FAQ

Below are suggestions about considerations that you should make throughout your home before you return following your stroke. Especially if you are in a wheelchair, you may need to make modifications that need professional installation. Other pieces of advice apply to homeowners in any situation.

• Entries and hallways should have a 32-inch or 82 cm clearance to accommodate people in wheelchairs. Lubricant will help doors to open as wide as hinges were designed. The edges of a swelled door may need to be shaved to allow for extra space. Uneven thresholds should be fixed or changed to prevent tripping.

• Portable ramps are often an affordable solution.

• Stroke survivors with difficulties grasping or twisting can use lever door handles to open doors more easily. The location of the knob may also need to change. Swing away hinges, folding doors or pocket doors can make passage less difficult. For more space or doorway clearance, doors between rooms can be removed.

• To make it easier to move around in a wheelchair, furniture may need to be moved. Rugs should be moved or replaced, unless they can be sufficiently secured with non-skid tape.

• To prevent slipping, avoid slick surfaces and wear non-skid shoes. Secure carpets or runners can be installed in hallways or stairwells for more traction.

• Handrails provide support while using stairs. They can be attached to walls, the floor or the ground. Outdoor handrails should withstand weather conditions. A ramp may be added as well.

• Stair glides or stair lifts can transport people up or down stairs while they are seated. However, these can be expensive. A platform lift works like a small elevator that transports a person up or down stairs. These are available for indoor or outdoor use.

• Pathways should be clear of any clutter. Extension cords can be used to reroute cords along walls. Cords should be secured to floors or walls when possible, and discarded or replaced if they fray.

• Survivors who do not need wheelchairs but have difficulty moving may need to use a cane, walker or scooter. It may be more comfortable for them to use handrails or grab bars mounted to the walls of the home.

• Phones should be easily accessible for stroke survivors in every room of the house. Cordless phones, mobile phones or wearable call buttons may be necessary. They will also prevent tripping on phone cords. Emergency numbers should be posted in a highly visible area. Large button phones are easier to read and use for patients with movement or vision problems. High contrast, such as dark on light or light on dark, helps people with vision problems to read numbers and words.

• Picture phones reduce the need to remember numbers or press many buttons. This phone can be programmed to fit individual needs. Symbols, drawings or photographs correspond to emergency numbers, and those of family and friends.

• Install smoke and carbon monoxide detectors. Check them regularly.

• Have a well-thought-out and posted fire escape plan.

A stroke survivor can still do their own laundry with a few changes. Machines may need to be relocated to the main floor of a home, and stackable machines may need to be used. Front-loading washing machines are usually more reachable, and need a smaller range of motion in general. Other changes you can make include the following:

• Visible markings for wash settings, such as coloured stickers, and large dials or knobs, can make washing settings easier to see and handle. Survivors who cannot turn with their hands or wrists may need buttons instead.

• Wet clothing can be heavy and difficult to transport. A nearby table or cart of suitable height can help. Work with fewer items at a time to save time and energy.

• A fold-down ironing board may take up less space, and need less energy and movement to assemble or disassemble.

• Organise laundry supplies in accessible, clearly labelled containers.

Before you return home, a plan should be in place for ensuring that regular home cleaning will be taken care of. An unclean environment in any room of the house is a health and safety hazard for anyone. Household tasks such as cleaning and doing laundry may be impossible or difficult for stroke survivors with severe disabilities. However, some modifications may make these or some of these tasks possible or less difficult.

• Everyday cleaning tasks like sweeping, mopping, washing, garbage disposal and general tidying may need to be done while seated. Working in small areas and taking frequent breaks can make this more manageable. There are products which can simplify cleaning processes, such as disposable cleaning wipes or multipurpose detergents.

• Use smaller containers, wheeled push carts, or lightweight mops and brooms that need less energy and strength to handle. Depending on movement limitations, you may want to choose cleaning supplies that are more easily handled, such as those with sprayers or pumps.

• Use long-handled brushes, sponges, or vacuum extensions for hard-to-reach places.

• Frequently used items should be placed on shelves or in drawers at optimal height.

Being unable to enjoy activities that you once did because of recent disabilities can be extremely frustrating. For many stroke survivors, dining is one such activity. Using utensils, sitting up at the table, and swallowing are often difficult following a stroke. In addition to help from health professionals such as a speech therapist and a nutritionist, specialized utensils and dishes are available that may make dining less frustrating and more enjoyable. Whatever the obstacle, patience plays a key role in improving your dining experience.

• Use a plate guard or scooped plate to help guide food onto utensils. It is a wall-like device that curves along the edge of one side of the plate. To stabilise the dish even more, it can be placed on a damp washcloth or rubber product.

• Try utensils with built-up, bendable or weighted handles. These will be easier to grip, slip less, and help a person with tremors to avoid spilling.

• Using swivel forks or spoons keep food in the same position while the handle moves. if you have difficulty holding utensils, you can also try universal cuff utensils. The cuff fits around the hand and utensils are attached to the cuff. These are often needed for people with limited hand movements, who cannot pinch or grasp utensils.

