1. Training Centre in Subacute Care TRACS WA Maximising Self-Care Rehabilitation An Introduction for Nursing Staff Part A Developed by Department of Occupational Therapy RPH and TRACS WA as part of the 2013 Learning Tool Supporting Patient Self Care Rehabilitation Goals in a Neurological Rehabilitation Setting: An Education Resource for Nursing Staff

2. Developed by TRACS WA and RPH OT Dept, 2013 Background This project was developed from a pilot project based on Ward 2, Royal Perth Hospital, Shenton Park Campus (RPH SPC) in 2013. The project was initiated by Jocelyn White, Senior Occupational Therapist and supported by TRACS WA, Ward 2 and the RPH SPC Occupational Therapy and Nursing Departments. The pilot program was developed and led by Jocelyn White. These teaching resources have been developed by the TRACS WA Team for sharing with the WA Health Subacute Care Community and beyond. Acknowledgements: Beverly Hardcastle, Julie Brayshaw, Diane Jones, Paul Cooper, Terrie Simpson and Jenny Langley.

3. Developed by TRACS WA and RPH OT Dept, 2013 Learning Objectives  Explore the principles of neurorehabilitation  Understand the overlap between the Occupational Therapy role and the Nursing role  Understand the concept of neuroplasticity  Develop awareness of some neurological symptoms and their effect on performance  Learn some strategies for self-care rehabilitation

4. Developed by TRACS WA and RPH OT Dept, 2013 Principles of neurorehabilitation  Teamwork  Goals  Specific, repetitive learning opportunities  Patient and family education (Albert & Kesselring, 2012) To maximise participation of the patient in his or her social setting (Wade & Jong, 2000)

5. Developed by TRACS WA and RPH OT Dept, 2013 The Occupational Therapy Role  Assessment and treatment  Cognition, perception, sensation, upper limb  Occupational performance  Techniques and strategies  Education  Home environment

6. Developed by TRACS WA and RPH OT Dept, 2013 The Nursing Role in Rehabilitation  Caregiver  Teacher  Care co-ordinator  Counsellor  Researcher  Advocate  Coach  Case manager  Consultant  Service manager Australasian Rehabilitation Nurses’ Association (2002) www.arna.com.au

7. Developed by TRACS WA and RPH OT Dept, 2013 Current Guidelines for Stroke Rehabilitation  Specialised rehabilitation  Assessment  Goal-setting  Intensity of treatment  Specific therapy for ADL  Training for staff, patients and carers  Co-ordinated, multidisciplinary staff (interprofessional practice) strokefoundation.com.au www.ebrsr.com

8. Developed by TRACS WA and RPH OT Dept, 2013 International Classification of Functioning, Disability and Health (ICF) World Health Organisation

9. Developed by TRACS WA and RPH OT Dept, 2013 Neuroplasticity  The brain's ability to reorganise itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment (medicinenet.com)  Treatment needs to be repetitive, challenging and relevant (Albert & Kesselring, 2012)

10. Developed by TRACS WA and RPH OT Dept, 2013 Neurological Symptoms  Neglect  Apraxia  Attention Deficits

11. Developed by TRACS WA and RPH OT Dept, 2013 Neglect  Failure to respond to meaningful stimuli  More common with right sided damage  Can be hyper-aware of unaffected side  Poor left-right discrimination  Impairs performance  Increases length of stay

12. Developed by TRACS WA and RPH OT Dept, 2013 Addressing Neglect  Develop awareness  Turn the head towards the shoulder  Train visual search strategy  Set up task and environment  Prompt

13. Developed by TRACS WA and RPH OT Dept, 2013 Apraxia  Loss of the ability to perform activities that a person is physically able and willing to do  Ideational apraxia - inability to perform a series of movements in a sequence  Ideomotor apraxia - inability to make the proper movement in response to a command e.g. “wave”

14. Developed by TRACS WA and RPH OT Dept, 2013 What Apraxia Can Look Like  Clumsiness  Unable to use tools correctly – toothbrush, razor  Unable to act out instructions

15. Developed by TRACS WA and RPH OT Dept, 2013 Addressing Apraxia  Verbal or physical cues  Strategy training  Errorless completion (Pomeroy et al., 2011)

