Does tough love help with stroke recovery?


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Hi folks. My mom's memorial was beautiful. She had stroke in Jan 09 and never came out of her coma. My father passed 20 years ago. So now it's just me and my brother. And as some of you know, my brother Clyde had a stroke at 52 in March 09. He is not in a coma, but has challenges walking, and lives in a nursing him. His speech and thought are slower.

 

He can be fairly demanding, and not willing to do much to get better. He often resists his therapists. He stays in his room all day with the curtains drawn, even though it's sunny outside. Yes, he's on the first floor, but still... I offer to wheel him to the patio to go outside but he says no. I offer to wheel him to Starbucks (he loves coffee) but he says no. When his cell phone runs out of charge, he insists that I come over to recharge it for him. I know he is able to call me, but he rarely does. I ask him to do so to keep in touch and let me know when he needs somethings or wants to talk. But he refuses because the cell phone will die. I offer to bring over DVD movies to watch but he says no.

 

At least now, he's eating with the other in the dining room. But he won't make friends with people because he says no one can understand him when he talks except me.

 

I want to encourage him to take action to get better, to be proactive and as independent as possible. Some times I think tough love is best with my brother. Does anyone have any suggestions -- either stroke survivorers or caregivers?

 

Dwight

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Hi Dwight,

 

Boy, any caregiver will tell you YES...it is sometimes necessary to practice tough love. I have not been good at it though! Sue here on the board does a much better job I think than I do. I'll give you an example. My husband Bill can shave himself, but most times he wants me to do it. I'm not consistent and when I tell him I want him to do it he doesn't look very happy! But - he does it. I do a lot of praising him!

 

He can also dress himself - but he just doesn't do it because, again, guess who will do it for him. (I wasn't good at allowing my kids to dress themselves when they were three, either!)

 

It sounds like your brother may be suffering from pretty severe depression - what do you think? I think one of the unfortunate things about SNFs is that your brother isn't being a "problem". He stays to himself and doesn't require much attention from a less than committed staff. He doesn't HAVE to do the therapy because he is not there for rehab, he's there for extended care. (I think that's correct anyway). The last time Bill was in the SNF I was told there was a different therapy regiman for someone who was going to stay for custodial care than one who was there for rehab in order to go home.

 

As anyone here will attest (I think) your brother won't be real appreciative in the beginning of your expecting him to do for himself, but in the end he will feel satisfied with himself that he CAN do for himself.

 

Good luck, Dwight!

 

Ann Rogers

Hi folks. My mom's memorial was beautiful. She had stroke in Jan 09 and never came out of her coma. My father passed 20 years ago. So now it's just me and my brother. And as some of you know, my brother Clyde had a stroke at 52 in March 09. He is not in a coma, but has challenges walking, and lives in a nursing him. His speech and thought are slower.

 

He can be fairly demanding, and not willing to do much to get better. He often resists his therapists. He stays in his room all day with the curtains drawn, even though it's sunny outside. Yes, he's on the first floor, but still... I offer to wheel him to the patio to go outside but he says no. I offer to wheel him to Starbucks (he loves coffee) but he says no. When his cell phone runs out of charge, he insists that I come over to recharge it for him. I know he is able to call me, but he rarely does. I ask him to do so to keep in touch and let me know when he needs somethings or wants to talk. But he refuses because the cell phone will die. I offer to bring over DVD movies to watch but he says no.

 

At least now, he's eating with the other in the dining room. But he won't make friends with people because he says no one can understand him when he talks except me.

 

I want to encourage him to take action to get better, to be proactive and as independent as possible. Some times I think tough love is best with my brother. Does anyone have any suggestions -- either stroke survivorers or caregivers?

