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

• 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

Goal Setting

• 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!

Fatigue

MANIFESTATIONS OF FATIGUE

Subjective

Physical

• Heavy / weak
• Mild pain
• Tired / worn out

Mental

• Mild sadness
• Tired
• Irritable
• Dull

Objective

Physical

• ↓ physical performance
• Slowing
• Lethargy / ↓ energy / sleepy

Mental

• Difficulty concentrating
• Slow processing
• Learning difficulties
• Less creative

• 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

Managing Fatigue

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

Returning to Work

Returning to Driving

• 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

• r 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.

Driving and the Law

• Taxi vouchers
• Public Transport
• Fuel Card
• Transport services

Alternatives to Driving

• Medical approval
• Driving assessment
• Vehicle modifications
• Restrictions/ limitations on license

Returning to Driving

QUESTIONS?

Social Work

Outpatient Stroke Service Norell Carter Social Worker

The Invisible Side of Stroke

• Recognising and treating the psychological and

emotional impact of stroke

• Acknowledging and dealing with the social effects of

stroke

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

• 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.

GRIEF, LOSS AND FEAR

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

• f 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
• r 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
• ne 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?

Can find on www.eatforhealth.gov.au

• Healthy weight
• Physical activity
• Variety of nutritious foods from the five food groups
• ‘Extras’ foods – sometimes
• Water

Australian Guide to Healthy Eating & Australian Dietary Guidelines

• 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

Breads, cereals, pasta, rice, noodles

• 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

Vegetables, legumes

• 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

Fruit

• 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

Lean meat, fish, poultry, eggs, nuts

• 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

Milk, cheese, yoghurt

• Provide saturated fat, salt, sugar and kJ’s!

‘Extras’ foods

• 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

Tips for Eating Well

• Fresh fruit or snack sized packs of fruit in natural

juice

• Fruit and vegetable pikelets/scones/muffins
• Vegetable sticks with low fat dip
• Small cans of ‘no added salt’ baked beans, bean

salad mix, corn

• Small handful unsalted nuts
• Low fat yoghurt

Any other ideas?

Healthy Snack Ideas

How do you think you can make your favourite recipes healthier?

• Vegetables and fruit are lower in kJ’s, add more to a

recipe to lower the kJ content (and increase fibre) of the total dish

• Swap some of the meat or chicken for cooked or

canned legumes

• Add more vegetables to pasta, rice and soup dishes
• Swap white varieties for wholemeal

e.g. flour, pasta, rice

• Swap high fat ingredients for low fat

alternatives

Recipe Modification Tips

• Adding fruit to a recipe can add sweetness and

flavour and reduce the need to add sugar

• Often the sugar in a recipe can be reduced by a third
• r even half without affecting the final product
• Use no added salt products when you can, and use

smaller amounts of high salt ingredients such as sauces and add more herbs, spices, garlic or ginger for flavour

Recipe Modification Tips

Healthy Cooking Techniques

• Baking
• Grilling or BBQ
• Steaming
• Roasting
• Stir-frying
• Slow cooking
• Poaching

Healthy Cooking Ingredients

• Use milk instead of cream in soups, sauces, quiches
• Use a stronger cheese and you will not need as much
• Instead of whipped cream, blend cottage or ricotta cheese

with a small amount of icing sugar

• Instead of sour cream, use reduced fat natural yoghurt or

blend cottage cheese with small amount of lemon juice

• Instead of butter use unsaturated oils including margarine,
• live oil and other plant-based oils
• Use ricotta, cottage cheese, hummus, avocado or

unsalted nut spreads as an alternative on bread for variety

Enjoy healthy eating and a balanced diet that is:

• Low in salt, saturated fat and added sugars
• High in plant-based oils
• Has a variety of plant-based and high-fibre foods

including fresh fruit and vegetables, breads and cereals

• Watch portion sizes especially if aiming for weight

loss

• Increase physical activity and quit smoking

Summary -

THANKYOU FOR ATTENDING! ANY QUESTIONS?

EVALUATION FORMS TO BE COMPLETED