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Stroke Information Session for patients, families and carers Stroke Information Session for patients, families and carers

Stroke in Ireland 3 rd largest cause of premature death Affects 10, 000 people Stroke in Ireland 3 rd largest cause of premature death Affects 10, 000 people annually 30, 000 people currently living with stroke

What is a Stroke ? Damage to part of brain caused by interruption to What is a Stroke ? Damage to part of brain caused by interruption to its blood supply. Focal cerebral symptoms of vascular origin lasting longer than 24 hours are defined as stroke

What is a TIA (Transient Ischemic Attack)? Symptoms lasting less than 24 hours with What is a TIA (Transient Ischemic Attack)? Symptoms lasting less than 24 hours with complete recovery are categorised as TIA 10. 5% of those with TIA are at risk of stroke within 90 days post TIA Greatest risk in first week post TIA clinic in St James’s Hospital

Types of Stroke A blood clot may block cerebral artery and interrupt blood supply Types of Stroke A blood clot may block cerebral artery and interrupt blood supply to brain May have formed within the artery (thrombosis) or May have been carried into the artery in the circulation from a clot elsewhere in the body (embolism) May also be result of localised haemorrhage due to rupture of a blood vessel in or near the brain.

Stroke Symptoms Sudden weakness affecting one side of the body Sudden numbness affecting one Stroke Symptoms Sudden weakness affecting one side of the body Sudden numbness affecting one side of the body Sudden difficulty speaking or understanding Sudden difficulty walking Sudden visual difficulty Sudden severe headache

F. A. S. T. ? THROMBOLYSIS Ambulance 999 F. A. S. T. ? THROMBOLYSIS Ambulance 999

Thrombolysis Considered for strokes caused by clots or narrowing in brain blood vessels, not Thrombolysis Considered for strokes caused by clots or narrowing in brain blood vessels, not strokes caused by bleeds in brain Have to arrive in hospital within 3. 5 hours of stroke Patient must be in good health before stroke Not given to every stroke as drug can dissolve a clot but increases risk of a bleed

Non-modifiable risk factors Age - stroke risk increases with age Race - African American Non-modifiable risk factors Age - stroke risk increases with age Race - African American and Hispanics higher risk Gender - men higher risk Genetic factors- family history of stroke, IHD, hypertension

Modifiable Risk Factors ↓ Blood Pressure ↓ Alcohol Consumption Quit Smoking Weight Management ↑ Modifiable Risk Factors ↓ Blood Pressure ↓ Alcohol Consumption Quit Smoking Weight Management ↑ Physical Activity Cholesterol Management Diabetes Management

Organised Stroke Care 24 hour approach Team work Communication “Goal-setting” “Discharge Planning” ? Picture Organised Stroke Care 24 hour approach Team work Communication “Goal-setting” “Discharge Planning” ? Picture of Stroke team?

Rehabilitation “A progressive, dynamic, goal-oriented process aimed at enabling a person with impairment to Rehabilitation “A progressive, dynamic, goal-oriented process aimed at enabling a person with impairment to reach his or her optimal physical, cognitive, emotional and social functional level” Canadian Heart and Stroke Foundation

Components of rehabilitation Preventing and managing medical complications. Restoring maximal functional independence. Helping with Components of rehabilitation Preventing and managing medical complications. Restoring maximal functional independence. Helping with coping & adaptation. Getting back out into the community. Enhancing quality of life.

Where does Rehab happen? Acute hospital Rehab Unit Day hospital Community setting Home Where does Rehab happen? Acute hospital Rehab Unit Day hospital Community setting Home

The Rehab Process Every stroke is different Difficult to predict recovery in early stages The Rehab Process Every stroke is different Difficult to predict recovery in early stages Not everyone will be able to participate in rehab Everybody can help towards achieving your goals, even small things when done consistently can make a difference using the correct technique to help someone stand using appropriate methods of assistive communication.

Post Stroke Depression / Emotional Aspects Signs of depression include Persistent sad, anxious or Post Stroke Depression / Emotional Aspects Signs of depression include Persistent sad, anxious or eating patterns Sleep disturbances Increase or decrease in appetite and eating patterns Loss of interest in activities or hobbies Fatigue Difficulty concentrating or remembering details Suicidal thoughts

What can help Communicate Improve nutrition Attend a stroke support group Set realistic goals What can help Communicate Improve nutrition Attend a stroke support group Set realistic goals and prioritise Practice stress and anxiety management techniques Be patient with yourself and loved ones Stay as active as possible Get out into the community

Role of Nursing Help individuals return to optimal daily living Focus on social processes Role of Nursing Help individuals return to optimal daily living Focus on social processes of adaptation and negotiation between individuals and environment Maintain and ensure physical integrity for recovery Use knowledge and understanding of individual patients’ needs to shape the MDT effort. Embark on a partnership approach to improve coping, well being and meaningful activities of living.

