THE FUNCTIONAL CONSEQUENCES OF STROKE IMPACT ON DAILY LIVING'

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THE FUNCTIONAL CONSEQUENCES OF STROKE IMPACT ON
DAILY LIVING.

• JANE HASTIE
• OCCUPATIONAL THERAPIST
• JUNE 2006

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AIM OF SESSION

• To clarify the various consequences of stroke
• To increase our understanding of what it is like
  to experience some of these problems and their
  impact on function
• To outline what our role as health professionals
  should be when working with stroke patients
• To give some useful tips for practice

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WHAT ARE THE CONSEQENCES OF STROKE?

• Physical
• Emotional
• Psychological

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WHAT ARE THE CONSEQENCES OF STROKE?

• PHYSICAL
• Weakness or paralysis (hemiplegia)
• Altered sensation
• Dizziness and poor balance
• Visual disturbances (hemianopia, double vision)
• Swallowing difficulties
• Speech and Language difficulties (dysphasia)
• Incontinence
• Fatigue
• Pain

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WHAT ARE THE CONSEQENCES OF STROKE?

• EMOTIONAL
• Depression
• Mood swings and emotional incontinence
• Anger and frustration

• PSYCHOLOGICAL
• Problems with perception
• Cognitive difficulties
• Behaviour changes

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FUNCTIONAL EFFECTS

• Specific effects of stroke vary greatly
• No two patients are the same!
• Even the simplest of tasks e.g. getting washed
  and dressed, feeding and toileting, may become
  difficult

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PRACTICAL SESSION

• Aim of session
• To help increase our understanding of what it
  is like to experience some of the problems
  associated with stroke and their impact on
  function.

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COGNITIVE SIMULATION

• Peter Piper picked a peck of pickled peppers, a
  peck of pickled peppers is what Peter Piper
  picked. The peppers that Peter Piper picked were
  pickled in Peoria!
• Substitute
• Sliced for picked
• Beets for peppers
• Paul for Peter
• Hot for pickled

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OUR ROLE

• When working with stroke patients we should aim
  to
• Enable individuals to achieve independence in
  activities of daily living
• Maximise their functional ability
• Maximise and maintain potential of retained
  undamaged abilities
• Compensate for residual disability through the
  use of aids or appliances or strategy training

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FOR EXAMPLE WHEN ASSISTING WITH WASHIHG AND
DRESSING

• If someone has reduced sitting balance
• Seat patient in solid chair at appropriate height
• Ensure feet squarely on the floor (use a block if
  needed)
• Use pillows, rolled up towels where appropriate
  to provide support
• Ensure table at an appropriate height
• Ensure items needed for getting washed and
  dressed are within reach

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FOR EXAMPLE WHEN ASSISTING WITH WASHIHG AND
DRESSING

• If someone has cognitive impairment
• Wherever possible allow the person to wash and
  dress in an appropriate environment e.g. the
  bathroom
• Give the person chance to be independent but do
  not allow the person to struggle for lengthy
  periods
• Keep the areas surrounding the patient free from
  distracting items
• Organise the persons wash things and clothes
  e.g. lay the clothes out in the order of putting
  them on
• Try to establish a consistent method/sequence of
  dressing
• Ask the person what comes next or what clothes
  they wish to wear and in what order
• Give clear instructions / prompts and allow
  plenty of time

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FOR EXAMPLE WHEN ASSISTING WITH WASHIHG AND
DRESSING

• If someone has sensory loss /or neglect
• Position their affected arm so that they can see
  it whilst getting washed and dressed
• Encourage the person to identify each part of the
  body during the task by naming or pointing to it
• Sit and place clothes etc. on the persons
  affected side, but within field of vision, so
  they have to constantly increase their awareness
  of the affected side
• Encourage the person to look for all clothing and
  equipment
• Assist the patient to dress their affected side
  first

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FOR EXAMPLE WHEN ASSISTING WITH WASHIHG AND
DRESSING

• If someone has poor levels of motivation and
  frustration
• Find the level that the person can achieve
  success and build from there
• Allow plenty of time

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FOR EXAMPLE WHEN ASSISTING WITH WASHIHG AND
DRESSING

• Precautions
• Avoid pulling the persons affected arm
• Avoid lifting the person under the armpits

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SUMMARY

• Stroke has a wide range of physical, emotional
  and psychological consequences
• Although specific effects vary even the simplest
  of tasks often become difficult
• Within our practice we must think about the
  functional difficulties and patient experience
• We should aim to promote independence and help
  patients compensate for residual disabilities
  through the use of equipment or strategy training