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The Daily Impact of Stroke

Activities of Daily Living
Activities of Daily Living (ADLs) are the activities in which people engage on a daily basis including work, school, leisure and self-care activities. Self-care activities include: grooming, bathing, dressing, toileting, and performing toilet and shower transfers. Initially, it’s obvious a patient can’t work or go back to more complex activities, but he or she also may not be capable of basic self-care due to a combination of cognitive and physical factors. Patients may be totally dependent upon others to care for them. In less severe strokes, or as patients with more severe strokes begin to recover, they are often able to resume aspects of self-care starting with the simplest (such as assisting a therapist with wiping one’s face) and moving to the more complex (such as dressing one’s self with little or no assistance).

Performing activities of daily living and regaining your independence in these areas are a focus of our occupational therapy department.

Leisure Skills
Experiencing physical and cognitive changes often leads to a decrease in one's ability to participate in leisure activities in and outside of the home. Our therapeutic recreation specialists can help you find new ways to enjoy your favorite hobbies and activities.

A stroke patient’s psychological functioning and psychosocial situation may be severely disrupted by the stroke. The degree of disturbance is usually determined by the severity of the stroke and degree of cognitive deficits. Early in their recovery, patients often cannot understand what has happened to them and are highly confused. They may be very fearful or angry and have no control over their emotions, which leads to inappropriate behavior. To their families, they may seem to be a different person.  Because of their continued cognitive problems, explanations or even attempts to “counsel” them are ineffective. They do, however, sometimes respond well to family support. As patients recover, they may begin to be able to understand their situation and what’s happened to them. At this point they are at risk for depression or other adjustment difficulties and must be closely monitored.

Every family is different but for most, the idea of long-term recovery from a stroke can be overwhelming. However, the injured brain can often heal and the changes can be inspiring. Along with the hope brought by recovery is the balance of acceptance of more permanent changes. This sets the foundation for effective coping and can often be the most challenging aspect of rehabilitation for patients and families.

Patients are affected by stroke in many ways, beyond their cognitive and physical functioning. Family members and caregivers are also affected by the patient’s stroke. Patients and families may experience a range of emotions that will change from time to time. Some examples of these emotions include:

  • Disbelief
  • Anger
  • Guilt
  • Depression
  • Isolation
  • Panic
  • Hope

It is important to recognize that these emotions are normal, and an expected part of the process of trying to understand and cope with a patient’s stroke. A stroke affects not only the patient, but everyone else who knows and cares about that person. It is also important to recognize that the young children or grandchildren of patients can be very distressed and upset by the stroke. It can be a very confusing time for children, and their daily routine is often disrupted. We recommend that families try to “normalize” children’s routines. If possible, children of patients with stroke should return to their normal school and activity routine as soon as possible. If you are not sure how to explain the patient’s stroke to a child, or if you have questions about how to prepare the child to visit the patient for the first time, a consultation with one of WakeMed’s child life specialists can be arranged.

Similarly, spouses and other family members may want to consider trying to return to as normal of a routine as possible. You should try to get adequate rest and good nutrition, and not feel guilty that you are not at the hospital continuously, particularly after the patient transfers to the Rehab Hospital or Neuro Critical Care Unit. The patient will be busy during the day with therapies and other activities, and will need rest breaks between therapies.

One of the first questions families ask when told a family member has had a stroke is “how long will it take my family member to get better?” Unfortunately, we usually don’t know the exact answer to that question. One thing we do know is that recovery from a stroke is a gradual process that may continue for months and even years.

It is everyone’s goal to maximize the patient’s recovery and ability to live independently or with very little help. Some individuals will eventually reach the goal of being able to live independently, and return to activities such as work and driving; however, others may continue to need more help from family and friends. There is no promise how much or how quickly each person may recover. Each person recovers at his or her own pace.