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A Word of Introduction:

The project Tell Me More about Stroke Services was undertaken for the Isle of Wight Stroke Club in May 2009. This was also part of the Isle of Wight Primary Care Trusts Stroke Improvement Programme which started in 2008. The Stroke Club also commissioned Pilgrim Projects to develop some digital stories with stroke survivors which are available to see separately. The Tell Me More interviews were undertaken by Stephanie Stanwick and Noemi Fabry from Enterprise for Communities and are illustrated here by Jess Wilson. Stephanie and Noemi would like to thank all those interviewed who were so open in telling them about the important elements of their experiences. These interviews took place in peoples own homes and were transcribed. The illustrated kernels reproduced here are all faithful and authentic to the individual telling the story. Other key points are summarised in themes in The Message Board. The nal element is some Reections by the authors about how these experiences could help improve stroke services on the Isle of Wight. The aim of this unique approach is to describe for others- stroke survivors, carers or clinicians - the problems people can face in their road to recovery, so they in turn help develop and improve the services local to them.

Illustration by cloe gillies

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Determination and Goals...

But really the target was I think a good thing, the wedding being there, he is a very determined person and unlike most of the other people in there who seem to be determined to accept their fate, he never wanted to accept his fate. But we didnt know even until two or three days before the wedding whether he would be allowed out. They said oh well we better get you down to physiotherapy then and get you a bit stronger so you can sit upright. So that gave me something to think about and I had to think about something to say at the reception. So I had worked out something to say and jotted down some notes for you to type up. The hospital were very good, It was lovely to be there but I had to go back to hospital straight afterwards and slept for a couple of hours. They let me out again for the rst part of the reception and I had the meal and said a few stupid, incoherent words, people clapped very gladly and then went back again, that was brilliant. I saw all these people and they had had a stroke like I had and I thought I dont want to be like that, I am not going to be like that, I think more than that though it has to do with your own personality, and then your determination to get yourself away from that area. There were a number of people in there who were not nearly as t as he was, and very frustrated as to what they couldnt do, but then they had no determination to get away from that. He said

I do remember being wheeled down and put into a scan machine I think it was and there after days were a bit of a blur. I slept a lot during the day, was woken up for a pill once a day and eventually started eating hospital food. I got used to it. I used to, as soon as I could get myself mobile, take myself off and go out and sit in the gardens, a few sweaters on because it wasnt very warm but I would rather do that than be in the wards. I am basically anti-social. I dont like other people particularly if they are ill. But my whole ambition right from the time I was in there was that it was only a very temporary set back and very soon I was going to be back doing whatever I was doing before. I wanted to be back doing the things I was doing,

But you had totally lost all feeling down your left-hand side and couldnt stand or walk or do anything at the beginning really could you. No, I had a lot of mental challenges to cope with which I think helped a lot. So I kept the brain turning over. My younger daughter was due to get married about three weeks after I had the stroke and the doctors told us they would either have to cancel the wedding or go ahead without me. I said nonsense, we are not cancelling the wedding and I am going to be there.

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It hasnt stopped me talking or thinking.

I also dislocated my elbow when I fell so they concentrated more on that. At the time I was in the hospital because of this and I had ve operations on it and I had to have it pinned but they treated me quite well. The after care was ne the nurse - she put me on to the Stroke Club, that was okay. I didnt have my CAT scan until a few days later, I couldnt have physio on the arm. I was in plaster from there to there for nearly three months. I picked up that bug - I picked that up.

Some people come to talk for a bit -one or two have been a bit, not over my head, but they have rambled on- you cant please everyone, but on the whole we had a talk from the re service about safety, dont leave your fags around. Id like to see a prison ofcer or the police with a dog, I love that. Id be making a fuss of the dog, that sort of thing appeals to me. but we all muck in together. You listen to other peoples problems.

It hasnt stopped me talking or thinking but it can get you down. I used to do a lot of knitting and sewing but I cant hold needles now. I used to do patchwork, make wedding dresses, bridesmaid dresses.

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I Am Not Drunk - Ive had a Stroke

Yes, he was bewildered, what had happened to him, but I would say, hed had a couple of far away experiences, he said everythings going away, and we called the doctor and he said Id better get you tested at the hospital. Obviously they were mini strokes, we never heard anything about those, but he had a big one before he even got tested. And he had a block carotid artery which could have possibly been cured. So that was important. He couldnt speak for six months.

