START lmproving Recovery

for

Stroke Surwivors
ime, teamwork and a focus on the body's weaknesses rather than its strengths are key to the effective delivery of an innovative stroke therapy program at Lincoln Place Long Term Care Home in
York, Ontario. Three years ago, staff at Lincoln Place decided to find a way to increase the effectiveness of and accessibility to stroke rehabilitation at their home. The START (Stroke

ft'r

[i I

what was then called the

Coordinated Stroke Strategy. Designed by the Heart and

Therapy Amalgamating Research-based
Treatments) program involves residents, families, caregivers and support staff in a multidisciplinary rehabilitation team that delivers long-term, intensive, individualized therapy that focuses on the side of the body most affected by the stroke.

Stroke Foundation, in collaboration with other health care settings from hospitals to long term care homes, the goal of the ini tiative was to design an efficient transitional process for the care of stroke survivors. One of the significant outcomes of the initiative was the Transition Information Plan (TIP) for Stroke Survivor Transfer to a Long Term Care Home. Incomplete information had hindered staff in their efforts to care for new residents admitted to their homes following a stroke, but the TIP tool

The CI program focuses on the side of the body that has been most affected by the stroke; the weaker or paralyzed side. Residents are encouraged to repeatedly use their weak side to perform simple tasks.

This repetition eventually leads to
increased independence

with dressing, eat-

ing, grooming, enhanced participation in
social activities and, most importantly, elevated self-esteem and confidence.

The CI approach moves away from more traditional therapy regimes, which are time-efficient but not effective for stroke survivors in the long run. A typical rehabilitation program focuses on the less impaired side of the body, therefore promoting dependence on the resident's stronger side and on assistive devices. Residents show more rapid improvement using traditional therapies than they

provided them

comprehensive overview of every aspect of the resident's after-care.

with a

ldenlifying need ond designing qccess
Each year, between 40,000 and
50,000 Canadians - 15,000 to 20,000 of them living in Ontario - suffer a stroke, and one in four people aged 65 years or older will experience stroke, cognitive impairment or both. Not every senior who has survived a stroke will qualify for active rehabilitation, and those who do might not live close to a rehabilitation centre. This creates a

Theropy mqkeover
With an increasing number of new
residents admitted with a stroke diagnosis, Lincoln Place staff were eager to imple-

ment new and innovative research-based treatments in their home. They transformed several offices in the recreation room area into a rehabilitation gym and

do with Cl therapy because the brairl-. quickly encodes the dependence on tlf,)t good side of the body and the assistivd"device. Since it is much easier to use the body's stronger side and the device than it
is to

work the impaired side, residents tend

outfitted the space with state-of-the-art
equipment designed with the elderly and stroke survivors in mind. The positive impact of the gym was visible immediately - and it wasn't just residents who were benefiting from the makeover. Stafl too, were taking advantage of the facilities. Other residents, not just stroke survivors, were exercising and enjoying the gym on a daily basis in an

to neglect or ignore altogether the weaker, with devastating more affected side
effects.

-

unique opportunity for long term care homes. There is a growing need for the
delivery of effective, efficient, results-based

t
. Lincoln

Shoring Core
Ploce wos glod

rehabilitation for stroke survivors in safe, appropriate and localized settings - and long term care homes fit the bill perfectly. Staff at Lincoln Place recognized this thrcc years ago in 2003. With their home centrally located in Toronto's Forest Hill neighbourhood, they became involved in
Janusz Kalcta is the programs

to be qble to shore its START progrom with dele, goles to the 2006 OLTCA & ORCA Convenlion ond Trode Show in
Toronlo this post spring os well os lhe 26th ond 27th Annuol Meetings of the

environment free

of

distractions, and

nursing staff were encouraged to use the gym to promote wellness and a healthy
lifestyle.

lnier-Urbon Slroke Acodemic Associo-

lion in Toronlo qnd Ottowo. The home olso presenled o professionol workshop to exlernol portners involved in the delivery of slroke core.
Focusing on lveaknesses rather than

by ,-----JOnusz
Kolelo

mdnd1'l

at

Lincoln Plare Long

Constroinl lnduced Theropy
The STAKI (Stroke Therapy Amalga-

Tcrm Care Homt.

for

more infor-

mation on lhe START program

antl Constraint Induccd Therapl', illr. Kaleta
can be reaclrcd b1'phone

mating Research-based Treatments) program at Lincoln Place is based on the
Constraint Induced (CI) Therapy concept developed by Dr. Edward Taub of the University of ,rUabama in Birmingham.

at (416) 967-6949

strengths (another unique twist), th'
SIARf pnrgram approaches each reside.y
as a unique individual and takcs a holistic

ext. 253 or b1, email at Jkaleta@lincolnplace.ca.

Long Term Core

help the resident to achieve his/her rehabilitation goals in a stimulating and challenging environment.

It is important to remember that time with CI therapy and the intensity of the therapy will likely determine the outis key comes of the START program.

l\tth

the support of their families and

the multidisciplinary rehabilitation team at Lincoln Place, stroke survivors focus on the
weaker side of their body and use this side as

A teqm opprooch to rehobilitotion
To make the START

much as possible not only during therapy sessions but also throughout the day and for all activities of daily living (ADts). This approach takes lime, patience and encour-

-

program effective,

everyone who cares for the resident must be included as an integral member of the team. At the centre of the program's success

A resident exercising in the
Rehobilitotion Gym.
approach to therapy that addresses physi-

agement, but the outcomes are far preferable to those obtained through traditional stroke therapies since residents ultimately recover more abilities and achieve a higher level of independent functioning. Recent scientific discoveries and research clearly suggest that the plasticity

is the active participation of residents

and their families with assistance from nursing staff and caregivers (the people
who spend a considerable amount of time assisting with such ADLs as hygiene, dressing, grooming, feeding, toileting), to registered nursing staff, to rehabilitation therapists and physiotherapists, to activation staff, to social workers, to spiritual leaders. AII the team members play a vital
role in the recovery process by helping residents focus on and use their weaker side throughout the day, during ADLs and

cal, cognitive, emotional and spiritual needs. The resident's role within his/her
family and community is also taken into consideration. Examining the interaction of all of these factors helps staff to custom-design a recovery program that will

and resilience of the brain allow for the
recovery of lost functions but only if the chain of dependency on the good side of the body is broken and healthy brain cells are induced to restore lost neural pathways.

-

!
It

September 2OO6

t*
H* sional stroke care training through the Heart and Stroke Foundation. TIP trainin
lii .:!
l

-\ '

&:
Rr
Iii: :

was also provided, and the home implemented the Heart and Stroke best practice guidelines for stroke care. Most recently, Lincoln Place signed an agreement with the Canadian Institute for

Health Information for use of the Functional Independence Measure (FIM) assessment tool for the National Rehabilitation Reporting System. The FIM tool should allow staff to accurately assess and measure the outcomes of their innovative stroke rehabilitation therapies. LTC

Check these sites out!

Theropy session with o stroke survivor.
therapy sessions, and by offering positivc
reinforcement and support.
To ensure

that all frontline staff were

onboard with the START program, Lincoln Place arranged for the delivery of profes-

. . . . . .

wtt.w.heartandstroke.ca www.caregiver.on.ca

www.stroke,org www.strokerecovery,org wnw.strokesurvivors.org
www.canadianstrokeuetivork.ca

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