After a Stroke: Support Gestures, Speech Therapy, Occupational Therapy in Daily Life

Estimated reading time: 17 minutes

Cerebrovascular Accident (Stroke) affects nearly 150,000 people in France each year and represents the leading cause of acquired disability in adults. For survivors, returning home after hospitalization and rehabilitation marks the beginning of a new stage: that of daily readaptation. Home care professionals play a crucial role in this phase, by supporting the person and relaying the work of rehabilitation specialists day by day.

This comprehensive guide presents the common aftereffects of stroke, appropriate support gestures, and how to collaborate effectively with rehabilitation professionals (speech therapists, occupational therapists, physiotherapists) to promote recovery and autonomy of the person being cared for.

Understanding Stroke and Its Aftereffects

What is a Stroke?

A stroke occurs when blood circulation to a part of the brain is interrupted, depriving brain cells of oxygen. Two mechanisms are possible:

Ischemic stroke (80% of cases): a clot blocks a cerebral artery.
Hemorrhagic stroke (20% of cases): a blood vessel ruptures and bleeds into the brain.

In both cases, the brain cells in the affected area die, resulting in the loss of the functions they controlled.

Possible Aftereffects

The aftereffects depend on the area of the brain affected and the extent of the lesions. They can be:

Motor:

• Hemiplegia: paralysis of one side of the body

• Hemiparesis: weakness of one side of the body

• Balance and coordination disorders

• Spasticity (muscle stiffness)

Sensory:

• Loss or reduction of sensation on one side

• Neuropathic pain

• Neglect of one side of space (hemineglect)

Cognitive:

• Attention and concentration disorders

• Memory disorders

• Reasoning and planning difficulties

• Slowness in information processing

Language (see our article on language disorders):

• Aphasia (difficulties speaking and/or understanding)

• Dysarthria (articulation difficulties)

Visual:

• Hemianopsia: loss of half the visual field

• Diplopia: double vision

Emotional and behavioral:

• Depression (very common)

• Emotional lability (uncontrollable crying or laughter)

• Intense fatigue

• Irritability

Swallowing:

• Dysphagia: difficulty swallowing

Daily Support Gestures

General Principles

Encourage autonomy: do with the person, not instead of them. Each gesture they perform themselves contributes to their recovery.
Stimulate the affected side: encourage use of the hemiplegic side, position yourself on the affected side for interactions.
Be patient: everything takes longer after a stroke. Don’t rush.
Adapt without overprotecting: find the right balance between help and autonomy.
Apply the instructions of rehabilitation specialists: respect the directions given by professionals.

Assistance with Transfers and Mobility

From bed to chair (and vice versa):

1. Position the chair on the person’s unaffected side (they can lean on their functional arm)

2. Help the person sit at the edge of the bed

3. Have them place their feet on the floor, with the foot on the affected side slightly forward

4. Stand facing them, knees against knees to block

5. On the count of 3, help them stand by guiding them by the pelvis

6. Pivot toward the chair

7. Help them sit down by controlling the descent

Accompanied walking:

• Position yourself on the affected side, slightly behind

• Hold by the waist or with a walking belt

• Walk slowly, at the person’s pace

• Anticipate obstacles

• If the person uses a cane, it should be on the unaffected side

Stairs:

• Going up: the unaffected foot goes up first, then the affected foot

• Going down: the affected foot goes down first, then the unaffected foot

• Hold the railing on the unaffected side

• The caregiver positions themselves downstream (below) for security

Bathing Assistance

Adaptations for hemiplegia:

• Prefer shower over bath (safer)

• Shower seat to sit

• Grab bar on the unaffected side

• Non-slip mat

• Encourage use of the affected arm as much as possible

The technique:

• Start with the unaffected side to allow the person to participate

• Guide the affected arm gently

• Dry skin folds thoroughly (risk of maceration)

• Monitor the skin on the affected side (the person may not feel irritations)

Dressing Assistance

Principles:

• Start by putting the garment on the affected side

• To undress, start with the unaffected side

• Prefer easy clothing (velcro closures, loose pants)

• Position clothing within reach of the unaffected side

Techniques:

• For a shirt: put on the affected arm first, then the unaffected arm

• For pants: sit down, cross the affected leg over the unaffected leg, put on pants

Meal Assistance

Setup:

• Sit up straight, slightly leaning forward

• Use adapted utensils if needed (large-handled utensils, plate guard)

• Place foods on the unaffected side (in case of hemineglect)

• Avoid distractions during meals

If swallowing disorders:

• Strictly follow the speech therapist’s instructions

• Adapt textures according to prescription

• Feed in small quantities

• Verify that the mouth is empty before the next bite

• Don’t make the person talk during meals

• Maintain sitting position for 30 min after meals

Collaboration with Rehabilitation Professionals

The Speech Therapist

The speech therapist intervenes for:

• Language disorders (aphasia, dysarthria)

• Swallowing disorders

• Associated cognitive disorders

The role of home care aide:

• Apply the instructions given for communication (see our article on language disorders)

• Respect prescribed food textures

• Observe and report difficulties

• Stimulate daily communication without causing failure

Examples of instructions to apply:

• “Don’t finish sentences for them”

• “Offer choices rather than open questions”

• “Thicken liquids with this powder”

The Occupational Therapist

The occupational therapist works on autonomy in daily activities. They can:

• Recommend assistive devices

• Propose home modifications

• Teach compensatory techniques

• Rehabilitate daily gestures

The role of home care aide:

• Use the recommended assistive devices

• Respect the taught techniques

• Observe if the aids are adapted

• Report encountered difficulties

Examples of assistive devices:

• Adapted utensils (large handles, angled)

• Bath board, shower seat

• Sock aid, reacher

• Grab bars

• Access ramp

The Physiotherapist

The physiotherapist rehabilitates motor function, balance, walking. They can also work on spasticity and pain.

