheelchair while in the hospital, but are unable to once at home. They may become very sensitive to and often fearful of changes in their environment, and will thus benefit from, and be comforted by, an effectively established routine.

______________

Sensory deprivation and over-stimulation
Many recent stroke survivors are overwhelmed by too much stimulation. When visiting, go singly or in small, quiet groups, and speak one at a time.
Conversely, some stroke survivors may have diminished sensations of touch, pressure, sight or pain, causing them to suffer a constant level of sensory deprivation, leading to psychological stress. The quiet of night may compound this-a radio playing softly or a soft light left on may help.