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Stroke rehabilitation during COVID-19

A webinar on practical, virtual rehabilitation and self-management techniques during COVID-19 for people living with stroke and VCI

This webinar offers timely practical guidance by healthcare experts regarding COVID-19, related conditions and rehabilitation.

Information on COVID-19 is emerging at a very rapid pace and it is generating many appointment disruptions, questions and concerns for people with stroke and vascular cognitive impairment. With physical distancing and social isolation, access to stroke rehabilitation services has become a challenge.  We know that inpatient stays are being shortened, whether in acute care or inpatient rehabilitation. Access to outpatient rehabilitation services is limited. People with stroke or VCI who started, were part-way rehabilitation are seeking credible resources and supports to move forward in their stroke recovery and rehabilitation efforts on their own with virtual support form healthcare team members. This webinar outlined techniques and strategies to continue that journey virtually, from the perspective of lived experience, of physiatry, of inpatient, community and of neurological rehabilitation. 

Please also refer to Rehabilitation and Recovery: Your guide to taking charge of your recovery.

 

Key advice and guidance from our guest speakers
Jen Bogart (Charlottetown, PEI) — Perspectives from a woman with lived stroke experience +

Jen’s advice: Reach out to your therapy team to discuss activities that will work best for you.

Jen recommends the following activities that may help along your stroke recovery journey:

Listen to classical music & relaxation

  • CBC Radio programs: In Concert & Tempo
  • Rest when you need to and to manage exhaustion
  • Eliminate noise, lights and electronics one hour before bedtime

Physical Activity & Creativity

  • Walking & Yoga
  • Lego, imaginary lists, Sudoku/puzzles, reading, colouring, practice buttons & zippers

Community

Dr. Debbie Timpson (Physiatrist, Pembroke Regional Hospital, ON) — Guidance from a Stroke Rehabilitation Specialist +
  • Stroke is a medical emergency.  Call 9-1-1 for any new stroke symptoms or change in health status.  Stroke teams are available to care for you.
  • Have an emergency contact list available including the names and phone numbers of individuals you will need to contact. Example from Heart & Stroke’s website here.
  • Touch base with your rehabilitation team if able, from acute care, rehab, or homecare; see what virtual options your therapy team may be offering.
  • Questions to ask your therapy team before starting virtual/home-based rehabilitation:
    • Is there any equipment or assistance I might need, and how do I obtain this?
    • Are there any worksheets available for me? Or information for my family?
    • What communication strategies should I be using? If I need to use supported conversation techniques, how can my family be taught this?
    • Are there any simple exercises I should be doing at home? And how do I progress these exercises at home?
  • Set up a schedule and clear space for your rehabilitation activities; it is also important to schedule rest times—both for people living with stroke, and for care supporters.
  • The most important type of exercise is repetitive and task specific—do not exercise to the point of fatigue or pain. Check with your therapy team regarding how intense and how long you should be exercising at this stage of your recovery.
  • Try to virtually keep in touch with friends, family and health care providers who can provide emotional support through this journey and offer more information specific for you. You can even set up a virtual stroke exercise group.
Dr. Janice Eng (University of British Columbia, GF Strong Rehabilitation Centre Vancouver Coastal Health Research Institute, BC) — Guidance from a neurological rehabilitation expert +

Janice advises that before starting this program you must consult with your rehabilitation team to see if this is program is suitable for you.

  • The Graded Repetitive Arm Supplementary Program (GRASP) is a one-hour arm and hand exercise program completed daily (for a minimum of 8 weeks) at home with weekly check-ins with a therapist in-person or by phone. It has been shown to improve upper limb function for some people recovering from stroke who have upper arm limitations.
  • The GRASP Manual is free to download here: www.neurorehab.med.ubc.ca
  • On the GRASP website, there are 5 short videos, that we recommend watching, as they provide tips that are useful for both clients and therapists on community-based exercises.
  • If you have a care supporter or family member available, we encourage them getting them involved with you as you move through the GRASP program.
  • Do not push yourself more than you are able to do so comfortably.  Maintaining communication with your therapy team on your progress is very important.
Manny Paiva (Manager, Parkwood Institute in London, ON) — Guidance from inpatient & outpatient/community stroke rehabilitation expert +

When completing virtual rehabilitation follow some of these tips to promote success:

  • Check-in with your rehabilitation team to determine the pieces of technology/equipment you may need.
  • If you are concerned about privacy, double check with your therapy team to determine the safest way to exchange information and maintain contact over the course of your rehabilitation.
  • Before you get started, remove distractions (e.g. phone notifications, emails, etc.).
  • Walk through the steps on the phone first with your therapy team member and establish a backup plan should you be disrupted.
  • For therapy leaders, ensure clear communication between all participants, speak slow, and continually check in to ensure everyone has the same understanding.
  • Be patient with yourself, your therapy team and your technology; this is a new way of navigating for most.  Do not be afraid to ask questions.

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