The role of home care aide:

• Apply instructions for transfers and mobility

• Encourage prescribed exercises between sessions

• Ensure proper use of walking aids

• Report new pain or difficulties

Team Coordination

The communication log is essential for:

• Transmitting daily observations

• Noting progress or difficulties

• Sharing instructions among professionals

Coordination meetings allow:

• Review progress

• Adjust goals

• Harmonize practices

Hemineglect: A Misunderstood Aftereffect

Understanding Hemineglect

Hemineglect (or unilateral spatial neglect) is a common disorder after a right hemisphere stroke. The person “ignores” the left half of space and their own body, as if it didn’t exist.

Manifestations:

• Only eats the right half of the plate

• Only shaves or applies makeup on the right side

• Bumps into obstacles on the left

• Doesn’t see people approaching from the left

• Forgets to dress or wash on the left side

Supporting a Person with Hemineglect

Stimulate attention toward the neglected side:

• Position yourself on the neglected side to talk to the person

• Place important objects on the neglected side

• Draw attention: “Look to the left”

Ensure safety:

• Watch for obstacles on the neglected side

• Supervision during movements

• Avoid risky situations

During meals:

• Turn the plate to present food on the neglected side

• Remind to eat the entire plate

During bathing:

• Remind to wash the neglected side

• Guide the gaze and gestures toward this side

Post-Stroke Fatigue

A Particular Fatigue

Fatigue after a stroke is different from ordinary fatigue:

• It doesn’t always improve with rest

• It occurs quickly during even minimal efforts

• It affects cognitive abilities (concentration, memory)

• It can last months, even years

Adapting Support

Respect rhythms:

• Plan rest periods

• Schedule activities during times of better form

• Break down tasks

Don’t underestimate:

• The person is not “lazy”

• The fatigue is real and disabling

Observe and report:

• Worsening fatigue may signal a problem

• Inform the care team

Post-Stroke Depression

A Major Risk

Depression affects 30 to 50% of people after a stroke. It can be:

• A psychological reaction to disability

• A direct consequence of brain lesions

The signs:

• Sadness, crying

• Loss of interest in activities

• Sleep and appetite disorders

• Fatigue

• Dark thoughts

• Refusal of rehabilitation

The Role of Home Care Aide

Observe and report signs of depression.
Maintain connection: be a warm and encouraging presence.
Gently stimulate: suggest pleasant activities without forcing.
Validate progress, even minimal.
Don’t trivialize: depression is not “normal” even after a stroke, it can be treated.

Cognitive Stimulation After a Stroke

The Importance of Stimulation

Cognitive functions can be affected by stroke and benefit from regular stimulation:

• Attention and concentration

• Memory

• Executive functions (planning, organization)

• Language

The SCARLETT program from DYNSEO is particularly suited to cognitive stimulation after a stroke. The exercises are designed to adapt to each person’s level and can target different cognitive functions. Used regularly, in addition to speech therapy rehabilitation, SCARLETT can help maintain and improve cognitive abilities.

Integrating Stimulation into Daily Life

During daily activities:

• Involve in decisions (choice of clothing, menu…)

• Encourage conversation

• Solicit memory (recall the day’s events)

Dedicated activities:

• Adapted board games

• Reading if possible

• Crosswords, sudoku according to abilities

• Cognitive stimulation programs like SCARLETT

Training and Resources

Training for Better Support

The training “Supporting seniors in a different way: play to stimulate and share” allows development of relational and stimulation skills essential in post-stroke support. Creating a quality relationship is fundamental to maintaining the person’s motivation in their rehabilitation.

Practical Resources

The Home Care Aide Toolkit from DYNSEO offers concrete resources for daily support of people after a stroke.

Conclusion: Partners in Recovery

Supporting a person after a stroke is teamwork where everyone has their role. The home care aide, through their daily presence and involvement in everyday gestures, is an essential partner in recovery.

The keys to this support are:

• Understanding the aftereffects and their implications

• Applying the instructions of rehabilitation specialists

• Encouraging autonomy

• Patience and kindness

• Observation and communication

• Close collaboration with the rehabilitation team

Every progress, even minimal, is a victory. Every recovered gesture is a step toward autonomy. The home care aide, through their daily support, contributes to these victories.

DYNSEO supports professionals with the SCARLETT program for cognitive stimulation, training to develop skills, and the toolkit for daily life. Because recovery after a stroke is a marathon, not a sprint, and every player counts.

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DYNSEO complementary resources:

• SCARLETT Program – Memory games adapted to seniors

• Training “Supporting seniors in a different way: play to stimulate and share”

• Home Care Aide Toolkit

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Article written by DYNSEO, specialist in digital solutions for healthy aging and support for cognitive disorders.