Finally - Real Help for Caregivers

As an OT, I sat through discharge meetings where caregivers were silent.  Some may have been too stunned to ask questions.  Others may have thought problems would disappear because the stroke survivor would completely recover (1).  Reality may not set in until caregivers struggle to get a family member inside his or her home.  I learned how intense demands are on caregivers after I went home alone after a stroke.  After 17 years, I know how many caregiver tasks have to be done to keep a stroke survivor out of a long-term care facility. 

I was excited when I read about a caregiver questionaire that is given before a stroke survivor is discharged from rehab (2).  Staff can use the questionaire before the client goes home to ask caregivers what they were thinking as they answered each question.  This creates an opportunity to change what caregivers know and encourage them to ask for help before they get into trouble.  And a dialogue is so much better than handouts.   homeafterstroke.blogspot.com

1.  Lutz B et al. Improving stroke caregiver readiness for transition from inpatient rehabilitation
        to home. The Gerontologist. 2016; Vol 00:No.00,1-10. doi10.1093/geront/gnw135.                    2. Camicia M, Lutz B, Harvath T, Joseph, J.  Using the Preparedness Assessment for the                    Transition Home After Stroke Instrument to identify stroke caregiver concerns predischarge:            Uncertainty, anticipation, and cues to action.  Rehabil Nurs. 2021 Jan-Feb 46(1):33-42.

Snow Shoes for a Stroke Survivor

Since my stroke I am careful about venturing outside when it snows, but I am not trapped inside until spring.  Once streets are plowed and sidewalks shoveled, I wear boots over my shoes to give me better traction when icy slush is left behind.  Boots also help when my car is covered with snow.  Dragging snow off my car dumps snow on my boots instead of my shoes.  Boots I tried on at a shoe store would not fit over my leg brace.  My leg brace does not allow me to point my toes which is a pre-requisite for donning boots.  On-line I found the Neos overshoe with a Velvro opening that goes all the way down to my toes.  The Villager model is lightweight and designed for occasional use which is perfect for me.  I walk more slowly with boots on, but that beats not being able to get to the grocery store or keep important appointments, like a doctor appointment.

Notes-to-Self.  1) Make the ankle straps long BEFORE I take the boots off.  Long straps make it easier to unsnap and snap the plastic buckles. After snapping the buckle closed, pull the end of the strap to make it tight.  2) Begin by opening the boot ALL the way to the toe so I will not have to wrestle with the nylon fabric to get my toe in the boot. 

A video at www.overshoesonline.com shows how to don this boot.
Warning #1: I do not put the boots on while standing as the video shows because I do not have good standing balance.  My boots go on safely while I am sitting.  Warning #2: The first set of boots I ordered was too big so they flopped around when I walked.   homeafterstroke.blogspot.com

Donning Socks Can Make You Crazy

At 58 years old I wanted to go home instead of going to a long-term care facility.  I live alone so I was motivated to learn how to don socks with one hand.  When Joyce complained about getting her sock crooked in The Tales of a Stroke Patient I understood her dilemma.  She reminded me of the tortuous process I use to do this task.  Pulling a sock up one-handed requires me to pull one side up, then the other side, repeat, repeat, and repeat.  However, holding my leg completely still in the air for that long a time is impossible.

I bend my knee to pull my leg up on the bed to keep it still and avoid leaning over to reach my toes.  My repeated pulling is not always symmetrical so I watch to see if my sock is twisting.

To prevent the heel from ending up on the side of my foot, I go back down to straighten the toe if needed.  When the toe is straight, the heel of the sock ends up on the heel of my foot.  homeafterstroke.blogspot.com

Animal Therapy

Lots of people have adopted pets during the covid pandemic.  Animals help people because they spend most of their lives in the present instead of obsessing about the past or future.  However,      I lived with a dog and a cat as a child so i know this is not an option for me now.  When I was ten I was walking our german shepard on a leash when she pulled me off my feet.  She felt she had to protect me from a loose dog who was barking feriously at us.  I did not have the strength to stop her.  I also cannot walk a dog on a lawn and bend down to pick up feces.  Walking on uneven ground is a fall hazard for me.  My friend Janet reminded me that cats can trip you when they crawl around your feet while you preparing food or walking across the room.  I also cannot empty a litter box one-handed.  

