750,000 people have a cerebrovascular accident (CVA) per year in the United States, which comes out to over 2,000 per day. 

Returning home after having a CVA can be a difficult transition for both the clients and their families. Maintaining or re-establishing roles can be an important component of the rehabilitation process and returning to the things that are important to these clients. Due to the prevalence of CVA in the U.S., it is important for practitioners to know how to address the transition home for our patients after a stroke which includes returning to roles such as a partner in marriage and parenting.

Parenting

Whether it is the parent of someone who has sustained a stroke or the client is a parent, there are some things as therapists that we can do to support this dynamic.  

1. Awareness to Behavior/Temperament Changes & De-escalation Strategies 

There may be times when the client becomes easily agitated and demonstrates “challenging” behaviors. It is important for the family of the client to understand that the area of the brain that was injured during the stroke, could alter behavior within the role as a parent (or in a marriage). There are strategies that can be used to de-escalate the situation during these instances. 

• Ask less general questions and more specific “how can I help” questions to decrease overwhelming feelings and develop a positive-collaborative communication style.

• Deep breathing in stressful situations and using this prior to responding in these situations. Breathing in through the nose and out through the mouth 3-5 times.

• Allow the client to express their emotions but encourage respectful vocabulary and remember the importance of staying calm and not responding negatively.

• Allow time for emotions to settle and return to subjects later using “I” statements to resolve the conflict. REMEMBER if safety is the concern it is important that this is prioritized and there is not any immediate danger to the caregiver or the client.

2. Supervision & Knowing Current Functional Limitations 

The motor, cognitive, and sensory changes that exist post stroke are not consistent for every client. Conversations about level of function and independence can be difficult for parents and families and typically relate back to safety. Understanding what the client is capable of doing at their current level of function is instrumental to maintaining safety within the home.

3. Support

Including a son/daughter in the rehabilitation is up to the discretion of the family, however there are some benefits to this inclusion. Fostering an understanding of the parent’s injury to the son/daughter can be done through including them in home programs/homework, attending therapy sessions to better understand what to work on within the home, and family education about the nature of the injury and the current limitations the client is experiencing.

Marriage

The challenges associated with returning to parenting and marriage after a stroke might involve some of the same strategies and techniques that we can teach to our clients and their loved ones to ease the transition back into the home.

1. Strategies for Maintaining Relationship & Managing Stressful Situations

• De-escalation strategies 

• Counseling appointments together and/or separate

• “Family meetings” with therapy or medical team for conflict resolution

•  Support groups

• Attending therapy (and other medical appointments together)

• Developing healthy communication patterns that can help achieve safe ADL collaboration and practicing this with your rehab team

2. Sex & Intimacy 

There is often a disconnect when considering sex and intimacy after being discharged from an acute or post-acute facility. Opening communication to topics such as:

• Discussing level of comfortability and the needs of both people in the partnership

• Exploring appropriate assistive devices that can promote independence during sexual activity 

• Using body positioning and current level of function to meet their goals as they relate to sex and intimacy. 

Read our article about sex and intimacy after stroke here!

Other Considerations

1. Return to Work

In addition to marriage and parenting after a stroke, the client might be preparing to transition back into the workplace. If the client identifies returning to work as an important goal for themselves, it is important we know how to support them such as targeting functional movements, strengthening, ROM, etc. necessary for work tasks in therapy sessions to promote return after a stroke. There are other recommendations we can make to assist these clients return to work such as:

• Encouraging open communication about current functional limitations with workplace boss/supervisor

• Education on body awareness and the importance of taking rest breaks during physically or cognitively demanding tasks

• Educating the client about proper ergonomics and strategies to set up the environment for success
  • Items are within reach of unaffected side
  • Supporting affected side to prevent shoulder subluxation
  • Seated position when appropriate

2. Friends/socialization 

Recognizing that rejoining friends and attending social events after a stroke may be an emotional experience for the client. Oftentimes it involves working through discomfort associated with friends noticing physical or other limitations. Recommendations for navigating these situations can include: 

• Starting with a comfortable environment that is set up for the client to be successful with a smaller crowd and progressing from there

• A plan for instances of incontinence that involve discrete management

• Implementing a space specifically for the client to go to such as a car or bedroom in times of frustration or feeling overwhelmed

Returning home and to the roles within a marriage or as a parent after a stroke can be a difficult transition for our clients and in order to holistically approach this transition, practitioners MUST address marriage, parenting, and the other roles important to each client. Being prepared to navigate these challenges as they arise will leave clients and their families better equipped for this transition.

Interested in learning more about inpatient rehab and strategies to get your client home? Check out our Inpatient Stroke Rehabilitation: 14 Strategies to Get your Patient Home. 

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