How can life be organized after a stroke?
For many stroke victims, the diagnosis of a stroke means that a lot changes in their lives. A stroke is a serious illness that often has severe consequences – including physical and mental disabilities. On the one hand, these mean many years of therapy and rehabilitation, and on the other, changes in everyday life.
For some of those affected, even the simplest things such as dressing or eating independently remain difficult or even impossible, even after rehabilitation has been completed. It is then necessary to adapt the personal environment to the new conditions, for example by redesigning the living space to make it suitable for the disabled or by taking advantage of nursing assistance. Often, these tasks fall to the relatives, who are just as affected as the stroke patient himself and need appropriate support.
Depending on the extent of the disease and the course of therapy, sometimes only isolated abilities such as driving or cycling are impaired for a certain time. In this case, it is important to train these again and gain confidence in them. But even if you may not be severely restricted, it always takes some time until you return to your usual daily routine.
Stroke & Driving
If you drive a car, your ability to drive after a stroke is affected in two ways. First, there is the risk that you will suddenly suffer another stroke. On the other hand, there is the risk that your performance is reduced due to the consequences of the stroke – for example, due to paralysis, visual disturbances or a slowed ability to react. In both cases, you endanger yourself and other road users behind the wheel of a car.
Self-responsibility required
The law requires all people with a driver’s license to take personal responsibility – whether they are stroke patients or not. Therefore, always check yourself to make sure you are driving a vehicle safely through traffic. After an illness such as a stroke, however, the law requires that those affected take “appropriate precautions” to ensure that they do not become a hazard at the wheel. This includes patients getting expert help.
Ask your doctor
The first port of call is your attending physician. He or she is in a position to assess whether you should still or already get behind the wheel again, or whether you should refrain from driving for safety reasons. This abstention is either temporary – until you are fit enough to drive again – or permanent, for example in the case of permanent paralysis.
In addition, inform the responsible authority (driver’s license office) voluntarily about the stroke and submit a specialist medical report there that is not older than six months. This is, for example, the discharge report of a rehabilitation clinic or the expert opinion of a neurologist with traffic medicine qualifications. This expert decides whether, for example, additional driving lessons, a visit to an ophthalmologist or a neuropsychological report are required.
In most cases, the authorities decide on the basis of the documents whether you may continue to drive (possibly with conditions or restrictions) or whether you must surrender your driver’s license. If the authority is not satisfied with the report, it will arrange for a medical-psychological examination (MPU).
Medical-psychological examination (MPU)
Assessment centers for driving suitability carry out the MPU. Such accredited testing centers exist, for example, at the TÜV. The MPU is divided into several parts:
Firstly, on the basis of a medical examination, a specialist doctor or a specialist or rehabilitation clinic draws up an up-to-date report on your state of health.
Third: In an interview, a psychologist determines whether you have also psychologically coped with your stroke, trust yourself to drive and feel fit for road traffic.
Driving test
Many stroke patients have limited mobility and need a modified vehicle. This might be a car with a steering wheel knob. There are driving schools that specialize in stroke patients and have converted cars that patients take driving lessons in. The driving test can then be taken at the TÜV or DEKRA.
The decision
Based on the documents you submit (specialist medical report, MPU, driving test), the driving license authority decides whether you are fit to drive. In the best case, the authority comes to the conclusion that you may keep your driving license without restriction.
Often, however, the expert opinion results in conditions or restrictions and a corresponding entry in the driver’s license. For example, after a stroke, some people are only allowed to drive a car with specially adapted steering. Others are no longer allowed to drive at night or on highways.
Costs
Get certainty
Although it’s not cheap and the driver’s license office may end up revoking your license, be sure to have your fitness to drive checked after a stroke. An objective assessment by experts will provide certainty in the event of possible self-doubt.
Above all, however, it is important to remember that anyone who is unfit to drive but nevertheless gets behind the wheel endangers themselves and others, is liable to prosecution and risks their insurance cover.
Stroke & profession
For working stroke patients, the question of their professional future arises. Talk to your doctor during rehabilitation about a possible return to work or a reorientation.
The most important contacts for such questions are the employment agency and the pension insurance institutions. Among other things, they promote measures for professional reintegration through training grants and retraining. The central task of vocational rehabilitation is to find the right job for you. Basically, there are the following possibilities:
- Return to the former job (if necessary with an adaptation of the job)
- Gradual reintegration (such as part-time work)
- Change of job within the previous company
- Retraining in another profession
Partial reduction in earning capacity
A partial reduction in earning capacity (formerly called “occupational disability”) exists if, due to illness or disability, it is possible to work at least three but less than six hours per day, based on a normal 5-day work week. If this is the case for you, it is possible for you to apply for a pension for partial reduction in earning capacity. This is intended to compensate for the reduction in your salary if you are no longer fully able to work.
