Living With Stroke Physical Changes and Challenges 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

We will be discussing… What physical changes are you experiencing? How are you coping with physical challenges? How do you compensate for your difficulties? What can you do to maintain physical activity?

Physical Changes Weak face, arm, and leg Difficulties with balance Handout page 12

Physical changes may change the way you …. Walk Climb stairs Do precise work with your hands

Physical changes may change the way you…. Shower Dress Cook

Physical changes may change the way you …. Clean Do laundry Vacuum

Physical changes may change the way you …. Garden Shop Get around

Physical changes may change the way you …. Exercise Play sports

How are you coping with your physical changes?

Physical challenges It’s natural to feel badly about physical limitations. Everyone who has a stroke has these feelings. Physical changes are a constant and visible reminder of a stroke. Many express frustration at dependence on others and inability to perform tasks they used to do easily.

Physical Challenges As discussed previously, the location of your stroke determines which nerves and muscles are affected. Many problems with strength, balance and movement improve over time, especially over the first year after stroke. Generally, the longer the time from the stroke, the smaller the change you can expect and the longer it takes to achieve it.

Physical Challenges Many often allow physical changes to limit their activities. Fear, embarrassment, or an all-or-nothing attitude are often the underlying reason for activity limitations. Underlying beliefs and attitudes are the real BARRIERS, not the physical limitations. Handout page 12

Physical and Activity Limitations

Ways of compensating for Physical Limitations Need to be PROACTIVE Need to be PHYSICALLY ACTIVE Need to learn COMPENSATORY STRATEGIES

Ways of compensating for Physical Limitations HOME MODIFICATIONS AIDS STRATEGIES ATTITUDES AND BELIEFS

Home Modifications

Home Modifications

Home Modifications

Home Modifications

Home Modifications

Ways of compensating for Physical Limitations HOME MODIFICATIONS AIDS STRATEGIES ATTITUDES AND BELIEFS

Aids Cane Walker Wheelchair

Ways of compensating for Physical Limitations HOME MODIFICATIONS AIDS STRATEGIES ATTITUDES AND BELIEFS

Strategies PHYSICAL ACTIVITY can improve your strength, walking ability, coordination and balance and prevent falls. This includes doing exercises and household chores Being involved in physical activities has both physical and emotional benefits Handout page 13

Strategies Use your weak arm or leg as much as possible Use weak hand as a stabilizer Sit on a chair or stool for grooming or cooking activities to help your balance and decrease your fatigue Handout page 13

Ways of compensating for Physical Limitations HOME MODIFICATIONS AIDS STRATEGIES ATTITUDES AND BELIEFS

Attitudes and Beliefs Need to OPEN your MIND to doing something differently or you may never do it again

Attitudes and Beliefs A POSITIVE approach can reduce the risk of depression

Attitudes and Beliefs An attitude of OPTIMISM can help people cope with change

VIDEO: Recovery and physiotherapy

Physical activities Did you do the following activities before your stroke? Do you do the following activities now? Would you like to do these activities in the future?

Physical activities I did this before I do this now I would like to do this in the future Walk Climb stairs Handout page 14

Physical activities I did this before I do this now I would like to do this in the future Shower Get dressed Handout page 14

Physical activities I did this before I do this now I would like to do this in the future Cook Clean Handout page 14

Physical activities I did this before I do this now I would like to do this in the future Wash dishes Do laundry Handout page 15

Physical activities I did this before I do this now I would like to do this in the future Indoor maintenance Outdoor Handout page 15

Physical activities I did this before I do this now I would like to do this in the future Garden Shop Handout page 15

Physical activities I did this before I do this now I would like to do this in the future Work Drive Handout page 16

Physical activities I did this before I do this now I would like to do this in the future Exercise Yoga/Tai Chi Handout page 16

Physical activities I did this before I do this now I would like to do this in the future Swimming Play sports Handout page 16

Physical activities I did this before I do this now I would like to do this in the future Go to gym Community Centre Handout page 17

Physical activities I did this before I do this now I would like to do this in the future Mall walking Other ____________ Handout page 17

Imagine the life you want Living With Stroke Imagine the life you want 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

What gets in the way 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

Setting Goals

Setting Goals

Setting Goals

Setting Goals

Setting Goals

What goal(s) did you come up with to increase your physical activity?

Physical Goal Walking Exercise at Home Cleaning Shopping Community Centre or Gym ______ Other Handout page 18

Commitment to Change Remember YOU have an important role to play in your recovery The way you look at your physical limitations can stop you from doing things OR help you compensate for your limitations You may need to find different ways of doing things so that you can continue to live a full and satisfying life!

Acknowledgements Aphasia Institute Providence Healthcare