Role of Nursing Focus is on the persons ability Mindful of patients long term Role of Nursing Focus is on the persons ability Mindful of patients long term and short term goals Teaching and coaching role Development of self care and independence Observation, assessment & interpretation Getting to know the person & determines plan of care Vital signs, skin, pressure care.

Role of Nursing Administering and monitoring therapeutic interventions Promoting self determination, attaining goals and Role of Nursing Administering and monitoring therapeutic interventions Promoting self determination, attaining goals and maximising safety. Monitoring patients response to allied health/medical intervention. Managing changing situations Physiological, social or spiritual. Management, Advocacy and co –ordination role Day Leave & Overnight leaves

Role of the Physiotherapist Help individual with their physical recovery after stroke. Goal of Role of the Physiotherapist Help individual with their physical recovery after stroke. Goal of treatment after stroke is for you to become as independent as possible in everyday tasks such as transfers, standing, walking and using your affected arm. Can be achieved by performing exercises in the physiotherapy gym and in the ward. Your physiotherapist will assess your individual needs and provide a treatment programme to suit you.

Physiotherapy Treatment Strengthening weak muscles Getting the best function in your weak arm and Physiotherapy Treatment Strengthening weak muscles Getting the best function in your weak arm and hand Managing cramps/muscle pains/shortening Working to improve balance, transfers and walking as appropriate. Providing aids/splints to help with transfers or walking. Providing you with your own exercise programme

Physiotherapy Treatment Your physiotherapist will often involve your family or carer in helping you Physiotherapy Treatment Your physiotherapist will often involve your family or carer in helping you with your exercise programme, your transfers or your walking if appropriate. Every patient is different – type of stroke, recovery – it is important to focus on your own rehabilitation. Independence is always encouraged! Do as much as you can yourself and use your weak arm and leg as much as possible even if it takes more time.

Role of the Occupational Therapist Works to help the person with a stroke become Role of the Occupational Therapist Works to help the person with a stroke become as independent as possible in activities of daily life – self care, productivity and leisure

Early OT Intervention Depending on the type of stroke intervention will focus on three Early OT Intervention Depending on the type of stroke intervention will focus on three main areas: Positioning and Seating Pressure Relief Upper Limb Positioning

Cognition Memory Attention Insight Vision Perception Inattention Further Occupational Therapy Intervention Upper Limb Functional Cognition Memory Attention Insight Vision Perception Inattention Further Occupational Therapy Intervention Upper Limb Functional Rehab Personal Activities of Daily Living Domestic Activities of Daily Living Functional Transfers e. g. bed to chair Home Assessments

Role of the Speech and Language Therapist Assessment of Speech Language Swallow after someone Role of the Speech and Language Therapist Assessment of Speech Language Swallow after someone has a stroke

Language (Aphasia) Language Centre ( left side of brain) affected Difficulties with Understanding Reading Language (Aphasia) Language Centre ( left side of brain) affected Difficulties with Understanding Reading Speaking Writing

What can help? Therapy – Individual / Group Total communication Communication aids What can help? Therapy – Individual / Group Total communication Communication aids

Speech Difficulties - Dysarthria Speech muscles weakened slurred speech Exercises Slow down Rephrase something Speech Difficulties - Dysarthria Speech muscles weakened slurred speech Exercises Slow down Rephrase something if the person you are speaking to cannot understand Use communication aids if needed

Swallowing Difficulties (Dysphagia) Difficulty bringing food/fluid from the mouth to the stomach safely Results Swallowing Difficulties (Dysphagia) Difficulty bringing food/fluid from the mouth to the stomach safely Results from muscle weakness and poor coordination Test at bedside and x-ray as necessary

Swallowing Difficulties (Dysphagia) Exercises to strengthen muscles Might need thicker fluids or a softer Swallowing Difficulties (Dysphagia) Exercises to strengthen muscles Might need thicker fluids or a softer diet

Dietitian – Our Role Provide dietary advice and support to patients based on individual Dietitian – Our Role Provide dietary advice and support to patients based on individual dietary needs Assess nutritional status on admission - Weight - Requirements - Height - Ability to eat - Body Mass Index (BMI) - Appetite - Weight loss - Food preferences Based on these, a nutritional plan is established and discussed with the patient

