Friday, March 9, 2012

Two steps forward, two steps back

Up until late January, Mom seemed to be making good progress. She was working with physical and occupational therapists up to two hours a day most days. Walking again was never expected, but she got to the point where she could move herself in bed, sit up with assistance, and even move around a bit in a wheelchair. She was communicating much better, able to say recognizable and meaningful words and short phrases. She usually couldn't write full words, but her letters were becoming clearer. And she seemed to understand most of what was said to her.

But the last several weeks she's been getting worse. She hasn't been cooperating with the therapists as much. Sometimes she's just too groggy to work with them, but often she really seems to be refusing to work. The therapists and I have talked about ways to try to motivate her, but most of what Mom enjoys is beyond her right now. Reading and knitting certainly aren't options.

She's also been slipping in terms of communication, both speaking and writing. Again, she really seems to be giving up. Oftentimes, I can't even get her to answer yes/no questions. When she does answer, it's frequently the wrong answer. I always ask her if she's exercised that day, and she'll say "no" when I know the answer is "yes". I can't tell if she's forgotten whether something has happened, or if she's just picking the wrong word. And she's still screaming. A lot. Trying to gently talk her through the screaming spells never works. I think sometimes she can't stop, even if she wants to. The parts of her brain that regulates emotions and impulse control have probably had a lot of damage too.

After I talked with Mom's primary care doctor about this reversal, he set up an appointment with a rehabilitation specialist. I went with her to see him yesterday. The specialist is recommending tests to find out if there are physical reasons for Mom not doing as well since January. They'll do bloodwork and a new CT scan of her brain. He also recommends that some of her medications be adjusted, so she can have the benefits of the antidepressants, pain killers, and muscle relaxers, without so much grogginess. After that, the specialist and her primary doctor will consult with each other and decide where Mom is in her recovery. Their focus now is to see if any of her negative symptoms are reversible, and if she's already made about as much progress as she's going to. For most stroke patients, most of the recovery takes place during the first six months. It's been three months since Mom's stroke.

I hope some of the answers are available next week. I have a care plan meeting scheduled with the staff at the subacute facility to talk about what to do after Mom's 100 days there are up. No matter what happens with the tests and consultations, I know that it's most likely that she will need to go to a long-term care facility. But I'll feel a bit more confident about some of the decisions I'll have to make if I know more about what to expect in terms of recovery.

1 comment:

Marjorie said...


My only persoanl experience was with my grandma - As you say, most of the noticable improvement was in the first 6 months, although she did continue to make some progress after that it was much slower, and I think did depend a great deal on her own motivation.