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Emotional and Behavioral Changes After Stroke
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Emotional Factors in Recovery
Following a stroke,
my wife become anxiety, fear, and frustration at the first day she recover and
bring back home. Initially she suffer
of confusion that makes it impossible to do the simplest mental tasks. She
often feel helpless and dependent, and her sense of self-worth is diminished.
I as caregiver and all family members are important to understand the
survivor's limitations and allow an appropriate time for recovery.
Self-worth, confidence and enjoyment of life will gradually return. My wife
as first few month her healing progress very slow. I as caregiver and
responsible husband has to be very patient to look after her and need a
comprehensive care.
What I am try so much to give encouragement to her. It is an extremely
important motivating factor for stroke survivors. Caregivers should avoid
being critical. So what I am doing, try to accept that my wife been attacked
by stroke is plan by the Greater Creator Allah. The happening is planned by
Allah for the good of our self. Avoid any 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.
the hope for her recovery is merging by 6 month duration of home
rehabilitation. She start to gain confident to do herself with minimum movement,
I am practiced the following guidelines that encourage a
positive recovery.
1. Set attainable goals the road to
recovery is built of simple achievements.
What I am doing is
to put the hope that my wife will recover back to normal position if we pray
to the God, Allah The Mercy. My wife was coaching to perform pray and put the
hope to Allah that the recovery process is going to improve her disability
and handicap. I support and courage her to do the exercise even a simple
movement of finger, leg, tight and so forth. By doing this she will be more
confident to do the movement of her muscle and bit by bit the improvement and
change occur. This bring her confident to the future live. This is the most
effective inside booster to speed up her healing process. Alhamdulillah the
change is great and her achievement very tremendous.
2. Involve the survivor in daily activities
and routines.
The most important
thing try to gain back patient confident, the disability of right arm and leg
after stroke attack was limited her movement and make her difficulties to do
her daily living need (DLN). For the few week I am doing all her DLN but
after six moth she recovery slightly better, then she manage to do herself a
few activity such as drinking and eating. I am keeping coaching and giving
motivation to her that her healing for recovery are better and faster. Thus
giving her inner self confidence and to achieve better will and hope for her
to be independent. Alhamdulillah it seem the strategy was successful and able
her to heal faster.
3. Encourage independent activities, while
recognizing the survivor's limitations.
I give encourage to
my wife to be independent in doing her DLN. A few accident happen when she
drop her glass and the glass break. She was so frustrated and always said
that her now to be disable person that can do nothing, But I and my family
try to motivate her that she has to learn again to do herself with certain
limitation. The process what we called as the new born child has to learn new
thing every day to able her be an independent person as the child grow up, By
giving fully support and motivate her every day it seem batter improvement
for her to gain recover confident to be independent person, Allhamdulillah
after one year we did this process she has acquire more healing for arm and
leg movement and able to do small thing by herself. Now the time pass over 15 year, she manage to do a light job
at home such as washing cloths by washing machine, washing plate and
glass and other kitchen ware. She
manage to take bath by herself.
The Effects of Stroke
Different sides of the brain deal with different areas of
human intellectual functioning. Generally speaking, brain damage due to a
stroke causes the kinds of problems noted below. However, it is important to
note that brain injury in left-handed individuals results in effects that are
exactly the opposite of those explained below.
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.
This happen to
my wife, nearly one month after stroke
attack, my wife have problem with speech, she will take some time to say a words,
neglect to talk to people. Most of the day she like to be silent. She also
happen to be very slow memory and take some time to recognize something, even
myself whose take care of her every day she take a few minutes to recognize
at the time in the morning when I meet her. These situation slowly gone after
one month and she able to go back to normal after one year. The role of
caregiver at this point is very crucial. He must be patient and must put
intention try his best to help patient to recover their memory by
consistently communicate with stroke survivor. Beside that caregiver must
invoke to God to get His help for faster healing process of the stroke
survivor. Alhamdulillah by keep on doing this my wife able to regain back her
speech and memory after one and half year.
Right brain injury (left hemiplegia)
People often assume that if a stroke has not affected
language and speech, a stroke survivor is not impaired. This is not true!
Left hemiplegia may result in problems with spatial-perceptual tasks - the
ability to judge distance, size, position, rate of movement, form and how
parts relate to wholes. People with severe spatial-perceptual deficits may
have more trouble with self-care than those with equally severe language
deficits. They may not be able to read a paper - not because they can't read,
but because they lose their place on the page. They tend to have a behavioral
style that is too quick and impulsive, and behave in a way that makes
overestimating their abilities easy. They are often unaware of their
deficits, and may think themselves capable of tasks they are not-driving for
instance, which even with minor spatial-perceptual disabilities can be
dangerous.
One-side neglect
Many stroke survivors have visual field defects - up to
half their visual field (what they can see with both eyes) is, in simplest
terms, not there. This is usually compensated for by turning the head.
