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Fostering Community Participation After Stroke

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

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  1. 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]

  2. Purpose The purpose of this presentation is to provide practical ways to foster community participation after stroke.

  3. 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

  4. 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

  5. What Is Participation? Participation – involvement in a life situation

  6. Signs Of Successful Community Participation GTA Rehab Network Stroke Information Card, 2007

  7. 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

  8. 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)

  9. Whose Role Is It?

  10. 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

  11. Community-based Programs For Stroke • Living with Stroke • A Community-Based Group Exercise Program for Persons with Chronic Stroke

  12. Community-based Programs For Stroke Continued • Getting on With the Rest of Your Life Post Stroke: Mission Possible • Moving On after Stroke Program (MOST)

  13. Returning To The System John is one year post discharge from outpatient services and is having difficulty.

  14. 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

  15. 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

  16. 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

  17. 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

  18. Example: Stroke Information Card

  19. 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

  20. 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

  21. 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

  22. 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,

  23. 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

  24. John What happened to John?

  25. Discussion Discussion and questions

  26. 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

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