1. 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

2. 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

3. How are you doing on the goals you
committed to?

4. Video: Professional video (dietitian)

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. Has your stroke changed WHAT textures you eat?

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

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

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

15. Has your stroke changed your ENJOYMENT of eating?

16. Do you go OUT to eat?

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

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

19. 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

20. 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

21. 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

22. 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

23. Different textures
Handout page 21

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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 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

34. 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

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

36. 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

37. 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

38. 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

39. 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

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

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

42. Acknowledgements
Aphasia Institute
Providence Healthcare