I get animals in my life by watching TV shows about veternarians and zoos.  I like these shows because the drama is real.  Drama on human reality shows is often manufactured by the show's producer.  Videotaped "private thoughts" are often preceded by the producer asking leading questions or making a comment, like "XXX is telling everyone you are a b****.   The producer's actions are deleted to preserve the illusion that what we see is genuine.  In animal based shows, cows and lions are not pretending to be sick or upset.  What vets and zoo staff do is repetitive so I watch the animals faces and the way they move after a procedure is over.  Short video clips show them happily running around a month after being treated.  The relief I feel when an animal looks better or happier is cathartic.  homeafterstroke.blogspot.com    

Janet Saved Me - Again

Janet is a dear friend I have known for over 40 years.  We have kept in touch no matter how many times we moved.  She is a person who can speak truth with kindness.  She gently talked me into paying a grocery store employee to shop for me during the winter.  Thanks to Janet, I did not become hysterical about being stuck in my house with no grocercies because of a blizzard.  When weather reports became dire, I ordered groceries on-line and picked them up before the snow storm hit.  This photo shows I was right to worry.

Normally I use handicapped parking because these spaces are wide enough for me to put a cart next to my car door to unload groceries.  The regular parking spaces I have to use for on-line shopping are narrow, so I put groceries in my trunk.  I am glad I put boxes and a cooler in my trunk before my 1st attempt at

on-line shopping.  I do not want to use my cane to fish around for cans and round produce that could roll to the back of my trunk.   

Note to self: The milk and bread I ordered were out of stock because so many people were doing last minute shopping.  Next time I will not check "no substitutions."  homeafterstroke.blogspot.com

Linda Schooled Me

Linda wrote a post in Leading a Healthy Life about dislocating her hip when she bent at the waist instead of bending her knees while reaching down to pick up something.  She screamed when her hip slipped out of its socket, when family members helped her sit on a chair, when the EMTs moved her to a transport chair, when they carried her up the basement stairs, when they put her in the ambulance, etc.  I also take chances when I reach down to pick up an object.  Even though I know better, it is frustrating to not be able to move the way I used to as an able-bodied person. 

I am grateful that Linda shared her painful experience.  Her description was so vivid it has changed my behavior.  For example, I put heavy bags on the top step (red circle) before I load them into a rolling cart inside my front door.  I put them in the cart first so they do not crush fragile products like bread.  When I leaned way down to move lighter bags from a step below the top step, I thought "don't do this."   Now I use a safer strategy.  I expend the energy to walk down to a lower step (green circle) before I lift the lighter bags up to the top step.  I will have to repeat this new strategy many times before it happens automatically.  

A few days later I felt my heels come off the floor while I was struggling to maintain my balance as I squatted to pick up an object under a chair.  Again I thought "don't do this."  I moved the chair.  In the coming weeks I will look for instances when I put my body in a stressful position.  Linda, thank you for reminding me to be careful.  homeafterstroke.blogspot.com

Hard to carry over skills acquired during exercise

  

Once I had a little movement in my affected hand, I used a SaeboFlex splint for months to help me transfer thousands of balls from one crate to another.  I thought the repetition would be boring, but watching a hand open and close after being totally flaccid for 3 months was mesmerizing.  Success with this simple repetitive exercise created hope.

The transition to functional tasks can be difficult.  Clients have to divide their attention between monitoring what their body is doing and what objects are doing.  The photo below shows only my thumb and middle finger contact the tube of toothpaste.  This is a precarious grasp.  Dropping an open tube of toothpaste can produce a splatter of toothpaste on the floor.  Toothpaste is sticky so cleaning it up is not easy.  I press the end of the tube against my stomach to hold it still while my other hand removes the cap.  This is one example of why it is not easy to carry over skills acquired during exercise.  Fortunately I have a strategy for dealing with my negative emotional response to failure during functional tasks. 

