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
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