Article: Supporting Stroke Survivor’s Goal Setting

Recently in the Yahoo Groups List serves, Stroke Survivors International and Stroke Talk for Young People, there have been conversations about stroke survivors’ goals and relationships with professionals as they try to set goals.

The evidence in rehabilitation clearly demonstrates that people achieve more function and better quality of life if they work towards the goals they set. Indeed the mandate of all rehabilitation professionals is to encourage patients to set their own goals.

Really— working with stroke survivors and their families to set goals and giving them the tools to accomplish those goals is like the old adage—“teaching someone to fish rather than giving them the  fish.” Carolyn Baum, an occupational therapy professor in the John Stanley Coulter Memorial lecture (February, 2011) says that rehabilitation professionals need to start thinking of rehabilitation differently—not as a time limited medical service, but to support participation in daily life.

 Supporting participation in daily life means working with stroke survivors and their families to give them the skills and tools to live their daily lives.  So while goal setting was seen as key component of rehabilitation practices, many of the stroke survivors on Stroke Survivors International and Stroke Talk for Young People lists clearly did not experience collaborative goal setting.   Was their experience unusual?   According to several authors (Barnard et al., 2010,  Bright et al., 2012; Jones et al., 2012; Levack et al., 2011;) who recently explored goal setting,  many therapists set the goals for  stroke survivors or manipulate the stroke survivors’  to accommodate the needs of the rehabilitation system and  what can be achieved within a  specified timeframe.

The goal setting picture is not as grim as Barnard, Jones, and Levack describe in their research. Many professionals strive to set goals collaboratively and ensure that they increase stroke survivors control and ability to manage their in their own home.

Recently when talking to a physician, she stressed that most patients don’t know what would be ideal for them or what they should get from the health system or even much about long term self-management.  Like Carolyn Baum, this physician spoke passionately about the need to working collaboratively with patients to support their learning and goal setting.

When John had his stroke, we were incredibly lucky to have several physiotherapists work very collaboratively with us.  Diana Wong from Neuro Home Rehab,  Jacqui Levy from Action Potential Rehab,  and Avi Nativ from Neurogym in Ottawa all took the time to educate us about neuroplasticity, what therapy could do, and what we could do.

 And -- although I don’t remember her name, I am forever grateful to the young physiotherapist in the hospital who put us in touch with Diana and Jacqui to begin with when John’s  prognosis was bleak --only nursing home admission—no rehab. If it hadn’t been for her, as the physician I was talking to yesterday reminded me,   I too would never have known what the possibilities were.  We are forever grateful to these wonderful physiotherapists who supported John’s participation in everyday life.

Links to articles:
• Bright, Collaborative Practice
• Barnard, Goal Setting
• Levack, Goal Setting
• Jones,  Getting the Balance between Encouragement and Taking Over

Article: The Mirror Therapy Program Enhances Upper-Limb Motor Recovery and Motor Function in Acute Stroke Patients

The Mirror Therapy Program Enhances Upper-Limb Motor Recovery and Motor Function in Acute Stroke Patients

ABSTRACT

Lee MM, Cho H, Song CH: The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil 2012;91:689Y700.

Objective: The purpose of this study was to evaluate the effects of the mirror therapy program on upper-limb motor recovery and motor function in patients with acute stroke.

Design: Twenty-six patients who had an acute stroke within 6 mos of study commencement were assigned to the experimental group (n = 13) or the control group (n = 13). Both experimental and control group members participated in a standard rehabilitation program, but only the experimental group members additionally participated in mirror therapy program, for 25 mins twice a day, five times a week, for 4 wks. The Fugl-Meyer Assessment, Brunnstrom motor recovery stage, and Manual Function Test were used to assess changes in upper-limb motor recovery and motor function after intervention.

Results: In upper-limb motor recovery, the scores of Fugl-Meyer Assessment (by shoulder/elbow/forearm items, 9.54 vs. 4.61; wrist items, 2.76 vs. 1.07; hand items, 4.43 vs. 1.46, respectively) and Brunnstrom stages for upper limb and hand (by 1.77 vs. 0.69 and 1.92 vs. 0.50, respectively) were improved more in the experimental group than in the control group (P G 0.05). In upper-limb motor function, the Manual Function Test score (by shoulder item, 5.00 vs. 2.23; hand item, 5.07 vs. 0.46, respectively) was significantly increased in the experimental group compared with the control group (P G 0.01). No significant differences were found between the groups for the coordination items in Fugl-Meyer Assessment.

Conclusions: This study confirms that mirror therapy program is an effective intervention for upper-limb motor recovery and motor function improvement in acute stroke patients. Additional research on mirror therapy program components, intensity, application time, and duration could result in it being used as a standardized form of hand rehabilitation in clinics and homes.

See the full article The Mirror Therapy Program Enhances Upper-Limb Motor Recovery and Motor Function in Acute Stroke Patients.

Eclectic: Carrie - Jazz for Cows

Cows dig Jazz

at 

Saskatchewan Music Festival !

YouTube: Getting Biking Directions (Google Map)

YouTube: Getting Biking Directions This Summer (Google Map)

You can get routes customized for cyclists by selecting "Bicycling" from the travel mode drop down box, and clicking on "Get Directions". These routes are created using several different kinds of roads and paths, indicated on the map.

