Pat O’Leary, Senior Physiotherapist in the Integrated Stroke Program at Bunbury Health Campus, was funded by TRACS WA to attend the combined SSA-Smart Strokes conference in Sydney in August 2018. The workplace issue which Pat was keen to target in her service was that patients in the subacute rehabilitation unit (SARU) were not receiving the optimum amount of rehabilitation during their inpatient stay as recommended by the 2017 National Stroke Foundation guidelines as outlined below.

For more information, see: https://informme.org.au/search?query=intensity+of+practice

  • Rehabilitation should be structured to provide as much scheduled therapy (occupational therapy and physiotherapy) as possible, and
  • Group circuit class therapy should be used to increase scheduled therapy time.

In addition, Pat had observed that SARU patients were not attending the gym and their rehabilitation was mostly being completed at the bedside – using an ‘acute’ model of short therapy sessions more appropriate to a medical ward than a rehabilitation facility.

Information presented at the ‘Stroke 2018’ conference included methods to achieve the number of repetitions needed to promote neuroplastic change and recovery (animal models suggest that this is at least 300, and up to 1000 repetitions/day), which revolved around group sessions and semi-supervised practice. Australian researchers at the conference presented evidence for ways that this intensity of functional practice could be achieved, even in older clients and those with cognitive and/or significant motor impairments. Following the conference, Pat contacted two of the workshop presenters. She found them to be very generous in sharing their resources and they were happy to give advice/tips, and discuss difficulties that they had encountered and how these were overcome.

Developing on work already commenced before Pat’s conference attendance, the SARU have purchased counters and now encourage patients to record their number of repetitions and keep a tally for the week on a white board. These are used in the morning Circuit Group, which includes a number of exercises with different order of difficulty - red/orange/green levels (needing more to less assistance) which correlates with the grading used for walking aids in the ward. SARU physiotherapist, Genevieve O’Connor and Curtin University physiotherapy student, Bianca Thyer, developed pictorial resources for the circuit class to help participants be more independent. These will be hosted on the TRACS WA website under a soon to be developed section on ‘promoting intensity of practice’.

In addition to these circuit exercise classes, Shae Flint (OT), had started ‘RehabFunc’ on Tuesday and Thursday afternoons; and the physiotherapy staff have now implemented a similar group for Monday and Wednesday afternoons (FizzioFunc). A range of illustrated activity stations based around a functional scenario, such as packing for a holiday, or baking a cake, have been developed. Shae also developed a Spotify playlist, in consultation with clients, to help create a fun and engaging environment for the session. Many of SARU’s nursing, allied health staff, and AHAs attend and support clients who need assistance to participate. The functional activities are altered regularly to maintain interest – Shae has even developed a Christmas themed set of activities in preparation for the festive season. We hope to have these resources available on the TRACS WA website in the near future.

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