 

Dwight

 

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hi dwight, sorry to hear Clyde is not trying to help himself. it sounds like to me he is depressed, possibly much more than others, due to his stroke and the passing of his mother, is he on any meds to help him with this? have you spoken to his dr about his behavior lately? sometimes due to the area of the brain hit by the stroke can cause this in survivors. from day one after my stroke all i thought of was getting better and working as hard as i could to achieve that. i do know others here have asked the same question about tough love. i would try it if it were me to try and get him motivated into helping himself. perhaps talking to his dr and therapists they can offer you suggestions also. the best way he can start to speak better is by trying and practicing, hopefully speech therapy can be involved with him too. i am so happy your mom's memorial went well for you. i hope clyde attended the memorial for his mom. you are now having to deal with the emotional deficits from a stroke, that you did'nt encounter with your mom, although everyone is different after their strokes. clyde needs to fight against his to not let it win out over him! as you know from being a member here that we can recover. is he able to plug his phone in to recharge itself or he just doesn't want to? some survivors just give up and i would hate for this to happen to clyde. you know him better than we do, do what you think might work on him. i wish you both the best. keep us updated on how hes doing.

hugs(((((())))) kimmie

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Kim,

 

That's interesting you asked about whether Clyde attended the memorial. He did not.

 

Yes, it may have partly been physical discomfort and being in a wheel chair. But it also has to do with him being of a different buddhist sect than my mom and I.

I really think it would've been good for him to attend, but I couldn't force him. At different times, I think he has told me he had antidepressants, but it might have been temporary. It's hard to get info from the doctor. He doesn't return emails, and even in person his answers are often not helpful.

 

But I will try the tough love approach and see how it goes.

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Dwight: If anyone can be a positive force for Clyde it is you. You are one source of inspiration and a person of so much love and tolerance.

Is there any way he could get involved with your sect of the Buddist family? Maybe being a part of a group where your Mom and You attended might help him emotionally. I join the others in saying he is probably depressed..... You know the saying "You can lead a horse to water, but you can't make him drink"?

I think that applies here. You are giving him the tools he needs ...... you can't keep doing what he wants you to do, especially if he is capable of doing it for himself. He would feel so much better about himself if he could see he was able to do something. It gives me such satisfaction when I can accomplish something. I do feel his not going to the memorial will hurt him in the long run. There will come a day when he will wish he had gone. I pray that day never comes though.

You did such a wonderful job Dwight in Patsy's celebration of life. Everything was done just so .... just for a beautiful flower and as the service went on that flower had buds that opened. Her memories live on in everyone that knew her. Maybe one day, you can share the videos with your Brother. I think the worst thing you could do is to enable Clyde. Maybe he could speak to a Professional. I will keep him in my prayers. I wish he could realize he has to make changes in order to get better. There is a big world just waiting for him. Your Mom hung on ...... I pray one day Clyde will feel her spirit to do the same thing..... for him to Embrace this wonderful gift of life. I know one day Dwight, you will get that phone call from him ......How you will rejoice when that day comes. Until then, just know you have extended your hand like you did for Patsy.

Now it's your turn to take my hand and those here at StrokeNet.

We love you and care for you. All the best to you my friend. This is time for you to take care of you These past few weeks have been extremely busy for you. I know your "well" must have gotten a lil dry. I am so happy you have such wonderful friends, family in your Buddist sect. Just a thought, could maybe a few of your friends could join you and go visit Clyde? Maybe bring lunch or coffee and then they just say come one Clyde we are taking you outside and we are going to visit for a bit. Maybe that might give him the "boost" to go..... He could just be grieving in his own way. There is no right way or wrong way to grieve. That is personal ...... These are just my thoughts as I am no way a Professional. :)

 

Hope to hear from you soon. :) Hugs, Jan

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Hi Dwight,

 

SNF - Skilled Nursing Facility. Duh.. I just read that he's in a nursing home - it's the same thing as SNF

 

Clinical depression is so insidious. I don't think we even realize it if we are or aren't! It's easy to be in denial because it isn't like being in a bad mood or feeling sad. Do you have his health power of attorney?

 

You are in such a difficult position. If you can get face to face with the doctor you might ask him if there is a time you could make an appointment with him. Let him know you need to talk NOT just to be brushed away. I've had enough experience now with doctors that I don't hesitate to challenge them - even though it certainly isn't the way I thought before this experience. They have to know someone is aware of your brother's condition I think, in order to go beyond the routine look in the door and writing a few notes!!! (It probably isn't that bad, but sometimes it seems like it is.)

