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Medical experts, family members give advice on care for stroke patients

Content image - Phnom Penh Post
An elderly woman who suffered a stroke rests on her bed in Phnom Penh. HONG RAKSMEY

Medical experts, family members give advice on care for stroke patients

For almost 10 years now, Thun Chenda has been caring for her mother who became paralysed. Her troubles began with the weakening of one arm and one leg and having difficulties in speaking.

From week to week, month to month, her 75-year-old mother’s condition has worsened from there. Now she cannot sit up on her own as her hand, leg and body is stiff, and she is especially having difficulty chewing food.

Before feeding her mother, Chenda needs to grind rice mixed with soup and lift her into a sitting position to eat, giving her time to chew each bite before offering another.

“I do not know why she has difficulty in chewing food, but this is what I need to do for her to be able to eat,” she said.

Unfortunately, patients with paralysis or stroke commonly need this level of patient care and a great deal of assistance besides that, either through a family member or if they can afford it, a professional caregiver and specialist doctors.

Sal Sreymao, 36, a Cambodian caregiver working in Thailand with more than six years of work experience, said that for patients who are unable to move and must stay immobilised in bed, caregivers must be sure to turn their body once every two hours to avoid stiffness, inflammation and ulcerations or bed sores.

Sreymao and her husband are both migrant workers who left their children with their grandmother in order to be able to work in Thailand and earn better wages to support themselves, their children and the rest of their family.

“People accused me of pulling or turning the patient’s leg like a chicken’s leg when they saw a video of me adjusting an elderly patient’s limbs, but I’m not angry with them because I know that they have never taken care of elderly people before and if they had cared for this kind of patient, they would have understood what I was doing,” she told The Post.

Physiotherapist Preng Chanly said that the basic symptoms of paralysis are patients being unable to move or get up and they lose control of their limbs or the limbs become very stiff.

Chanly, who works at the Khmer-Soviet Friendship Hospital, recommended that patients with partial paralysis receive some kind of physiotherapy and that their caregivers be trained in some of those methods.

“I think that if the hospital has this type of patient, the hospital should have professional nurses to care for and give treatment to them. If there is no physiotherapist, caregivers should change the patients’ position every two hours to prevent patients from having back ulcers, especially around the buttocks,” he said.

In addition to cleansing their body and changing position and placement, the paralysed patient should be assisted when eating and attention should be paid to their diet, according to Bopha, who has cared for her mother after she had a stroke for more than 20 years.

Bopha said that for the past two years, her mother has not been able to walk on crutches by herself and needs constant care from her children and grandchildren.

“We always provide healthy food. Sometimes she refuses to eat, so we have to comfort and explain to her, but we must not make her angry. We’ve added soft fruits for her frequently, and kept near her, including lemon juice in the morning. She could have better health if she could sleep well. We need to reduce her rice in the evening to avoid gaining weight,” she said.

However, she acknowledges that her mother finds it difficult to chew foods and can even start choking when drinking water.

Regarding stroke patients, the official social media page of Calmette Hospital provided some advice about patient’s diet and muscle weakness on October 7.

“People who have had a stroke often have an eating disorder related to choking. Choking on food is because the food or water drops into the air way when swallowing. The reason for that is muscle weakness, so they are not closing the windpipe on either side. When food enters the airways into the lungs, it can cause pneumonia or even death from severe choking,” the hospital said.

The hospital goes on to say that physiologists can teach patients and caregivers how to safely swallow foods and drink liquids. Mouth exercises such as pulling the mouth forward and backward, closing the mouth, opening the lower jaw, turning to the side, once left, once right can also help patients with their ability to chew.

“Patients should continue to do tongue exercises, such as sticking out the tongue and pulling the tongue out of the mouth to strengthen the tongue muscles in order to help push food into the throat. They can also exercise by shouting for a long time “Ahhhhhh” to strengthen the muscles in the throat and increase breathing strength,” Calmette advised.

The patient can also vocalise with the sound of “Erb, Erb,” for a long time to increase the strength of muscles used to close the airway when swallowing food or water to avoid choking.

For safe eating and drinking, patients must sit up straight while eating and caregivers must stop providing food or water if they are coughing or become tired. Patient needs to sit up for another 30 minutes after eating and caregivers must ensure that patients have swallowed all of their food and that none remains in the mouth before adding more. And caregivers must clean their patient’s mouths and teeth regularly.

Calmette Hospital also recommends that patients be referred to the hospital if they have had a stroke and are having trouble eating due to choking in order to consult with a specialist.

Bopha said she takes time off from work to take her mother for health check-ups every three to six months, especially for testing her blood sugar, urine and for other problems and that no matter how busy each family member is personally, they all work together and take turns to show their gratitude to their parents and make the most of the time they have left remaining with them.

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