Trying to help a neighbor

[jakeruby]

Hi-
I'm a nurse and have been helping a neighbor (76 yr old male), post-stroke.  He is hemipalegic (left side weak..arm almost flacid, and leg with increasing strength.

He had his stroke in June 07, went to a nursing home for a few months, and then came home in October.  He had PT come twice per week for 15 min at a time, and they cut him off after 60 days.

The therapist had no stoke experience, and did more talking than giving therapy.

I'm convinced he needs some intensive rehab as I see his weak limbs getting stronger, even with little to no therapy.

I've called the nearest rehab center that specializes in brain trauma, and stroke and am hoping to help him get evaluated.

I'm just wondering if it's too late...did we miss the window of opportunity?  Just looking for some encouragement!

Thanks so much!

[caregiver222]

Well, there will always be improvement, as long as the essential cause of the stroke has been identified and the situation stabilized. Easier said than done. It is not financially possibile for anyone except the very wealthy to get appropriate rehabilitative care. The answer lies in the user of "extensors". Lay people, or reasonably paid aides who take the time and effort to continue the rehabilitation process. One of the things to do is to have weekly get togethers and set small goals to be achieved at the end of the week or month. The so-called evaluations" by professionals are pretty useless. It is simply not possible to perform an evaluation unless you are in intimate 24/7 contact with a stroke patient for several days. The one thing I have aobserved about stroke patients is that, depending on the time and date you evaluate them they can seem vegatative and near death, or be alert and interactive. They live in "cycles" of good days and bad days, and sometimes two or three bad days and two or three good days. There is a constant need for "posititive reinforcement" when something good happens. If the patient speaks they need to be immediaty hugged or given a treat. Immediately means immediately. Not ten seconds later while you get off the cell. Hang up the cell. That's how it goes moving west. 15 minutes of professional "therapy" is pretty meaningless. What the therapist should have done is spent that fifteen minutes explaining to an aide that kind of exercfises to do, instead of doing them himself (or herself). He could undoubtedly benefit from some DHEA hormone. I would suggest 10 mg to start and move it to 50 mg, 5 mg a day upwards. This is a growth hormone available without prescription. It will help defeat muscle atrophy. It also improves brain function. At this point the "window of opportunity" doesn't apply. The so-called "window" refers to reversing ischemic damage before it has a chance to take place. Progressive ischemic damage isn't the issue. My own opinion is that in the case of physical rehab, it's never too late. You have to keep good records in a small permanently bound book. I like the little grade school lined books with the marbelized colors. I buy them buy the dozen. You have to draw up an exercise chart and set goals. The limbs have to be flexed through a complete "range of motion", so that's a start as a write in goal. Every limb flexed four times a day. Then you can see if the patient can try this himself. With my little 103 year old I developed hand strength by permitting her to hold a cup, and increasing the amount of fluid in the cup. She went from barely being able to hold the cup to supporting a full cup with one hand.  Walking practice is helpful. When I take my little one out in a wheelchair to the park, I stop the wheelchair ten steps away and walk her to the bench. Then I walk her back to the chair. Every meal represents an opportunity for therapy. Insure there is some walking to the table and away from the table. Insure there is "reaching". Don't put everything exactly in front of the person. I set up a little Lionel four-wheeled Birney 0-27 trolley in an oval track. Manipulation of the transformer handle is a task and the feedback is watching the trolley speed around. I also got a little rocket-firing tank that is driven around the room, and although my little one never quite got the hang of it, she delighted in blasting off the rockets. You need robotic toys with two or three simple, easily manipulated controls that provide visual feedback. He should have some "parallel bars" to assist in walking. You can have these installed inexpensiveloy using a profuct known as "speedrail". This is better than pipe. There are flanges and "T" joints and you can bolt it to the floor. Walking goals are important. The little weights that go around the wrist with velcro are also helpful, although they proved too much for my little one.