 

Warmly,

 

Ann

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Hi Dwight,

 

Sorry to hear Clyde is being ornery as well demanding of you. Yes, tough love may be needed; perhaps even bribery, if necessary. If he's had these behaviors since March, keep in mind that the behaviors will not improve over night. When trying to change behaviors, you must allow time and patience.

 

Clyde has created his own little comfort zone. It is difficult for survivors to step out of that comfort zone but a necessary part of recovery.

 

I would be forceful with his doctor in establishing a face to face meeting.

 

Please keep us updated as you can.

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Yep, tough love, bribery, encouragement, loud praise, whatever works to make him want to get out of that comfortable little coccoon he has built for himself. A lot of stroke survivors in the nursing home situation build a coccoon, it is a safe warm place where there is food and no demands made on you.

 

I know from experience with my mum in her Dementia Lodge, and now her nursing home that it is not legal for staff to persuade you to do something once you say "no". Same rule does not apply to families however.

 

If he is in a wheelchair when you arrive then just let off the brakes and wheel him outside, or into a sunny space. Start talking to him about life outside and what you want from him, a cup of coffee and a (treat) a walk along the (lake, river,whatever the local beauty spot is). Come in and open up the world for him. Tell him that is your new vocation in life...lol.

 

Tell him he is your brother..you love him and you want him back as a friend and a companion. Ask him to grant you the privilege of having him as a friend again.

 

Dwight, life is tough but we are tougher.

 

Sue.

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  • 3 weeks later...

Well, I had a little progress with my brother Clyde. (By the way, one reason it's hard to deal with him is his irrational temper. When I showed him the memorial videos of mom, he muttered something about them being bullshit. When my mom was alive, he once said he was waiting for her to die to collect the insurance money!)

He and I have been somewhat estranged over the past few decades, though we got closer when caring for mom. I find now that mom is gone, I have less patience with some of his selfish behavior.

 

So I went to see him with tough love on my mind. I wanted to encourage him to be more proactive in his recovery. I gave him a kind of belated birthday gift: the candy he likes, some magazines to read (Entertainment Weekly and Scientific American) and some toys. I told him the mags were good for mental stimulation. He said he watches TV. I said that wasn't enough. The toys were objects that helped with manual dexterity. Surprisingly, he did agree he needed to read more.

 

In the past, he refused to charge his own cell phone as it was confusing. I told him since he was getting better and starting to walk on his own -- I'd only come by once a month now, or sooner if he called me on his cell, and I was available. So I turned over his cell recharger to him and told him he needed to charge his phone himself now. Again, I'm trying to get him to find his own solutions and empower himself. Instead of just depending on me. (My mother might have done that for hiim, but I'm not mom and I won't enable him to be dependent.)

 

I told him he should try to make friends with other residents at the nursing home, and starting calling his old friends on the phone. I had explained that I was going to rent out mom's condo for a year (where he used to live before his stroke). At the end of the year, if he's self-sufficient he can move back there. If not, I'll rent it out for another year. I even articulated that if he really applies himself, he might be able to go home in a year, but if he doesn't -- he'd be in the nursing home for the rest of his life. Tough, I know. But tough love. I have compassion for him, but I also have expectations of him. He's only 53 so doctors say he has a decent chance for a good recovery if he wants one.

 

So we'll see how this month goes. Wish me luck.

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Dwight: TY for the update. Sounds like you have had a lot on your plate. Clyde has a very loving, compassionate Brother and I sure pray he wakes up and realizes who is on his side. He has more than a Brother in you, he has a good Friend, a Teacher, so much .....

 

You have had to just lay the cards out on the table Dwight, I know it was hard for you to do, but, you needed to . You have given him options, now it is on him.

 

I think once you left, he realized your kindness that you showed him, bringing him magazines, toys and his phone charger. Now it is on him.

 

Either he can live in the Nursing Home for the rest of his life, or, he can go back to your Mom's Condo. To me, it would be a No Brainer.

