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Section 7
Family Caregiver Adjustment

Question 7 | Test | Table of Contents

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In the last section, we discussed four core concepts of regaining normalcy after a stroke.  These four core concepts are understanding dressing apraxia, the structured dressing technique, the energy management technique, and rebuilding physical intimacy.

In this section, we will discuss four important factors for a caregiver of a stroke victim to consider.  These four factors are disabling with kindness, TEA, meanness, and complaining.  We will also discuss the family task chart technique.

4 Factors for a Caregiver of a Stroke Victim to Consider

♦ Factor # 1 - Disabling with Kindness
A first important struggle, is not giving in to enabling behavior.  They can help the loved one they are caring for grow stronger.

♦ Factor # 2 - Transient Emotional Attack
A second important factor for the caregiver of a stroke victim to consider is TEA, or transient emotional attack.  Richard, age 73, had returned home from a rehabilitation center following his stroke to live with his daughter Elaine. 

Elaine stated, "Dad has always been such an easygoing man, but these days I don’t know what to do!  I was cleaning last week and noticed his slippers were getting ratty, so I threw them out and got him new ones.  Later that day he asked where they were, and when I told him I threw them away, he burst into tears!  There was no comforting him!"  As you have experienced, stroke victims often experience very labile moods from euphoria to despondence.  I feel that a caregiver who is not prepared for this instability of mood may be more emotionally challenged by caregiving.

♦ Factor # 3 - Meanness
 In addition to disabling with kindness and TEA, a third important factor for the caregiver of a stroke victim to consider is meanness.  While the transient emotional attacks many stroke victims experience are transitory, Elaine found that her father had some more permanent personality changes that caused her a great deal of stress.  Elaine stated, "my father has said the cruelest things to me!  He’s been mean and petty and he constantly insults my cooking!  If I try to defend myself, he just says even crueler things." 

I stated to Elaine, "even though it is very difficult, it is important not to react in kind to the meanness of your father.  That will only make matters worse.  Try to count to ten or twenty and do whatever it takes to remember that this, too, will pass if you do not exacerbate the situation."  I practiced several progressive relaxation and relaxation breathing exercises Elaine could use to cope with outbursts of meanness. 

Elaine also indicated that, perhaps out of an increased consciousness of his own mortality, Richard had been talking about ways he could donate things or money to charity.  I stated, "Perhaps one way you can address your father’s tendency to be mean by encouraging these charitable activities to remind Richard of how much he still has to give."

♦ Factor # 4 - Complaining
A fourth issue concerning the caregiver of a stroke victim which I discussed with Elaine is complaining.  Elaine stated, "If I complain to my father about his behavior, he takes it personally and starts crying or criticizing me.  I used to talk to my friends, but they got sick of it.  So that just leaves me, and frankly I depress myself." 

I stated to Elaine, "You’re right.  even though you’re always there to listen, if you complain to yourself you cannot cheer up yourself or your father."  Elaine was obviously taking a positive step by seeking counseling, but I also assisted Elaine in finding a local support group for stoke caregivers so that she had an additional place to discharge her negative emotions.

Elaine frequently complained about feeling overwhelmed by the number of tasks she felt she needed to balance in order to take care of her father.  Although Elaine’s husband and children, as well as her brother, had offered to help her either by participating in Richard’s care or by helping her with regular household tasks, Elaine expressed difficulty delegating.  I suggested that Elaine and her family use the family chart technique to help Elaine conserve energy by delegating effectively.

♦ Technique: The Family Task Chart
The Family Task chart is divided into four sections down the left side, and covers the general task areas of personal care for the stroke victim, household tasks, nursing care, and therapy.  Across the top of the chart are listed the three categories of "provided by family or friends," "provided by personal care aide", and provided by other.  An example of the family task chart is provided in full detail in the Manual that accompanies this course.  Using the chart, each task can be assigned by agreement to a family member or other caregiver.  The chart can be amended to accommodate designating times and days for each task. 

I suggested that Elaine have a family meeting once per week for the family to create a family task chart for the following week.  The following month, Elaine started, "the task chart has really helped.  When I know I need help keeping up with everything, I don’t have to chase people down to find help, it’s already on the chart.  I’ve actually had some relaxed time to spend with my father, and I feel a lot more in control."

Think of your Elaine.  Would the family task chart help him or her feel more in control and organized regarding his or her caregiving activities?

In this section, we have discussed four important factors for a caregiver of a stoke victim to consider.  These four factors are disabling with kindness, TEA, meanness, and complaining.  We will also discuss the family task chart technique.
Reviewed 2023

Peer-Reviewed Journal Article References:
Gaugler, J. E. (2010). The longitudinal ramifications of stroke caregiving: A systematic review. Rehabilitation Psychology, 55(2), 108–125.

Pendergrass, A., Hautzinger, M., Elliott, T. R., Schilling, O., Becker, C., & Pfeiffer, K. (2017). Family caregiver adjustment and stroke survivor impairment: A path analytic model. Rehabilitation Psychology, 62(2), 81–88.

Perrin, P. B., Heesacker, M., Uthe, C. E., & Rittman, M. R. (2010). Caregiver mental health and racial/ethnic disparities in stroke: Implications for culturally sensitive interventions. Rehabilitation Psychology, 55(4), 372–382.

Terrill, A. L., Reblin, M., MacKenzie, J. J., Cardell, B., Einerson, J., Berg, C. A., Majersik, J. J., & Richards, L. (2018). Development of a novel positive psychology-based intervention for couples post-stroke. Rehabilitation Psychology, 63(1), 43–54.

Webb, S. S., Moore, M. J., Yamshchikova, A., Kozik, V., Duta, M. D., Voiculescu, I., & Demeyere, N. (2021). Validation of an automated scoring program for a digital complex figure copy task within healthy aging and stroke. Neuropsychology. Advance online publication.

Zapata, M. A. (2020). Disability affirmation and acceptance predict hope among adults with physical disabilities. Rehabilitation Psychology, 65(3), 291–298.

QUESTION 7
What are four factors concerning the caregivers of stroke victims? To select and enter your answer go to Test.

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