• A cup with a lid and straw reduces the risk of spilling or dribbling. You can also use weighted cups. Like weighted utensils, this weighs down a hand with tremors and reduces spills.

• Have a chair that supports your posture at the dining table. It is also important that the chair is adequately cushioned. A person in a wheelchair should have access to a table that is a proper height for their wheelchair.

• Survivors of severe strokes may need to have food chopped, ground or pureed. Liquids may sometimes need to be thickened. Your rehabilitation team can give advice on how to avoid swallowing and choking problems, and develop a specialised diet and fluid intake to lessen the chance of additional strokes.

Kitchens can also be dangerous for stroke survivors with movement limitations or decreased sensation. They are often small spaces with counters and appliances that are difficult to access from a seated position. Objects that are hot, sharp or difficult to reach can pose serious safety hazards for anyone, but are often more serious for people with disabilities.

To prevent accidents, it is important to consider every aspect of the kitchen that you will come into contact with on a daily basis. Some of the suggestions below involve major construction changes. Others are simple organizational ideas that may make kitchen activities and eating more feasible:

• Opt for a stove with controls at the front. Push buttons don’t need to be turned or twisted, but may need more thought to use. Controls arranged in the same location as burners can help make the thinking process easier. Automatic shut off controls can be installed to increase safety, for people who may forget to turn off stoves.

• Install a mirror over the stove to reflect what’s inside pots and pans. This helps someone who’s seated see inside them.

• Make sure oven mittens or hot pads are easily accessible near the stove. They can prevent burns, but may also make it more difficult to hold a pot or pan.

• Provide a clear space near stoves or ovens so dishes can be placed quickly without spills. Heat resistant cutting boards can be one solution. Always have a fire extinguisher in easy reach.

• Roll-under sinks and stoves can help a wheelchair user to approach them with room for their knees to fit underneath. Insulate pipes to prevent leg burns.

• Lower the height of sinks and countertops, but leave enough space for a person’s knees to fit underneath. This makes it easier to work at them.

• Replace faucet handles with levers, to make taps easier to turn on or off.

• Food organisation is key. A side-by-side refrigerator, where the freezer is on one side and the refrigerator on another, makes it easier for people to access both compartments. When a freezer is stacked on top of the refrigerator, frozen foods can be difficult to reach or may even fall on someone’s head as they are pulling items down.

• Label containers with bold black letters on a white background to make identifying food easier. Leave plenty of space between bottles or jars. Containers with larger-sized lids may help make them easier to open.

• Purchase pre-sliced foods, or use utensils and cooking tools with weighted or built-up handles. A spiked cutting board or placing the board on a non-skid surface can also decrease the chance of being cut.

• Leftover food should be dated and perishable foods should be thrown away when expired.

Of all the rooms in the house, it seems most important that your bedroom be a place where you can feel comfortable and safe. Because this is a private area of the home for you, it should be catered to meet your needs.

To increase your independence in your bedroom, you may need to reorganize your clothing and personal items so that they are accessible by you, the stroke survivor. To increase

your safety, you need to be sure that help is within reach if needed. It is also important to consider the room from a nighttime perspective: adequate lighting, clear pathways, and access to a toilet are essential in order to avoid accidents in the dark.

• Change handles on doors or drawers to cabinet handles or D-loops, which can be opened with little or no assistance.

• Lower closet bars and organize dressers so frequently used clothes are in the most easily-accessible drawers.

• Avoid clothes with tight-fitting sleeves, armholes, pant legs and waistlines, as

• well as clothes which must be put on over the head. Choose clothes that fasten in the front with Velcro or elastic in place of buttons, zippers and shoe laces.

• Use dressing aids if you need them such as a reacher, button hook, dressing stick, sock aid, shoe horn or mirror.

• Keep a commode chair near the bed to avoid bathroom accidents in the night. A

• three in one commode chair has three features: a raised seat, grab bars on both

• sides of the chair, and a removable bucket. During the day or when it is not

• needed, the commode chair can be kept in a nearby closet.

• Stroke survivors must also understand that accidents are often unavoidable. To

• make accidents easier, blue pads can be placed underneath sheets on the bed.

• Blue pads are pads, often washable and reusable, with a cloth and waterproof

• side to prevent staining on furniture.

• Keep blankets clear of walking paths.

• Keep a telephone and light switch or lamp within easy reach of the bed.

The changes following a stroke can impact one’s ability to perform typical daily activities. When a stroke patient returns home, their home environment can impact their recovery. It is important that the home supports continued recovery and safety for the patient.

The effects of a stroke are different for everyone, depending on the part of the brain injured, how bad the injury is, and the person’s general health. Any of these effects can change the way a person functions in their home. As a patient, it’s a good idea to have a trial visit home before being discharged from the hospital, so any changes can be made before your return. You may only notice some disabilities after returning to your daily routine.

Changes to the home are most effective when they meet one’s specific needs. Professional occupational therapists can help determine the best modifications to suit the situation. They are available through most hospitals, medical centres or community clinics.