Full reduction in earning capacity
People who are fully incapable of working are those who, due to illness or disability, are unable to perform any gainful activity with some degree of regularity for an unforeseeable period of time. In concrete terms, this means that someone is capable of working less than three hours a day in a 5-day week on the general labor market.
People who are unable to work have the possibility to apply for a pension due to full reduction in earning capacity. It replaces wages. The reduced earning capacity pension is usually granted as a temporary pension, i.e. for a maximum of three years. The time limit can also be repeated upon application. After a total of nine years, it is usually assumed that the person concerned is permanently incapacitated. Then the temporary pension payment changes to an unlimited permanent pension.
Stroke & Travel
The general rule is: No extremes! Mountain tours above 2,500 meters sea level, deep-sea diving, a photo safari through the jungle or cruises in the Arctic are not suitable travel plans for stroke patients.
Prepare the trip well
Prepare well for the trip. For example, book accommodations for the disabled, if necessary. Find out about the medical care available locally. Ask your doctor about recommended vaccinations. Also, ask him or her to provide you with a certificate of your diagnosis and treatment (possibly in English).
Also, be sure to bring sufficient quantities (or appropriate prescriptions) of any medications you need to take regularly (such as anticoagulants or antihypertensives). Ask your doctor or pharmacist how to properly transport and store medications.
Before traveling abroad, it is advisable to take out international health insurance with repatriation in case of illness. This will save you high costs in an emergency!
Healthy on the road
To avoid overloading your cardiovascular system, avoid long car or bus rides in extreme heat. Strong temperature differences, for example between the outside temperature and the air-conditioned air in the hotel room or car, are also unfavorable for the heart and circulation.
Divide any medication you need between your hand luggage and your travel luggage, in case one of the pieces of luggage gets lost. At your vacation destination, also make sure that you store the medication properly (as indicated in the package insert) so that it does not lose its effectiveness.
What tips are there for relatives?
The consequences of a stroke affect not only the patients themselves, but also the people who share their lives. Relatives usually need a lot of time, patience and empathy. In addition, it is often necessary for them to completely turn their own lives upside down to help care for the patient. In some cases, even caregivers or therapists reach their limits and need the support of relatives.
The stranger in one’s own home
It is particularly problematic for relatives of stroke patients when the personality of a familiar person changes as a result of the illness. Many stroke patients initially react to the helplessness and the sudden loss of their own abilities with despair and depression, while others tend to show aggression.
Lovingly and with respect
As a family member, do not make decisions over the head of the patient. It is better to let the patient speak for himself. This is especially true if the person is no longer able to communicate easily because of the stroke. Give the patient time to communicate.
Between asking and helping
Relatives are the most important helpers for stroke patients on the way back to a life as independent as possible. This is because therapy sessions alone are usually not enough to regain speech, attention skills or movement control, for example.
The whole of everyday life is a training course for those affected. Therefore, resist the temptation to mother the affected person too much, to take over every handshake or to finish incomplete sentences for him. Only intervene if the person is unable to cope with a situation on his own or is too exhausted to do so.
On the other hand, some relatives make the mistake of turning the day into a continuous training session. This may completely overwhelm the patient. Life with a disability is very strenuous, especially in the beginning, so rest breaks are urgently needed.
Strengthening self-confidence and joie de vivre
Dealing with aphasics – special features
Dealing with people who suffer from impaired speech (aphasia) is usually difficult for family members because of communication problems. Some helpful tips:
Don’t take the words out of the aphasic person’s mouth: People with aphasia often speak haltingly and search for words for a long time. In this case, it is important to wait and see whether the aphasic person finds the term he is looking for. For him, every linguistic sense of achievement is important. He often succeeds in expressing himself if he is given enough time.
Facilitate communication: Speak slowly and clearly with an aphasic and underline what is said with facial expressions and gestures.
Ensure understanding: Sometimes someone is not sure they have understood an aphasic correctly. Then simple yes/no questions help to make sure you are correct. Ask if he understood everything if the aphasic seems confused.
Don’t correct too much: Don’t correct directly when an aphasic makes mistakes in sentence structure or use of a term. This is because it further frustrates and alienates the person. Some aphasics then refuse to speak at all for fear of making embarrassing mistakes.
