Case Study: Mandy’s Journey from Stroke to Strength
Mandy, an assistant manager at a pub and mother of a 7-year-old daughter, had a long history of migraines. However, she recently began experiencing severe headaches that were distinctly different from her usual migraines, accompanied by weakness in her left leg and arm. Mandy was later hospitalised, where she was diagnosed with a stroke. This sudden and unexpected event left Mandy feeling frightened and uncertain about her future, particularly concerning her ability to return to work and care for her family.
Upon her admission to the hospital, Mandy described her mood as “so-so” and was taking antidepressants. As part of her initial psychological support, she was encouraged to document her negative thoughts in a journal. She also displayed mild cognitive impairments, particularly in visuospatial abilities, language, and attention.
To address these cognitive changes, Mandy participated in cognitive stimulation exercises. One such activity involved reading a list of words in a paragraph and identifying words related to two categories: ‘stripy’ and ‘food.’ She was required to circle the words related to ‘stripy’ and cross out the words related to ‘food.’ This exercise aimed to enhance her divided attention, which is crucial for managing multiple tasks simultaneously, such as engaging in conversation while preparing a meal.
During these sessions, Mandy noticed changes in her vision, especially when trying to locate items on a cluttered table. Despite the absence of double vision or neglect, these visual difficulties were significant. With support, Mandy experimented with using a therapeutic ruler to scan the entire page while reading. Over time, her ability to divide and switch attention between tasks improved, and she developed better focus and self-correction abilities. Nevertheless, her mood remained flat, with only occasional smiles.
As her rehabilitation progressed, Mandy’s mood fluctuated, and periods of low mood began to affect her participation in physical therapy. She experienced sleep disturbances, often lying awake until the early hours of the morning and texting on her phone. To address these issues, Mandy was introduced to sleep hygiene techniques, including maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bedtime.
Mandy’s relationship with her daughter became strained, with her daughter frequently crying and becoming more distant. During home visits, Mandy felt disconnected, sensing that her home no longer felt like home. To address these relational issues, Mandy and her family engaged in psychoeducation to understand how the stroke had affected her and what kind of support she needed going forward. Mandy also participated in group mindfulness therapy, which she found relaxing, and attended peer support sessions with other residents on similar recovery paths. These interactions provided emotional support and practical coping strategies.
Mandy joined a group therapy program called the ‘Adjustment to Loss and Change Group,’ where she explored the Kübler-Ross grief cycle. This therapeutic approach helped Mandy understand and accept the changes in her life post-stroke. She was encouraged to journal about weekly challenges, focusing on both strengths and difficulties, and to envision her future self. This exercise helped her reframe her worries, recognizing what she still had versus what she had lost.
Through a combination of cognitive stimulation, journaling, high-intensity therapy, and mindfulness practices, Mandy began to feel more positive about her future. Her relationship with her daughter improved as she became more present and emotionally available. Reframing her worries and focusing on her strengths empowered Mandy, giving her a renewed sense of purpose.
Before her discharge, Mandy’s depressive symptoms, initially severe, had significantly reduced to within the normal range. Reflecting on her journey, Mandy expressed that despite the hardship of experiencing a stroke, it had led her to learn a great deal about herself. This insight marked a significant milestone in her recovery, highlighting the importance of psychological resilience and adaptive coping mechanisms in the face of life-altering events.
Mandy’s case illustrates the comprehensive approach needed for stroke rehabilitation, encompassing physical, cognitive, and emotional therapies. Her journey from fear and uncertainty to empowerment and acceptance underscores the importance of holistic and person-centred care in promoting recovery and improving quality of life post-stroke. Through dedicated therapy and support, Mandy not only regained functional abilities but also achieved significant personal growth and emotional resilience.