Outpatient Stroke Program
PROGRAM PURPOSE
The Stroke Program provides a specialized interdisciplinary treatment approach for patients with significant functional limitations following the diagnosis of stroke. In partnership with the client, this program offers individual and group education and treatment.
GOALS
- To provide an interdisciplinary treatment approach utilizing both individual and group formats which assists clients to achieve their optimal level of functional independence.
- To create a seamless continuum of care for clients with a stroke.
- To decrease the wait time for admission to outpatient neuro programs.
OBJECTIVES
- Provide timely and equal access to treatment programs for the residents of Niagara requiring rehabilitation.
- Ensure referral sources have an understanding of admission criteria and program parameters.
- Develop/Utilize clinical pathways.
- Develop individualized client-centred treatment plans superimposed on a group treatment model.
- Provide clients with self-management tools to maintain skills post treatment.
- Ensure efficient transition through phases (levels) of the rehabilitation process including discharge and reintegration into the community.
- Provide linkage to District Stroke Program.
- Support continuous education for the development of a team of clinical experts.
- act as a resource to the Niagara Health System by providing consultation, education and other forms of learning.
- Utilize staff and equipment resources efficiently.
- Monitor quality and effectiveness of the program through ongoing evaluation.
PROGRAM DESCRIPTION
PATIENT POPULATION
Adults living in the Niagara Region with a diagnosis of stroke.
SERVICES PROVIDED
The Stroke Program will provide group and individual treatment to optimize functional independence. Physiatry, Nursing, Occupational Therapy, Physiotherapy, Recreational Therapy, Social Work and Speech Language Pathology will provide these services as needed. Other professional services can be accessed based on need.
ADMISSION CRITERIA
- Medically stable
- Resident of Niagara Region
- Able to get transportation to the Center
- Diagnosis of stroke
- In need of more than one discipline's services
- Able to tolerate a group setting for 2.5 hours of interactions
- Able to manage own personal care or has caregiver available to assist
- Free from communicable disease
- Living in a private residence
- Potential to improve physically, emotionally or functionally
- Must demonstrate motivation and willingness to participate
- Advanced directives must be reviewed
- Able to set goals that are achievable within the context of the treatment program
- In agreement with discharge criteria
Patients would not be eligible for admission if one or more of the above criteria were not met.
Discharge CRITERIA
- Goals met
- Absent for two treatment sessions without notification
- Completion of group sessions (8-10 weeks)
- Non-compliance with agreed upon treatment goals
- Becomes medically unstable
- No evidence of improvement in functional abilities
STANDARDS OF CARE
Patients admitted to the Stroke Program can expect timely admission and a comprehensive treatment and education program. Individual patient goals will be set that are measurable and achievable. One-to-one treatment will be based on need and focused on specific goal areas. Progress towards goals will be monitored by the team and documented as an outcome at discharge.
The Stroke Experience
The Stroke Experience Instructions:
- Stroke survivors, caregivers, students and health professionals participate in a 1 hour interactive session.
- The participants are divided into 4 small groups. At each station the participants are provided simulated impairments and are asked to perform functional activities (see Activity Tour cards for details):
a. Activity Station 1: Upper Extremity
b. Activity Station 2: Mobility
c. Activity Station 3: Visual & Perception
d. Activity Station 4: CommunicationEach Activity Station is facilitated by a staff member.
- Each small group member remains at each Activity Station for 10 minutes and each participant is asked to perform a functional task with their simulated impairment. Following the 10 minutes, each small group is asked to rotate to the next station until the participant has engaged in each Activity Station.
- Following the 40 minutes the 4 small groups come together and a large group discussion is facilitated by a team member. Participants are asked to reflect on their experience.
- Participants are also asked to complete a Reflective Questionnaire (see The Stroke Experience Reflective Questionnaire for details).