So he had a little badge that said Ive had a stroke, Im not drunk.

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He was not making any sense with it, but he was shouting out German words and French words, because his mothers French. I used to give him the childrens cards, tomatoes and animals, and ask him what they were. I showed him a banana once and he went tomato, mato. But we were told off by the speech therapist, she said that we dont believe in that, but gradually he was looking at things and pointing. I found my own way to help him. And he actually slept in a chair, because he was in pain. Gradually going to Laidlaw, brought him out of himself, once a week, you went, for a little bit of physio and a bit of chat, and he gradually, gradually got better didnt you? I can remember him getting so frustrated, he was walking along the front and he suddenly got his walking stick and threw it. You do need a bit of help though I think, because its so frustrating if youre trying to dress yourself, its easy to collapse into I cant say self pity because it is a terrible shame. You were embarrassed werent you, if someone asked him the way or did he know where something was, and he couldnt say anything,..that woman said, oh hes drunk

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I was on Holiday with a friend when

in for a month. The physiotherapist came and the occupational therapist and I had to go to the gym and learn how to start all over again. I couldnt remember who the people were. Somebody came and they gave me

with a friend, we were both staying on the seventh oor and we had just gone into breakfast. I have really high blood pressure and I forgot my tablets, I ran up seven ights of stairs and when I got near the top, I wondered whether Id make it. I just collected the tablets and came downstairs, I started to feel - I didnt feel myself I didnt have a headache or anything but I got a little bit of tingling. We had to make an early morning start to come home and I like to pack and get everything ready, but I packed and I unpacked, I packed and I unpacked again and again. I kept thinking Id left something behind, I took the whole night nearly to pack and I was in quite a state.

I was very confused. I did make rapid strides physically and I can walk, I can touch my toes. But when I came home I felt like a stranger in my own at, I didnt know how to use the television, I didnt know how to answer the telephone, I wiped all my numbers off the television system and it took about four days to get used to making a phone call again. Even now I nd it hard to understand a form, I cant even enjoy a magazine because I cant retain anything, I love to watch programmes on television, mainly the quiz programmes because Im trying to train my brain again and that is something that only I can do. I cant remember anything Ive learnt, so Im having to start all over again and its quite an experience and Im nding something different about myself each day and I have to now live a day at a time. My friend and I have some very interesting conversations and understand each other perfectly well. I think shes the only one that understands me and she tells me something and half an hour later I cant remember but I cant explain it to anyone that hasnt had a stroke.

so I phoned my friend, she said are you all right youre slurring your speech, lets see if we can get a bit of advice on what you can do because you have got this nasty headache . She rang Accident and Emergency and they asked if I would go to the telephone and tell them, I went towards the phone, and suddenly, I had difculty, I couldnt remember my address, I couldnt remember really what was wrong, I couldnt remember my name. I was taken to casualty and I spent quite a long time, different people came and looked at me and I was taken on to a ward to be assessed and I was there all day, I cant tell you, what happened ,but at midnight I was put into a gown and I had to have a brain scan. I was petried of that because I didnt know what to expect and it was sort of like going through a polo, They were able to give me the results straight away and, I had a brain bleed on the left hand side in the front. When there was a bed on the stroke ward I went up there and I was

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Only 2 Hours.

He had his rst stroke in 2000. He was in hospital for three weeks. It wasnt severe but there was no stroke ward, he was on a main ward with just ordinary general patients and nobody seemed to understand how to look after somebody whod had a stroke. When he had his last stroke, it was eight years virtually to the day, he went to the stroke ward and the atmosphere was so different. You felt youd got people you could talk to and ask advice. The thing is people that have had a stroke dont realise the strain they put on the carer and if the carers got somebody to turn to you feel that its relieving your burden a bit because you can explain something to them and they can tell you how to deal with it. I feel sometimes ... you get to a point you feel oh if only you could say, right, were going away, hes going to respite care and Im going to have a break but he wont go to respite care anymore. So I get two two-hours twice a week, a carer comes in to sit with him and I get two hours off but those two hours go by so quickly especially when you say well I must do this and I must do that, I must do something else and its not two hours to do what you want. Its either get the prescription, take it to the doctor or theres something to do and even now I feel very, very frustrated at times. Its nice to have the Community Matron, shes at the other end of the telephone and if I need her she will come. If she thinks he needs a doctor she will then phone the surgery and get the doctor. She does all that a doctor would do if you called him in, his blood pressure, his temperature, she listens to his chest and his back to make sure that he hasnt got any uid on his lungs.

