Community Stroke Rehabilitation developing a vision for the future Christine Dryden Specialist Nurse

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Community Stroke
Rehabilitation - developing a vision
for the future Christine
Dryden Specialist Nurse
Facilitator for
Cardiovascular Disease
Community Cardiology North Tyneside
Primary Care TrustChristine.dryden_at_northumbria-h
ealthcare.nhs.uk
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• So is it Rehabilitation?

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Definition of Rehabilitation

• rehabilitate    to return someone or something
  to a good or healthy condition, state or way of
  living
• Rehabilitation is a treatment or treatments
  designed to facilitate the process of recovery
  from injury, illness, or disease to as normal a
  condition as possible.

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Rehabilitation after stroke

• Empowering someone to reach an optimal level
  of recovery, so as to achieve best quality of
  life and function in the most appropriate
  setting, to include family, work and other social
  contacts , as cost-effectively as possible.

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Pilot For Programme

• How did this come about?
• Rehabilitation / Exercise?
• Includes education
• What are the outcomes?
• Problems
• Future

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Who should exercise?
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• If there were a pill that cost very little,
• reduced cardiac deaths by 27 percent,
• improved quality of life, and reduced anxiety
• and depression, every cardiac patient in
• Europe would be expected to take it. There
• is no such pill, but taking part in cardiac
• rehabilitation programme can provide all
• these benefits. In the UK, only a small number
• of those in need are offered the chance to
• take part.
• Professor Bob Lewin, European society of
  Cardiology,
• Amsterdam 2005

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• Cardiac rehabilitation is the process by
  which patients with cardiac disease, in
  partnership with a multidisciplinary team of
  health care professionals are encouraged and
  supported to achieve and maintain optimal
  physical and psychological health. SIGN
  guidelines (2002)
• Cardiac rehabilitation is the process of
  helping people with a heart condition make any
  necessary changes to their life and get back on
  their feet again-physically, emotionally,
  socially and vocationally.
• BACR (2007)

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The Evidence!

• 30 years of scientific research
• have proved that cardiac
• rehabilitation is one of the
• most effective life saving
• treatments available.

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• If there were a pill that cost very little,
• reduced cardiac deaths by 27 percent,
• improved quality of life, and reduced anxiety
• and depression, every cardiac patient in
• Europe would be expected to take it. There
• is no such pill, but taking part in cardiac
• rehabilitation programme can provide all
• these benefits. In the UK, only a small
• number of those in need are offered the
• chance to take part.
• Professor Bob Lewin, European society of
  Cardiology,
• Amsterdam 2005

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Pilot

• Essentially an exercise programme combined with
  education and risk factor modification.
• Multi Disciplinary Team ( Nurses,
  Physiotherapists, Exercise specialists,
  Psychologists, Pharmacists, Dieticians,
  Occupational Therapists, Stroke Information
  Coordinator )
• 6 week programme.

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Educational Topics

• Stroke and TIA
• Health Psychology
• Medication
• Diet
• Importance of exercise/use of home exercise diary
  
• Relaxation
• Stroke Services Information Co-ordinator
• Open discussion, group decision or group led

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Exercise content

• Warm up (15 mins) Increases myocardial blood
  supply slowly, increases soft tissue flexibility
  , mobilise joints
• Conditioning phase (20 mins) increases
  cardiovascular and respiratory fitness
• Cool down (15 mins) Slowly bring heart rate and
  respiratory rate back to within 10 of rest rates.

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• It helps in a number of ways
• To improve exercise capacity
• To improve participants ability to perform the
  Activities of Daily Living (ADLs)
• To improve sense of well being / confidence
• To gain a better understanding of diagnosis and
  recognition of potential problems

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• It helps in a number of ways
• To promote secondary prevention
• To promote primary prevention to carers
• To signpost patients to other agencies/ phase 4
• Helps people live longer or at least a healthier
  lifestyle !

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Shuttle Walk Results
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59 year old female

• All sessions were very useful to me, not
  only did I improve but I could see others
  improvement. Access to information was very
  important to everyone I felt

• Restored my confidence and helped with my
  coordination and balance

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Patients Views

• exercises quite stimulating
• well worth exercise would certainly do it again
• enjoyed chance to hear other professionals
• excellent course to be on as it gives me
  confidence
• Chance to see other professionals who you
  wouldnt normally see

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Life long support

• Long term maintenance of individual goals.
• Annual reviews
• Healthy living centres
• Healthy hearts
• Council
• Walking clubs
• Group exercise
• Referral back into rehab. primary care.

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Small beginnings!!
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• The best thing about the future is that it only
  comes one day at a time.   

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Sir Thomas Adams stated in the 17th Century
He is a better physician that keeps the disease
off us, than he that cures them of it. Prevention
is so much better than cure, it saves us the
labour of being sick.