Supportive Care Bulletin
Helpful tips for family caregivers
It is said that art imitates life. But one can actually learn powerful life lessons from art. This month we turn to theater improv to learn useful—and fun—ways to respond to a loved one with dementia. We also continue our series about the professionals who can help your relative regain skills and independence. Our focus is on physical therapists and how they assist one’s recovery and reduce the need for surgery and/or medication. Last, we address the oft-overlooked emotional consequences of a stroke. They can be alarming! But also easier to cope with, and even treat, if you and your loved one are aware of the signs.
Lessons from theater improv
While there is no denying the hardships of Alzheimer’s and other dementias, a growing number of families are exploring innovative strategies for including lightness and laughter on the journey. One option is to steal a page from the theater arts—specifically, improvisational theater.
In conventional comedy improv, actors are presented with the unexpected and must come up with their lines on the spot. The objective is to have some fun with the situation. In the case of caring for someone with dementia, it’s the disease that’s throwing the unimagined your way. Your role is to respond with good humor.
Keep it positive. It is a tenet of theater improv to ensure that everyone on stage looks good. In other words, that the humor doesn’t shame or belittle your colleagues. With dementia, this may mean turning the joke on yourself. If Mom forgets an appointment, “Silly me, I must have forgotten to mention it.”
Flow with the cue that’s given. If Dad puts on three shirts at once, “Very snazzy, Dad. Looks like I’ve got a choice as to which shirt to see you in today.” If Mom pours ketchup onto her pancakes instead of maple syrup, “Hey, that’s pretty. You’re starting off with a new topping for your cakes this morning. If you want to switch off to syrup, let me know.”
Learn to say “Yes, and….” Especially with dementia, improvise to respond to the emotion your loved one is displaying, rather than the facts. Adopt a position of “Yes, and…,” suspending disbelief no matter how strange the statement. For instance, instead of telling Dad that the birthday party he’s recalling happened twenty years ago, not yesterday—denying his reality—go with his happy flow. “That was your favorite cherry chocolate cake, right? Yum! Let’s see if we can find some cake today.”Return to top
What is a physical therapist?
Trusting the body’s ability to heal itself and get stronger: This is the basis of physical therapy. Physical therapists use exercises and hands-on care to reduce physical pain and limitations. Their motto? “Physical therapy brings motion to life.” Their goal is to help people stay active. And mobile! In some situations, physical therapy can be an alternative to surgery or drugs.
A referral to a physical therapist is likely for situations such as the following:
- Stabilization after a fall. Special exercises increase strength, flexibility, and balance. These exercises reduce the chance of a repeat fall. Or fracture. A physical therapist can also identify trip hazards in the home.
- Parkinson’s and other nerve conditions. Therapy can help your loved one retain the ability to move safely.
- Rehabilitation after a surgery. Think of knees, hips, shoulders, and feet. Exercises can speed recovery.
- Diabetes management. Exercises are prescribed to keep the blood moving! This can help lower blood glucose levels. It can also lead to faster healing of skin wounds.
- Chronic pain. Hands-on care and exercises are used to decrease pain. With therapy, many patients can avoid opioids.
A collaborative approach
With physical therapy, your relative is a member of the healing team. Therapists tailor care plans to meet patient interests and special needs. Their goal is to empower patients. Ultimately, the benefits depend on your loved one’s ability to follow through. You may want to brainstorm with your relative about strategies. Some like charting and watching progress. Others give themselves a healthy reward after each session, such as watching the next episode of a favorite series.
Covered by Medicare
Medicare, Medi-gap, and most other insurances typically cover physical therapy prescribed by a doctor. Therapy can take place in an office or clinic or, under special circumstances, in the home.Return to top
Emotions following a stroke
A stroke usually results in damage to the brain. Some of the effects will be permanent. Others, temporary. Through exercises and practice, your relative may regain many if not all of his or her physical abilities.
The emotional toll. What takes most patients and families by surprise are the emotional changes that can come with a stroke. Depression is common. Some 30% to 50% of stroke survivors experience depression. Sometimes severe depression—to the point of suicide. Becoming suddenly dependent on others may trigger down feelings. For instance, needing help with basic activities, such as dressing or eating. Even if there is no disability, the stroke’s injury to the brain may itself cause depression, even a long-lasting depression.
Does your loved one laugh or cry out of the blue? These unexpected emotional storms are another common outcome of a stroke. They are often out of sync with current activities and can be very distressing. Your loved one may feel hijacked by his or her feelings. And both you and your relative may feel embarrassed, and worried. Ask your loved one how you can help: Briefly check in and move on? Or should you actively offer comfort? Distraction, slow breathing, and relaxation exercises can help interrupt such episodes. In social situations, let others know this is simply an aftereffect from the stroke.
If you even think depression might be an issue, ask the doctor. Talk of suicide should be taken seriously. Also talk of feeling worthless or hopeless. Depression left untreated could become a chronic problem that lasts for years. Help is possible. Several medications for depression have proven quite effective for both post-stroke depression and for the bouts of unexpected crying or laughing. Get connected with others, too. Support groups provide reassurance and useful tips for families and for the person who had the stroke.Return to top