Category: Advancing Modules

General introduction to module

Following a stroke, there may be physical, cognitive and emotional problems to face, some of which will be apparent, others more subtle. To ensure care that is both effective and holistic, continuing assessment of physical, intellectual, emotional and spiritual needs is important.

Mood Disturbance after stroke

Life and relationship changes follow a known process of adjustment. However, a significant number of people struggle to adjust and mood disturbance is not uncommon. The most common forms of mood disturbance are depression, anxiety and emotional lability. Research shows that abnormal mood impedes rehabilitation.

The incidence of depression within the first year can range from 10% to above 50% (depending on how and when depression is measured) but is estimated to stand at around 33% (Hackett et al 2005). At twelve months post stroke, depression is associated with increased mortality (House et al 2001). There is increasing evidence that the integration of psychological therapy (e.g. motivational interviewing, problem-solving interventions) into education programmes for people who have had a stroke can decrease the risk of depression developing post stroke.

Discriminating between different mood states can be difficult due to overlap between the physical and cognitive effects of stroke and mood symptoms. Screening, treating and monitoring for mood disturbance throughout the patient journey is essential given its impact on rehabilitation and the financial costs of care (RCP 2016).

Spiritual Care

‘The Scottish Government Health Department (SGHD) has developed a distinctive policy background for spiritual care in NHS Scotland. This follows on from the World Health Organisation’s (WHO) description of health requiring a spiritual and compassionate element alongside the physical, psychological and social elements in order to describe a holistic or whole person approach to health and healthcare.’

Spiritual Care Matters, An Introductory Resource for all NHS Scotland Staff, 2009

Within the healthcare setting, spiritual care is about wholeness and well-being, meaning in life, and the inner resources upon which people draw when health is compromised; in other words, our personal coping mechanisms. When specifically identified, this support may have a religious dimension with referrals to relevant faith communities being facilitated.

For full references see Additional Information box below.

Introduction

Introduction - Speech bubble

Module lead

Dr. Louise Roach, Clinical Psychologist,  NHS Lanarkshire.

Group members

Jennifer MacKay, Stroke Nurse Specialist, NHS Lanarkshire.

Joanne Graham, Head of Service Delivery, Chest Heart & Stroke Scotland.

Katrina  McCormick, eLearning & Health Information Manager, Chest Heart & Stroke Scotland.

Dr. Kirsten Kernohan, Principal Clinical Psychologist, NHS Greater Glasgow & Clyde.

Linda Campbell, Stroke Coordinator, NHS Highland.

Mark Evans, Head of Spiritual & Pastoral Care, NHS Fife.

Serena Battistoni, eLearning Interactive Content Developer, Chest Heart & Stroke Scotland.

 

This module was originally developed by:

Group Lead: Lynn Reid, Lead Training Coordinator, CHSS

Group Members: Joanne Graham, Stroke Training Coordinator, NHS Fife/CHSS
Pauline Halliday, Clinical Specialist Occupational Therapist, NHS Lothian
Dr Marion Murray, Clinical Neuropsychologist, NHS Lothian
Elizabeth Norby, Advice Line Nurse, CHSS
Rev Iain Telfer, Chaplain, NHS Lothian

Critical Readers: Frances Bailey, Project Coordinator, CHSS
Mairi Crystal, Lead Stroke Nurse, CHSS/NHS Grampian
Prof Martin Dennis, Professor of Stroke Medicine, University of Edinburgh
Amanda Fair, Staff Nurse, NHS Fife
Lucy Felton-Edkins, Speech & Language Therapist, NHS Lothian
Elaine Grubb, Stroke Nurse, CHSS/NHS Dumfries & Galloway

08: Emotional impact of stroke

This module aims to provide an understanding of the emotional issues which may affect an individual after a stroke. Specifically, this module will cover three common emotional problems: emotional lability, depression, and anxiety.

The answers to all the test questions are contained within the module. This information may be provided in the ‘Additional Information’ boxes on some of the pages.

Conclusion (continued)

The 4 patient scenarios / cases have covered the following four aspects of physical rehabilitation:

  • Early mobilisation
  • Spasticity management
  • Patient-centred goal setting
  • Rehabilitation in the community

Conclusion

Conclusion - Completed jigsaw

Conclusion

Having worked through this module you will have learnt about:

  • The common components of physical management
  • Early mobilisation following stroke
  • Ways of managing spasticity
  • Orthotic devices which may be used to assist walking
  • The use of goal setting in clinical practice
  • Physical fitness and fatigue management
  • The issues that people face in the community

In addition, this film shows real patients talking about how fatigue affected them after their stroke.

Key Messages

  • Physical fitness can be improved after stroke
  • There are many ways of improving physical fitness such as home exercise programmes, walking outdoors and attending the local gym
  • Planning and pacing activities after stroke can help manage fatigue
  • Community rehabilitation aims to enable people to integrate and participate in community activities which they have identified after their stroke

Outcome 9 months post stroke

Jimmy is now back working full time and Debbie has changed her shift patterns to occasionally help with the business if he is busy. He goes to the gym regularly, recognises the signs of fatigue and knows how to pace himself. Jimmy now participates in all family activities and they are planning a holiday together.

A picture of holiday pamphlets

2 months later

Amy, the stroke liaison nurse, re-visits the family to see how they are getting on. Jimmy continues to attend the gym three times a week where he meets friends and describes the visits as enjoyable. Jimmy is delighted to be doing more with the family and has noticed that he is feeling less tired and is sleeping better. He is thinking about returning to work but Debbie is concerned about him going back too soon.

Jimmy continues to practice his hand coordination exercises at home. However he is concerned that he can’t use a computer keyboard effectively and writing remains difficult.

Select the items on Jimmy’s desk below to identify which tasks he may find difficult at work and see what the community rehabilitation team may recommend.

6 weeks later

The community stroke rehabilitation team review how Jimmy is progressing. Jimmy tells them that he is now attending the gym five mornings a week. He feels that it is going well and that he no longer needs the support of the fitness instructor. In conversation with Debbie, Jimmy’s wife, the team discover that Jimmy sleeps most of the afternoon and is having difficulty sleeping at night. She has also noticed that as he has become more fatigued, his mood seems lower and she questions whether he should be going to the gym at all.

The team explore with Jimmy the above details further and discover that he has been exercising daily in the gym for an hour and a half without a break. He also walks to and from the gym rather than getting the bus because he thinks the more exercise he does the less the chance of having another stroke. He does admit to feeling a bit fed up.

Q. How do the team manage this situation? Select true or false for each of the options listed below.

Jimmy now understands that he needs to pace himself and get proper rest as many of his difficulties are associated with this.

At the gym

Jimmy is now confident walking out doors, his balance has improved and he regularly attends the gym where he is supported by a fitness instructor who is trained to assist people with stroke. Click on the link for more information about exercise after stroke: www.exerciseafterstroke.org.uk 

What does Jimmy’s gym programme consist of? Drag the gym-based activities to the most appropriate to address.