Post-Stroke Care: Essential Tips for Recovery After 6 Months

Stroke, Care Recommendations for Patients After 6 Months

Dear Dr.
Tsai,
My father is 68 years old and suffered a hemorrhagic stroke in early May this year, resulting in hemiplegia.
After three months in a PAC (Post-Acute Care) unit, he was discharged in August.
During his treatment, he progressed from left-sided hemiplegia (affecting his arm, leg, and mouth) to being able to walk independently at discharge (though he cannot run).
His chewing and speech are normal (with occasional difficulty swallowing), and he can raise his arms but with weakness (his fingers and wrists can only move slightly).

Currently, he is being cared for at home, where he walks for 20 minutes twice a day and practices hand exercises (lifting his arms) 3-4 times daily.
He attends physical therapy at a rehabilitation clinic three times a week (which includes cycling) and receives acupuncture at a traditional Chinese medicine clinic twice a week.
However, during the rest of the time, he prefers to lie in bed and sleep.
His medications include half a tablet of Purcon in the morning and one tablet of Nifedipine SR 30 mg in the morning and evening.

Since his discharge, my father often feels that the medications make him feel weak and lethargic, leading him to refuse rehabilitation and acupuncture treatments.
It has been over two months since he returned home, and there has been little progress in his hemiplegic condition.
Recently, he has started to feel increasing stiffness in his legs and tends to avoid using the affected side due to weakness.
His mental state has also been declining (he has been seeing a psychiatrist and is regularly taking medication to help with relaxation).
Dr.
Tsai, I would like to ask the following:
1.
What recommendations do you have for his ongoing home care?
2.
Are there any other medication or medical suggestions?
3.
If his blood pressure remains stable, can the medications be discontinued?
Thank you!

Guang, 30~39 year old female. Ask Date: 2018/10/26

Dr. Cai Zongzhang reply Neurology

Hello, regarding your father's situation, for the medication aspect, it is recommended that you continue follow-up visits and discuss the physiological effects of the medication with the physician.
The physician will assess the possibility of any adjustments.
The decision to discontinue medication should also be made after evaluation by the physician.
Additionally, rehabilitation is essential and should be ongoing; you can continue to encourage and enhance his motivation for participation.
Thank you for your efforts, and keep up the good work.

Reply Date: 2018/10/26

More Info

Post-stroke recovery is a complex and often challenging journey, especially for patients who have experienced significant impairments. Your father's case, having suffered a hemorrhagic stroke and experiencing hemiparesis, requires a comprehensive approach to rehabilitation and care. Here are some essential tips and considerations for his ongoing recovery after six months post-stroke.

1. Continued Rehabilitation
While your father has made some progress, it is crucial to maintain a structured rehabilitation program. The fact that he is currently participating in physical therapy three times a week is a positive step. However, it may be beneficial to increase the frequency of his rehabilitation sessions if possible. Research shows that more intensive rehabilitation can lead to better outcomes, particularly in the first year after a stroke.
In addition to physical therapy, consider incorporating occupational therapy, which focuses on improving daily living skills and enhancing independence. Speech therapy may also be beneficial if there are any lingering issues with communication or swallowing.

2. Home Exercise Program
Encourage your father to engage in a daily home exercise program. This can include:
- Strengthening exercises for the affected arm and leg, focusing on range of motion and gradually increasing resistance.

- Balance training to help prevent falls, which is a common concern for stroke survivors.

- Functional activities that mimic daily tasks, such as reaching for objects, grasping, and walking.

Using simple household items as resistance or support can make these exercises more accessible.

3. Medication Management
Your father's current medication regimen, including Purcon and Nifedipine, should be regularly reviewed by his healthcare provider. If he feels that the medications are causing excessive fatigue or weakness, it is essential to discuss these side effects with his doctor. Adjustments may be necessary to find a balance that manages his blood pressure without compromising his energy levels.

Regarding the possibility of stopping medication if blood pressure is stable, this decision should always be made in consultation with a healthcare professional. Abruptly stopping blood pressure medications can lead to serious health risks, including stroke recurrence.

4. Mental Health Support
It is not uncommon for stroke survivors to experience depression or anxiety, especially when faced with physical limitations. Your father's increasing feelings of low mood and reluctance to engage in rehabilitation may indicate a need for additional mental health support. Regular consultations with a psychiatrist or psychologist can provide him with coping strategies and possibly adjust his medications for better mood management.

5. Encouragement and Motivation
Motivation can significantly impact recovery. Encourage your father by celebrating small achievements and progress, no matter how minor they may seem. Setting realistic goals can help him stay focused and motivated. Involve him in decision-making about his rehabilitation to foster a sense of control over his recovery.

6. Family Support and Education
Family involvement is crucial in the recovery process. Educate yourself and other family members about stroke recovery, so you can provide informed support. Encourage your father to participate in social activities, even if they are limited, to combat feelings of isolation.

7. Regular Follow-ups
Ensure that your father has regular follow-up appointments with his healthcare team, including neurologists, rehabilitation specialists, and primary care physicians. These appointments are vital for monitoring his progress, adjusting treatment plans, and addressing any new concerns.

Conclusion
In summary, your father's recovery journey requires a multifaceted approach that includes continued rehabilitation, medication management, mental health support, and family involvement. While progress may seem slow, persistence and a supportive environment can lead to significant improvements over time. Always consult with healthcare professionals before making any changes to his treatment plan, and encourage open communication about his feelings and concerns regarding his recovery.

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