 

I feel he will choose the latter. I hope so. But, it is up to him. He is the one that is going to have to make changes for him....

 

He is blessed to have you in his life.

 

Thank you for being you..... you are truly inspirational. You are keeping your Mom's loving legacy alive and I know she is looking down on you from Heaven with just joy in her heart.

She raised an awesome son....

 

Keep us posted. I am keeping you and your Brother in my thoughts and prayers.

 

Hugs, Jan :friends:

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You are a great brother acting like a father and he an only child. Keep up the care he's bound to get better and decide what he wants in the long run. Tough love is the norm if you want him to get better and be there for him along the recovery way.

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Dwight,

 

Thank you for the update on Clyde. I agree with you on the stipulations you have set for him - they are reasonable and give him goals to work at and achieve.

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Hi, Dwight

You have been in my thoughts and I was wondering how things were going. I believe what you are doing is the only viable path and I applaud you for doing this.

 

Please do keep us posted.

 

Stessie

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Thank you all for your comments. I appreciate the support on this thread about my brother. Frankly I was a bit nervous that those of you who are stroke survivors might be offended by my tough approach. Or that you'd think I was being insensitive. I'm glad this approach seems reasonable.

 

But if ever I do go too far, please feel free to tell me so. As I've never had a stroke, I really don't know exactly what kind of a different world Clyde must navigate in. Sometimes it's hard for me to know what he is unwilling to do for his recovery VS. what he is unable to do. If anyone has any thoughts on this, please share. Again, I count on you guys to guide me.

 

By the way, I do miss my mother of course very much. But I have a lot of memories of her and a lot of gratitude to her. She remains present in my life, but in a new way. I can say that I feel happy these days, and some of that must be the will of mom watching over her children.

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Dwight: Would it be possible to speak to the staff that watch over your Brother? Maybe if they could give you a a heads up as to what he does when you aren't there or around.... maybe that might give you insight to his days. Just a thought. I just cant' imagine him just laying in bed all day without the tv or radio on.... or him just not having any sort of life.
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That's a good idea, Jan, for me to talk to the staff that watch over Clyde. With mom, I know she always had a clear advocate in her regular nurse. It's less clear to me who is Clyde's regular nurse. And I can check to see if the speech or physical therapists are working with him. Though I think he said they were done working with him.

 

Frequently when I visit him, he is just sitting in his wheelchair watching TV. He does go to the dining room for meals. He said he does try to walk on his own and has had some progress. Though I suspect there are many opportunities for physical activity and stimulation and social contact that he does not take advantage of.

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I assume you're verifying, but if you are going to give him the motivation (we hope) - does he have the tools to get there. I occasionally try tough love, and feel like crap afterward - response I rec'v is typically only for a short time not permanent. So, I'll suggest you monitor progress making sure he has what he needs - I'd ask staff for progress notes - if he's been refusing therapy they may not ask anymore (I don't think they'd do that, but you know what I mean - if you ask someone multiple times and they say no, are you going to keep asking) - he may now want to get home, but staff assumes he doesn't). So, does he have the tools to get there, and how do you make sure he doesn't give up/get sidetracked/forget after trying awhile - my wife wants to drive again - that's great but she just can't do it - we wrote down that goal and what it takes to get there - turning head/lifting legs/multi tasking and are working toward accomplishing those individually. If she hits a rough spot, which we have, I'll continue to be there to get her restarted after it smooths out - you may need to do this too.

Goodluck. I commend you on your effort.

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Tom, your point is well-taken. I will be watching for his progress or non-progress. Luckily what I'm hoping for is simpler than driving a car. That's am ambitious goal for your wife.

That's great that you have broken down the skills she'll need to drive into parts. Good luck with her on that.

 

These are some new behaviors I'm hoping will develop:

 

-- Will he start charging his own cell when it runs out of juice

-- Will he start calling me or his friends now that I will be there less often

-- Will he start making friends with other residents

-- Will he read some of the magazines I gave him

-- Will he be more cooperative with therapists

-- Will he start wheeling himself outside to the patio

-- Will start thinking about what his future could look like,

what it will take for him to be self-sufficient, what it would

be like to return home and leave the nursing center

 

Time will tell. I will let you guys know.

