Care Guides for Survivors

Regaining Independence After Stroke

Post on 06/07/16

After a stroke, it is important that the stroke patient returns to an optimal level of function. This is achieved by maximising the level of independence in all activities of daily living (ADL).

Activities of daily living include:

  • Self-care
  • Work
  • Driving a motor vehicle
  • Leisure
  • Sex

Self-Care

Self-care refers mainly to:

  • Bathing
  • Dressing
  • Grooming
  • Feeding
  • Toileting

To be able to carry out self-care tasks independently, the patient needs fairly good upper limb function and mobility skills. Assistive devices to help him become independent e.g. dressing stick, long-handled reacher, non-slip mat may be helpful; consult the occupational therapist.

Bathing and showering

  1. Place affected arm on lap; wash the body with the unaffected arm.
  2. Clean affected leg by crossing it over the unaffected leg.
  3. Use appropriate aids to help wash difficult-to-reach areas.
  4. Use the mobile shower commode chair or sit on the toilet seat if balance is reduced.

Dressing

Start on the affected side first. When undressing, begin on the unaffected side first.

Putting on a blouse or shirt:

  • Lean forward to place affected hand into shirt’s sleeve first
  • Pull sleeve up and bring around the back to the opposite shoulder
  • Now place unaffected arm into other sleeve
  • Adjust and button shirt

 Putting on trousers:

  • Dress the affected leg first by placing affected leg across the unaffected one
  • Uncross leg then dress the unaffected leg
  • Sit down to pull up trousers by shifting weight of bottom from one side to the other, if balance is reduced

Grooming:

  • Sit down if balance is reduced
  • Make sure that the necessary items are within easy reach

Feeding

  • Place the affected arm on the tabletop
  • If patient has decreased mental function, approach patient from the affected side to provide appropriate cues

Toileting

  • Sitting toilets are preferred
  • Adapted over-toilet seats may be installed over squatting toilets
  • Install grab rails for better balance
  • Make sure toilet paper is within easy reach
  • A bedside commode is recommended if it is difficult to go to the toilet

Work

Work includes domestic chores, child-minding and employment. Patients may be referred to the Bizlink Work Assessment Unit for an assessment and / or work retraining programme at an Occupational Therapist to explore return to suitable employment.

Driving a Motor Vehicle

Following a stroke, you may be advised to stop driving temporarily as required by the Medical Guideline for Fitness to Drive (1997) that was agreed between the Singapore Medical Association and Singapore Traffic Police. Fitness to return to driving has important medical and legal implications. You are advised to consult your neurologist / physician on your medical fitness to return to driving. You may be referred by your doctor for a specific Driving Assessment and Rehabilitation Programme at a specialist centre of an Occupational Therapy department clinic.

Leisure

Leisure includes activities that patients do for fun or as a hobby e.g. playing a musical instrument, outdoor games and picnicking. Adaptation or modifications may be needed to help the patients take up their favourite leisure activities again.

Sex

A stroke may cause physical and emotional changes where sexuality is concerned, depending on which part of the brain has been affected. Following a stroke, there is no medical reason for restricting or changing sexual activity. Men may have difficulty getting an erection or ejaculating. But there are medications to help men with erectile dysfunction to improve their sexual activity. Women may have reduced sensation in the vagina or less lubrication.

The physical disability itself may make sexual intercourse more difficult than before. This is the easiest problem to overcome. There are alternative positions and methods. For the affected person paralysed with stroke, it is much easier to make love if he or she lies on the weaker side, or lies on the back. This will leave the unaffected arm free. Once the couple finds that this is safe, they will devise their own solutions.

Alternative forms of intimacy, such as cuddling or hugging are encouraged.

It is normal for stroke patients to have periods of disinterest in sex and loss of desire. Doubts and fears can make you feel less than your best. At times, concern about your health may shut out interest in sex. Loss of interest or desire for sex may affect the stroke patient or the partner. There would be no problems if both no longer wish to continue to have sex.

Due to depression, the stroke patient may lose the desire for sex. A decrease in sex drive may also be caused by side effects of some medications. Some may lose their desire for sex because their partner has become physically unattractive. In a weak marriage, the stress of coping with the stroke patient may be used as a reason to stop sexual activity.

It is important to find out the reason for the loss of desire. Both partners should not be afraid to discuss the subject openly. The doctor may be able to refer the couple to someone who specialises in sexual difficulties.

In Summary

  • It is possible to regain partial or full independence in daily life after stroke following rehabilitation
  • Compensatory techniques, use of assistive devices may be required
  • Check with the occupational therapist before buying any new equipment
  • Re-engagement in meaningful lifestyle activities or adapting to a new lifestyle, within one’s capabilities is essential for promoting a sense of well being and quality of life
  • Consult with your physician or occupational therapist if unsure of optimal function within safety limits

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