Highlighting fellow OPA members and colleagues in clinical and non-clinical stroke rehabilitation roles

By Esmé French, Physiotherapy Today – Winter Issue #151 (2016)

Rehabilitation and recovery after stroke is a dynamic and ongoing process that occurs across all settings and over time.

Canadian Stroke Best Practice Recommendations remind us that rehabilitation is a process not a place; it is a set of activities which begin soon after stroke onset when the patient is medically stable and can identify goals for rehabilitation.1 Stroke rehabilitation has been shown to be most beneficial when started early; however, functional recovery of stroke-related impairments is still possible months and even years later.2

“Stroke Rehabilitation is a progressive, dynamic, goal orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, and/or social functional level.”
(Canadian Stroke Best Practice Recommendations, 2013)

Physiotherapy is a key component of comprehensive clinical stroke care and is provided in acute and a variety of post-acute care settings, including rehabilitation units, clinics, at home and in community centres. 1 Physiotherapists are also engaged in a number of key non-clinical roles within the Ontario Stroke System and support the Ontario Stroke Network’s vision of “Fewer strokes. Better outcomes.”3

To maximize outcomes for people with stroke, both the organization of stroke rehabilitation systems and direct clinical care must be optimized. This article highlights just a few of the many OPA members involved in the organization and delivery of quality stroke care.

Front Line Physiotherapy in the Acute to Community Stroke Care Setting

Laura Ratushny is one of the physiotherapists working in the acute Regional Stroke Unit (RSU) at Thunder Bay Regional Health Sciences Centre. Laura’s primary role includes completion of a comprehensive assessment and initiation of treatment for the patient’s stroke-related impairments, as well as providing valuable support to the team to help determine the most appropriate post-acute discharge destination.

“I love working in the fast-paced environment of the RSU. Patients are often medically complex and have many medical and social factors that need to be considered. The stroke team members are all incredibly knowledgeable and compassionate people who work together in harmony to provide patients with comprehensive care. Although patients are not with us for long on the RSU, it is wonderful to see them taking the first steps toward their recovery.”

Madeleine Hongisto is part of the inpatient stroke rehabilitation team at St. Joseph’s Hospital in Thunder Bay. Madeleine and her physiotherapy colleagues strive to provide early, intensive and evidence-based stroke rehabilitation while balancing the need to use resources efficiently to meet inpatient stroke Quality-Based Procedures recommendations.4 Preparing clients for the transition to home or the next appropriate level of care is a critical part of the physiotherapy role in the inpatient stroke rehabilitation setting.

“Inpatient stroke rehab is an exciting place to work. At this stage we get to see patients every day and spend lots of time working one-to-one with them. Collaboration is key, and having a full interdisciplinary team involved means being able to treat the patient as a whole person. In this environment you really get to get in and use all your skills as a physio to help clients work toward their goals. I feel honoured to be part of people’s lives while they are undergoing such a transition, and help set the tone for the rest of their rehab journey.”

Catharine Tombs has experience with delivering specialized outpatient neurology physiotherapy services to people with stroke through St. Joseph’s Hospital in Thunder Bay. Most of the stroke recovery journey takes place in the community over many years. For many stroke survivors and their families the real work begins following inpatient rehabilitation. Best practice recommends that people with stroke with ongoing rehabilitation goals should continue to have access to specialized stroke services after leaving hospital [Evidence Level A] which can include in-home community-based rehabilitation and/or facility-based outpatient services.1

“Guiding stroke-survivors to continue striving to meet their physical and wellness goals using chronic disease-self management principles and linking with community-based programs is extremely rewarding and allows me to be creative and use a diverse and evolving skill-set.”

Denise Taylor is the Physiotherapy Professional Practice Leader and Moving on After Stroke (MOST) Coordinator with St. Joseph’s Hospital in Thunder Bay. The MOST program is a post-rehabilitation community self-management, exercise and support program for people with stroke and their family members. MOST plays an important role in the community reintegration process as many people have difficulty returning to life after stroke including fulfilling family roles, socializing, accessing transportation, and completing activities of daily living. Denise and her colleagues deliver MOST in Thunder Bay with videoconferencing available throughout Northwestern Ontario.

