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Stroke vairies between people through?
- - age
- - pre morbid personality
- - relationships
- - social situations prior to the stroke
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What can a stroke impact on?
- - QoL
- - socail impacts of stroke
- - psychological effects
- - sexuality
- - supporting clients and carers
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What % of stroke survivours live at home and have a disability?
- 88%
- Meaning 12 are instituionalised
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How many people die in the first month and first yr post stroke?
- 1/5 die within a month of having their first stroke
- 1/3 die within the first yr
- For every stroke survivor there are at least 4 family members or carers whose lives are changed forever
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What is HRQoL?
- Health related quality of life
- - instruments look at mental health, social and physical functioning
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What is NEMESIS?
- - North East Melbourne Stroke Incidence Study
- - is the largest incidence study of stroke conducted in australia
- - major aims were to determine the incidence, costs and outcome of stroke in Aust
- - at 2yr post stroke 25% of stroke survivors had very poor HRQoL
- - 8% had HRQoL assessed as equivalent to or worse than death
- At 5 yrs 20% have HRQoL very poor
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Stroke grief and loss
- for many families stroke is overwhelming
- - shock- numbness, confusion, sense of unreality
- - denial- pt thinks they will be right in a month
- - reaction- depression, guilt, anger, fusteration
- - mobilisation- when pt is ready to live
- - coping- learning to live with a disability
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How many people post stroke will experience depression?
33%
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What are the types of depression?
- acute
- medium
- long
- may undergo unrecognised and diagonsed
- may be organic in origin- from the brain
- 1/5 people will experience depression in their lives people after stroke seems to be 2/3
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Reactive depression
- - a normal response after a loss is experienced
-
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Who are those with a high risk factor for stroke?
- - female
- - past history of stroke
- - dysphasia
- - social isolation
- - functional impairment
- - cognitive imapirment
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What are the signs of depression?
- - feeling miserable or sad most of the time
- - lost interest in activities you would have once enjoyed
- - lost/ gained lot of weight or changes in appetite
- - sleep disturbances
- - feeling tired or had no energy
- - feeling worthless or excessively guilty
- - poor concentration or difficulty thinking or very indecisive
- - recurrent thoughts of death
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What is the impact of rehab on pts?
- - may compromise achievement or maintenance of functional gains
- - slow recovery> longer hospital stays
- - remission in post stroke depression leads to greater improvement in ADL function
- in english depression can make it hard for people to manage the treatment for their stroke effectively
- people with untreated depression find ithard to concentrate, stay motivated, keep appointments and stick to treatment plans, including meds
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How can we manage depression?
- - meds
- - psychological therapy- cognitive behaviour therapy, counselling
- - lifestyle- PA, diet, reduced alcohol use
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What emotional changes might wee see post stroke?
- - anxiety
- - emotional liability- 25% in first yr
- - apathy- lack of motivation
- - frustration
- - irritability
- in first 6 months post stroke emotional problems affect 1/4 of stroke survivors
- - gentle guidance, prompting, support and encouragementwill assist
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What behavioural changes will u see post stroke?
- - difficulty recognising emotional cues
- - imapired social awareness
- - impaire capacity for self control
- - difficulty with judgement
- - lack of insight> act impulively
- - inability to learn from experience
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What sid of the brain strokes will people experience behavioural issues?
- - right sided (non dom)
- - can tell emotional cues from voice, expression, behaviour if happy or sad
- - unaware of deficits- may attempt to drive
- - neuro- pyschologicsts may be able to help provide some strategies to help you manage these pts
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What other issues do stroke victims suffer from?
- - fatigue
- - communication difficulties
- - pain, sensory changes, numbness
- - incontinence
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What personal challenges do stroke victims suffer?
- - loss of previous self
- - loss of independence
- - changes to life plan eg retirement
- - fear of another stroke
- - stage of life resopsibilites caring for grandkids
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What changes in relationships can be seen before a stroke?
- - changes in estabilished dynamics
- -increased burden for partner/ family
- - mourning the lost partner
- - reestablishing relship with new partner they r
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What happens to sexuality and intimacy post stroke?
- - fear of another stroke
- - changed physical function
- - changed body image/ self esteem
- - changes in libido (desire)
- - communication difficulties
- - behavioural. cognitive issues
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Children and teenagers
- - loss of care of one parent
- - loss of consistent roles
- - loss of emotional stability
- - unwillingness to bring friends home
- - want parent to be like other parents
- - more expected of them
- - can feel emotionally neglected
- - feel responsible for parents mood
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WHat is emplyment like post stroke?
- - may be unable to work as previously
- - impact on self esteem
- - change of role
- - reduced contact with workmates
- - effect finacically
- - may affect accomodation options
- each yr 12,000 ausies of working age survive a stroke
- pt may not be able to return to work as they cannot maintain the physical expectations
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What are the social changes that occur post stroke?
- - cahnges to leisure
- - fill in the day
- - decreased community participation
- - social isolation- loss of networks
- - community attitudes
- - driving and transport
- these r both carer and stroke person
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impact of caregiving
- emoitonal il healht
- no social life
- no leisure
- effefts family
- isolation
- exhausting
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some suggestions
- ¥Be aware most people need to take
- time to mourn losses and to adjust
- to change
¥
- ¥
- Be mindful of the psychosocial impact of stroke
- and refer clients to other disciplines
- like
psychology and social work as appropriate
- ¥
- Help clients set realistic and achievable goals
- ¥
- Plan comprehensively for discharge 16
- Understand behaviours may not be
- controllable
- As physiotherapist you have an
- important role to play in the multidisciplinary team and decisions to be made
- in regards to safe discharge options for the patients from the hospital
- environment.
- Client centred and goal directed
- physiotherapy can be valuable to both the multidisciplinary team and the
- patient to assist in planning a
- comprehensive discharge for the patient.
- ¥ Evaluate longer term needs of
- clients & carers
-
provide info
- ¥Studies show families and
- patients
want more information
¥
- ¥
- Information is most effective if given in
various forms and provided repeatedly
- ¥
- Keep your own knowledge current
- ¥
- Encourage clients & carers to utilise
- available services and resources
- >referrals
- Sometimes mismatch between goals of
- therapists and family.
- Ongoing therapy is important for
- patients to continue to work on rehab goals and to help improve their mobility,
- coordination, strength which in turn can improve their quality of life.
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