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Training Centre in Subacute Care TRACS WA
Maximising Self-Care Rehabilitation
An Introduction for Nursing Staff
Part A
Developed by Department of Occupational Therapy RPH and TRACS WA
as part of the 2013 Learning Tool
Supporting Patient Self Care Rehabilitation Goals in a Neurological
Rehabilitation Setting: An Education Resource for Nursing Staff
Background
This project was developed from a pilot project based on Ward 2,
Royal Perth Hospital, Shenton Park Campus (RPH SPC) in 2013.
The project was initiated by Jocelyn White, Senior Occupational
Therapist and supported by TRACS WA, Ward 2 and the RPH
SPC Occupational Therapy and Nursing Departments.
The pilot program was developed and led by Jocelyn White.
These teaching resources have been developed by the TRACS
WA Team for sharing with the WA Health Subacute Care
Community and beyond.
Acknowledgements: Beverly Hardcastle, Julie Brayshaw, Diane
Jones, Paul Cooper, Terrie Simpson and Jenny Langley.
Developed by TRACS WA and RPH OT Dept, 2013
Learning Objectives
 Explore the principles of neurorehabilitation
 Understand the overlap between the Occupational
Therapy role and the Nursing role
 Understand the concept of neuroplasticity
 Develop awareness of some neurological
symptoms and their effect on performance
 Learn some strategies for self-care rehabilitation
Developed by TRACS WA and RPH OT Dept, 2013
Principles of neurorehabilitation
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Teamwork
Goals
Specific, repetitive learning opportunities
Patient and family education
(Albert & Kesselring, 2012)
To maximise participation of the
patient in his or her social setting
(Wade & Jong, 2000)
Developed by TRACS WA and RPH OT Dept, 2013
The Occupational Therapy Role
 Assessment and treatment
 Cognition, perception, sensation, upper
limb
 Occupational performance
 Techniques and strategies
 Education
 Home environment
Developed by TRACS WA and RPH OT Dept, 2013
The Nursing Role in Rehabilitation
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Caregiver
Teacher
Care co-ordinator
Counsellor
Researcher
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Advocate
Coach
Case manager
Consultant
Service manager
Australasian Rehabilitation Nurses’
Association (2002)
www.arna.com.au
Developed by TRACS WA and RPH OT Dept, 2013
Current Guidelines for Stroke Rehabilitation
 Specialised rehabilitation
 Assessment
 Goal-setting
 Intensity of treatment
 Specific therapy for ADL
 Training for staff, patients and carers
 Co-ordinated, multidisciplinary staff
strokefoundation.com.au
(interprofessional practice)
www.ebrsr.com
Developed by TRACS WA and RPH OT Dept, 2013
International Classification of Functioning,
Disability and Health (ICF)
World Health Organisation
Developed by TRACS WA and RPH OT Dept, 2013
Neuroplasticity
 The brain's ability to reorganise itself by forming
new neural connections throughout life.
Neuroplasticity allows the neurons (nerve cells)
in the brain to compensate for injury and disease
and to adjust their activities in response to new
situations or to changes in their environment
(medicinenet.com)
 Treatment needs to be repetitive, challenging
and relevant
(Albert & Kesselring, 2012)
Developed by TRACS WA and RPH OT Dept, 2013
Neurological Symptoms
 Neglect
 Apraxia
 Attention Deficits
Developed by TRACS WA and RPH OT Dept, 2013
Neglect
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Failure to respond to meaningful stimuli
More common with right sided damage
Can be hyper-aware of unaffected side
Poor left-right discrimination
Impairs performance
Increases length of stay
Developed by TRACS WA and RPH OT Dept, 2013
Addressing Neglect
 Develop awareness
 Turn the head towards the shoulder
 Train visual search strategy
 Set up task and environment
 Prompt
Developed by TRACS WA and RPH OT Dept, 2013
Apraxia
 Loss of the ability to perform activities that
a person is physically able and willing to do
 Ideational apraxia - inability to perform a
series of movements in a sequence
 Ideomotor apraxia - inability to make the
proper movement in response to a
command e.g. “wave”
