Module test
Category: Physical rehabilitation
Conclusion (continued)
The 4 patient scenarios / cases have covered the following four aspects of physical rehabilitation:
- Early mobilisation
- Spasticity management
- Patient-centred goal setting
- Rehabilitation in the community
Conclusion
Conclusion
Having worked through this module you will have learnt about:
- The common components of physical management
- Early mobilisation following stroke
- Ways of managing spasticity
- Orthotic devices which may be used to assist walking
- The use of goal setting in clinical practice
- Physical fitness and fatigue management
- The issues that people face in the community
In addition, this film shows real patients talking about how fatigue affected them after their stroke.
Key Messages
- Physical fitness can be improved after stroke
- There are many ways of improving physical fitness such as home exercise programmes, walking outdoors and attending the local gym
- Planning and pacing activities after stroke can help manage fatigue
- Community rehabilitation aims to enable people to integrate and participate in community activities which they have identified after their stroke
Outcome 9 months post stroke
Jimmy is now back working full time and Debbie has changed her shift patterns to occasionally help with the business if he is busy. He goes to the gym regularly, recognises the signs of fatigue and knows how to pace himself. Jimmy now participates in all family activities and they are planning a holiday together.
2 months later
Amy, the stroke liaison nurse, re-visits the family to see how they are getting on. Jimmy continues to attend the gym three times a week where he meets friends and describes the visits as enjoyable. Jimmy is delighted to be doing more with the family and has noticed that he is feeling less tired and is sleeping better. He is thinking about returning to work but Debbie is concerned about him going back too soon.
Jimmy continues to practice his hand coordination exercises at home. However he is concerned that he can’t use a computer keyboard effectively and writing remains difficult.
Select the items on Jimmy’s desk below to identify which tasks he may find difficult at work and see what the community rehabilitation team may recommend.
6 weeks later
The community stroke rehabilitation team review how Jimmy is progressing. Jimmy tells them that he is now attending the gym five mornings a week. He feels that it is going well and that he no longer needs the support of the fitness instructor. In conversation with Debbie, Jimmy’s wife, the team discover that Jimmy sleeps most of the afternoon and is having difficulty sleeping at night. She has also noticed that as he has become more fatigued, his mood seems lower and she questions whether he should be going to the gym at all.
The team explore with Jimmy the above details further and discover that he has been exercising daily in the gym for an hour and a half without a break. He also walks to and from the gym rather than getting the bus because he thinks the more exercise he does the less the chance of having another stroke. He does admit to feeling a bit fed up.
Q. How do the team manage this situation? Select true or false for each of the options listed below.
Jimmy now understands that he needs to pace himself and get proper rest as many of his difficulties are associated with this.
At the gym
Jimmy is now confident walking out doors, his balance has improved and he regularly attends the gym where he is supported by a fitness instructor who is trained to assist people with stroke. Click on the link for more information about exercise after stroke: www.exerciseafterstroke.org.ukÂ
What does Jimmy’s gym programme consist of? Drag the gym-based activities to the most appropriate to address.
Addressing the problems
Jimmy and the therapists then plan solutions to the potential problems that are identified for his journey to the gym. Drag the action to the problem.
Jimmy’s choice of physical activity
Jimmy decides that he would like to attend the local gym. Although he has always intended joining, he had never got round to it. He is worried about getting there and knowing what to do in the gym. The therapists explain that initially they will accompany him and that once there he will have the support of a fitness instructor.
The therapists discuss how Jimmy could access the local gym, and participate in a fitness programme. They start by doing an environmental assessment to identify what Jimmy will have to achieve in order to access the gym.