However, some individuals, usually those with left hemiplegia, have what
ranges from a reduced to no sense that their left side exists, or that
anything or anybody approaching from that side exists. This is called
neglect, and is potentially isolating for these individuals.
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.
This situation is
absolute true happen to my wife, she most likely to cry every times my
relative come to see her, some time she do not want to talk. What I am doing
to help her, by communicate to her regularly every day, keep on talking and
give her confident that the situation happen just for a few month, she must
have the strong will to try herself to regain back her ability to move, to
talk, to walk and so forth. By doing this she will put intention to be
dedicated keep on trying her best to do the activities that can recover back
her normal condition as before stroke attack. Allahmdulillah this strategy is
able to give a good healing for her after one year.
Emotional Liability
Often, excessive crying seems to have little relationship
to sadness or what is happening around the survivor. This loss of emotional
control due to brain injury is called emotional liability. Someone who is
emotionally labile may not be sad when crying, happy when laughing, or angry
when appearing hostile. If possible, interrupting the emotional behavior of
such a person (by clapping hands or snapping fingers) is usually a good idea,
saving them embarrassment and fatigue.
What I am doing to
recover back my wife from emotional problem, by giving special care to her, I
am caring her as like caring of newly born baby. For the first few months I
have to accord her at all the day in the room. Always beside her and
communicate to her. Sleeping together, day and night. Her emotional slowly
back to normal after one year duration of taking her personally by me.
By doing this
special care to her, I mange to avoid her from depress and think negatively,
by looking to her right arm and leg cannot move, her mind thinking of be a
disable person, worry her future will not able to perform as a good wife,
cannot look after her child and thousand of questioning.
To correct her negative thinking the spouse
must show his sincerity and honesty in taking care during this critical
situation. Caregiver must be patient, to deal with stroke survivor. Because
the healing process may take some time, if we are not patient and give up
half way, the survivor will dump with problem and stress. This will effect
the healing process and also be a resistant that can slow down the recovery
process.
Change in Personality
Changes in personality and emotional response are common
after a stroke. The type, size and location of a stroke, as well as the
individual's previous personality all have a bearing on what these changes
will be. The stroke survivor may seem a different person, showing feelings of
anger, caution or anxiety that are completely out of character. The affected
individual may also feel this-and feel less of a person.
This is the most
difficult and challenge situation to be face by caregiver. For the first few
month we cannot predict patient personality, keep on changing from month to
month. After some time the caregiver facing stress situation and if we cannot
coop up and manage our stress it to be depression. This happen to me for
the second year of caring my stroke
wife. In my case I had to support with Alprazolam (zanex) to release my
stress, but this medication only effective for some time only.
To resolve this
problem. I am doing the following action:
Thus the personal
review and practiced that has heal my depression and stress. When myself able
to regain confidence and back to normal, I able to concentrate to take care
to my disable wife. By put my intention to fulfill my obligation as a husband
that was ordinance by Islam. By this intention, Allah give me the confident,
patient and doing with sincerity. By setting my mind and applied the paradigm
shift, all the burden and hardship which I am facing in taking care my wife
for more 15 years was able to be a motivation factor for me to get Allah
reward in hereafter. Hoping of Paradise.
When my wife saw the
sincerity and dedication that been shown by her husband in taking care her,
from time to time her morality was improved, she can think positively and
able to accepts the handicap given by Allah is part of the process to uplift
the rank of His humble and to delete the sin which was done before, That the
promise of Allah to those who is patient with His test and challenge in this
universe. Amin.
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.
My wife happen to be
memory deficits for the first month is quite serious. I realize her will take
some time to recover back her memory at first she wake up from sleep. When
she open her eyes, she will took a few minute to realize myself in front of
her. After six months, she able to faster recovery her memory. The healing
time for my wife to be back to normal for his memory, the time taken nearly
one year.
As caregiver I
consistently give her support in term of moral and helping her to recall back
her memory by chit chat with her everyday. By doing this her able to speed up
to recover the memory. Thus activities is part of brain memory exercise.
Another method I am
using to heal my wife memory, by helping her to fluently recite Quran. By
coaching her from time to time, at early stage I used Pen Read Quran. That
able to read phrase by phrase of Quran. Then my wife follow the reciter to
polish her reading speed. After one year she able to read fluently.
By using this
technique she able to heal her memory back to normal. Currently her memory
back to normal. She can remember either information before the stroke and
also information after the stroke. Some time her memory is better then me.
Alhamdulillah, Thanks Allah who given back my wife memory.
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.
Quality Control
Even minor brain damage affects a memory related area of
behavior called quality control. This refers to how well individuals check
and control their own behavior. A previously fastidious person may fail to
bathe or zip his fly, or a formerly polite person may become rude and
profane. Caregivers need to be aware of these deficits, and praise
appropriate efforts to compensate for them.
Wallahualam
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