Moving on from Stroke Day Therapy Unit Outpatient Stroke Service - PowerPoint PPT Presentation

Moving on from Stroke Day Therapy Unit Outpatient Stroke Service

WELCOME BACK! Week 3:  Occupational Therapy  Social Work  Dietitian

OCCUPATIONAL THERAPY Living your life…..

Returning to Everyday Activities

Goal Setting  Set goals – make them specific and measurable  Write out an action plan – the ‘how’ of achieving your goals.  Identify obstacles to achieving your goals.  Build in rewards and visualise the end result

Goal Setting

Fatigue  Fatigue affects up to 70% of individuals after brain injury  Can influence mood, physical functioning, attention, memory, communication and tolerance levels.  Recognising fatigue is important!

MANIFESTATIONS OF FATIGUE Subjective Objective Physical Physical  Heavy / weak  ↓ physical performance  Mild pain  Slowing  Tired / worn out  Lethargy / ↓ energy / sleepy Mental Mental  Mild sadness  Difficulty concentrating  Tired  Slow processing  Irritable  Learning difficulties  Dull  Less creative

Managing Fatigue  Recognise early warning signs  Pace yourself  Build in structure and routine  Gradually and slowly build up activities  Sleep more and build in rests  Say “NO”, delegate and prioritise  Be a morning person  Exercise daily  Keep a diary

Returning to Work  Going back to work can be hard after a stroke because of:  Physical changes  Lack of motivation  Attitudes of work place colleagues  Fatigue.  Lack of concentration or memory.  http://www.crsaustralia.gov.au

Returning to Driving

Driving and the Law  As a driver, you are required to inform the Department of Transport of any driving impairment.  A driving impairment means:  any permanent or long term physical or mental condition (which may include a dependence on drugs or alcohol) that is likely to, or treatment for which is likely to, impair your ability to control a motor vehicle.  any permanent or long term increase in, or aggravation of an existing physical or mental condition (which may include a dependence on drugs and alcohol) about which you have previously notified the department.

Alternatives to Driving  Taxi vouchers  Public Transport  Fuel Card  Transport services

Returning to Driving  Medical approval  Driving assessment  Vehicle modifications  Restrictions/ limitations on license

QUESTIONS?

Social Work

The Invisible Side of Stroke  Recognising and treating the psychological and emotional impact of stroke  Acknowledging and dealing with the social effects of Outpatient Stroke Service stroke Norell Carter Social Worker

Life After Stroke  After stroke people can experience a loss of personal freedom, independence and a change in roles and routines.  After a stroke, people can experience emotional and behavioural changes.

WHATEVER YOU’RE FEELING, IT’S OK Each person is unique in the way that they respond to life after stroke

LOSS AND GRIEF Symptoms of Grief:  Anger  Anxiety/Panic Attacks  Blame  Denial  Irritability/Frustration  Loneliness/Numbness

GRIEF, LOSS AND FEAR  There is no time frame for grief.  The changes and subsequent losses that we may experience can be visible or invisible.  They may be physical, intellectual, psychological, emotional, social and spiritual nature.

EMOTIONAL AND PERSONALITY CHANGES AFTER STROKE

DEPRESSION AND ANXIETY AFTER STROKE

WHAT IS DEPRESSION?  Depression is more than just feeling sad. It has serious effects on both physical and mental health.  Up to two thirds of people who have a stroke feel depressed at some point.  It’s important to seek help early; the sooner the better  With the right treatment most people recover from depression and anxiety

WHAT IS ANXIETY?  Anxiety is more than just feeling stressed or worried.  Anxiety can be expressed in different ways such as uncontrollable worry, intense fear (phobias or panic attacks), upsetting dreams or flashbacks of a traumatic event.

 Some common symptoms of anxiety include: - hot and cold flushes - racing heart - tightening of the chest - snowballing worries - obsessive thinking and compulsive behaviour

HOW MIGHT A STROKE AFFECT MY PERSONALITY?  Personality and/or behavioural changes are also common after stroke and can include: - irritability - aggression - perseveration - apathy - emotional lability - disinhibition - impulsivity

RELATIONSHIPS & SEXUALITY .

IMPACT OF STROKE ON CARERS  Stroke can create challenges for people we love or care about. They may experience unsettling changes and losses in their lives.  Stroke is a learning journey involving loss for both the person who has had a stroke and also the people around them.

