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Stroke Recovery: Better Results with Cognitive Support

By , 5:14 pm on

Imagine rolling a boulder up hill.

Now put on a blind-fold and keep going.

Just like pushing the boulder blindfolded, physical and mental challenges make stroke recovery hard. When you encourage and provide cognitive support, you help keep rehabilitation on track.


Preventing Another Stroke Is Job One

Having one stroke puts the survivor at a high risk for a second one.  By their presence and attention, family and professional caregivers assist in stroke prevention. According to British cardiologists, isolation and loneliness increase risk of stroke by 32%.  Clearly, stroke prevention and recovery hinges on a positive “mental game.”

The most successful caregivers boost the “mental game” further by supporting independence during rehabilitation, instead of trying to do everything for a loved one.  Give your loved one space to stretch his abilitiesCreate a reward system for sticking with dietary changes, exercise schedules, and other “life after stroke” modifications.

Do all you can to support your loved one in keeping physical, occupational and speech therapy appointments and continuing the exercises at home. Go into the sessions together, learn what to do, and then practice together at home. Some people video the sessions, with permission, to better capture proper technique.

Pain is a key reason people avoid physical therapy.  Talk with the therapy team about appropriate ways to position limbs and joints to reduce strain and pain, during both exercise sessions and rest times.

What You Can Do About Cognitive Problems

Stroke survivors often experience depression, apathy, uncontrollable emotions, communication problems (Aphasia), sleep issues, and memory loss.

Watch for depression, which can be caused by changes in the brain.  Depression effects the way a person feels pain, magnifies fatigue and related confusion, and can hinder recovery.  Stroke survivors often experience anxiety along with depression.  (More on signs of stroke-related depression.)

With depression:

  1. Seek medical treatment
  2. Be a good listener.  Reassure your loved one; it is alright to feel sad.
  3. Create a purposeful routine, such as specific times to get up, exercise, run errands
  4. Encourage movement and effort.  Establish goals you can work on together, such as leg lifts for your loved one, sit ups for you.  Consider videoing exercise sessions to create a record of progress your loved one can see.
  5. Connect with family and friends

Emotions may be out of control and unpredictable. Uncontrollable and inappropriate crying or laughing can be embarrassing and upsetting to the stroke survivor.  This medical condition is called emotional lability or PBA (Pseudobulbar Affect).  Tell your loved one you understand and explain this is a common after stroke condition. Consult a doctor for treatment.

Thinking abilities, such as language, comprehension, learning and memory, may have been damaged by the stroke.  A survivor might experience altered visual, (i.e., faces), verbal (i.e., names), or general (i.e., learning) memories. Cognitive losses may be temporary.

  1. Help create routines for key tasks, like brushing teeth, getting dressed
  2. Break tasks down
  3. Make and use to do lists
  4. Reduce clutter and store things in designated places
  5. Schedule the hardest tasks for your loved one’s best time of day

If ability to communicate has been damaged by stroke, working with speech and occupational therapists is crucial.

Caregiver and stroke survivor should:

  • Closely follow therapist’s advice
  • Be patient and calm
  • Take time to communicate
  • Work with one idea at a time
  • Use a communication book with words and phrases, photos, symbols, and maps

Cognitive problems can be worsened by fatigue resulting from sleeping and/or breathing problems. If you notice, or your loved one mentions difficulty sleeping, keep a notebook of sleeping, memory or attention problems, headaches, irritability, fatigue, and loud snoring.  Ask him if she’s experiencing frequent waking and gasping for breath, increased sweating and shortness of breath at night, or insomnia.  These issues should be treated by a doctor.

For more ideas on stroke recovery:

Tips for Successful Stroke Recovery

What Stroke Survivors Want You To Know

Vascular Dementia and Managing Blood Pressure

Drs. Stein, Silver, and Frates: Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke

Recovery after stroke is an on-going process, even an uphill climb for some. The social and emotional support both family and professional caregivers provide is crucial to achieving the best rehabilitation results possible.

Call me or one of our care managers; we’re here to help, 402-261-5158, in either Lincoln or Omaha.

Sources: American Heart Association Stroke Connection (; National stroke association, (; National Institute of Neurological Disorders and Stroke; National Institutes of Health, Heart-BMJ (British Medical Journal), and Mayo Clinic

Lee Nyberg, a partner at Home Care Assistance of Nebraska, focuses on education and aging issues, co-leads a Parkinson’s support group, and is a Legislative Advocate for the Alzheimer’s Association.