Some information explains the aggression, how he can get aggressive, and at times very demanding and youve got to learn to count to ten. Ive got to the point now where if hes being nasty then my best bet is just leave him like you would a child. Alright, get on with it, and I go upstairs out of the way and by the time I come back down the mood has passed and hes ne but at that point you dont realise what a strain it puts on you, not really, not till it happens to you Ive got a load of books that came my daughter got them from the Stroke Association. They sent me all these books through and that was when I came to understand the behavioural problems, and if it hadnt have been for them I mean I just wouldnt have known because I just would have taken it that it was just

so I found that those books were very helpful. So the Stroke Club is a good release because you can go and he can chat to the others there, I can talk to them, so youre together but apart and he enjoys that and he enjoys the outings

theyre either carers or theyre the stroke survivor. So theyre a lovely lot, and the message from them is always the same, if you need to talk pick up the phone. You can get some lunch so its like a treat really because I havent got to think oh Ive got to cook the dinner, somebody else, even if its only soup and a roll, somebody else is doing it for you, thats the nice bit.

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To be Treated in a Special way

The Community matron takes my blood pressure and everything, she does the lot. She acts like a doctor and its true, shes just like the doctor, and she can prescribe or change anything and she just tells the doctor what shes doing

One Friday night I went to bed and woke up in the morning and I couldnt get my speech out, it was like I was drunk. I dont drink but I was slurred, I didnt know whether I was coming or going. That was on Friday, on the Saturday morning, it was nearly dinner time, I said to my wife the best thing I can do is see a doctor so she phoned the surgery, went down and it was my own doctor funnily enough that was on duty and he said youve had a stroke youre going to be warded. Id heard of a stroke, I never thought it would happen to me, Theres more help given now to stroke victims and the stroke club is there.

I wouldnt have been in and out of the hospital like a yo-yo. I was a regular feature in hospital. It started in 2000 and I had a big stroke and then pneumonia, pleurisy, pulmonary embolism, DVT and then the doctors thought that I had trouble with my pancreas so they sent me into hospital for that but, as I said, they couldnt nd anything and something else developed Its important to be treated for a stroke not just as an ordinary patient, thats what happens. Anyway now stroke affects people different ways,

I was on the ward and in the next bed to me was someone I knew and hed had a stroke and he was only in two or three days and they moved him to a side room, he didnt come out, he didnt come out of it. I think Im very lucky to have got this far.

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The Kind of Support

wI just assumed that. Ive read a lot, and I knew that he was having a stroke. And when the Sister did tell me that he had a big stroke, and then I really wanted to know, was it a blood one or was it a blockage. So thats why they sent him over to Southampton, and it was a blockage. He cant go up the stairs, he sleeps in the front room now, since he had pneumonia, it injured his heart muscles. When he came home thats when we decided to get him downstairs. Trying to get him to move was awful, so I thought he needs a reclining chair, so I went to see if I could hire one, if he wanted to go to the toilet Id just help him there. Then I thought Im going to get a bed down here, and thats when I got his rising up and down bed, in case that happened again, and I put it over in the corner there because I only had a small three piece suit, and so he was with us and we could sit him up and lay him down. We built the garage into another room and put a bed in there. Ive got a bed that I could press a button and he could sit up.

And I mean sometimes I snap back, but he does try. I mean he could really have sat down and not done anything, and just withered away, but he hasnt, hes kept himself going. But I do worry if I go out and leave him, in case hes fallen down, and I dont like leaving him much at all. I should do, but I dont. I couldnt go on holiday and leave him behind, never, ever. The kind of support you get is from your family, but I think people can get fed up, but at the moment, touch wood, it hasnt shown. The Stroke Club - I saw it in the newspaper and said lets go and see the people at Riverside, and so we went. He really likes going there, because when he walks in they all say hello so he enjoys himself. We went off to Newquay with them a month ago, but we couldnt do much because of the weather. But it was a break, its a change, and the food was nice, and I didnt have to cook. My brother comes and gets us once a year, and he takes us down to Norfolk and really treats me, he says Im going to look after you. He took us out on a boat and we had a banquet with 12 other people. He puts us in with his friends and they do good, exciting things, its really nice. And he comes and fetches us all the way and takes us, brings us all the way back, so its good. So thats what I call my holiday now. And apart from that, I manage.