16. Developed by TRACS WA and RPH OT Dept, 2013 Attention  A multi-faceted cognitive construct  Arousal  Alertness and orienting  Focused attention and distractibility  Cognitive speed  Sustained attention  Vigilance and persistence  Working memory and attention span  Shifting and dividing attention  Initiation  Performance consistency  Ability to mobilise and direct attentional resources

17. Developed by TRACS WA and RPH OT Dept, 2013 Addressing Attention  Get the patient’s attention  KISS – Keep it simple  Allow time for processing  Minimise distractions  Consider hearing aids and glasses  Increase challenges gradually

18. Developed by TRACS WA and RPH OT Dept, 2013 Prompting Strategies Gesture Open question Closed question Instruction Mirror Copy Physical Assistance

19. Developed by TRACS WA and RPH OT Dept, 2013 General Strategies  Get attention  Clear and concise  Allow time for processing  Prompt  Minimal assistance

20. Developed by TRACS WA and RPH OT Dept, 2013 Delivering Self-Care Rehabilitation  Specific and individualised  Consistent  Repetition, repetition, repetition  Feedback  Consider what you say and do YOU are part of the setting and the treatment

21. Developed by TRACS WA and RPH OT Dept, 2013 OT and Nursing Communication  Care plans  Goal-setting  Patient notes  Team meetings  Tell the OT what you have observed: it’s helpful and valued

22. Developed by TRACS WA and RPH OT Dept, 2013 We have covered....  The principles of neurorehabilitation  The overlap between the Occupational Therapy role and the Nursing role  The concept of neuroplasticity  The symptoms of neglect, apraxia and attention deficits their effect on performance  Some strategies for self-care rehabilitation

23. Developed by TRACS WA and RPH OT Dept, 2013 Next steps  Next session  Executive skills  Self-awareness  Dual/multi-tasking  Watch one, Do one  Questions?

24. Developed by TRACS WA and RPH OT Dept, 2013 References  Albert, S., & Kesselring, J. (2012). Neurorehabilitation of stroke. Journal of Neurology, 259(5), 817-832.  Cappa, S. F., Benke, T., Clarke, S., Rossi, B., Stemmer, B., & Heugten, C. M. v. (2005). EFNS Guidelines on cognitive rehabilitation: report of an EFNS task force. European Journal of Neurology, 12, 665-680.  Pomeroy, C. H. C. (2006). Influence of unilateral neglect on independence in activities of daily living after stroke. International Journal of Therapy & Rehabilitation, 13(2), 82- 85.  Pomeroy, V., S. M. Aglioti, V. W. Mark, D. McFarland, C. Stinear, S. L. Wolf, M. Corbetta and S. M. Fitzpatrick. "Neurological Principles and Rehabilitation of Action Disorders: Rehabilitation Interventions." Neurorehabil Neural Repair 25, no. 5 Suppl (2011): 33S-43S.  Robinson-Smith, Gale and Elise Robinson Pizzi. "Maximizing Stroke Recovery Using Patient Self-Care Self- Efficacy." Rehabilitation Nursing 28, no. 2 (2003): 48-51.

25. Developed by TRACS WA and RPH OT Dept, 2013 References continued  Robinson-Smith, Gale, Mark V. Johnston and Judith Allen. "Self-Care Self-Efficacy, Quality of Life, and Depression after Stroke." Archives of Physical Medicine and Rehabilitation 81, no. 4 (2000): 460-464.  Sathian, K., Buxbaum, L. J., Cohen, L. G., Krakauer, J. W., Lang, C. E., Corbetta, M., & Fitzpatrick, S. M. (2011). Neurological principles and rehabilitation of action disorders: common clinical deficits. Neurorehabil Neural Repair, 25(5 Suppl)  Smania, N., S. M. Aglioti, F. Girardi, M. Tinazzi, A. Fiaschi, A. Cosentino and E. Corato. "Rehabilitation of Limb Apraxia Improves Daily Life Activities in Patients with Stroke." Neurology 67, no. 11 (2006): 2050-2.  Wade, D. T., & Jong, B. A. d. (2000). Recent advances in rehabilitation. BMJ, 320(7246)