Marisa Rose Acute Stroke Lead NEL Cardiac and stroke network Sue Winnall Head Occupational therapist – Rehabilitation Mile End Hospital

 Investigation into cause and nature of stroke  Reduce your risk of having it again  Preventing secondary medical complications This is all done … you still have trouble getting out the chair, you still bump into things on the right, you still don’t understand what people are saying to you, you can still not find the toilet, you can not recognise the toilet or undress yourself

 Of people who survive a stroke:  Only 20% with have full recovery in 2 weeks  60% will require rehabilitation of varying levels and intensity  20% will be severely functionally dependent

Blue- Medical Red- Therapy Intervention amount 72h4 weeks12 weeksLong term

 Stroke Rehabilitation Units reduce disability and institutionalisation  More intensive OT and physio result in improved functional outcomes  Early intervention result in better functional outcomes  Gains made in rehabilitation are maintained over time

 Physical  Sensory  Cognitive  Perceptual  Emotional  Focus on activities and roles important to people  Structured by personal goals  Support  Information

LessonTennisToilet One1) Ball and racket (badminton, squash, tennis) 2) The grip 3) Get familiar with court, conceptualise the general game 1) Recognise toilet, toilet paper, toilet seat 2) Hold toilet paper Two1) Prompts to realign/remember the grip 2) Practise action of forehand 1) Prompts to hold toilet paper 2) Practise wiping with correct action Three, four, five etc1) Practise action again & again & again until you become efficient enough not to need the prompts or facilitation of your coach 1) Practise again & again & again until you become efficient enough not to need the prompts from your therapist

 Semantics – let’s clear this up first  Not just about location

LocationMedical perspectiveRehab perspective Acute hospital 72h medical stability, investigations (Medically unstable or medical stability unknown) Initial assessment Including: mobility, swallowing, initial interview, cognitive/perceptual screening, functional assessment

LocationMedical perspectiveRehab perspective Acute hospital Rehabilitation hospital (if medical staff available) Monitoring, Medications for risk factor & if necessary, dealing with Secondary complications (Becoming Medically stable but Could fluctuate) As above Further assessment Daily Rehabilitation

LocationMedical perspectiveRehab perspective Acute hospital Rehabilitation hospital (if medical staff available) Monitoring & respond if patient changes (Medically stable) Continued assessment Daily rehabilitation

LocationMedical perspectiveRehab perspective Patient’s homeShould not be necessary GP monitoring as per general population (Medically stable) Daily, intense rehabilitation by each relevant allied health professionals

LocationMedical perspectiveRehab perspective Patient’s homeShould not be necessary GP monitoring as per general population (Medically stable) Rehabilitation 2 to 3 times per week by each relevant professional

LocationMedical perspectiveRehab perspective Patient’s home Outpatient clinic Voluntary services Voc rehab services GP monitoring as per general population Focusing on particular social participation, long term needs

LocationMedical perspectiveRehab perspective Clinic Patient’s home Check of risk factorsCurrent functioning Disability check Care package check

 Rehabilitation is specialist  Rehabilitation is complex  Stroke is complex  Stroke is not cardiac – very different rehab needs  Stroke is very multi disciplinary  Stroke goes on a long way past the hyper acute and acute phase