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Things are different now but.

This was in 1998. I went to hospital, I must have gone into a coma or something and I woke up two weeks after and I was in Southampton General. I was there for three months and then they sent me back to St Marys. They never had a stroke ward like they do now and they stuck me in an old peoples ward and I was 47 years old and I was the youngest and it was horrible.

Now Im on botox, I asked if I could go on it, I am now having botox which is working and also having this treatment for my leg in Salisbury. I have got to learn to work with it so my foot can go up and down, Ive got dropped foot. So thats good. I can go shopping with my husband now but I still wanted to get better. Im lucky, my care manager sorted things, I go to the Riverside at Newport and Ive been up there since Ive been like this, must be nine years this year Ive been up there, and they asked me to go on reception so I do two days reception work now on a Monday and Friday. It took me a long time to get used to all the numbers and to do it and I persevered . The care manager I had from hospital, she was sick and then I had someone else, I havent got a care manager at the moment, Im just waiting. If anything crops up I can phone, there is always a duty manager on and they will come to me I want to get something out sometimes but its there, but I cant get it out, cant get the word, its all part and parcel of it. My family say, oh shes off again, and I say Ive been scrambled upstairs, thats what I say. There are certain things you cant do. I think, oh I wish I could go walking, I wish I could do this, you cant do some of these things? You have got to plan your day. Ive got four grandchildren and I would love to have them to stay but I cant change their nappies. It is just normal things you cant do. I would love to have them for the night but I cant, I cant see to them, I cant bath them, I cant run with them, just the normal little things, -it gets you down. I found out who my friends were. People I thought were just acquaintances have been really good friends now. People I saw once in a blue moon I see every week now, but friends I thought was friends- no. My independence has gone. I cant just say oh Ill go here and do this and do that - I cant do it. Like when the children were small on a day like this Id say right, come on, lets go down the beach for the day. I cant do it now, I cant get on the beach it is things like that. It was nine years ago now, a lady came to St Marys and she wanted to know of anybody who had a stroke on the Isle of Wight, I went to one of these meetings, because there wasnt anything for strokes on the Isle of Wight back then. So it was at St. Marys, the social club, we all met. The beginning of the Stroke Club and then we decided to meet somewhere else and it went on from there and Ive been with them since day one, I want to help people with strokes not to be left alone, make sure that everyone who comes out of the stroke ward goes with this package that has all the names and addresses and phone numbers for contacting the stroke club so that people who have had strokes can come along and become members.

Now that weve done the stroke ward it is beautiful. I didnt want anybody else to go through what I went through. I didnt have anything because I was walking, I learned myself to walk with a nurse, so because they said I was walking they didnt want to know about other things. Back then I came out of hospital with no information, no nothing, just get on with it sort of thing.

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Coping with Anxiety...

it never goes away. I can get in the car and be going along just looking at something and it will sweep over me and it is up to me then to make that go. I say to myself its only in your head, it will not harm you, its only thoughts and thats what I try to concentrate on.

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Well I went to bed and dropped straight off which is unusual for me, and I just woke up and I knew something was wrong, my speech was wrong, Id wet myself and I woke my husband, he rang for an ambulance and they came, did all the vital signs and that. My blood pressure was way up but I didnt understand what was going on, I was panicking and when I got to the hospital I had another one, a mini stroke and they said dont worry about it, were doing everything. I took their word for it, Im quite an excitable person, I worry about everything. I was there about three or four days when they said I could go home and I was going out the door when I collapsed. I was so scared I kept going into this panic. They even brought someone over from mental health I didnt realise I was going into this panic, you see, She sat down and spoke to me because every time I went out of the ward I panicked and had to go back to bed, I was there eight or nine days. I had a very good GP, and he put me on some medication to calm me down and things were getting better and then they tried to wean me off - I was so anti drugs, he said I needed some psychiatric help really but there was nothing available, nothing. So my husband suggested seeing somebody privately. I saw this lady and she was absolutely brilliant with me and she said to me not to be afraid of the drug I was on, it was my friend rather than my enemy and she recommended I had this small Librium, 5mg, and if ever I needed that, this would be my little prop. I went from there and paid for some relaxation classes, it was one to one and that got me focused so when my panics were bad I could turn my brain to something different. I am a Catholic and quite a good believer and we found things like saying the Lords Prayer, if I said it for three and a half minutes the panic would go, so this is how I taught myself to get myself out of it and gradually, I suppose it took about ve years until I started to feel condent.