Dietitian – Our Role High protein high calorie diet For patients with weight loss Dietitian – Our Role High protein high calorie diet For patients with weight loss or decreased appetite For patients with increased requirements e. g. wound healing Encourage nourishing snacks and food fortification Nutritional supplements may be needed to meet requirements (milk/juice based drinks)

Dietitian – Our Role Modified Consistency Diet For patients who have a swallow impairment Dietitian – Our Role Modified Consistency Diet For patients who have a swallow impairment Four types of consistency Soft Minced and moist Smooth pureed Liquidised

Dietitian – Our Role Naso-gastric or PEG tube feeding Patients who have an unsafe Dietitian – Our Role Naso-gastric or PEG tube feeding Patients who have an unsafe swallow or those who are not eating enough to maintain good nutritional status. Naso-gastric feeding tube PEG feeding tube

Dietitian – Our Role Healthy eating guidelines Dietitian – Our Role Healthy eating guidelines

Role of Medical Social Worker (MSW) The role of the Medical Social Worker is Role of Medical Social Worker (MSW) The role of the Medical Social Worker is to assist patients and their families resolve any: - Social difficulties - Environmental difficulties - Emotional difficulties

What do MSWs do? Work with patient to enhance patient’s ability to cope Plan What do MSWs do? Work with patient to enhance patient’s ability to cope Plan discharge and coordinate community services (HCP, HH, DC, Mow’s, …, LTC placements) Liaise with stroke team to ensure holistic approach Provide practical and emotional support - often patients need emotional support and counselling to assist them to adjust to their illness or disability and to help them to identify strengths and coping strategies

The Irish Heart Foundation The Irish Heart Foundation

Irish Heart Foundation The national charity fighting stroke and heart disease 90% funded by Irish Heart Foundation The national charity fighting stroke and heart disease 90% funded by public and corporate donations Our mission is to make preventable death and disability from heart disease and stroke a thing of the past

Why support groups IHF research found a strong belief among survivors that support groups Why support groups IHF research found a strong belief among survivors that support groups are crucial in getting their lives back on track.

What is a Stroke Support Group? The evidence shows that weekly groups are crucial What is a Stroke Support Group? The evidence shows that weekly groups are crucial in providing the support people need. This includes: • Information, advice & emotional support • A social outlet for stroke survivors to come together • A forum to share experiences that can be vital in dealing with the effects of stroke • Involves local volunteers to support needs of the group. • Wide range of activities, outings and guest speakers

Activities • Group discussions and chats which provide help, information and a social outlet Activities • Group discussions and chats which provide help, information and a social outlet for stroke survivors • Exercise groups – physiotherapists instruct regular routine of seated movements & exercises • Games, table quizzes, boccia, indoor curling, scrabble • Outings/Trips: Meeting other stroke groups, visiting local attractions • The HF Stroke Survivor Conference, summer lunch and Christmas parties

Stroke group benefits - Provides peer support and enables survivors to share experiences and Stroke group benefits - Provides peer support and enables survivors to share experiences and solutions to barriers facing survivors - Develops self confidence; reduces isolation and anxiety - Builds coping skills and adjustment to life after stroke - Physical improvements through group therapy - Provides a forum where people can get vital information - Provides access to counselling

Member Quotes: “ At the group meetings we all help each other and you Member Quotes: “ At the group meetings we all help each other and you see the improvement in people” “It’s comradeship. I never miss a Tuesday, I look forward to it. ”” “It’s just great to know that I’m not the only one feeling this way” “it’s a break, it’s a change, get out of the house” “I find the exercise class really helpful, and it helps remind me to keep them up during the week. ”

Everyone is welcome • We strive to make sure that everyone feels at home Everyone is welcome • We strive to make sure that everyone feels at home in our groups. That’s what gives the biggest benefit. • To foster inclusion we are developing a training programme with speech and language experts to ensure that people with communication disabilities such as aphasia feel fully part of their group.

Next steps If you are interested in taking part in a group, please contact Next steps If you are interested in taking part in a group, please contact us. Please email: [email protected] ie Please visit www. irishheart. ie Helpline 1800 25 25 50

Volunteer Stroke Scheme Stroke Support Groups: Dundrum and Crumlin – Bridie Lyons (086)3893943 Whitehall, Volunteer Stroke Scheme Stroke Support Groups: Dundrum and Crumlin – Bridie Lyons (086)3893943 Whitehall, Castleknock, Dun Laoghaire and Naas – Helena Heffernon (086) 1300237 Dundalk and Drogheda – Seamus Casey (086) 1300238 Roscommon – Martina Greene (087) 3668835

Questions? Questions?