Category: Advancing Modules

Rosemary’s stroke

Rosemary has a right-sided weakness. Whilst she has good recovery of movement at her shoulder it is still weak. She has limited movement in her hand and wrist and at present her right arm is not functional. She is mobile with a stick and requires supervision when mobilising outdoors. Rosemary has muscle weakness around her ankle and therefore requires an ankle/foot orthosis (splint) for walking. She needs assistance to put the splint and her right shoe on. Rosemary is normally right-handed.

A home visit was completed and identified that Rosemary will require some equipment for her toilet and bath and a banister rail fitted on the internal stairs. She will need to be supervised on the stairs and her family are happy to assist with this when she is discharged.

Rosemary has some communication problems – word-finding difficulties, problems with reading, and requires time to process things which are said to her.

The multidisciplinary team has arranged for Rosemary to be seen at home by the Stroke Nurse, Community Rehabilitation Occupational Therapist, out-patient Physiotherapist and by the locality Speech & Language Therapist.

Vocational Rehabilitation: Scenario – Rosemary

photo portrait of Rosemary

photo portrait of Rosemary

Rosemary Duncan is a 47-year old woman who had a stroke 2 months ago and is currently an in-patient on the stroke rehabilitation unit. She lives with her husband and two teenage children. Rosemary is preparing for discharge home.

Learning points

 

  1. Understand the relationship between work and health.
  2. Recognise how a stroke can impact upon a person’s ability to return to work.
  3. Be able to discuss and advise on basic return to work issues, and know where to signpost for further support.
  4. Understand the impact of stroke on sexuality.
  5. Be able to discuss and advise on sexuality and know how to access more specialist advice if required.
  6. Understand the impact of stroke on a person’s ability to return to driving.
  7. Be able to explain the legal aspects and regulations with regards to resuming driving after a stroke and how to refer someone for specialist advice and assessment of driving abilities.
  8. Understand the impact of stroke on a person’s ability to resume leisure activities after a stroke.
  9. Understand how to advise someone on how they might engage in leisure activities after a stroke and know where to access more specialist advice.

Introduction

Introduction - Speech bubble

Module authors

Module lead

Thérèse Lebedis, Consultant AHP/Occupational Therapist in Stroke, NHS Grampian.

Group members

Gowri Saravanan, Neurology Specialist Nurse, NHS Shetland.

Karis Georgeson, Occupational Therapist, NHS Shetland.

Katy Scott, Vocational Rehabilitation Specialist  NHS Grampian.

Marie Denholm, Specialist Occupational Therapist, Scottish Driving Assessment Service, NHS Lothian.

Rhona Martin,  Chest Heart & Stroke Scotland Lead Stroke Nurse, NHS Fife.

Serena Battistoni, eLearning Interactive Content Developer, Chest Heart & Stroke Scotland.

 

This module was originally developed by:

Group Lead: Thérèse Lebedis, Consultant Occupational Therapist in Stroke, NHS Grampian

Group Members: Jill Beswick, Specialist Rehabilitation Occupational Therapist, NHS Shetland
Shona Campbell, Specialist Occupational Therapist (Community Rehabilitation) NHS Grampian
Mairi Crystal, Lead Stroke Nurse, NHS Grampian/CHSS
Hazel Hamilton, Stroke Coordinator, NHS Highland
Shelagh Hewitt, Head IV Occupational Therapist, NHS Tayside
Heather Orr, Clinical Specialist Occupational Therapist in Stroke, NHS Tayside
Paula Young, Clinical Specialist Occupational Therapist in Stroke, NHS Highland
Margaret Somerville, Director of Advice & Support, CHSS

Critical Readers: Prof Martin Dennis, Professor of Stroke Medicine, University of Edinburgh
Geraldine Ditta, Lead Stroke Nurse, NHS Highland/CHSS
Sandra Japp, Charge Nurse, NHS Tayside
Lynne Main, Occupational Therapist, NHS Lothian
Jenny Stewart, Speech and language Therapist, NHS Highland
Dorothy Storey, Stroke Liaison Nurse, NHS Shetland
Janet Wightman, Specialist Occupational Therapist, Scottish Driving Assessment Service (Driving case only)

10: Resuming daily activities after stroke

This module aims to provide an understanding of issues relating to the resumption of normal daily life and activities after a stroke. This module could cover many aspects of a person’s life however we have chosen to deal with four commonly reported areas of difficulty; return to work, sexuality, driving and leisure activities.

The answers to all the test questions are contained within the module. This information may be provided in the ‘Additional Information’ boxes on some of the pages.

 

Conclusion

Conclusion - Completed jigsaw

People who have had a stroke or TIA are at greater risk of further strokes, as well as heart attacks and other vascular disease. An important aspect of management is to establish the patient’s risk and to minimise this.

On completion of this module you will have learned:

  • Recognition of important underlying causes of stroke e.g. ischaemic due to cardiac embolism
  • Knowledge about risks of stroke after TIA and minor stroke and how one might present this to a patient e.g. relative risk, absolute risk.
  • Understanding of the change of risk over time and the importance of this for starting treatments as early as possible
  • Understanding the indications for, and the effects of
    • antiplatelet drugs and their combinations
    • anticoagulants
    • carotid endarterectomy
  • Understanding the problem of poor adherence to medications
  • Advice on lifestyle modification and how best to influence / support lifestyle behaviour

Key Messages

  • Many conditions may mimic strokes, especially in younger patients
  • It is important to distinguish haemorrhagic from ischaemic strokes since treatment for ischaemia may be harmful in haemorrhages
  • Good control of blood pressure significantly reduces the risk of a recurrent haemorrhagic stroke
  • The stages of change model is a useful tool for supporting lifestyle risk factor management

 

6 weeks later

The stroke nurse receives a phone call from Suzanne. She is upset as Jason has been drinking heavily since his birthday despite his original plan and does not seem to be interested in trying to reduce his intake. She is concerned about his risk of having another stroke. She wonders if rather than reducing his alcohol intake, the other strategy of abstinence may be more effective for Jason. She explains that this was previously discussed during a visit from the specialist alcohol service. The stroke nurse advises Suzanne to contact them again to discuss this suggestion further. She will continue to maintain regular contact with Suzanne and Jason.