Portsmouth Community Stroke Rehabilitation Team Core Stroke Skills Project Jan 08 Jan 09

1. PortsmouthCommunity Stroke Rehabilitation TeamCore Stroke Skills ProjectJan 08 � Jan 09

2. INTRODUCTION TO THE TEAM Stroke specialist team Facilitating early transfer home to continue rehabilitation following stroke once medically stable Interdisciplinary � nurses, health care support workers, physios, OT�s and SLT�s Intensive, responsive and consistent

3. INITIAL BRIEF � what makes us a stroke specialist team? Bands 5 and 6 within CSRT over a year Create a framework of �core stroke skills� Stroke specific Inter-professional Explained through written definitions, descriptions, diagrams and photographs Aim to be: A resource for all CSRT staff A link to basic competencies

4. LISTING THE SKILLS- FOUR CATEGORIES All CSRT initially �brainstormed� and came up with approximately 30 skills to be included Project Group reviewed and added to this The skills were then divided into 4 categories- Medical Movement and Handling Health and Well Being Communication and Senses

5. GATHERING THE INFORMATION During the Project Meetings the skills were allocated to individual team members to draw up a definition, description etc Usually to closest profession (e.g. Physio for transfers, OT for cognition, Nurse for medications) as they had the easiest access to resources Information was gained from experience, knowledge, the internet, books, articles and other colleagues

6. REVIEWING THE INFORMATION Group met to review the information and we ensured an OT, Physio and Nurse reviewed and commented on every section to ensure true inter-professional skills Changes were then made and reviewed again, as many times as necessary until a consensus was reached

7. COMPLETED PRODUCT Core Stroke Skills Folder Total of 49 sections All information also held electronically

8. REDUCING THE RISK OF STROKE (SECONDARY PREVENTION) � 40% of strokes can be avoided � The risk can be reduced by � Taking prescribed medication (for factors such as blood pressure, diabetes, heart disease, Atrial Fibrillation (irregular heart beat) and high cholesterol) � Controlling blood pressure � Recognising and understanding symptoms of TIAs � Having annual health check � Knowing family history � Not smoking � Keeping within recommended units of alcohol � Maintain healthy weight � Taking regular exercise � Eating a healthy diet which is low in fat, low in salt and includes plenty of fresh fruit and vegetables

9. SIT TO STAND � 1.��� Position hands along side hips / arm of chair � � 2.�� Move bottom forwards to edge of seat � � 3.��� Position feet back � � Lean forwards to stand � � 5.�� Look up when standing � � �

10. FATIGUE � � Post stroke fatigue is a common condition primarily characterised by increased levels of physical fatigue. It, either mental and /or physical, often poses a barrier to return to work and other daily activities, quality of life, and rehabilitation, especially during the first year after stroke onset though improvement in fatigue levels has been noted after 3 months. � � Management Patient and family education and counselling have been identified as the most important rehabilitation intervention for the management of stroke related fatigue. Identifying of fatigue provoking activities, problem solving and identification of fatigue management strategies should be provided, including energy conservation strategies (e.g. prioritising, pacing, delegating & scheduling rest) and establishing appropriate balance between rest and activity. � Identify patients with significant fatigue levels Ensure visits programmed to allow adequate rest periods between and limit daily visits if necessary. Provide early secondary prevention visit and include information on fatigue and how to manage it emphasising the need for rest. Ensure that the family have a clear understanding of fatigue and that it is a consequence of a stroke. Ensure that patient and family are aware of consequences of fatigue and detrimental effect on physical and mental capabilities i.e that functional level will temporarily decrease. Make patient and family aware that it is a long term effect but will eventually improve.

11. PERCEPTION � The definition of perception is making sense of the senses, or the ability to process and interpret information from the environment to make a meaningful whole. There are many different aspects of our perception, all of which can be affected by a stroke. Some of the main problems are summarised below, however the OT will always give detailed assessment and guidance as every patient is different. Other factors including physical disability, vision and cognition will impact on perception and how it is treated. There are 3 main deficit areas of perception- Agnosia, Spatial Relations and Body Scheme � Body Image What is it? A lack of visual and mental image of one�s body Signs to look out for? Appears confused when completing personal care, unable to follow prompts involving body parts How do we treat? Prompts and education during functional activities, some activities and games may be useful Aids we may use? Mirrors, diagrams � Inattention (Unilateral Neglect) What is it? Decreased awareness of affected side of environment and / or body Signs to look out for? Neglecting to look at or use affected hand in activity. Bumping into things on affected side. Only �seeing� things on unaffected side How do we treat? Prompts to attend to affected side. Activities set up to involve both sides. Activities and games are often helpful. Altering layout of environment Aids we may use? Brightly coloured strips can draw attention to affected side. Gloves or tubigrip can sometimes help

12. THEN WHAT? Some minor changes / additions have been made Interest from all UK - ? publication Led to CSRT competencies � core competencies with professional �add ons� National Stroke Improvement Programme � Establishing A Gold Standard Stroke Rehabilitation Team

13. REFLECTIONS Good to identify and document the wide range of skills we use Good to identify those skills which make our team �specialist� Worked very well in project work and making decisions together Demonstrated we are truly inter-disciplinary in both skills and working Pleased the file is very �user-friendly� to all staff

14. sarah.easton@porthosp.nhs.uk