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