“Delivering Moving on after Stroke is one of the most fulfilling parts of my role as a physiotherapist. It helps me develop my skills as a facilitator and promote self-management with clients and families. I have to say I learn just as much from the participants of MOST about life experiences, problem solving and relationships as they learn from me about exercise, goal-setting, and stroke prevention. I love watching participants develop skills and support from one another within the group which will last much longer than the duration of the nine week program.”

Kirsti Reinikka, physiotherapist with St. Joseph’s Hospital in Thunder Bay, played a key role in developing, coordinating and supporting the “Keep Moving with Stroke” community-based exercise class. Exercise and physical activity counseling have been shown to be an integral part of self-management strategies for people with stroke. The expertise of physiotherapists was utilized to develop a training program for fitness instructors to deliver a stroke-specific community exercise class. This approach provides improved access to ongoing exercise and supports people with stroke to maintain function and mobility while more fully participating in their community.

“It has been my privilege to be involved with the Keep Moving programs from the research phase through to established classes. What stands out for me are the relationships that have been critical for success: community recreation, academic, and of course the stroke survivors. It is exciting to see participants so committed to one another, the classes, and opportunities for further research. It really demonstrates the value of linking sectors together to provide the best care and support possible.”

Physiotherapists Supporting Stroke Care Behind the Scenes

Cally Martin is the Regional Director for the Stroke Network of Southeastern Ontario based in Kingston. Cally provides leadership in her region working collaboratively with many partners across the continuum of care. The Network seeks to improve access to evidence-based stroke prevention and stroke care in order to reduce stroke incidence, reduce mortality and improve longer term outcomes such as stroke recovery, quality of life and community re-integration.

The work of the Network teams includes re-organizing stroke-care delivery across the care continuum to support continuous quality improvement, promoting system-change, professional education, knowledge translation and public awareness.

“So much can be accomplished by working together with a shared vision to lead improvements in stroke care delivery. I love working with many players who each contribute valued unique perspectives, involving the stroke survivors and their families in co-designing improvements and seeing positive change in our stroke care and outcomes.”

Marianne Thornton is the Education Coordinator for the Champlain Regional Stroke Network (CRSN) based in Ottawa. She states “I have the privilege of assessing and striving to meet the gaps in knowledge of health care professionals in the CRSN for all disciplines through the continuum of care. The great benefit of being part of the Ontario Stroke Network is that each of the 11 regions shares skills and resources through the province.” Marianne’s role provides perspective on teamwork and how each discipline is a valuable part of the stroke rehabilitation team.

In their roles as Regional Stroke Rehabilitation Coordinators, Esmé French (Northwestern Ontario Regional Stroke Network, Thunder Bay), Shelley Huffman (Stroke Network of Southeastern Ontario, Kingston) and Deb Willems (Stroke Network of Southwestern Ontario, London) share a common goal to improve evidence-informed quality stroke rehabilitative care. They work to support implementation of best practices in stroke rehabilitation through continuous quality improvement, capacity building, engaging partners, fostering sustainability, knowledge translation activities, evaluation and research.

“We really enjoy being able to focus on improving all aspects of stroke rehabilitation, ultimately improving outcomes for persons with stroke. Our work includes advice and advocacy for a future state at the system level to improve how stroke rehabilitation is organized, funded and delivered; change management to support evidence based care within our organizations; as well as education and support for frontline staff.”

The organization and delivery of stroke rehabilitation is truly a progressive, dynamic, goal orientated process which physiotherapists across Ontario are proud to be a part of.

Esmé French is a graduate of the McMaster University physiotherapy program and is the Regional Stroke Rehabilitation Specialist with the Northwestern Ontario Regional Stroke Network in Thunder Bay. Her current interests include community-based exercise for people living with stroke, supporting the use of telemedicine applications in stroke rehabilitation, as well as facilitating smooth transitions through the stroke rehabilitation continuum of care.

References

  1. Canadian Stroke Best Practice Recommendations: http://www.strokebestpractices.ca/index.php/stroke-rehabilitation/
  2. Evidence Based Review of Stroke Rehabilitation: http://www.ebrsr.com/sites/default/files/Chapter3_Background-Concepts_FINAL_16ed.pdf
  3. Ontario Stroke Network: http://ontariostrokenetwork.ca
  4. Quality-Based Procedures: Clinical Handbook for Stroke (Acute and Postacute): http://www.hqontario.ca/Portals/0/Documents/eds/clinical-
    handbooks/qbp-stroke-1512-en.pdf