We went to Newquay and I was excited about going but when I was in a strange bed, strange room, it started. So I just got out and took one (tablet) and I was ne, it calms me down and makes me think rationally and get into my exercise and then I can just carry on and do things. The turning point for me must have been two years after I had it and I started the Stroke Club and I knew there were other people like me because people didnt talk about it then, it was very taboo. I used to say dont tell anyone Ive had anything wrong. If people said to me, oh I havent seen you for a long time Id say, oh Ive just been getting on with things. My worst fear is that Im with my grandchildren and I just die, but that is something you have to learn to live with, you have to try and block it out. I used to write sheets of paper with positives and negatives, what are all the positive things Ive done today, whats all the negatives - and the positives so outweighed it, but with me I was self critical. I was brought up in the environment that there was something taboo about mental problems, and it was overcoming that block that helped me. Now I can talk about it. Sometimes my children dont understand,

I say its because my brain cant formulate these things unless I sit down and think about it, do you know what I mean? It can happen anywhere, I can be in the garden and all of a sudden I get this awful feeling come over me and I think come on, talk to yourself, you can do this, breathe properly and then it passes. Basically it was my own self determination. I read lots of books, I read a book called Treating Anxiety Without Drugs by Margaret Hills. I read lots of books that tell you about mental health, sometimes the signals from my brain I know what I want to say but sometimes the signals from my brain dont tell my body what to do. It gets jumbled and it is like opening a page that isnt right so I close the book and go on to the next page, if you can understand. I can say that my road to recovery was partly self help and partly medical help. I had to nd out all this on my own. I was determined that I didnt want it to ruin my life.

The Advice I would Give .

I think I would actually try to talk to their relatives quite a bit at rst to help them to understand how difcult it is to be muddled up and not say the words that you want to say and maybe be a bit incontinent, not be able to use your body as you used to use it, and if they are understanding about that then that person thats had the stroke can recover in so much better way. When you realise that you cant talk properly and your body doesnt work in the way that it used to work and if only somebody would say to you in a very positive way just have patience and just wait and just

But I must say that a great deal of ones own determination and insight is needed to recover from things as I had. Id like to think I am an optimist and that stood me in great stead because it would have been so easy to have stayed in a trough of Oh what the hells going to happen next sort of thing You shouldnt push yourself, you have to learn that the disability is present but it doesnt stop you from carrying on quite a normal life so thats all I can say about that really. When I needed that kind of perseverance I found that it was inside of me. Theres something inside of you that enables you to think well Im going to do it.

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In the Beginning ..

I was in the health service and my last job was as a health visitor, Then I met two nurses that had begun to do some work with stroke patients on the island. It wasnt very well organised and they had a huge job on their hands, they were extremely understanding and in touch with people, they listened, and I admired them both tremendously for the work that they were doing. So I phoned people up and phoned the Stroke Association and thought lets have a go on the island. Youve got to use your nous when youre starting something up and so you just go round and talk to people. Everybody could see that that would be a really good idea. So the hospital allowed us to meet there and it got bigger and bigger, and there was a real need for it - we had some really good ideas, and we had some really good people that came to join us as well.

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The stroke club has got stronger. The group of people that formed the committee had all different abilities, different strengths and different ways of enabling us to go forward. Now we have hydrotherapy. Theres a kind of helping ethos about the club for people having had a stroke. A stroke can have such catastrophic effects on a person. So when you are in a club and you see all of the amazing things that people are capable of - Ive met the most courageous people that inspire you really to do things so that they can have at least some pleasure out of their lives. Its very important to value people. It is quite inspiring, you know, when you meet loving people that give of their lives without cost at all and of course one of the good things about the club is that you meet every month so its a regular occurrencetheres a continuing friendship. You dont have to have a friendship thats intrusive but the support that comes from getting to know people You learn so much about people, when to talk to them, when to support them and when to leave them alone. Youve got to be positive about things but the familiarity of knowing a face even if you cant talk very well, its very comforting to people actually and the Isle of Wight isnt a very big place. Theres friendships that occur outside of the club because people come to the club and all of those things go on, its everlasting.