Even after 17 years, trying new functional tasks can be frustrating.  The first time I try a new task, one or more steps are difficult or impossible for me to do.  This means I cannot finish what I started!  To help me persist in the face of failure I call my first attempt a rehearsal.  The purpose of a rehearsal is to discover solutions that will make my second attempt awesome.  Waiting until the next day gives me time to think of new things I can try next time.      homeafterstroke.blogspot.com

Staying in My Home is Not Easy

The independent living facility I hope to go to has a heated underground garage.  Until I move, I need 5 snow strategies because I have to park my car on the street.  When snow is forecast my 1st strategy is to go grocery shopping.  When we get a dusting of snow I use my 2nd strategy.  I use a child-size shovel to push snow onto my lawn.  I sprinkle Ice Melt on my walkway and in front of my car.  The big container is heavy so I use a funnel to pour Ice Melt into a small container sitting in my bathroom sink.  My sound hand lifts the big container.  My affected forearm under the big container controls the degree of tilt.  

New Jersey often gets above freezing after a snow storm.  When the weather forecast says this will happen I use my 3rd strategy.  I wait a few days for the sun to free my snow-covered car.  However, the street has a low spot that captures water as the sun melts the snow.  I need a 4th strategy to cross this small pond.  I place a thick rubber matt over the water so I can to get to my car safely.  

When the weather forecast says New Jersey will stay below freezing after a snow storm I use my 5th strategy.  I pay two teenage boys to clean my car, walkway, and snow that the snowplow has pushed against the side of my car.  They also shovel snow in front of and behind my car so I have a clean parking space.  Old people in my neighborhood are nasty when someone takes the parking space in front of their house.  homeafterstroke.blogspot.com

Darkness Did Me In

I was out of milk and bread but the next day was Saturday - the busiest day of the week at grocery stores.  I planned to go at 6:30 a.m. to avoid the people who fill their carts to the brim and take forever to check out.  I had forgotten the sun comes up later at this time of year because I never go out this early.  When I started driving I remembered why I no longer drive in the dark.  After cataract surgery I could ignore the tiny concentric circles around every light (halos) that the lens in my left eye creates at night.  However, when I got a 2nd lens in my right eye, the halos became too distracting.  On the way to the store I vowed to order groceries on-line.  This creates 2 challenges.

My 1st challenge is that Shoprite recently changed their pick-up procedure for on-line shopping.  Instead of calling when I drive up for my groceries at my reseved time, I must now text.  I have used a computer for 25 years and an iphone for 10 years, but I have never texted someone who is not in my contacts list.  In desperation I went into the store and showed an employee the e-mail that confirmed my order.  Thankfully she pulled the bags for my order and put it in a cart.  She had to follow me 4 stores away because the parking lot was filled to the max.  Christmas was only        4 days away.  I have since learned how to text a stranger so I will try on-line ordering again.

My 2nd challenge is that 1 loaf of bread and 1 half gallon of milk does not last a week.  I use lots of milk in my cereal and coffee.  I use a lots of bread because I make a peanut butter sandwich for lunch every day, a meat sandwich for dinner many nights, and wrap each pill in a small piece of bread to prevent it from going down my windpipe.  I eat thinly sliced bread that has only 40 calories per slice.  I am going to order 2 loaves and 2 cartons one week and 1 loaf and 1 carton the next week to see if it prevents midweek trips to the store.  homeafterstroke.blogspot.com

Sunlight

Opening my blinds to let in sunshine improves my mood.  It may be one reason I am sleeping better.    My last home had windows on only one side of the house so I love that my current home has windows on both sides.  I usually keep my curtains closed in winter to save heat, but this year I need the sunlight.  Different windows create different light patterns.  

homeafterstroke.blogspot.com