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Fostering Community Participation After Stroke . Purpose. The purpose of this presentation is to provide practical ways to foster community participation after stroke. . Target Audience. All health care providers Rehabilitation specialists and nurses Social workers Family physicians
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Fostering Community Participation After Stroke Information contained in this presentation was produced and/or compiled by APSS. Written permission is required to reproduce any material contained in the presentation. 04/08:04/09[R]
Purpose The purpose of this presentation is to provide practical ways to foster community participation after stroke.
Target Audience All health care providers • Rehabilitation specialists and nurses • Social workers • Family physicians • Home care specialists • Community based health professionals • Community based support workers
Learning Objectives • Define community participation • List 3 ways to enhance the participation of stroke survivors at the systems level • List 4 evidence-based programs for stroke survivors • List 4 ways to enhance participation of stroke survivors at the clinical level • List 5 community services which currently exist in Alberta • List 7 participation focused outcome measures
What Is Participation? Participation – involvement in a life situation
Signs Of Successful Community Participation GTA Rehab Network Stroke Information Card, 2007
John • John, 54 year old lawyer’s assistant has a right hemisphere stroke • Residual impairments include, ↓ sensation in his left upper extremity, fatigue, ↓ attention • Attains optimal participation: • Returns to work part-time • Reads books (for shorter periods of time) • Back to playing golf (9 holes with adaptations) and has lunch with friends after the game
Why Is Participation After Stroke Important? • Low levels of satisfaction • 39% to 65% reported limitations in activities and restrictions in community participation (Pang, Eng & Miller, 2007) • Biggest participation restrictions are in the areas of work, leisure, mobility, education, family, financial and social participation (Cardol et. al., 2002)
Fostering Participation At The Systems Level • Community re-integration is achieved by continuity of services and accessibility to: • education • self-management information • caregiver support • social supports in the community • The Community Service Inventory • Rehab services in the community where the stroke survivor resides • Facilitate repatriation into the home community APSS Pillar 3, 2007
Community-based Programs For Stroke • Living with Stroke • A Community-Based Group Exercise Program for Persons with Chronic Stroke
Community-based Programs For Stroke Continued • Getting on With the Rest of Your Life Post Stroke: Mission Possible • Moving On after Stroke Program (MOST)
Returning To The System John is one year post discharge from outpatient services and is having difficulty.
Returning To The System • A stroke survivor living in the community may continue to change and should be able to re-access formal rehabilitation programs, APSS • Health regions must establish mechanisms to facilitate re-access to rehabilitation, APSS • Any stroke survivor with reduced activity at 6 months or later should be assessed for appropriate targeted rehab, CSS
Fostering Participation At The Clinical Level • The importance of social support • Creating awareness of opportunities • Re-framing optimal participation • Strategizing how to participate more fully in the community • Working with community sites and the person’s social network
Fostering Participation At The Clinical Level: The Importance Of Social Support • Family, friends and caregivers play an important role in participation after stroke • A support person in the home is a major determinant of return home after stroke and prevention of re-institutionalization • Interventions to promote participation need to consider the circumstances of the caregiver
Fostering Participation At The Clinical Level: Awareness • Raise awareness of opportunities for participation • Inform Alberta www.informalberta.ca • Stroke Information Card www.strokestrategy.ab.ca
Existing Community Programs In Alberta • Stroke Recovery Association of Alberta http://www.telusplanet.net/public/fln/about.html • Supports for Community Living http://www.seniors.gov.ab.ca/CSS/bii/publications/BII_regions.pdf • NABIS and SABIS http://www.nabis.ab.ca/ or http://www.sabis.ab.ca/html/sabis.htm • Caregiver College http://www.capitalhealth.ca/AboutUs/OurOrganization/AreasofService/Rehabilitation/AlbertaCaregiverCollege/Caregivers_of_Adult-Brain_Injury_and_Stroke_Survivors.htm
Fostering Participation At The Clinical Level • Assist stroke survivors to re-frame what optimal participation looks like • Assist stroke survivors to strategize how they may participate more fully in their community • Work with community sites and the person’s social network
Mrs. Murray • Right sided stroke with resultant left sided weakness • Uses a cane inside her home, and a wheelchair in the community • Meets with members of her team to discuss participation • Wants to participate in a women’s social group • Community centre is not accessible
Participation Focused Outcome Measures • Clinical rehabilitation aims to maximize participation, APSS • Participation is rarely assessed, Wade, 2003 • In order to demonstrate treatment efficacy, it is necessary to include assessment of participation • Fewer than 6% of measures pertain to participation,
Participation Focused Outcome Measures Participation measurement instruments used in stroke rehabilitation research and reported in the literature: • The EuroQol Quality of Life Scale (EQ-5D) • Medical Outcomes Study Short Form 36 (SF-36) • Nottingham Health Profile (NHP) • Stroke-Adapted Sickness Impact Profile(SA-SIP-30) • Stroke Specific Quality of Life Scale (SSQOL) Salter et. al, 2005 • Stroke Impact Scale (SIS) Duncan et. al,1999 • Canadian Occupational Performance Measure (COPM) Cup, et. al., 2003
John What happened to John?
Discussion Discussion and questions
Prepared by: Margaret Grant, BScOT Rehabilitation Education Coordinator Alberta Provincial Stroke Strategy Reviewed by: Agnes Joyce, BScOT, MScHP Regional Stroke Service Coordinator Regional Stroke Program, Capital Health Fostering Community Participation After Stroke Reviewed by: Jill Cameron, PhD Ministry of Health and Long-term Care Career Scientist Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto Trish Manns, PT PhD Assistant Professor, Department of Physical Therapy, University of Alberta