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Moving on from Stroke
Day Therapy Unit
Outpatient Stroke Service
WELCOME BACK! Week 3:
Occupational Therapy
Social Work
Dietitian
OCCUPATIONAL THERAPY
Living your life…..
Returning to Everyday Activities
Set goals – make them specific and
measurable
Write out an action plan – the ‘how’ of
achieving your goals.
Identify obstacles to achieving your goals.
Build in rewards and visualise the end result
Goal Setting
Goal Setting
Fatigue affects up to 70% of individuals after brain
injury
Can influence mood, physical functioning, attention,
memory, communication and tolerance levels.
Recognising fatigue is important!
Fatigue
MANIFESTATIONS OF FATIGUE Subjective
Physical
Heavy / weak
Mild pain
Tired / worn out
Mental
Mild sadness
Tired
Irritable
Dull
Objective
Physical
↓ physical performance
Slowing
Lethargy / ↓ energy / sleepy
Mental
Difficulty concentrating
Slow processing
Learning difficulties
Less creative
Recognise early warning signs
Pace yourself
Build in structure and routine
Gradually and slowly build up activities
Sleep more and build in rests
Say “NO”, delegate and prioritise
Be a morning person
Exercise daily
Keep a diary
Managing Fatigue
Going back to work can be hard after a stroke because
of:
Physical changes
Lack of motivation
Attitudes of work place colleagues
Fatigue.
Lack of concentration or memory.
http://www.crsaustralia.gov.au
Returning to Work
Returning to Driving
As a driver, you are required to inform the Department of
Transport of any driving impairment.
A driving impairment means:
any permanent or long term physical or mental
condition (which may include a dependence on drugs
or alcohol) that is likely to, or treatment for which is
likely to, impair your ability to control a motor vehicle.
any permanent or long term increase in, or
aggravation of an existing physical or mental
condition (which may include a dependence on drugs
and alcohol) about which you have previously notified
the department.
Driving and the Law
Taxi vouchers
Public Transport
Fuel Card
Transport services
Alternatives to Driving
Medical approval
Driving assessment
Vehicle modifications
Restrictions/ limitations on license
Returning to Driving
QUESTIONS?
Social Work
Outpatient Stroke Service
Norell Carter
Social Worker
The Invisible Side of Stroke
Recognising and treating the psychological and
emotional impact of stroke
Acknowledging and dealing with the social effects of
stroke
Life After Stroke After stroke people can experience a loss of
personal freedom, independence and a change in
roles and routines.
After a stroke, people can experience emotional and
behavioural changes.
WHATEVER YOU’RE FEELING, IT’S OK
Each person is unique in the way that they respond to life after stroke
LOSS AND GRIEF
Symptoms of Grief:
Anger
Anxiety/Panic Attacks
Blame
Denial
Irritability/Frustration
Loneliness/Numbness
There is no time frame for grief.
The changes and subsequent losses that we may
experience can be visible or invisible.
They may be physical, intellectual, psychological,
emotional, social and spiritual nature.
GRIEF, LOSS AND FEAR
EMOTIONAL AND PERSONALITY
CHANGES AFTER STROKE
DEPRESSION AND ANXIETY
AFTER STROKE
WHAT IS DEPRESSION?
Depression is more than just feeling sad. It has
serious effects on both physical and mental health.
Up to two thirds of people who have a stroke feel
depressed at some point.
It’s important to seek help early; the sooner the
better
With the right treatment most people recover from
depression and anxiety
WHAT IS ANXIETY?
Anxiety is more than just feeling stressed or
worried.
Anxiety can be expressed in different ways such
as uncontrollable worry, intense fear (phobias or
panic attacks), upsetting dreams or flashbacks
of a traumatic event.
Some common symptoms of anxiety include:
- hot and cold flushes
- racing heart
- tightening of the chest
- snowballing worries
- obsessive thinking and compulsive behaviour
HOW MIGHT A STROKE
AFFECT MY PERSONALITY? Personality and/or behavioural changes are also
common after stroke and can include:
- irritability
- aggression
- perseveration
- apathy
- emotional lability
- disinhibition
- impulsivity
RELATIONSHIPS & SEXUALITY
.
IMPACT OF STROKE ON CARERS
Stroke can create challenges for people we love
or care about. They may experience unsettling
changes and losses in their lives.
Stroke is a learning journey involving loss for
both the person who has had a stroke and also
the people around them.
DEVELOPING A MEANINGFUL
LIFE DOESN’T JUST HAPPEN
We have to create it
STRATEGIES TO HELP ADJUST TO
LIFE AFTER STROKE:
SOCIAL Support group
Volunteer
Community Groups
Support others
Reconnect with friends and
family
Reinstate routines
Act, Belong, Commit
Seek opportunities for joy
PHYSICAL
Exercise
Eating healthy
Spend time in nature
Regular sleep
Access to a GP
Relaxation/meditation
Breathing techniques
Creativity
Music
Self-Care
Massage
THINKING
Thinking of memories
Notice good things
Finding gratitude
Planning purposeful
activities
Setting goals
Healthy thinking
FEELINGS
• Journaling
• Relaxation
• Reading novels
• Expressing emotions
• Finding a safe space
• Rituals
• Time for reflection
• Massage
• Baths
SPIRITUAL
Yoga
Relaxation
Mindfulness
Music
Read
Journal writing
Retreats
Visit a memory place
Meditation
HOW TO DE-STRESS AND
BE IN THE MOMENT
ACCEPTANCE AND DENIAL
Following a stroke, acceptance and denial are
not stages one reaches and are finished with.
