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Stroke Best Practices for outpatient/community rehab

Stroke Best Practices for outpatient/community rehab. Date: October 11, 2017 Janine Theben. Outpatient & Community Based Rehabilitation. Stroke survivors with ongoing rehabilitation goals should have access to specialized stroke services

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Stroke Best Practices for outpatient/community rehab

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  1. Stroke Best Practices for outpatient/community rehab Date: October 11, 2017 Janine Theben

  2. Outpatient & Community Based Rehabilitation Stroke survivors with ongoing rehabilitation goals should have access to specialized stroke services Services should be available and provided by a specialized interprofessional team, within 48h of discharge from acuter or within 72 hours from rehab Services should be delivered in the most suitable setting based on needs, goals and availability of social support, preferences

  3. Outpatient & Community Based Rehabilitation • Outpatient and/or community based rehabilitation services should include the same elements and inpatient rehab • Interprofessional team • Case coordination including regular team communication to discuss assessments of new clients, review client management, goals, and plans for discharge or transition • Therapy is provided for a minimum of 45 minutes per day per discipline, 2-5 days per week based on patient goals for at least 8 weeks • Patients and families should be involved in their management, goal setting, an transition planning • Team should promote practice and transfer of skills gained in therapy into the patients daily routine and in the community

  4. Special Topics • Additional topics that could be covered here: –Rehabilitation of visual perceptual deficits • UE treatments including: Functional Electrical Stimulation, Constraint Induces Movement Therapy, Mirror Therapy • Aerobic Training

  5. Visual Perception • Effects 21% of stroke patients • Treatment – clear … • Remedial based techniques: prisms, eye patching, repetitive transcranial magnetic stimulation, and neck muscle vibration • Errorless learning and gesture training for limb apraxia • Mirror therapy for unilateral inattention

  6. UE Treatments • FES targeted at wrist and forearm should be considered to reduce motor impairment and improve function • Traditional or modified constraint induced movement therapy should be considered for patients who demonstrate 20 degrees of active wrist extension and 10 degrees active finger extension and minimal sensory or cognitive deficits • Mirror therapy as an adjunct to motor therapy (improves UE motor function and ADL) • GRASP (suitable for hospital use and home) as a supplementary training program

  7. Aerobic Training • Screen/submaximal test like 6 min walk or exercise stress test (?) . What is the target intensity of the planned program? • Tailored aerobic training using large muscle groups (3 times per week for 8 weeks, 20 min per session plus warm up and cool down). Monitor HR and BP • Transition to self directed physical activity in home or community • Address barriers to participation

  8. Clinician Resources to Guide Evidence Based Practice Canadian Stroke Best Practice Recommendations QBP Handbook Stroke Engine Heart and Stroke Foundation Website (specifically TACLS) Evidence Based Review of Stroke Rehabilitation West GTA Stroke Network Website Core Competency SWO Stroke Unit Orientation Grasp Via Therapy App

  9. Stroke Best Practise at http://www.strokebestpractices.ca

  10. http://westgtastroke.ca/

  11. Upcoming Opportunities for Professional Development Through the West GTA Stroke Network Marianne Lawton Workshop “Normal Movement Bobath Course” for PTAs/OTAs-November 18, 2017 Interprofessional Workshop for Acute and Rehab staff-___ Sharing Forum for Rehab and the Community-Spring 2018 Hemispheres Mirror Therapy Lunch and Learn with Tara Packham

  12. What are your education needs moving forward?

  13. References Teasall, R et al (2013) Dysphagia and Aspiration Following Stroke. Evidence-Based Review of Stroke Rehabilitation. Retrieved from http://www.ebrsr.com/sites/default/files/Chapter15_Dysphagia_FINAL_16ed.pdf Dalmas Griffin, Maggie. (2014, April 20). If you could see what I see. Retrieved from https://www.youtube.com/watch?v=ry3u2mWTfqo. University of Miami. (n.d.) brain3.gif retrieved from http://calder.med.miami.edu/pointis/tbifam/swal1.html International Journal of Stroke, 2016, Vol. 11(2 239-252) ! 2016 World Stroke Organization http://www.strokebestpractices.ca www.strokebestpractices.ca

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