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Everything hit me like a ton of bricks

Lots of little things like walking was all right but I was frustrated at being so tired.

and then on the Monday, I went down to the doctors, and he was a young doctor I saw, he just said oh youve had a mini stroke, take her home, plenty of rest,

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but I kept complaining of this arm and they said well thats normal what do you expect? I couldnt do anything with the hand, I couldnt move it. The hand and arm was hurting so much, I went back to surgery and in the end they took me up the hospital for an x-ray, because of the osteoporosis Id crushed all the bones in the wrist, the hardest thing was because of being left handed, I couldnt do anything. I remember that Sunday I was just feeling, I was here but I was a million miles away, and just really feeling something wasnt right , I just couldnt place what it was. I was just going to lie on the bed and all I remember is coming out through the door and I was in a heap in the hall and I was shouting out but nothing was coming out, I didnt realise it but I wasnt getting any words out. But the biggest and this was the most depressing thing was the fact that I couldnt use my hand . I still go and pick something up and I get cross because all of a sudden I feel Ive got grip but its not. My memory as well, because I was doing a computer course at the time and when I went back to do the course I just couldnt remember where I was, I was doing Microsoft Word and I just couldnt, looked at the screen and it was just like looking at a blank screen, I hadnt got a clue where I was, what I was doing, how far along Id done. Im actually starting now to do this again up at Riverside and its a fantastic unit and you just do it. If youve had enough after half hour you can stop.

I dont know with what, I just had no energy, Id try and get my words out and they were all sort of slurry and the headache! But the biggest most frustrating thing was to get my hand back because there was so much I couldnt do . I was stubborn, you know, and then afterwards, I had depression and everything hit me like a ton of bricks. I kept on -oh Im okay, Im ne, because Id got a splint on my hand I was up and I was doing stuff here and then all of a sudden Obviously my body was just shattered I was just worn out and I just didnt realise how worn out I was. I got cross I think with myself but the depression was bad. People are just ignorant, if youre talking funny they think youre drunk, you know, they dont think that maybe its a genuine reason, they just sort of cast you aside if you cant remember things people ask why cant you, you can remember this. Its just certain things that you can, certain things you cant. I write things on a piece of paper -its terrible, like a kid, Ive pens now, theres notepads in the drawer, so I know where it is, thats the only way to remember it. Since going to the group its nice because theres other people that have got the same, -

We all can have a laugh and a joke and we can do things and they have people in and we have a talk, its like a family, which is nice to know youve got that.

Some Reections..

Information providing information about Strokes for people needs to be more carefully thought through to help people cope with their scrambled brains. This applies not only to the format of the information itself but also how and when it is made available to the patients and their carers. The Stroke Club has the expertise and understanding, together with the professionals, to develop this further for local public services Brain Training- was a phrase used by one of those interviewed to describe the process of getting things back together. The theme is repeated by many in different ways to describe their own way back to ordinary every day life. They all had their own coping strategies and methods, but all of these are important in helping to support others in building their own recovery programmes. The Stroke Club could provide a key role in this work. Supporting Carers- we need to do more to support carers to understand what is happening to their loved ones. Alongside the physical rehabilitation is the need to help them with their own isolation, and understand how best to cope and help with the scrambled brains and the different challenges that presents. This can be about speech, anxiety, depression, frustration and anger. A knowledgeable professional could help the Stroke Club to develop this further. Respite for carers is much talked about in national policies but a simple and practical approach could be developed alongside the more formal services provided. Skills, Knowledge and Understanding- some spoke with great respect about the care provided by the various clinicians involved with them and they acknowledged the great progress made in the quality of services provided over recent years. But there is a skills gap particularly where care needs to go beyond the physical to support the brain training and to support the development of self management approaches.

Self Management and Motivation this was a key element in all these peoples experiences, and a more structured recognition of self management approaches which are used to help other chronic conditions could be built on to support local people, and provided by the Stroke Club. These approaches could also be started when people are admitted to the Stroke Unit by helping people to understand the importance of motivation, pacing and setting their own goals. Coping with Anxiety and Depression- many people struggled with anxiety and depression nding their own coping strategies but nding it difcult to express the issues they were facing. This is an element that the Stroke Club could think about developing as part of their programmes The Stroke Club is a Community valued by many people for the support, the physical programmes, the friendships, their commitment, care and availability a simple solution but equally challenging more please.

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Illustration by Jasmina Factory

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illustrations by www.jesswilson.co.uk

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