Developed by TRACS WA and RPH OT Dept, 2013
What Apraxia Can Look Like
 Clumsiness
 Unable to use tools correctly – toothbrush,
razor
 Unable to act out instructions
Developed by TRACS WA and RPH OT Dept, 2013
Addressing Apraxia
 Verbal or physical cues
 Strategy training
 Errorless completion
(Pomeroy et al., 2011)
Developed by TRACS WA and RPH OT Dept, 2013
Attention
 A multi-faceted cognitive construct
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Arousal
Alertness and orienting
Focused attention and distractibility
Cognitive speed
Sustained attention
Vigilance and persistence
Working memory and attention span
Shifting and dividing attention
Initiation
Performance consistency
Ability to mobilise and direct attentional resources
Developed by TRACS WA and RPH OT Dept, 2013
Addressing Attention
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Get the patient’s attention
KISS – Keep it simple
Allow time for processing
Minimise distractions
Consider hearing aids and glasses
Increase challenges gradually
Developed by TRACS WA and RPH OT Dept, 2013
Prompting Strategies
Gesture
Open question
Closed question
Instruction
Mirror
Copy
Physical Assistance
Developed by TRACS WA and RPH OT Dept, 2013
General Strategies
 Get attention
 Clear and concise
 Allow time for processing
 Prompt
 Minimal assistance
Developed by TRACS WA and RPH OT Dept, 2013
Delivering Self-Care Rehabilitation
 Specific and individualised
 Consistent
 Repetition, repetition, repetition
 Feedback
 Consider what you say and do
YOU are part of the setting and the treatment
Developed by TRACS WA and RPH OT Dept, 2013
OT and Nursing Communication
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Care plans
Goal-setting
Patient notes
Team meetings
Tell the OT what you have observed: it’s
helpful and valued
Developed by TRACS WA and RPH OT Dept, 2013
We have covered....
 The principles of neurorehabilitation
 The overlap between the Occupational
Therapy role and the Nursing role
 The concept of neuroplasticity
 The symptoms of neglect, apraxia and
attention deficits their effect on performance
 Some strategies for self-care rehabilitation
Developed by TRACS WA and RPH OT Dept, 2013
Next steps
 Next session
 Executive skills
 Self-awareness
 Dual/multi-tasking
 Watch one, Do one
 Questions?
Developed by TRACS WA and RPH OT Dept, 2013
References
 Albert, S., & Kesselring, J. (2012). Neurorehabilitation of
stroke. Journal of Neurology, 259(5), 817-832.
 Cappa, S. F., Benke, T., Clarke, S., Rossi, B., Stemmer, B.,
& Heugten, C. M. v. (2005). EFNS Guidelines on cognitive
rehabilitation: report of an EFNS task force. European
Journal of Neurology, 12, 665-680.
 Pomeroy, C. H. C. (2006). Influence of unilateral neglect on
independence in activities of daily living after stroke.
International Journal of Therapy & Rehabilitation, 13(2), 8285.
 Pomeroy, V., S. M. Aglioti, V. W. Mark, D. McFarland, C.
Stinear, S. L. Wolf, M. Corbetta and S. M. Fitzpatrick.
"Neurological Principles and Rehabilitation of Action
Disorders: Rehabilitation Interventions." Neurorehabil Neural
Repair 25, no. 5 Suppl (2011): 33S-43S.
 Robinson-Smith, Gale and Elise Robinson Pizzi.
"Maximizing Stroke Recovery Using Patient Self-Care SelfEfficacy." Rehabilitation Nursing 28, no. 2 (2003): 48-51.
Developed by TRACS WA and RPH OT Dept, 2013
References continued
 Robinson-Smith, Gale, Mark V. Johnston and Judith Allen.
"Self-Care Self-Efficacy, Quality of Life, and Depression after
Stroke." Archives of Physical Medicine and Rehabilitation
81, no. 4 (2000): 460-464.
 Sathian, K., Buxbaum, L. J., Cohen, L. G., Krakauer, J. W.,
Lang, C. E., Corbetta, M., & Fitzpatrick, S. M. (2011).
Neurological principles and rehabilitation of action disorders:
common clinical deficits. Neurorehabil Neural Repair, 25(5
Suppl)
 Smania, N., S. M. Aglioti, F. Girardi, M. Tinazzi, A. Fiaschi,
A. Cosentino and E. Corato. "Rehabilitation of Limb Apraxia
Improves Daily Life Activities in Patients with Stroke."
Neurology 67, no. 11 (2006): 2050-2.
 Wade, D. T., & Jong, B. A. d. (2000). Recent advances in
rehabilitation. BMJ, 320(7246)
Developed by TRACS WA and RPH OT Dept, 2013