Transcript CONCEPTUALISING STROKE REHABILITATION

Marisa Rose
Acute Stroke Lead NEL Cardiac and stroke network
[email protected]
Sue Winnall
Head Occupational therapist – Rehabilitation Mile End Hospital
[email protected]
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Investigation into cause and nature of stroke
Reduce your risk of having it again
Preventing secondary medical complications
This is all done … you still have trouble getting
out the chair, you still bump into things on the
right, you still don’t understand what people
are saying to you, you can still not find the
toilet, you can not recognise the toilet or
undress yourself
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Of people who survive a stroke:
 Only 20% with have full recovery in 2 weeks
 60% will require rehabilitation of varying levels
and intensity
 20% will be severely functionally dependent
Blue- Medical
Red- Therapy
Intervention
amount
72h
4 weeks
12 weeks
Long term
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Stroke Rehabilitation Units reduce disability
and institutionalisation
More intensive OT and physio result in
improved functional outcomes
Early intervention result in better functional
outcomes
Gains made in rehabilitation are maintained
over time
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Physical
Sensory
Cognitive
Perceptual
Emotional
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Focus on activities and roles important to people
Structured by personal goals
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Support
Information
Lesson
Tennis
Toilet
One
1) Ball and racket (badminton,
squash, tennis)
2) The grip
3) Get familiar with court,
conceptualise the general game
1) Recognise toilet, toilet
paper, toilet seat
2) Hold toilet paper
Two
1) Prompts to realign/remember
the grip
2) Practise action of forehand
1) Prompts to hold toilet
paper
2) Practise wiping with
correct action
Three, four, five etc 1) Practise action again & again &
again until you become efficient
enough not to need the prompts
or facilitation of your coach
1) Practise again & again &
again until you become
efficient enough not to need
the prompts from your
therapist
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Semantics – let’s clear this up first
Not just about location
Location
Medical perspective
Rehab perspective
Acute
hospital
72h medical
stability,
investigations
(Medically unstable
or medical stability
unknown)
Initial assessment
Including: mobility,
swallowing, initial
interview,
cognitive/perceptual
screening,
functional
assessment
Location
Medical perspective Rehab perspective
Acute hospital
Rehabilitation
hospital (if medical
staff available)
Monitoring,
Medications
for risk factor
& if necessary,
dealing with
Secondary
complications
(Becoming
Medically
stable but
Could
fluctuate)
As above
Further
assessment
Daily
Rehabilitation
Location
Medical perspective Rehab perspective
Acute hospital
Rehabilitation
hospital (if medical
staff available)
Monitoring &
respond if patient
changes
(Medically stable)
Continued
assessment
Daily rehabilitation
Location
Medical perspective Rehab perspective
Patient’s home
Should not be
necessary
GP monitoring as
per general
population
(Medically stable)
Daily, intense
rehabilitation by
each relevant allied
health professionals
Location
Medical perspective Rehab perspective
Patient’s home
Should not be
necessary
GP monitoring as
per general
population
(Medically stable)
Rehabilitation 2 to 3
times per week by
each relevant
professional
Location
Medical perspective Rehab perspective
Patient’s home
Outpatient clinic
Voluntary services
Voc rehab services
GP monitoring as
per general
population
Focusing on
particular social
participation, long
term needs
Location
Medical perspective Rehab perspective
Clinic
Patient’s home
Check of risk factors Current functioning
Disability check
Care package check
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Rehabilitation is specialist
Rehabilitation is complex
Stroke is complex
Stroke is not cardiac – very different rehab
needs
Stroke is very multi disciplinary
Stroke goes on a long way past the hyper
acute and acute phase