Stroke Rehabilitation Pilot project – from vision to reality

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The Ontario Ministry of Health and Long Term Care has committed to investing $30 million a year in a strategy to conquer the fourth leading cause of death in Canada -stroke. There are between 40,000 to 50,000 strokes in Canada each year. The Ontario Coordinated Stroke Strategy is addressing bestpractice stroke care across the continuum from prevention, acute care, rehabilitation, long term care and community reintegration.

The Stroke Rehabilitation Pilot Project (SRPP) at the Parkwood Hospital site of St. Joseph’s Health Care, London was launched in January 2003 as one of six pilot projects in Ontario to evaluate recommendations made by the provincial Stroke Rehabilitation Consensus Panel. Prior to the development of the SRPP, stroke-specific outpatient rehabilitation for survivors of severe strokes and stroke rehabilitation outreach was not available in Southwestern Ontario.

The SRPP focuses on implementing and evaluating outpatient rehabilitation for those with severe stroke, and outreach that provides the ten counties of Southwestern Ontario access to stroke rehabilitation education and client-specific consultation. The preliminary results show that there is a need for both these services.

“Due to the nature of stroke recovery, some stroke survivors require rehabilitation for weeks or even months after they are discharged from hospital,” says Neemera Jamani, coordinator of the SRPP team. The outcome measurements demonstrate that providing rehabilitation to people with severe stroke can result in functional gains, even up to five years post-stroke. In fact, four clients have made sufficient improvement to be able to move out of a nursing home into their own home. The clients participating in the pilot outpatient program have met or exceeded 93% of the goals they set.

Outpatient serviceThe SRPP outpatient service helps clients achieve their rehabilitation goals, provides education and training to clients and their families, and assists clients with reintegration into the community.Clients of this project are stroke survivors who have any of the following:

  • Significant communication needs;
  • Significant cognitive impairments;
  • Severe disability.

When the SRPP outpatient team receives a referral, they develop a customized, goal-focused program for each client, and tailor the frequency, duration and intensity of therapies required. The client is reassessed two months after discharge from the program to determine whether outcomes have been sustained.

After Fred Fox was discharged from the inpatient stroke unit at Parkwood, he continued his physiotherapy at the SRPP outpatient clinic. “The high point in my outpatient care came for me when I began walking with a cane and regained my mobility,” says Fred.

The many success stories of graduates from the SRPP outpatient service show how stroke survivors have met their goals through this service.

Outreach ServiceThe outreach service allows individuals with stroke to receive rehabilitation closer to home by providing stroke expertise to health care professionals in the stroke survivor’s community. Access to this service is just a phone call away. The service extends to the ten counties of Southwestern Ontario and is offered to: hospitals, long-term care facilities, Community Care Access Centres, and other related agencies. SRPP team members provide client-specific consultation, education, training and support to service providers. The team travels to the client. Videoconferencing is also used.

The SRPP team also visits long term care facilities to provide education on the Tips and Tools for Everyday Living Ð A Guide for Stroke Caregivers Ð a resource outlining best stroke care practices for health care providers primarily in long term care facilities and in the stroke survivor’s own community. The London outreach team created the outline for teaching Tips and Tools in collaboration with Owen Sound and Kitchener-Waterloo-Wellington rehabilitation therapists.

These Tips and Tools education sessions have been piloted in Southwestern Ontario and teach four major topics in stroke care:¥cognition, perception, and behaviour;¥feeding and swallowing;¥communication;¥mobility.

“Health care providers now have a way to tap into expertise on stroke rehabilitation when they need it,” says Neemera. “They appreciate the opportunity for education and consultation they can apply to their practice.”

The evaluation results for the six stroke rehabilitation pilot projects will be submitted to the Ministry of Health in November 2004. The many collective learnings from all of these projects will contribute to the growing body of knowledge of best practice stroke rehabilitation and the evolution of a stroke rehabilitation delivery system for the province of Ontario.