Mary and Virginia

Virginia recently had a stroke. Since Virginia, 67, will be staying with her sister Mary, 65, for a few weeks, this visit was to Mary's home. The sisters agree that Virginia’s return to her own house will be a challenge. Although she does not require a wheelchair, walker or cane, Virginia moves much slower than she did before the stroke. Virginia’s home has stairs to enter the house and more stairs to reach the bathrooms. Virginia has been working on climbing stairs with her physical therapist, and says that she can do it, but, like everything else, “it takes forever.” Also, when Virginia finally moves home she will be alone much of the time -- her son works outside the home and won't always be there to help.

Mary seems to accept her caregiving role very naturally. She already cares for her baby nephew, who sleeps in a crib in her room, and her nine-year-old nephew who is autistic. She also cares for her granddaughter and baby-sits for other relatives. She describes her role in Virginia’s care as that of an observer -- Virginia is fortunate that she can do most things on her own despite the stroke; it just takes longer.

It is evident that Mary and Virginia have a very close family. Relatives drive them whenever they need to leave the house. Mary told us of the barbecue held at her home last weekend for Memorial Day, pointing out the remains of a huge sheet cake on a dining room side table. Everyone likes to gather at Mary’s home for barbecues because of the space, she told me. After meeting Mary, though, I think the real reason people visit is her obvious instinct for hospitality and caring. Mary admitted that she needs to take better care of herself -- she has vertigo, arthritis, and a small brain tumor that seemed to be causing her pain during our visit.

Life After the Stroke
Before the stroke, Virginia was a cook for a living. When Julie asked if Virginia still prepares her own food, she said she did, and Mary added that “you can’t help a cook in the kitchen.“ Virginia feeds herself as well, although she is working with a speech therapist to help with swallowing and coughing problems. Virginia has had only one fall, which occurred about a week ago in the bathroom. Fortunately, she was not seriously hurt but did admit that she was still sore. More than anything, she said, the fall was embarrassing. She bathes herself in the shower equipped with a shower chair, grab bars, and a hand held showerhead. She also uses the toilet by herself, but has learned to go as soon as she feels she might have to in order to make it in time because the whole process takes a lot longer than it used to. She has a plastic toilet seat riser with side handles that fits on the toilet seat to make getting on and off of the seat easier. However, she admits that she would like to have a different kind -- one more like a chair, with handles on the side like the one she had in the hospital. Julie offered to bring a catalog on her next visit to see if they could find what she’s looking for. Virginia dresses herself slowly (the buttons take the longest, she said) but she manages.

Assessment of Functions
When Julie assessed Virginia’s functions to determine her primary needs, Virginia proved that the debilitating effects of her stroke were fairly minimal. Julie’s testing showed that she had no memory problems (she was able to list the months of the year in backwards order just as fast as I did in my head along with her), no hearing problems (she was able to repeat what Julie said even when her mouth was covered with a sheet of paper so Virginia could not read her lips), no problems with touch or determining the temperature of things, and no vision problems that she hadn’t had before the stroke. Her strength was normal as well. It was her speech and general movement that had been changed since the stroke. When asked, Virginia did admit that her writing, affected by her movement difficulties, was worse than before.

Goals
Julie asked Virginia what specific things she would most like to improve. Virginia’s responses were to speak better, to move more safely around her home, and to bathe more safely, especially when she returns to her own home. She also wants to be able to feed herself less slowly without swallowing and coughing. Julie then asked Virginia to rank these things from one to ten in terms of their importance, with ten being the most important. Virginia said that for her, speaking better and moving safely were tens, and bathing safely was an eight. Virginia felt that her present speech deserved a score of five, her ability to move safely a seven, and her ability to bathe safely an eight. However, when she was asked to rank her satisfaction with these things, she gave speech a one and movement and bathing fives. Next time Julie meets with her, she will see if any of these rankings change.

Action Plan
Virginia is working with speech, physical, and occupational therapists to improve functions in these areas. Julie was there to suggest changes that could be made in Mary’s home -- as well as changes to Virginia’s home when she returns there --to help with these problems. Mary and Virginia gave us a tour of the home, and Julie asked questions along the way about how Virginia did certain things. In the bathroom, the shower chair, grab bars, and hand held showerhead were great, Julie said, but she suggested removing the shower doors, which were complemented with a shower curtain, so that Virginia could change the way she entered the shower. She had Virginia demonstrate how she normally did this, and Julie expressed her concern when she saw that at one point, she was on one foot, which could easily lead to imbalance that could result in falling. Instead, when the shower doors are removed, Virginia will be able to sit down on the chair while standing on the mat outside the shower (which Julie noted was good because it had a non-slick backing) and then swing her legs around, never having to stand in the potentially slick shower or to be on only one leg. She also suggested that Virginia get off the chair by sliding her hands underneath herself and pushing on the chair, which would be easier and take less strength than trying to pull herself up by grabbing onto something. They also talked about how the chair could work in Virginia’s bathtub at her home -- she would be able to enter the bathtub in the same way to prevent losing her balance. When Mary and Virginia said that they left the bathroom light on at night, Julie said that that was good, and that they should make sure there was enough lighting at night for Virginia to be able to get up if she needed to.

Julie said she would return in a week to see how the changes in the bathroom were working and to bring them a catalog that includes alternate types of toilet seats and chairs. Virginia is used to doing things on her own, and Julie will continue to try to help her to live as independently and safely as possible.

--written by Laura Butler of the Internet Stroke Center