DEVELOPING A MEANINGFUL LIFE DOESN’T JUST HAPPEN We have to create it

STRATEGIES TO HELP ADJUST TO LIFE AFTER STROKE: SOCIAL  Support group  Volunteer  Community Groups  Support others  Reconnect with friends and family  Reinstate routines  Act, Belong, Commit  Seek opportunities for joy

PHYSICAL  Exercise  Eating healthy  Spend time in nature  Regular sleep  Access to a GP  Relaxation/meditation  Breathing techniques  Creativity  Music  Self-Care  Massage

THINKING  Thinking of memories  Notice good things  Finding gratitude  Planning purposeful activities  Setting goals  Healthy thinking

FEELINGS • Journaling • Relaxation • Reading novels • Expressing emotions • Finding a safe space • Rituals • Time for reflection • Massage • Baths

SPIRITUAL  Yoga  Relaxation  Mindfulness  Music  Read  Journal writing  Retreats  Visit a memory place  Meditation

HOW TO DE-STRESS AND BE IN THE MOMENT

ACCEPTANCE AND DENIAL  Following a stroke, acceptance and denial are not stages one reaches and are finished with.  We move toward and away from these states as one adjusts to life after a stroke.

COMING TO A PLACE OF ACCEPTANCE  As with anything in life, the degree to which we accept the ‘as - is’ is the degree to which we cope better in the world.  Finding acceptance within, is the pathway to freedom.  When we accept our life in the present moment we let go of resistance, and only then can we begin the change.

COUNSELLING AND SUPPORT FOR INDIVIDUALS AND FAMILY MEMBERS  National Stroke Foundation Strokeline – Ph: 1800 787 653 www.strokefoundation.com.au  Relationships Australia – Ph: 1300 364 277  Lifeline Australia – Ph: 13 11 14  Beyond Blue – Ph: 1300 224 636

COUNSELLING AND SUPPORT FOR CARERS  Carers Australia WA – Ph: 1800 242 636 (Freecall)  1300 CARERS (1300 227 377)  Carers Australia WA Counselling Line – Ph: 1800 007 332 (Freecall)

ANY QUESTIONS?

Dietitian Recap: What is Healthy Eating?

Australian Guide to Healthy Eating & Australian Dietary Guidelines Can find on www.eatforhealth.gov.au  Healthy weight  Physical activity  Variety of nutritious foods from the five food groups  ‘Extras’ foods – sometimes  Water

Breads, cereals, pasta, rice, noodles  Provide carbohydrates, iron, B vitamins and fibre  A serve is 1 slice bread, ½ medium roll, ½ cup cooked rice or pasta, ½ cup cooked porridge, 2/3 cup wheat cereal flakes, ¼ cup muesli, 1 crumpet  Choose multigrain or wholemeal products

Vegetables, legumes  Provide fibre, vitamin A, vitamin C, folate and carbohydrates  A serve is ½ cup cooked vegetables, ½ cup cooked beans/lentils, 1 cup salad, ½ cup sweet corn, ½ medium potato  Include a variety of colours

Fruit  Provide fibre, vitamin C, folate and carbohydrates  A serve is 1 medium apple/banana/orange/pear, 2 small apricots/kiwi fruit/plums, 1 cup diced or canned fruit  Consume with skin on where possible  Fresh, tinned or frozen are all good choices

Lean meat, fish, poultry, eggs, nuts  Provide protein, iron and zinc  A serve is 65g cooked lean meats including beef, lamb, veal, pork or kangaroo, 85g cooked lean poultry, 100g cooked fish, 2 large eggs, 1 cup cooked legumes, 170g tofu, 30g nuts/seeds  Avoid high fat deli meats, sausages and fried foods

Milk, cheese, yoghurt  Provide carbohydrates, protein, calcium and vitamins  A serve is 1 cup fresh/long life milk, ½ cup evaporated milk, 2 slices hard cheese, ½ cup ricotta cheese, ¾ cup yoghurt  Choose reduced fat varieties

‘Extras’ foods  Provide saturated fat, salt, sugar and kJ’s !

Tips for Eating Well  Eat regularly  Don’t skip breakfast  Eat with other people, not TV  Choose healthier takeaway food options  Make healthy food choices at restaurants  Choose healthy snacks  Use low fat cooking techniques