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Section 1
Left Hemisphere Stroke - 8 Steps to Smooth Communication

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In this section, we will discuss reflex crying and four recommendations for family and friends of a person who has suffered a stroke.

Madeline’s father, George, 76, had suffered a stroke.  The stroke had left George with a weak right side, mild aphasia, and difficulty using his hands when doing simple tasks, like eating.  Madeline knew this must be frustrating for her father, but she couldn’t understand George’s emotional changes and mood swings. 

How to Explain the Reflex Cry
Madeline stated, "My dad has physical challenges, sure.  But he never used to react like this.  Even when he broke his hip a few years ago, he was in a pretty good mood, and he never cried.  Now he’s so upset when his plate slips away from him at dinner, he sometimes bursts into tears! And sometimes he cries for no reason at all!"

I explained to Madeline, "Your father may be experiencing something called reflex crying.  You can think of reflex crying as what happens when the doctor hits your knee with the reflex hammer and your leg jerks. 

"In the same way, because of the damage caused by his stroke, George’s crying reflex may be triggered even when he isn’t experiencing the kind of intense emotions that would have normally, before the stroke, caused your father to cry.  Over time, reflexive episodes of inappropriate crying, laughter, and anger often diminish, as do any unaccustomed feelings of suspicion or overwhelming sadness your father may be feeling."

4 Recommendations for Family and Friends

To help Madeline deal with George’s emotional reactions of stroke, I gave her the following four recommendations for family and friends of a person who has experienced a stroke:
           
Recommendation # 1 - Ask
Ask the patient what would comfort them.  I suggested that Madeline ask her father how he would like her to handle it when he cries.  I emphasized that this should be done at a time when George is not crying.  I stated, "Some stroke patients prefer that you not call attention to the fact that they are crying, but to continue conversation with them as if they were not.  Distracting George with conversation may actually make the crying stop more quickly."

Recommendation # 2 - Be Empathetic
Be empathetic and understanding.  Whether George’s tears are a reaction to a particular upset, like when his plate slips away from him, or seem to have no apparent cause, I told Madeline that it could be helpful to say something like, "I can see how difficult things are for you right now and how hard you are trying."  I stated, "I have found a good gauge regarding what is appropriate to say, is to think of what you would want to hear if you were in George’s position."

Recommendation # 3 - Be Respectful
Be respectful of feelings.  I stated to Madeline, "Because of your own discomfort at seeing your father crying, you may be tempted to look away or leave him alone.  But unless George specifically tells you that he wants you to leave, it may be better to stay nearby, remain calm, and be as supportive as possible."

Recommendation # 4 - Restorative Powers of Crying
In addition to ask the patient what would comfort them, be empathetic and understanding, and be respectful of feelings, the fourth recommendation I gave Madeline is to know that crying has restorative powers.  I stated, "Although your father’s crying may be stressful to you, it may be beneficial to him.  Researchers have discovered that crying has both a psychological and physical healing value, because it releases tensions and relieves emotional stress."

Since George’s left hemisphere stroke had left him with mild aphasia, his difficulties with speaking and understanding became a source of intense stress.  Madeline stated, "Sometimes it’s so hard to communicate with Dad!  I try helping him find words when he seems stuck, and I’ve been trying to speak slowly and loudly, but he just gets frustrated to tears!

♦ Technique: Smooth Communication in 8 Steps
I recommended that Madeline try the Smooth Communication in 8 Steps technique.  The eight steps in this technique are:
-- Step # 1. Prepare an area for conversation.  I stated to Madeline, "Quiet, calm surroundings with few distractions will help George concentrate on communication, and will help you focus on understanding him better as well."
-- Step # 2. Use simple sentences, but be careful to avoid a condescending tone.
-- Step # 3. Unless the stroke sufferer has a hearing impairment, a normal tone of voice is more effective for enhancing communication than an excessively loud one.
-- Step # 4. Don’t pause between words, as this can be confusing.  On the other hand, clear pauses between sentences or phrases can help the stroke sufferer grasp the meaning more easily.
-- Step # 5. Phrase questions simply, so that they can be responded to with yes or no answers.
-- Step # 6. Never force a response; rather, encourage a response.
-- Step # 7. Because it takes a great deal of energy for someone with aphasia to talk and process information, try to time conversations for when the stroke sufferer is well rested and relaxed.
-- Step # 8.  Since communication is the goal, it is inappropriate to correct grammar or pronunciation.  I stated to Madeline, "Focus on the ideas George is expressing.  Correcting the mechanics of his speech may be distracting, or even upsetting."

Think of your Madeline.  Would reviewing the smooth communication in 8 steps technique help him or her improve communication with a stroke sufferer dealing with aphasia?

In this section, we have discussed reflex crying and four recommendations for family and friends of a patient who has suffered a stroke.

In the next section, we will discuss we will discuss six suggestions for getting up when you’re feeling down.

QUESTION 1
What are the four recommendations for family and friends of a patient who has suffered a stroke?
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