And other fun stuff

Stay calm. Speak in

a calm, neutral voice *

Refrain from making judgmental statements about the situation or the person.*

Agitated behaviors can be very difficult.*

Remember to look after yourself and take regular breaks. 

•Don’t engage. You won’t win.*

•Let the person talk and listen.*

•Paraphrase *

•Empathize with them*.

• Tell them that you want to help him/her

• If the person is still angry and agitated calmly set a limit.*

• Carry through with the promise.

• If the person calms you can try to help him/her problem-solve. *

Confused

Scared

Overwhelmed

Sick/In pain

Cognitive impairment reduces one’s ability to be “socially appropriate”.

It’s not personal…it just feels that way. *

Use distraction when you can.

Use their name.

Even if the person is on the phone try to remember your non-verbal cues*

Periodically take slow (quiet) deep breaths.

Use physical tension relievers

Distance yourself some from their emotion*

Be your own cheerleader. *

When all else fails…

Keep calm

Follow posted protocol

Debrief afterward with a colleague or your manager

When you already know the person’s complaints/concerns , nothing has changed , & you can do nothing more.

Be Polite, but firm. Set limits and enforce them. *

› Ex. Mr. Smith, I’m sorry you’re upset. Nothing has changed since the last time we spoke. I will speak to you again on …. At…(suggest a time/date that makes sense). Goodbye.

• Changes in mood, behavior and affect.

• Not following social norms

• Changes in sensitivity/tolerance

• Changes in processing/reasoning

Emotional Lability

Social embarrassment; Communication issues*

More frequent and more intense emotions

Insight may be impaired which complicates this.

Problem Outlook• Confusion *• Tiredness &

Concentration problems.

• Memory Problems. • May affect short-term

memory (more common) or total memory. *

Cognitive problems after a stroke usually improve initially &then remain stable.

Tiredness & confusion usually improve with time & as you learn to adapt.

Depression can & may need to be treated*

Problem Strategy• Personality changes• Increased apathy• Irritability/

impulsiveness• reasoning & problem

solving/ judgment• Perceptual changes*,

agnosia, getting lost, altered body image, apraxia, inattention

Patience and understanding are important to cope with this as a caregiver/family member or friend.

Avoid over reacting. It may feel personal but it isn’t really.

Miscommunication in the brain between the cortex and sub-cortical area

Strokes often cause a neurologically based disorder of affective expression.

This results in involuntary emotional expression disorder (IEED), and difficulty regulating outward emotional expression.

“Emotional expression is uncontrolled and without an apparent triggers.”*

Redirect attention back to activity/conversation once the outburst settles

Distracting

Timing, tempo, tone

Encouraging slow, deep breaths

Giving specific instruction re behavior

Encouraging self-observation by the client

Remember, Doing your best is ENOUGH!

https://www.youtube.com/watch?v=AFKACRqNJFE https://www.youtube.com/watch?v=KKejCymVS2Q https://www.youtube.com/watch?v=tyUl3kqmeLo https://www.youtube.com/watch?v=pBe4A32fpyI https://www.youtube.com/watch?v=46JP5iby7yM https://www.youtube.com/watch?v=ACKbkmO9rLg https://www.youtube.com/watch?v=iORtNxwMK6o

In your group review the article.

Highlight something helpful

Underline something you’ve done before.

Put a star beside something you might try.

(Alzheimer’s Australia) Agitated Behaviors. Retrieved March 12, 2013 from: http://www.fightdementia.org.au/services/agitated-behaviours.aspx

(Ariel Waters). How to Calm and agitated person. Retrieved march 12, 2013 from: http://www.ehow.com/how_10010662_calm-agitated-person.html

(image) Anti-stress Kit. Retrieved March 12, 2013 from: http://www.google.ca/imgres?q=stress+kit+image&um=1&hl=en&safe=active&sa=N&biw=1280&bih=603&tbm=isch&tbnid=jDkGp3LNr3JWIM:&imgrefurl=http://chen1923.blogspot.com/2009/11/anti-stress-kit.html&docid=chDGAT2eexfzmM&imgurl=http://3.bp.blogspot.com/_WjazDiGVblo/SwaEqMdSxkI/AAAAAAAAAaw/rBHPKa5zHT8/s1600/ANTISTRESS.jpg&w=1600&h=1131&ei=Uoo_UYHhGaaO0QG-j4B4&zoom=1&iact=rc&dur=312&page=1&tbnh=134&tbnw=175&start=0&ndsp=26&ved=1t:429,r:7,s:0,i:100&tx=82&ty=81

Caswell, Jon. May/June 2007 Stroke Connection. Living With Emotional Thunderstorms. Retrieved on May 3, 2013 from:

http://www.nxtbook.com/nxtbooks/aha/strokeconnection_20070506/index.php#/20.

Chest Heart and Stroke Scotland. Thinking and Behavior Issues After Stroke. Stroke Series SS9. Retrieved on May 3, 2013 from: http://www.chss.org.uk/publications/documents/Stroke/SS9 Thinking and behaviour issues.pdf

What to say to a porcupine: Strategies for Dealing with Difficult Customers WHITE PAPER. Retrieved on October 24, 2014 from: Strategies for Dealing with Difficult http://www.werc.org/assets/1/workflow_staging/Publications/828.PDF