Training Centre in Subacute Care TRACS WA
Maximising Self-Care Rehabilitation
An Introduction for Nursing Staff
Presentation B
Developed by Department of Occupational Therapy RPH and TRACS WA
as part of the 2013 Learning Tool
Supporting Patient Self Care Rehabilitation Goals in a Neurological
Rehabilitation Setting: An Education Resource for Nursing Staff
Learning Objectives
 Review general principles and strategies
for neurorehabilitation
 Develop understanding of neurological
symptoms affecting higher cognitive
functioning
 Develop further strategies for maximising
self-care rehabilitation
Developed by TRACS WA and RPH OT Dept, 2013
Principles of Rehabilitation
 Rehabilitation aims to maximise
participation of the patient in his or her
social setting
 It requires:
 Teamwork
 Goals
 Specific, repetitive learning opportunities
 Patient and family education
Developed by TRACS WA and RPH OT Dept, 2013
Interprofessional Practice
 Two or more professions working together
as a team with a common purpose,
commitment and mutual respect
(Freeth et al, 2008)
 It involves a negotiated agreement
between health professionals which values
the expertise and contributions that various
health professionals bring to patient care
(Zwarenstein et al, 2009)
Developed by TRACS WA and RPH OT Dept, 2013
Higher Cognitive Functions
(meta-cognition)
 Self-awareness
 Executive functions
 Dual/multi-tasking
Developed by TRACS WA and RPH OT Dept, 2013
Self-Awareness
 Insight
 “The ability to consciously process
information about ourselves in a manner
that reflects a relatively objective view”
(Prigatano, 1997)
 “The ability to recognise deficits or
problems caused by injury”
(Crosson et al, 1989)
Developed by TRACS WA and RPH OT Dept, 2013
Hierarchy of Self-Awareness
Anticipating
awareness
Emergent awareness
Intellectual awareness
(Crosson et al, 1989)
Developed by TRACS WA and RPH OT Dept, 2013
Developing Self-Awareness
Self-awareness can best be achieved when
patients discover their own errors rather than
relying on feedback from others
 Define the task
 Predict the performance
 Anticipate and pre-plan for errors or
obstacles
 Choose a suitable strategy
 Assess the amount of assistance needed
 Reflect
(Goverover et al, 2007)
Developed by TRACS WA and RPH OT Dept, 2013
Executive Functioning
 Provides control and direction for lower
level, automatic functions
 Includes: initiation, planning, sequencing,
monitoring, solving problems, dual tasking,
switching, inhibition and working memory
(Poulin et al., 2012)
Developed by TRACS WA and RPH OT Dept, 2013
Dysexecutive Syndrome
 Disinhibited behaviours
 Motivational or drive difficulties
 Disorganised behaviours
 Links with depression and anxiety
(Cook, 2008)
Developed by TRACS WA and RPH OT Dept, 2013
Addressing Dysexecutive Syndrome
 Strategy training
 Verbalise the plan before and during task
 Stop and problem-solve
 Working memory training
 External compensation
(Poulin et al., 2012)
Developed by TRACS WA and RPH OT Dept, 2013
Dual or Multi-Tasking
 Part of executive functioning
 Dovetailing of tasks to be time effective
 Requires retrospective and prospective
memory, planning and error monitoring
(Cook, 2008)
Developed by TRACS WA and RPH OT Dept, 2013
Dual tasking, mobility and falls
 Walking and talking
 Verbal tasks can affect sitting balance in
stroke patients
(Harley et al, 2006)
 Attention and dual task deficits increase
falls risk
(Hyndman & Ashburn, 2003)
Developed by TRACS WA and RPH OT Dept, 2013
Addressing dual tasking problems
 Simplify the tasks
 Consider the complexity or automaticity of
the tasks
 Increase challenges gradually
 Avoid unnecessary interruptions
 Increased falls risk
(McCulloch, 2007)
Developed by TRACS WA and RPH OT Dept, 2013
We have covered....
