Working With Stroke Survivors

by Maureen Sangster

‘It’s a bit of a struggle ’ Alec said, moving slowly, accompanied by his friend across the room to the position he liked at one of the four trestle tables set up round the hall in a community centre.
It was the weekly meeting of the Stroke group for Stroke survivors with dedicated volunteers present. I was there for six sessions to deliver ‘something fun using writing, poetry and song.’
How would I be able to connect across the huge space in the middle of the tables that allowed for easy access for wheelchairs? But then the tea trolley was wheeled in by the group coordinator. That empty middle ground was filled with an element characteristic of Stroke groups, the sharing of ordinary activities, the serving of teas and coffees and biscuits that was also illustrative of the extent to which they helped each other.
‘Margaret can’t speak but she gets her meaning over’. Liz, a stroke survivor was responding to the expressive nods of a silent woman and carried a mug of coffee over to her.
‘What are you going to do? You’re a poet.’ Liz sounded fearful. ‘Being asked to concentrate too long is a problem now. I used to be able to read really challenging books but now it’s simple crime fiction.’
She was aware of what she’d lost.
‘Don’t worry.’ I said. Taking an Alice in Wonderland approach to reading (“What is the use of a book,” said Alice “without pictures?”), I’d prepared a PowerPoint presentation called The Pattern of the Seasons. People chatted about the images of the season laid out on the tables before I ran the slide show. ‘Just the right length.’ someone said as changing pictures of each season were followed by short quotes (at most 6 lines) from poems and songs.
‘Would anyone like to read this quote out loud?’ I asked.
Alec said ‘Oh, I’ll read that.’ He read
When all at once I saw a crowd
A host, of golden daffodils:’
Liz joined in, then others remembering Wordsworth’s Daffodils and saying that they had had to memorise poetry when at school. The familiar rhymes proved comforting.
Wee, sleekit, cow’rin, tim’rous beastie,
O, what a panic’s in thy breastie! (Burns, To a Moose)
brought forth names of other Burns poems and from one participant knowledge of farming. ‘It’s amazing what some people know,’ the group coordinator said. .
Margaret smiled at an image of flip flops and sand when I read out from Robert Louis Stevenson’s ‘At the seaside’
When I was down beside the sea
A wooden spade they gave to me
To dig the sandy shore.
My holes were empty like a cup,
In every hole the sea came up,
Till it could come no more.
The slideshow demonstrated bibliotherapy in action, how it can encourage an emotional response to a theme and the effect poetry can have on mood. There was self-expression, chatting about their favourite season or favourite elements within that season – like the first appearance of crocus bulbs or snowdrops growing in snow. Stroke survivors had an opportunity to reconnect with  heir past through sharing memories of visits to places. Some spoke of how different a landscape was if you had to move slowly through it. There could however be a gain in an appreciation of detail.
Stroke can have frightening outcomes – a dominant hand no longer being able to hold a pen, a leg that’s heavy and drags. Speech, sight, cognitive ability, perception, motor skills: people may find one or more of these affected. A great degree of recovery is possible yet many must learn to live with impairment. Loss of one identity requires active reaching out to regain a new one. Bibliotherapy inspires people to be expressive about who they were, are and will be.
Strokes can occur at any stage. (The group age range was 40 – 80.) Traditional poetry was an obvious choice for bibliotherapy material – hence the use of Wordsworth, Stevenson and Rudyard Kipling. A mix of poetry and song with visuals is an ideal form for these groups, appealing as it does to a wide range of senses so that there will at least be something for everyone. Delivery incorporating reading aloud and singing either by the facilitator or participants is stimulating and fun.
Stroke groups already tailor accessible activities to take into account vulnerabilities and impairment and focus on enjoyment, confidence building and variety of stimuli. Having a writer come in to offer sessions brings a new focus and expertise.
I included a traditional song Halloween, the words written by Violet Jacob on hearing that her only son had been killed in the Battle of the Somme Lifting of mood for stroke survivors is key but is to be balanced with material echoing a recognition of loss. A participant said he had letters from an uncle of his who’d died in the 1st World War. He’d bring them in (this would lead on to a session on Treasures using a Scottish Book trust publication of that name and to which everyone would bring a valued object)
Survivors of stroke know they must weave any sense of loss into themselves and go forward changed but positive about what they treasure in life. Bibliotherapy themes should encourage talking about change and recovery and courage, like snowdrops flourishing in the cold.
Do therefore – allow a minor chord to sound
Do be aware of different levels of impairment. If doing creative writing after discussion, do it in small groups with someone available to scribe and also provide structure templates (e.g. acrostic)
Have text in a manageable format for poor concentration or cognitive deficit
Do have a theme that engages all
Use familiar texts -they bring security – mixed in with less well-known texts
Do have fun
Don’t put anyone under scrutiny – create an informal atmosphere asking people to talk amongst themselves as well as respond to the facilitator
Don’t produce dense wads of text – visual presentation is useful here like PowerPoint or postcards
Scottish book Trust: see their website for downloadable e-books of yearly publications on themes My Favourite Place, Treasures and Home www.
Poems of Robert Burns
A Child’s Garden of Verses by Robert Louis Stevenson
The Nation’s Favourite Poems (Foreword Griff Rhys Jones) Random Press
Hallowe’en , song (words Violet Jacob, tune Jim Reid)
lyrics –
National Poetry Day postcards on themes, obtainable from Scottish Poetry Library A Place Called Earth (you tube video with song by Celine Dion I’m alive (International Reading association)
note: the above is a composite account drawn from a number of sessions