In the midst of COVID-19, it’s easy to lose sight of other common diseases like stroke. If not treated quickly, a stroke can lead to permanent brain damage for a patient and also cause loved ones to transition into caregivers overnight.

Every 40 seconds someone in the United States has a stroke. And every four minutes, someone dies.

Stroke is the fifth leading cause of death for Americans and it is the leading cause of serious long-term disability. A stroke, sometimes referred to as a brain attack, occurs when blood flow is blocked from reaching your brain.

What makes matters worse is that a survivor’s family is not immune. Loved ones are often forced to make the overnight transition into well-meaning, yet unprepared caregivers.

Amanda Doss, a physical therapist at Novant Health Physical Medicine and Rehabilitation, shares tips to help caregivers when they need it the most.

Develop a plan

The American Stroke Association says that patients experiencing stroke-like symptoms – face drooping, arm weakness or speech difficulty – should call 911 and get to the hospital as soon as possible. And remember, emergency rooms are safe for everyone. Anyone who enters an emergency room is screened for COVID-19, and those with suspected cases are immediately taken to a specially designated area.

“It’s important to remember that even during a pandemic, other diseases like stroke continue to exist,” said Doss. “Our outpatient rehab volumes have stayed up throughout COVID-19.”

Over the last three months, Doss and her team have stayed busy making adjustments to accommodate for new cleaning precautions and social distancing guidelines in the clinic. Patients and team members now don masks and go through a temperature check screening process before entering the building.   

To help with social distancing, caregivers now have to wait in the lobby while their loved ones go back for their appointment. Doss says this change has made good communication with the patient and caregiver vital before and after each visit.

“Even with masks on I can usually get a read on how the patient and the caregiver are doing,” Doss said. “I can tell if they are feeling exasperated, scared or overwhelmed. They want answers and they are looking to us for help.”

Doss starts each physical therapy appointment by doing an initial assessment. She often asks the patient what they are struggling with and what kind of activities they want to be able to get back to doing.

“If you get patients talking about their previous life and things they enjoy, it often helps to motivate them to work hard through therapy to get back to that level of functionality,” she said.

From there, Doss works with a team of physical therapists, occupational therapists and speech therapists to design a personalized treatment plan for each patient.

Doss says success is defined with two metrics. The first is if the patient can get back to the activities that are meaningful to them. The second, less obvious measure, is determined by how well the patient adapts to life after the stroke.

Going home

For caregivers, the realization of their new normal usually doesn’t sink in until the patient returns home for the very first time.

“We always talk with the caregivers about their home situation,” said Doss. “It’s important to make sure you roll up rugs, have sturdy railings, night lights and get rid of any clutter to make clear pathways around the house.”

Novant Health also offers a Stroke Bridge Clinic to help survivors safely transition from the hospital to home. Nurse navigators help patients with scheduling appointments, medications, and relearning how to do simple tasks.

Many of the Stoke Bridge Clinic appointments are now completed virtually. Since the pandemic hit back in March, Novant Health has ramped up its video visit capabilities and now conducts more than 5,000 virtual visits a day.

Doss also recommends making an easy-to-follow medication plan for your loved one.

“Chances are the patient is going to be taking a lot of new medication which can be stressful for the caregiver,” she said. “I recommend that you print out the medication list and dosing schedule and buy yourself a pill sorter to make things easy.”

Don’t do this

Doss warns that caregivers should avoid being too quick to offer assistance.

“These days we are all spending more time at home together. And many family members are natural caregivers,” she said. “They want to help and show their love, but lots of times that translates into doing things for the patient.”

In addition to mobility issues, a stroke can also slow the cognitive processing time for patients.

“Sometimes it is just a split second, and sometimes it is 15 to 20 seconds,” she said. “But waiting for the answer helps the patient continue to think for themselves and make their needs known.”

Dealing with depression

Depression is also common in stroke survivors. It’s often caused by biochemical changes in the brain, and can result in feelings of irritability and hopelessness. Add a pandemic to the mix and things just seem to get worse.

“It takes a lot of energy to think through what used to be automatic,” said Doss. “Depression is a big challenge to returning to your former level of function, especially if you are stuck at home. Recognizing it and getting it treated early is the best case scenario.”

Doss says that caregivers should set up their patients for success by doing the exercises with them and reminding them of the activities they are trying to get back to doing together.

“As a caregiver, it’s also important to say yes when someone offers to help,” said Doss. “And after the dust settles and people forget, don’t be afraid to ask for help again. When you take time for yourself, and then you come back to your loved one, you are refreshed and a better overall caregiver.”

Top picture: Amanda Doss works with a patient at Novant Health Physical Medicine and Rehabilitation in Winston-Salem. 

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