How do I get my husband to try to recover from a stroke?

A fellow caregiver asked...

My husband had a Ischemic Stroke on 12/25/08 on his left side of the brain, when he was 54. Most of 2009 was spent dealing with pain on the effected side (right side) and he had several seizures. He was finally in rehab in Aug 09 (it took so long due to insurance and the pain he was having - no one wanted to take him) for 6 weeks but they wouldn't keep him any longer because he didn't want to participate. He was still having pain and I found out after that he could not see out of his left eye at all. I have had his eyes taken care of - cataracts - which he didn't have 1 year prior to his stroke when he saw the eye doctor for a regular check up. I believe the pain is mostly taken care of because I can now touch his arm without him screaming but I do believe there is some pain still and I am trying to get the doctors to do something about that. He does not speak - aphasia and of course he does not walk. The question is does anyone know of anyway to motivate someone like this to try. He just wants to stay in bed all day every day and watch tv. Yes, he is on an antidepressant. He smokes and won't give it up and in fact I believe he smokes more now. I have to fight with him just to get him out of bed every 2-3 weeks to give him a shower. I think some of the pain he is feeling is coming from just laying in bed all day every day. I am so lost right now I am just not sure what to do for him or about him. Is there anything I can do to help him or is it just time for me to get use to the fact he will be like this until he dies?

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Sorry to hear about this. Although I don't expect that he would make much physical improvements from the point of view of standard stroke recovery this far out from the stroke, a few thoughts come to mind.

First, is his pain under good control? There are many ways to try to improve the pain control. Medications, including gabapentin, amitriptyline, Lyrica, or Cymbalta, can be very effective. Other avenues to pursue would be massage, accupuncture, or Physiatry (Physical Rehab Medicine). I would ask your doctor about each of those options. Often, the non-medication avenues provide good range of motion and relaxation techniques that help the pain considerably. Even a referral to a pain clinic might give you some good thoughts for dealing with his pain issues.

Second, it may be that despite being on an anti-depressants, he is still quite depressed. In my experience, there is no substitute for having him see a Psychiatrist or Psychologist. Simply throwing an anit-depressant into his system is not sufficient. He needs a specialist to help tailor his therapy - activities and medication management.

Third, he may have post-stroke fatigue. This is often from central causes or from sleep issues. A safe stimulant medication such as Provigil could be very helpful, as could a sleep medicine referral to screen for sleep hygiene issues.

Good luck!