Stroke Recovery: Challenges and Care for Patients

Stroke

Hello, my mother suffered a second stroke at the beginning of 1998, which resulted in paralysis on her left side.
Initially, after the stroke, she was still able to walk and speak.
After being admitted to the hospital, the doctors provided treatment, but due to her agitation, she remained in the intensive care unit.
By the evening, she was able to feed herself, but the next morning, the hospital informed us that her condition was critical and she needed to be transferred to a larger hospital for further treatment.

By the time she arrived at the larger hospital, her left arm and leg, which she could initially lift, had lost significant strength.
Unfortunately, the larger hospital did not provide immediate intervention, and after several days, her left side became completely paralyzed, and she lost her ability to speak.
Now, she requires constant care from someone to assist her with all her daily activities.
During the course of seeking medical help, I asked many doctors why my mother could make sounds when she cried but could not speak.
However, the doctors did not have an answer.
I believe that if the doctors had provided the correct treatment immediately after her stroke, my mother would not be in her current condition.
I have a friend who also had a stroke, but because the doctors provided the right treatment, he is now only slightly slow in his movements and can manage his daily life independently.
My mother has been undergoing rehabilitation, but her condition has not improved.
I would like to ask how she should be treated in her current state so that she can care for herself.
Currently, my mother is very restless at night and makes noise, preventing those around her from resting.
Strangely, she does not seem to rest much during the day, yet at night she cannot sleep, which keeps us all awake.
When we help her move, her left leg often causes her severe pain, leading her to cry out.
Sometimes, her left leg also shows signs of swelling.
What could be causing this? Additionally, despite undergoing rehabilitation for her left hand, it continues to droop, and she experiences pain whether she is exercising or changing clothes.
Thank you for your response!

plchiang, 30~39 year old female. Ask Date: 2001/01/30

Dr. Huang Yingzhe reply Neurology

I'm sorry to hear about your mother's current condition.
Based on your description, this has been the case for two years now, and given that it followed a second stroke, it's likely that her physical strength may not improve significantly at this point (I must be honest!).
The left-sided paralysis and inability to speak suggest a higher possibility of a brainstem stroke (unless she is left-handed or falls into a rare exception, or it is a result of recurrent strokes).
The pain on the left side (possibly due to spasticity) and edema are common sequelae of stroke.
Sometimes, despite our best efforts, patients may not show improvement, which reflects the current limitations of medical technology.
I apologize for this.
The more helpful approach at this stage would be to address her suffering, including nighttime disturbances.
I recommend consulting with a neurologist for further assistance, and I hope this will be beneficial.

Reply Date: 2001/01/30

More Info

Stroke recovery is a complex and often challenging journey for both patients and their caregivers. Your mother's experience, marked by significant physical and communicative impairments following her second stroke, highlights the multifaceted nature of rehabilitation and the importance of timely medical intervention.

When a stroke occurs, particularly one that affects the left side of the brain, it can lead to right-sided paralysis and difficulties with speech, as the left hemisphere is primarily responsible for language and motor control on the right side of the body. The fact that your mother was initially able to walk and communicate suggests that she had some preserved function, but the subsequent decline in her abilities indicates a potential progression of her condition, possibly due to complications such as delayed treatment or secondary issues like spasticity or muscle atrophy.

The challenges you describe, including her inability to speak and the pain associated with movement, are common in stroke patients. The crying sounds she makes could be a form of emotional expression rather than verbal communication, which can be frustrating for both her and her caregivers. This phenomenon is often seen in patients with aphasia, a condition that affects the ability to communicate verbally despite preserved emotional expression.

Regarding her rehabilitation, it is crucial to have a structured and consistent therapy plan. While you mentioned that she is undergoing rehabilitation, it may be beneficial to reassess her therapy regimen. Engaging with a multidisciplinary team, including physical therapists, occupational therapists, and speech-language pathologists, can provide a comprehensive approach to her recovery. These professionals can tailor exercises to improve her mobility, strength, and communication skills, focusing on her specific needs and capabilities.

The pain and swelling in her left leg could be attributed to several factors, including muscle spasticity, poor circulation, or even the effects of prolonged immobility. It is essential to address these symptoms with her healthcare team, as they can recommend appropriate interventions, such as medications for spasticity, compression garments for swelling, or specific exercises to improve circulation and reduce discomfort.

As for her nighttime restlessness, this could be due to a variety of reasons, including discomfort, anxiety, or even side effects from medications. Establishing a calming bedtime routine and ensuring her sleeping environment is conducive to rest may help. Additionally, discussing her sleep patterns with her doctor could lead to adjustments in her treatment plan that promote better sleep.

In terms of her ability to care for herself, setting realistic goals is essential. While complete independence may not be achievable, focusing on small, incremental improvements can enhance her quality of life. Encouraging her to participate in activities of daily living, even in a limited capacity, can foster a sense of autonomy and accomplishment.

Lastly, it is vital to maintain open communication with her healthcare providers. If you feel that her current rehabilitation is not yielding the desired results, advocating for a reevaluation of her treatment plan is important. Each stroke recovery journey is unique, and adjustments may be necessary to optimize her rehabilitation outcomes.

In summary, stroke recovery is a long and often arduous process that requires patience, persistence, and a supportive care environment. By working closely with healthcare professionals and focusing on tailored rehabilitation strategies, there is potential for improvement in your mother's condition, even if the journey is challenging.

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