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Hi Dwight,

 

I haven't posted in a long time, but reading this post and the replies drew me out.

 

I do like the tough love approach. It works on my 90-year-old father - when he starts treating me like his servant I have to remind him I have my limitations and he needs to be patient and appreciative, or my servitude ends. Recently I have started making him put his own dishes in the sink after meals, put his own clean clothes in his dresser drawers, wipe the sink when he finishes in the bathroom, and fill the cat food bowl that sits on his dresser.

 

He's not very good at doing any of these jobs, but the idea is for him to do for himself everything he safely can, and rely on other people less (which was how this living arrangement was suppose to work in the first place). Your brother's daily existance is probably not much different than my father's - eat, sleep, personal hygiene, watch tv.

 

I have a couple of questions regarding the situation with your brother.

 

1. Are you the person closest to your brother? Does he have other family or a very close friend? (Someone you could work with to help your brother)

 

2. Where does he see himself in a few months, or years? Does he have ANY goals?

 

Sorry to hear about your mother's passing.

 

Lady Anne / Lynn

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Thank you, Lynn. It's always good to hear the experiences of others who've tried tough love. It sounds like your requests of your father (which seem quite reasonable) are fairly similar to mine. They are tasks which help gauge the survivor's efforts to care for themselves.

 

In regard to your questions, yes I'm definitely the family member closest to my brother. My father passed many years ago, my mom recently, and it's just us two boys. He does have a few friends that come by at times to see him. He has outright asked them to let him live with them and be his caretaker, which isn't logical or reasonable. My sense is that those friends don't want to be much more involved than they are.

 

As for goals, I have definitely tried to get him to articulate goals for himself in the near and far future. Sometimes, to be dramatic, he'll just say, "I'll probably be dead in a year." Or "My main goal in life is sleep and watch tv and make to thru the day." I know he has a goal of getting out of the nursing home, but he's not very cooperative in envisioning the steps he needs to take to do that.

 

Thanks for taking the time to share your thoughts.

 

Dwight

 

 

Hi Dwight,

 

I haven't posted in a long time, but reading this post and the replies drew me out.

 

I do like the tough love approach. It works on my 90-year-old father - when he starts treating me like his servant I have to remind him I have my limitations and he needs to be patient and appreciative, or my servitude ends. Recently I have started making him put his own dishes in the sink after meals, put his own clean clothes in his dresser drawers, wipe the sink when he finishes in the bathroom, and fill the cat food bowl that sits on his dresser.

 

He's not very good at doing any of these jobs, but the idea is for him to do for himself everything he safely can, and rely on other people less (which was how this living arrangement was suppose to work in the first place). Your brother's daily existance is probably not much different than my father's - eat, sleep, personal hygiene, watch tv.

 

I have a couple of questions regarding the situation with your brother.

 

1. Are you the person closest to your brother? Does he have other family or a very close friend? (Someone you could work with to help your brother)

 

2. Where does he see himself in a few months, or years? Does he have ANY goals?

 

Sorry to hear about your mother's passing.

 

Lady Anne / Lynn

 

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Dwight: I truly feel your "list" is very reasonable. You have put so much thought and care into this whole project for your Brother. I can't think of anything else you could possibly do. You have done everything you can do.....

You have thought it through , you have seeked out others suggestions. I just hope one day we will read an update on how he is trying to take some of these on and get on with his life. He has an awesome brother that I hope he will realize it right there and there are so many memories that could be made.

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Thanks, Jan. Hey, did you see I've been promoted. I am now a "Senior Member." That's cool.

 

Dwight

 

 

 

Dwight: I truly feel your "list" is very reasonable. You have put so much thought and care into this whole project for your Brother. I can't think of anything else you could possibly do. You have done everything you can do.....

You have thought it through , you have seeked out others suggestions. I just hope one day we will read an update on how he is trying to take some of these on and get on with his life. He has an awesome brother that I hope he will realize it right there and there are so many memories that could be made.

 

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