• A darker green line indicates bike trails where there are no motor vehicles.
• A lighter green line indicates streets with bike lanes.
• A green and white dotted line indicates streets recommended for cyclists, but without a bike lane.

Bicycling directions are in beta so there are not embedded on the web; but you can click "View Larger Map" at the bottom of the map and then click Bicycle symbol and you still get a bicycle map.  Hopeful soon it is passed beta. Bing and Yahoo do not have bicycle map.

I will give three example maps (only By Car but click View Larger Map and you can see the Bicycle Map) from downtown to:

• Yellow Head Trail,
• West Edmonton Mall,
• Loop - Home to 109 Street Bridge to UofA to Groat Road and home.

Thousands of other routes by bicycle on Google map.  If you are uncomfortable ride bicycle with cars in the same lane,  just switch to path/sidewalk.

From Downtown to Yellow Head Trail (and beyond if you want)

Click "View Larger Map" and click symbol Bicycle to see the Bicycle Map.
A - 102 Ave and 116 street - Downtown
B - 124 Ave and 127 street - Yellow Head Trail
Bicycle main route mainly path near 121 St.
Cycle Distance 5.3 km, Approx Time 18 mins.


View Larger Map

From Downtown to West Edmonton Mall (to get coffee of course!)

Click "View Larger Map" and click symbol Bicycle to see the Bicycle Map.
A - 102 Ave and 116 street - Downtown
B - 170 Street & 88 Avenue - West Edmonton Mall
Partly path and partly comfortable bicycle & car.
Cycle Distance 9.2 km, Approx Time 35 mins.


View Larger Map

Loop - Home to 109 St. Bridge to UofA to Groat Road to Home (excellent  route!).

Click "View Larger Map" and click symbol Bicycle to see the Bicycle Map.
A - 102 Ave and 116 street - Downtown
B - 87 Ave and 112 street - UofA, Good Earth (for good coffee/food)
C - Turn North 116 St & turn left on Saskatchewan Drive &
      Get over the Groat Bridge & climb huge hill Victoria Road & Home.
Partly path and partly comfortable bicycle & car.
Cycle Distance 8.4 km, Approx Time 40 mins.

View Larger Map

Saturdays Comics - July 21st / 2012

For Better and For Worse Lynn Johnston / 2007/02/08 "... and swear words come out! Weird!"	Dilbert Scott Adams / 2012-07-19/ "Maybe you invited it to a meeting."
Garfield Jim Davis / 2012-07-19 "That's all I had prepared."	Betty Delainey & Rasmussen / 2012-07-19 "... career counsellor, but a bum might work."

* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).

** I tried to get low or free price at the people http://www.UniversalUclick.com/ for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using GoComics.com and Dilbert.com.

*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Eclectic: Diane - A $3.98 Damage-Free Hanging Decorative Arc Hook

You all know the story of the proverbial straw that broke the proverbial camel's back. Well, this past week, my straw happened to be a $3.98 Damage-Free Hanging Decorative Arc Hook.

Before I commence this story, let me give a little background. You see that last post? The one right under here? Which is titled "One Hoop Jumped, One More to Go"? well that thing should have been titled "One Hoop Jumped and Another Zillion to Go!!!"

So the doctor does send a script for PT and OT, but I hear nothing. Usually (in my experience) these things go pretty quick. By day three, I call the rehab center who tells me that yes, indeed, they got a script but it had the WRONG CODE on it and they have been trying to call the doctor's office to get the right code and have left several messages and no one is returning their phone calls.

So here I am again, jumping hoops. Trying to get ahold of someone (anyone there?) at the doctor's office who knows what the "right code" might be. Finally, on Friday, rehab gets the "right code" but only for PT, not OT.

Good thing is that they sent the PT script through the insurance and it was approved. Yes! But still no OT. Doctor is just not responding... But the woman at the rehab center says "let's set up a PT appt." and I say "OK" and then she says it will cost $40.00/hour, and I say, Bob is approved for Medical/Financial Assistance and she says, well I don't know anything about that, so you better call them, otherwise it will cost $40 for PT and, if the doctor does send the right code, it's another $40 for OT, so $80/day at 3 days per week.......

and yikes, we can't afford that...

Read the full article Decorative Arc Hook at The Pink House at the Corner.

Eclectic: Regina - Different Ella Courses Helping Our Brains — Part Three

By Regina Price

These are the ELLA courses that were on May, 2012. There were different courses in other years. People were asked about the courses at the end of the sessions each year and the program development committee then decided which courses to include this year because of the feedback of participants. There are various courses through each time slot.

The courses in the first class in the morning included those about religious issues, law and politics; the history and significance of childhood; writing and preserving your memories; the history of the concerto; another journey through science; tai chi; and working with photos on your computer. In the morning there are also two period art classes including intermediate watercolor painting; exploring your inner artist, and life studies and portraiture in pencil and paint. For me, it was too hard to choose but I ended up in the concerto class.

