Title: CONCEPTUALISING STROKE REHABILITATION
1CONCEPTUALISING STROKE REHABILITATION
- Marisa Rose
- Acute Stroke Lead NEL Cardiac and stroke network
- Marisa.rose_at_bdpct.nhs.uk
- Sue Winnall
- Head Occupational therapist Rehabilitation
Mile End Hospital - Sue.winnall_at_thpct.nhs.uk
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2Having a stroke
3Role of acute care in this instance
- 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 dont understand what people are
saying to you, you can still not find the toilet,
you can not recognise the toilet or undress
yourself
4What about thrombolysis?
5How many people need rehab?
- 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
6Intervention over time
- Blue- Medical
- Red- Therapy
Intervention amount
72h
4 weeks
12 weeks
Long term
7Rehabilitation
Stroke rehab
8Stroke rehabilitation evidence
- 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
9What is stroke rehabilitation?
- Physical
- Sensory
- Cognitive
- Perceptual
- Emotional
- Focus on activities and roles important to people
- Structured by personal goals
- Support
- Information
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11Anyone for tennis?
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
12The phases of rehab
- Semantics lets clear this up first
- Not just about location
13Hyperacute stroke
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
14Acute stroke
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
15Inpatient rehabiliation
Location Medical perspective Rehab perspective
Acute hospital Rehabilitation hospital (if medical staff available) Monitoring respond if patient changes (Medically stable) Continued assessment Daily rehabilitation
16Early supported discharge
Location Medical perspective Rehab perspective
Patients home Should not be necessary GP monitoring as per general population (Medically stable) Daily, intense rehabilitation by each relevant allied health professionals
17Community rehabiliation
Location Medical perspective Rehab perspective
Patients home Should not be necessary GP monitoring as per general population (Medically stable) Rehabilitation 2 to 3 times per week by each relevant professional
18Long term rehabiliation
Location Medical perspective Rehab perspective
Patients home Outpatient clinic Voluntary services Voc rehab services GP monitoring as per general population Focusing on particular social participation, long term needs
19Long term follow up
Location Medical perspective Rehab perspective
Clinic Patients home Check of risk factors Current functioning Disability check Care package check
20In summary
- 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