Living With Stroke Swallowing and Nutrition Trainer: Prior to conducting this training workshop, it is essential that you become familiar with both the facilitator manual and participant manual for the Living with Stroke (LWS) program. It is also vital to have a good understanding of the Facilitator Training Workshop materials and the way that the content and the exercises are designed to explain and build facilitation skills. Two trainers, or a trainer plus an assistant, are required to conduct this workshop effectively. To avoid confusion between this workshop and the LWS program, the individuals participating in the workshop are referred to as facilitators and the individuals participating in the LWS program are referred to as participants. Similarly, the training is referred to as a workshop, whereas LWS is referred to as a program. As you conduct this workshop, it is crucial that you engage the facilitators by modelling the facilitation approach you are teaching the facilitators. Therefore, wherever possible, break up the content review with questions asking for personal experiences and with examples from your own facilitation experience. Sample questions are provided for many areas, but you may wish to develop your own examples or questions as you prepare for the workshop. The more interactive the session and the more relevant the information to the facilitators, the easier it will be for them to understand the principles and the process involved in facilitation and to develop confidence in leading LWS. Facilitator Training Workshop, 2007

Topics Module 1: Understanding stroke Module 2: Physical changes and challenges Module 3: Swallowing and nutrition Module 4: Cognition, perception and communication Module 5: Emotions, roles and relationships Module 6: Reducing the risk of stroke and moving forward

How are you doing on the goals you committed to?

Video: Professional video (dietitian)

Swallowing difficulties SWALLOWING DIFFICULTIES may initially affect up to HALF of all stroke survivors The muscles of your face, mouth, tongue, and throat may be weak or lack coordination These problems create difficulty in eating specific types of foods and specific textures safely

Do you have problems with eating and swallowing? Living With Stroke Do you have problems with eating and swallowing? Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Do you have difficulties with? Living With Stroke Do you have difficulties with? Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Do you have difficulties with? Living With Stroke Do you have difficulties with? Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Swallowing difficulties can lead to: POOR NUTRITION or DEHYDRATION Risk of ASPIRATION (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease LESS ENJOYMENT of eating or drinking EMBARASSMENT or ISOLATION in social situations involving eating

How has your ability to SWALLOW changed since your stroke? BETTER WORSE NO CHANGE

Has your stroke changed WHAT textures you eat?

Has your stroke changed WHAT you eat? I have not changed what I eat I eat healthier foods

Has your stroke changed HOW MUCH you eat? MORE LESS NO CHANGE

Has your stroke changed HOW MUCH you drink? MORE LESS NO CHANGE

Has your stroke changed your ENJOYMENT of eating?

Do you go OUT to eat?

Do you FEEL any of the following when eating? Tired Self- concious Enjoyment Takes effort

What TREATMENTS are available for people with swallowing disorders? Using SAFE SWALLOWING STRATEGIES CHANGING TEXTURES of foods and liquids

Safe swallowing strategies Living With Stroke Safe swallowing strategies Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 19 Facilitator Training Workshop, 2007

Safe swallowing strategies Living With Stroke Safe swallowing strategies Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 19-20 Facilitator Training Workshop, 2007

Safe swallowing strategies Living With Stroke Safe swallowing strategies Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 20 Facilitator Training Workshop, 2007

Taking care of yourself Living With Stroke Taking care of yourself Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Different textures Handout page 21

Healthy eating Living With Stroke Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Living With Stroke Plan meals and snacks Eat three meals every day and set regular mealtimes Space meals no more than 6 hours apart Eat smaller portions and gradually reduce serving size Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Nutrition Guidelines Follow Canada’s Food Guide Living With Stroke Nutrition Guidelines Follow Canada’s Food Guide Link to Canada’s Food Guide Trainer: This is a good interactive and thought-provoking icebreaker. Ask each person to answer a question such as the following: What do these quotations mean to you? How do you think they apply to your role as a facilitator? Share your answer first to demonstrate. (Here’s an example: After hearing for a long time about the importance of healthy eating, I was able to change my eating habits because I changed the way I thought of food. Previously, I thought of food primarily as a pleasure. Now, I think of food primarily as fuel for my body. This change in thinking changed my attitude to food and eating and the way I shop for food and cook.) You may wish to have different people answer different questions to introduce some variety and stimulate discussion. Facilitator Training Workshop, 2007

Canada’s food guide Living With Stroke Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 22 Facilitator Training Workshop, 2007

Eat more high-fibre foods Living With Stroke Eat more high-fibre foods Whole grain breads and cereals Legumes: lentils, dried beans and peas Brown rice and whole wheat pasta Fruits and vegetables Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 23 Facilitator Training Workshop, 2007

Limit Salt Fat Sugar Living With Stroke Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Handout page 23 Facilitator Training Workshop, 2007

Living With Stroke Salt Remove salt shaker from the table and substitute salt free seasonings Reduce the amount of salt you add when cooking Use reduced-sodium or no-salt added products Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Salt Limit foods with high salt content. Examples are: Living With Stroke Salt Limit foods with high salt content. Examples are: cured meats, such as bacon or ham brined foods such as pickles, olives and sauerkraut condiments such as MSG (monosodium glutamate), ketchup, soy sauce, barbeque sauce Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Living With Stroke Salt Instead of salt experiment with seasonings such as herbs, spices, lemon zest, vinegar, and salt-free seasoning blends Sodium intake should be limited to 1,500 mg (2/3 tsp) a day if diagnosed with high blood pressure No more than 2300mg (about 1 tsp) of sodium a day otherwise Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Living With Stroke Fats Use half as much vegetable oil, soft or liquid margarine and salad dressing Choose fat-free salad dressings Choose lower-fat dairy products Read food labels and select foods with less than 3 grams of fat per serving Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Living With Stroke Sugar Limit consumption of high sugar foods such as cakes, pies, and candy bars Limit consumption of regular soft drinks and fruit drinks. Drink water instead. Eat fruit canned in fruit juice, not syrup Add fruit to plain yogurt Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Read Food labels Select foods with: NO added SALT NO added SUGAR NO TRANS FAT or FAT-FREE

Other things to think about Living With Stroke Other things to think about Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Meals on wheels Living With Stroke Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Plan meals and snacks You may benefit from a healthy snack: Living With Stroke Plan meals and snacks You may benefit from a healthy snack: Fruits and vegetables Unsalted nuts Plain popcorn without butter or salt Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Coping Try healthier recipes Talk to a dietitian Living With Stroke Coping Try healthier recipes Talk to a dietitian Smaller, more frequent meals Nutritional supplements Eat before attending a social function Trainer: Review the objectives of the facilitator training workshop. Ask if there are any questions or clarification required for any points. Ensure that the group understands all the points. Facilitator Training Workshop, 2007

Can you come up with a goal to eat a healthier diet?

Diet goal Reduce salt Reduce fat Eat more fruits and vegetables Eat more whole grains Read food labels Other: _______ Handout page 24

Acknowledgements Aphasia Institute Providence Healthcare