The second period included learning about the courses about values, ethics and sustainability; not just a fairy tale: forms and functions of fantasy; tracing tendencies in art; meet you at the agora; mobile tendencies and social media; and a joyful noise. Being in a class learning about singing and practising singing was important to me because I have problems with aphasia so I went to a joyful noise course.

After the noon speaker and lunch, students went to the afternoon classes. The choices were learning about new issues in Canadian foreign policy; Ukrainian culture; it’s all about books; water-the precious resource for life; cardio salsa, zumba gold; computer and internet basics; introduction to cartooning. Also, afternoon art classes were beginner watercolor; and beginner sketching and journaling. These classes were very interesting but I decided I needed to be out of a chair for a while and I ended up in cardio salsa class.

The final classes were: you’ve come a long way. baby; topics in Canadian Native history; iconic 20th century Canadian poets; hoarding culture: possessing the past; the Astronomical Universe; and a class of Hatha Yoga. I decided to take about hoarding the past which was very interesting and illuminating about museums around Europe. It helped my brain and I was very interested about learning about past art and culture items, which helped me to think about things I never thought about earlier in my life.

I wrote this article to emphasize that ELLA has very different, interesting courses which can help us through our 4 phases (for me--through these courses): spiritual (learning about the concerto), emotional (the joyful noise), physical (the cardio salsa) and mental (learning about hoarding the past). These phases come from the Aboriginal culture and it helped me immensely after and through my brain aneurysm (a kind of stroke). In the future, I will write about these 4 phases and how we can make our lives meaningful to us using these tools or phases.

Eclectic: Philip J Reed - 5 Tips for Stroke Prevention

Today we feature a guest post by Philip J. Reed titled "5 Tips for Stroke Prevention". We extend Philip a very warm welcome and we hope you find his post motivating, informative and actionable. - Gary of Prince Edward Island Stroke Recovery.

Philip J Reed, on behalf of The George Washington University Hospital Cardiovascular Center.  Philip J Reed is a health and fitness enthusiast who understands the value of knowledge and prevention.  If you have any questions or would like additional information, please leave a comment here, or contact us through the link in the byline.


When a stroke occurs, brain cells can begin dying within seconds. Even prompt symptom recognition and quick access to stroke services may not be enough to prevent long-term damage.The best way to maintain full function is to reduce your risk factors, and we will discuss five ways to do that below.

1. Know your numbers. Your blood pressure and cholesterol can both be major risk factors. High blood pressure, which often has few or no symptoms, is one of the leading causes of stroke. It creates stress in blood vessel walls, and left untreated, can lead to blood vessel deterioration, blood clots, brain hemorrhage and stroke. High cholesterol can be just as damaging as it builds up on the walls of the arteries, blocking and damaging them. Positive lifestyle changes, such as exercise and weight loss, may be able to help you gain control over your blood pressure and cholesterol. Your doctor can help you explore other avenues for reducing your numbers if lifestyle changes are ineffective or do not reduce your numbers enough.
2. Make healthy choices. Excessive alcohol consumption and tobacco use both pose stroke risks and can increase your blood pressure. Smoking, which doubles your stroke risk, forces your heart to work harder to pump blood throughout your body and can promote plaque build-up in your arteries. Quitting smoking and drinking alcohol in moderation may be able to help reduce your stroke risk.
3. Maintain a healthy body weight. Overweight and obesity create extra work for your circulatory system and are linked to high blood pressure, high cholesterol and Type 2 diabetes. Losing weight can be difficult, but making healthier food choices that include lean protein, fresh vegetables and fruits, and whole grains can make you feel better physically and mentally and help you lose weight. If you are unsure about how or where you should start, talk to your health care professional or a nutritionist to learn more.
4. Control your diabetes. If you have diabetes, your stroke risk may be four times higher than it is for those who do not have diabetes. Many people with diabetes also tend to have co-morbid health conditions, such as high blood pressure and high cholesterol, further increasing their risk. If you have diabetes, managing your blood glucose levels, staying active, eating a healthy diet and seeing your health care professional regularly can all help reduce your risk of stroke. Here are some additional great tips for managing diabetes.
5. Stay active. A sedentary lifestyle can increase your risk of developing high blood pressure, diabetes, weight gain and other health conditions associated with stroke. Health care professionals recommend exercising at least 30 minutes a day five days a week. Even beginners can enjoy a brisk walk or low impact water aerobics class. Talk to your doctor to ensure you are taking any necessary precautions before starting an exercise regimen.

The National Stroke Association estimates that as many as four out of five strokes can be prevented. Controlling risk factors where you can may help reduce your odds of needing stroke services and help you live a healthier life overall.

Saturdays Comics - July 14th / 2012

For Better and For Worse Lynn Johnston / 2007-02-07 "He's never sworn that like before! He is crazy?"	Dilbert Scott Adams / 2012-07-03 "I'm starting a pump-and-dump ..."
Garfield Jim Davis / 2012-07-13 "She still hasn't said anything ..."	Betty Delainey & Rasmussen / 2012-07-07  "Alex, you just fired me ..."

* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).

** I tried to get low or free price at the people http://www.UniversalUclick.com/ for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using GoComics.com and Dilbert.com.

*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.