Last month while visiting my family, my aunt suffered a stroke. The stroke occurred on the left side of her brain, resulting in right sided paralysis and language problems (aphasia). During the first week of her hospitalization, while she was still in ICU, my mom and I went to visit her. My aunt was awake, but obviously dazed, and unsure of what had happened or where, exactly, she was.
Contributing to my aunt's apparent confusion, was the usual ICU clamor of nurse's conversations, phones ringing, other patients and their families talking, and televisions set to the local news station.
Adding to all of the activity, the physician on call came for a visit. He was pleasant enough, but after a brief introduction, and with no prior knowledge of my aunt, he set about with his bedside exam of sensory testing. "close your eyes," he instructed. "Now, tell me, am I touching your right or left?" My aunt opened her eyes, as if trying to understand what he was asking. "no, no, close your eyes, he instructed." And once again, he delivered his series of questions: " am I touching the right the left? " "Can you feel it, yes? no?" I could tell that my aunt was unable to follow the line of questioning, and as is typical of individuals soon after a stroke, her answers were unreliable. The physician, now appearing frustrated by his attempt to glean a clear response, left her bedside. My aunt turned to me with a bewildered look, and said: "I am so confused." The most relevant statement the physician needed to hear as it clearly reflected her current state.
Patients recovering from stroke are bombarded with daily questions from hospital staff and visitors, which often adds to their overall confusion and frustration. If you have a family member or friend who has recently suffered a stroke and is now experiencing difficulty understanding or using language below are some tips for easing the communication frustration:
- If the individual uses hearing aids or glasses be sure they are available and being used by staff members. Frequently families will leave hearing aids at home not wanting them to get lost. While I understand the concern, not being able to hear AND not being able to understand or use language is only going to compound the patient's confusion and delay language recovery.
- Limit your use of "yes/no" questioning to simple, closed-end questions. For example, rather than asking: "do you want to get up in the chair or stay in bed?" Ask: "do you want to sit in the chair?" Adding head nods and other gestures, pointing to the words: yes/no, may also help to obtain a more reliable response.
- Orient the individual daily and frequently. Hospital staff members should all be wearing name tags. It might also be helpful for family members to wear a name tag when visiting so as to eliminate quizzing about names that the individual cannot easily retrieve.
- A note pad or wipe off board can be used to chronicle visitors and daily events. So, now, instead of asking about the day, you can initiate and orient by saying: "oh, I see___ came for a visit today", or" PT had you up in the chair today."
- Meals may be the best use of your visiting time as nursing is often short handed. If you visit following a meal and notice a green bean still in the individuals mouth or they are having frequent choking and coughing, alert the physician or nurse to a possible swallowing problem.
- Turn the TV off when visiting and, and select programming carefully. Do you really want CNN or Fox news to be the stimulation a recovering brain is receiving?
Recovery from stroke can be a long journey of months, and for an individual with aphasia the early weeks can be frustrating, confusing, and scary. Your reassurance and simple communication can help support recovery.
For additional information abut aphasia visit: http://www.aphasia.org/
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