1. Living With Stroke Emotions, Roles and Relationships
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. EMOTIONS

5. Emotions A stroke has significant EMOTIONAL CONSEQUENCES
Both STROKE SURVIVORS and CAREGIVERS often feel a flood of emotions after a stroke
Adjusting to a stroke is really an emotional journey

6. Emotions
These emotions include: ANGER, SADNESS, GRIEF, and FEELINGS OF LOSS (loss of abilities, loss of independence)
May also feel ANXIOUS, OVERWHELMED, STRESSED, and UNABLE TO COPE with all the changes and necessary adjustments after a stroke

7. We will discuss
Anxiety
Anger
Depression
Positive outlook

8. Anxiety includes Worry Fear Trouble sleeping Irritability or anger
Inability to concentrate

9. Anger

10. Anger

11. Anger

12. Anger

13. Anger

14. Anger

15. Anger
Frequent feelings of sudden intense ANGER can increase your risk of stroke
Talk to your healthcare professional if you have frequent feelings of anger and are having trouble dealing with it

16. Depression Depression is common after stroke
Half of all survivors and about a third of caregivers experience depression
Men and women show depression differently
Signs of depression are more
common in women

17. Depression may include:
Decreased motivation
Less enjoyment of life
Indecisiveness or poor concentration

18. Depression may include:
Change in appetite
Disturbed sleep
Low energy and fatigue

19. Depression symptoms
Typically these symptoms last longer than two weeks and usually start at least three months after stroke

20. Facts about depression
Depression is NOT just unhappiness or “a bad day”
Depression is a real condition with a biological basis in the brain
Depression is a normal reaction to a major life change
Depression is not a sign of weakness

21. Facts about depression
The sooner depression is identified and treated the better the outcome
Antidepressant medications are an important tool to treat depression
You cannot become dependent or addicted to antidepressant medications

22. Depression and pain Depression and pain are often associated
Pain can cause or worsen depression
Similarly, depression can worsen pain

23. Caregivers
Caregivers have also experienced the stroke and its effects as a major life change
Caregivers may be struggling to meet new responsibilities and roles while coping with their own emotional response to stroke
As a result, caregivers have an increased risk for depression

24. Geriatric Depression Scale
The Geriatric Depression Scale (GDS) is a clinically useful indicator of depression
Heart & Stroke Living with Stroke Participant Manual page 71

25. Geriatric Depression Scale
Handout page 35

26. Treatment of depression
Depression can slow your recovery
Treatment for depression can help you recover from stroke
Treatment should never be regarded as giving in or giving up
Treatment of depression is an investment in your overall health

27. Positive outlook

28. VIDEO: Emotional Issues

29. Have you experienced any of the feelings or attitudes mentioned in the video?

30. Do you experience any of these feelings?
Happy
Depressed
Angry
Sad
Worried
Stressed
Handout page 34

31. Do you experience any of these feelings?
Lack of energy
Tired all the time
Difficulties
concentrating
Loss of appetite
Trouble sleeping
Lonely
Handout page 36

32. What can you do to deal with depression or mood changes?

33. How to deal with mood changes
Be ENGAGED IN LIFE
Stay PHYSICALLY ACTIVE
Avoid SOCIAL isolation
Handout page 37

34. How to deal with mood changes
Stay in touch with FAMILY and FRIENDS
Talk to other STROKE SURVIVORS and CAREGIVERS
Handout page 37

35. How to deal with mood changes
Learn about STROKE to help you understand what’s happening
Talk to your HEALTHCARE TEAM about your concerns
Speak to your doctor about MEDICATION
if you think you are depressed
Handout page 38

36. How to deal with mood changes
Set GOALS and work toward them to help you maintain a sense of CONTROL, improve your CONFIDENCE and raise your SELF-ESTEEM
Take an ACTIVE role in your recovery, one step at a time
Handout page 38

37. ROLES Living With Stroke
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

38. Roles

44. Did anyone stop working?
How did it make you feel?
Any positive changes?

46. Caregiver

47. Caregiver

48. Caregiver

49. Caregiver

50. Caregiver Caregivers, what are some of the issues and feelings you
are experiencing?
What do you do to prevent burnout?

51. Services

52. Services

53. Services

54. Services
What services do you use?

55. VIDEO: Family Support and Caregivers

56. RELATIONSHIPS Living With Stroke
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

57. Stroke and relationships
A stroke can affect your relationship with your:
Husband/Wife
Brother/Sister
Children
Friends
Others

58. Relationships
A stroke can change your role at home and your relationship with your spouse or children
The previous caregiver in the relationship may now require care
Some find their need for help embarassing or distressing

59. Relationships
You are dealing with the impact of the stroke as well as the changes in your role and relationship

60. Relationships
The small irritations of daily life often cause more stress than the big events, because they tend to affect the perception of control
Everyone needs to feel a sense of control and mastery in life

61. Relationships Some experience positive changes
Many spend more time together and enjoy the resulting closeness
Examples: cook together, read together, do chores together

62. Has your relationship with your family changed in a positive way since your stroke?

63. Maintaining social relationships
After a stroke, people may reduce their social activity because they cannot do things the way they used to
If you are prepared to make some changes, there’s no reason to give up social activities

64. Maintaining social relationships

65. Maintaining social relationships

66. Maintaining social relationships

67. Maintaining social relationships

68. Maintaining social relationships

69. Maintaining social relationships

70. Maintaining social relationships

71. Maintaining social relationships

72. Maintaining social relationships

73. Maintaining social relationships

74. Maintaining social relationships
Meet up at a coffee shop
or restaurant
Go to the park
Go to the movies
Handout page 39

75. Maintaining social relationships
Join a community centre
Attend your place of worship
Join a support group
Handout page 39

76. Can you come up with a goal to deal with the changes that have occurred since your stroke ?

77. Wellness goal Be physically active Be social Join a group
Talk to doctor about medications
Other: ________
Handout page 40

78. Acknowledgements
Aphasia Institute
Providence Healthcare