 General principles and strategies for
neurorehabilitation
 The impact of reduced self-awareness,
dysexecutive syndrome and dual/multitasking on self-care activities
 Further strategies for maximising self-care
rehabilitation
Developed by TRACS WA and RPH OT Dept, 2013
Putting it into practice
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Observe OT self-care session
OT observes nurse self-care sessions
24/7 rehabilitation, consistency
Communication
 Any questions?
 Evaluation forms
Developed by TRACS WA and RPH OT Dept, 2013
Background
This project was developed from a pilot project based on Ward 2,
Royal Perth Hospital, Shenton Park Campus (RPH SPC) in 2013.
The project was initiated by Jocelyn White, Senior Occupational
Therapist and supported by TRACS WA, Ward 2 and the RPH SPC
Occupational Therapy and Nursing Departments.
The pilot program was developed and led by Jocelyn White.
These teaching resources have been developed by the TRACS WA
Team for sharing with the WA Health Subacute Care Community and
beyond.
Acknowledgements: Beverly Hardcastle, Julie Brayshaw, Diane
Jones, Paul Cooper, Terrie Simpson and Jenny Langley.
Developed by TRACS WA and RPH OT Dept, 2013
References
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Albert, S., & Kesselring, J. (2012). Neurorehabilitation of stroke.
Journal of Neurology, 259(5), 817-832
Cook, C. (2008). An exploration of the neural control of multitasking
and the implications for practice. British Journal of Occupational
Therapy, 71(6), 241-247
Crosson, B., Barco, P. P., Velozo, C. A., Bolesta, M. M., Cooper, P.
V., & Werts, D. (1989). Awareness and compensation in postacute
head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4,
46-54.
Freeth, D., Hammick, M., Reeves, S., Koppel, I., & Barr, H. (2008).
Effective interprofessional education: Development, delivery and
evauation. Oxford: Blackwell.
Goverover, Y., Johnston, M. V., Toglia, J., & Deluca, J. (2007).
Treatment to improve self-awareness in persons with acquired
brain injury. Brain Inj, 21(9), 913-923
Harley, C., Boyd, J. E., Cockburn, J., Collin, C., Haggard, P., Wann,
J. P., & Wade, D. T. (2006). Disruption of sitting balance after
stroke: influence of spoken output. J Neurol Neurosurg Psychiatry,
77(5), 674-676
Developed by TRACS WA and RPH OT Dept, 2013
References continued
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Hyndman, D., & Ashburn, A. (2003). People with stroke living in the
community: Attention deficits, balance, ADL ability and falls. Disabil
Rehabil, 25(15), 817-822
McCulloch, K. (2007). Attention and dual-task conditions: physical
therapy implications for individuals with acquired brain injury. J
Neurol Phys Ther, 31(3), 104-118
Ownsworth, T., & Clare, L. (2006). The association between
awareness deficits and rehabilitation outcome following acquired
brain injury. Clin Psychol Rev, 26(6), 783-795
Poulin, V., Korner-Bitensky, N., Dawson, D. R., & Bherer, L. (2012).
Efficacy of executive function interventions after stroke: a
systematic review. Top Stroke Rehabil, 19(2), 158-171
Prigatano, G. P. (1997). The problem of impaired self-awareness in
nueropsychological rehabilitation. In J. Leon-Carrion (Ed.),
Neuropsychological rehabilitation fundamentals, innovations and
directions (pp. 301). Florida: GR/St Lucie Press
Developed by TRACS WA and RPH OT Dept, 2013
References continued
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Toglia, J., & Kirk, U. (2000). Understanding wareness deficits
following brain injury. Neurorehabilitation, 15(1), 57-70
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Wade, D. T., & Jong, B. A. d. (2000). Recent advances in
rehabilitation. BMJ, 320(7246), 1385-1388
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Zwarenstein, M., Goldman, J., & Reeves, S. (2009).
Interprofessional Collaboration: effects of practice-based
interventions on professional practice and healthcare outcomes
(review). Cochrane Database of Systematic Reviews, 2009(3)
Developed by TRACS WA and RPH OT Dept, 2013