Neuro

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Author:
jessiekate22
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180749
Filename:
Neuro
Updated:
2012-10-31 21:56:37
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Community services home rehabilitation follow up stroke patients community
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  1. Evidence about community physiotherapy
    • What does the evidence say? – well at this stage not very much!
    • •Most of the studies of community physio have
    • been descriptive rather than evaluative, (like case studies) and therefore the generalizability of the results is limited
    • •A lot of studies describe heterogeneous
    • rehab. Physio treatment can encompass a whole range of techniques and therefore you can’t
    • determine the value of each component. Also the effects of stroke are so varied in type and magnitude that the sample may not be representative of all stroke
    • clients.

    • •Effectiveness needs to be addressed in
    • clinical and financial terms. The research does show that early discharge from hospital is cost – effective . That is, it costs the healthcare system less
    • money to provide community services than inpatient care.But, there is a paucity of evidence suggesting that it is clinically equal/superior.

    • •A systematic review by Cochrane reports
    • that therapy based rehabilitation ( includes all team member inputs not just physio) targetted
    • towards stroke patients living at home appears to improve independence in ADL’s but because the review is derived from so many different interventions they recommend further investigation.
  2. When did community physios start and where?
    • - 1970s in England but was advisory- do home ass and advise nurses
    • - current shift towards primary rather than secondary stroke prevention
    • - great as the population is becoming older
  3. Benefits of commnity physios post stroke
    • - people sent home asap medically stable wjere better with ADLs and functional ability
    • - is limited by severity
    • - hospital costs account for 71% of total stroke care costs
    • - home theropy appeared to be slightly more effective- careers and pts did seem to be more depressed
    • - 1 yr post stroke- did appear that pt improved greatly with mobility but not 6 months post
  4. What are the principles of home rehab?
    • aim is to support independence for pt at home
    • - holistic- look at the entire picture
    • - transdisciplinary- you may need to ask about swallowing as ur the only person seeing them
    • - continuity of care- refer relevant services
    • - assessment is specific to pt and their envt and their goals
    • - goals
    • - primary vs top-up therapy- primary 6 months post stroke and top up > 6 months
  5. what are the components of care?
    • - follow up post D/C- pt in own envt
    • - can work out who needs further referrals
    • - educate pt
    • - compliance of home program
    • - monitor pts
    • - goal seting
    • - assess pt 
  6. Mobility what things do u need to consider?
    • - destinations- in house, out house, community
    • - distance, time constraints, ambient conditions (temp), terrain, physical load (carry objects), attentional demands, postural transition, traffic levels (crowds)
  7. What are the short term prescription of equipment?
    • - 3 month hire- HES- $50 and deliver equip, they adjust hieights as needed
    • - pharmacy/ med supplier can provide aswell
  8. What are systems that can provide long term equip hire?
    • - PADP- program of appliances for disabled people. Govt scheme- 100 bucks to enter, if you are a high income earner u may need to put in 20% of cost of equip. Only for people for perm disability
    • - pharm/ med peops
    • - second hand
  9. Social intervention for people post stroke
    • socialisation in the home- can they join family for meals and have discusion
    • - socialise outside the house- can they garden
    • - hobbies?
  10. Post stroke
    • - most people do not resume their pre-stroke social activities
    • •More males than females get back to their former social activities
    • •More single than married people do –
    • don’t have someone else to rely on/ company at home
    • •More educated people do – correlated with
    • economic status – access to services
    • •No difference depending on the age of the
    • person
    • •Those with limited hobbies prior to the
    • stroke are more likely to develop a new hobby – they are not able to compare their performance against anything??
  11. What are the barriers to stroke?
    • - physical- cog, impair
    • - transport- cant drive 3 months
    • - finance
    • - planning and timing
    • - depression effects > 30%
    • -stigma
    • -  friendship/ relationship changes
    • -fear/ lack of confidence