We move toward and away from these states as
one adjusts to life after a stroke.
COMING TO A PLACE OF
ACCEPTANCE
As with anything in life, the degree to which we
accept the ‘as-is’ is the degree to which we cope
better in the world.
Finding acceptance within, is the pathway to
freedom.
When we accept our life in the present moment
we let go of resistance, and only then can we
begin the change.
COUNSELLING AND SUPPORT FOR INDIVIDUALS AND FAMILY MEMBERS
National Stroke Foundation
Strokeline – Ph: 1800 787 653
www.strokefoundation.com.au
Relationships Australia – Ph: 1300 364 277
Lifeline Australia – Ph: 13 11 14
Beyond Blue – Ph: 1300 224 636
COUNSELLING AND SUPPORT FOR CARERS
Carers Australia WA – Ph: 1800 242 636
(Freecall)
1300 CARERS (1300 227 377)
Carers Australia WA Counselling Line –
Ph: 1800 007 332 (Freecall)
THANKYOU FOR ATTENDING
ANY QUESTIONS?
Dietitian Recap:
What is Healthy Eating?
Can find on www.eatforhealth.gov.au
Healthy weight
Physical activity
Variety of nutritious foods from the five food groups
‘Extras’ foods – sometimes
Water
Australian Guide to Healthy Eating
& Australian Dietary Guidelines
Provide carbohydrates, iron, B vitamins and fibre
A serve is 1 slice bread, ½ medium roll, ½ cup
cooked rice or pasta, ½ cup cooked porridge, 2/3
cup wheat cereal flakes, ¼ cup muesli, 1 crumpet
Choose multigrain or wholemeal products
Breads, cereals, pasta, rice, noodles
Provide fibre, vitamin A, vitamin C, folate and
carbohydrates
A serve is ½ cup cooked vegetables, ½ cup cooked
beans/lentils, 1 cup salad, ½ cup sweet corn, ½
medium potato
Include a variety of colours
Vegetables, legumes
Provide fibre, vitamin C, folate and carbohydrates
A serve is 1 medium apple/banana/orange/pear, 2
small apricots/kiwi fruit/plums, 1 cup diced or canned
fruit
Consume with skin on where possible
Fresh, tinned or frozen are all good choices
Fruit
Provide protein, iron and zinc
A serve is 65g cooked lean meats including beef,
lamb, veal, pork or kangaroo, 85g cooked lean
poultry, 100g cooked fish, 2 large eggs, 1 cup
cooked legumes, 170g tofu, 30g nuts/seeds
Avoid high fat deli meats, sausages and fried foods
Lean meat, fish, poultry, eggs, nuts
Provide carbohydrates, protein, calcium and vitamins
A serve is 1 cup fresh/long life milk, ½ cup
evaporated milk, 2 slices hard cheese, ½ cup ricotta
cheese, ¾ cup yoghurt
Choose reduced fat varieties
Milk, cheese, yoghurt
Provide saturated fat, salt, sugar and kJ’s!
‘Extras’ foods
Eat regularly
Don’t skip breakfast
Eat with other people, not TV
Choose healthier takeaway food options
Make healthy food choices at restaurants
Choose healthy snacks
Use low fat cooking techniques
Tips for Eating Well
Fresh fruit or snack sized packs of fruit in natural
juice
Fruit and vegetable pikelets/scones/muffins
Vegetable sticks with low fat dip
Small cans of ‘no added salt’ baked beans, bean
salad mix, corn
Small handful unsalted nuts
Low fat yoghurt
Any other ideas?
Healthy Snack Ideas
How do you think you can make
your favourite recipes healthier?
Vegetables and fruit are lower in kJ’s, add more to a
recipe to lower the kJ content (and increase fibre) of
the total dish
Swap some of the meat or chicken for cooked or
canned legumes
Add more vegetables to pasta, rice and soup dishes
Swap white varieties for wholemeal
e.g. flour, pasta, rice
Swap high fat ingredients for low fat
alternatives
Recipe Modification Tips
Adding fruit to a recipe can add sweetness and
flavour and reduce the need to add sugar
Often the sugar in a recipe can be reduced by a third
or even half without affecting the final product
Use no added salt products when you can, and use
smaller amounts of high salt ingredients such as
sauces and add more herbs, spices, garlic or ginger
for flavour
Recipe Modification Tips
Healthy Cooking Techniques
Baking
Grilling or BBQ
Steaming
Roasting
Stir-frying
Slow cooking
Poaching
Healthy Cooking Ingredients Use milk instead of cream in soups, sauces, quiches
Use a stronger cheese and you will not need as much
Instead of whipped cream, blend cottage or ricotta cheese
with a small amount of icing sugar
Instead of sour cream, use reduced fat natural yoghurt or
blend cottage cheese with small amount of lemon juice
Instead of butter use unsaturated oils including margarine,
olive oil and other plant-based oils
Use ricotta, cottage cheese, hummus, avocado or
unsalted nut spreads as an alternative on bread
for variety
Enjoy healthy eating and a balanced diet that is:
Low in salt, saturated fat and added sugars
High in plant-based oils
Has a variety of plant-based and high-fibre foods
including fresh fruit and vegetables, breads and
cereals
Watch portion sizes especially if aiming for weight
loss
Increase physical activity and quit smoking
Summary -
THANKYOU FOR ATTENDING! ANY QUESTIONS?
EVALUATION FORMS TO BE COMPLETED