    • - envt restrictions
    • - comparison to pre stroke performance
  12. need to consider
    • - security
    • - use of equip- chair raise, frame with basket
    • - the way activity performed
    • - encourage clinet to get help, go slower (avoid fatigue), accept a diff standard of work, plan ahead
    • - practice with clinet
  13. What are some rural issues with community physios post stroke?
    • - distance needed to travel
    • - lack of physical resources
    • - stadd shortages
    • - staff training in stoke care
  14. WHo is stroke education targetted at?
    • - individulas during home visits
    • - stroke survivors
    • - familu/friends providing care
    • - volumteers/ paid carers
    • - health professionals
  15. What are the advantages for comunity phsiotherapy?
    • - travel elimination for the pt
    • - time 
    • - cost 
    • - fatigue
    • - tone
    • - family are involved but shows them realistically what the pt is capable of so they dont milk it. Family have the main burden. They can also help pt maintian exercises etc
    • - you can advocate for clinet and provide neeed support
    • - comfortable envt for pt- home can be modified to suit pt
    • - quick response- easier to maintain contact with pt
    • - decreases hopsital wait
    • - easier for diable pts
    • - aftercare can prevet discharge deterioration
    • - allow pt to live at home for longer
    • - studies have shown that stroke pts dicharde deteriorated significantly a yr later
  16. What are the disadvantages of community physio?
    • - travel expenses for the physio
    • - time of the physio
    • - isolation- stroke clients and carers often suffer from depression/ anxiety
    • - group/ peer support
    • - physio may feel isolated
    • - not all the equipment you might nee can be readily available
  17. What is community health based on?
    • - team approach
    • -all the services working together to achieve clinet goals
    • - leisure/ social activities
    • - physical assistance
    • - information provision
    • - peer support
  18. What are some leisure/ social activites that are available for stroke pts?
    • - NSW sports council for the disabled
    • - headstart community access program
    • - NICAN
    • - hydrotherapy
    • - Gym access
    • - Life without barries
    • - Walking/ craft groups
    • - citizen groups
    • - WEA/TAFE
    • - Respite
    • - Holidays
  19. What are the community services that provide physical assistance?
    • - ACAT- aged care assessment team- so pt can remain at home
    • - carer resource centre- provides info and support for carers
    • - community options- provides care/ respite for people with complex care needs
    • - home care services- provide care/ flexiblerespite options. Basic services such as housecleaning, personal care etc
    • HACC- home and community care program- helps withhousehold tasks, relief care,  meals, similar to home care but is federally and other is state govt funded
    • Neighbour aid- provide volunteers to assist with transport, shopping, visiting, and respite. 22 centres in hunter
    • CACP- community and aged care packages offer a range of services to assist people to live at home- an ACAT assessment is required
    • Teleross- provide daily telephone calls to ensure the client is ok
  20. Community services: Information
    • National stroke foundation
    • Stroke and disabiliyt information
    • IDEAS: provide info on services, equip, accessible accommodation- including holidays for disabled people
    • Seniors info service: provide info on organisations/ support group in your area
  21. Community Service peer support
    • Day centres- not stoke specific- gives clinets a change to meet other people, also provide respite
    • - stroke recovery clubs- range of activites offered
    • * gentle exercises
    • * lunch/ morning tea
    • * outings/ picnics
    • * guest speakers
    • * watch videos
    • * play bingo/ dominoes etc
  22. Community services other consderations
    • - financial assistance- centrelink
    • - aboriginal health/ migrant health workers
    • - nutrition and dietetics
    • - home modifications
    • - community legal service
    • - meals on wheels
    • - couselling
    • - cleaning services
    • - linen services
    • - transport
    • - sexuality
    • - vision
    • - communication
    • - employment
  23. The community physio provides:
    • - Assessment of the client in their own
    • home/community
    • - Prescription of mobility and manual
    • handling equipment
    • - Exercise and home-based therapy programs
    • - Education to the client/carer/providers
    • of service to those affected by stroke
    • - Referral/linkage to related services and
    • resources for stroke management
    • - Group therapy when appropriate

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