Module 1 Learning About Stroke The main focus of Module 1 is to explain what happens during the acute phase of stroke. A guest speaker explains how stroke is diagnosed and treated, plus possible risk factors. Recurrent stroke will also be discussed, with special interest paid to nutrition. Each topic will feature its own guest speakers. Module 1 includes an introduction to LEAP, the facilitators and the group members. LEARNING OBJECTIVES Objectives are measurable ways to determine how much class participants have learned and benefited from a patient education course. Facilitators identify the following objectives at the beginning of the class and review them again at the close of the class. Objectives and Primary Points are for the use of guest speakers and facilitators and are not designed to be provided as a handout for the class. At the conclusion of the module, participants should be able to: Identify class members and one reason why others are attending the class Identify the class facilitators and their roles in patient education Define stroke and describe the different types
Recognize warning signs of a stroke (FAST) and TIAs Explain available and emerging treatment options for stroke Describe stroke prevention strategies Identify strategies to minimize dangers involved in activities of daily living (ADL), such as fall prevention Describe strengthening exercises for stroke survivors Review importance of nutrition and diet in reducing risk of recurrent stroke Evaluate food based on nutrition labels MODULE AGENDA Registration and blood pressure checks; distribute handouts (HOPE: A Stroke Recovery Guide, Myth or Reality Questionnaire A, Nutrition Inquiry, About My Stroke, Module 1 Evaluation)... 30 minutes Opening and introductions... 30 minutes Relaxation exercise... 5 minutes Overview of course materials... 5 minutes Presentation 1: Stroke 101... 45 minutes Break... 20 minutes Presentation 2: Fall Prevention, Fatigue Management and Exercise... 20 minutes Presentation 3: Role of Nutrition... 25 minutes Summary and closing... 10 minutes Module evaluation... 5 minutes Total Time 195 minutes (3 hours, 15 minutes)
GUEST SPEAKER TALKING POINTS Stroke 101 presented by a physician What is a stroke? Different types What happens Why it happens Diagnosis and treatment Call 9-1-1 Use of diagnostic tools (CT, MRI, carotid angiogram, echocardiogram, etc.) tpa, surgical procedures, risk factor reduction through lifestyle changes and/or medications Preventing a recurrent stroke Recognizing symptoms (FAST) Brief overview of clinical trials and their importance Fall Prevention, Fatigue Management and Exercise presented by an occupational or physical therapist Role of Nutrition presented by a nutritionist or dietician The guest speaker should review the registration forms to determine attendees knowledge of nutrition to tailor the talk. Various dietary restrictions: diabetic, lower calories, low cholesterol, low salt (treat high blood pressure) Restrictions of certain foods when on cholesterol lowering drugs and/or anti-clotting drugs How to shop and read a food label How to include more fiber Instead of, Try Superfoods
SUGGESTED COURSE MATERIALS Myth or Reality Questionnaire A This exercise is to be passed out and completed before class begins. This is intended to be used as a measurement tool, testing the attendees basic stroke knowledge at the beginning of the class series and again later in the program to assess their understanding. HOPE: A Stroke Recovery Guide (available for download at www.stroke.org/hope) National Stroke Association Fact Sheets (available for download at www.stroke.org) Stroke 101 Recovery After Stroke: Recurrent Stroke Handouts Blood Pressure Log About My Stroke and Recovery Myth or Reality Questionnaire A STARS Steps Against Recurrent Stroke Tips to Help Prevent Falls Nutrition Inquiry Module 1 Evaluation National Stroke Association Brochures Steps Against Recurrent Stroke (STARS) High Blood Pressure and Stroke M&Ms (Meaningful Messages)
STEP-BY-STEP GUIDE TO IMPLEMENTATION REGISTRATION AND BLOOD PRESSURE CHECKS; DISTRIBUTE HANDOUTS Stroke Facts Questionnaire At registration/check-in, each attendee should receive a copy of the Myth or Reality Questionnaire A to complete before the module begins. Attendees are not expected to know the answers and do not need to put their names on the questionnaire. Questionnaires A and B (given in module 4) are a measurement tool to determine any increase in knowledge from beginning to end. Advise them that the class will be going over the questionnaire again later in the course. Welcoming Environment Conducive to Learning and Sharing The facilitators first task is to help all attendees feel comfortable in their environment. After making certain each person has a name tent and materials, facilitators or volunteers should lead the attendee to an open seat and create a name tent. Depending on the size of the group, it might be helpful to organize the attendees for the first and fourth modules in a U -shaped seating arrangement with tables and chairs. Once settled, blood pressure volunteers should meet attendees at their seats to take their blood pressure and offer refreshments (if available). Facilitators are advised to circulate in an attempt to make personal contact with every attendee prior to the official start of the module. The facilitators attitude, warmth and friendliness set an immediate tone for the program. The sooner a facilitator attempts to identify personal needs and individual disabilities, the sooner attendees will begin to adapt to the group environment and feel comfortable about their place in the program. Start on Time Beginning and ending on schedule not only gives the program consistency, but is also a courtesy to attendees and lets them know their time is valuable. People will undoubtedly drift in after the module has begun. Facilitators can welcome the newcomers graciously as volunteers help them find their seats. Be clear about the fact that class is now beginning.
OPENING AND INTRODUCTIONS Introduce Yourself and Volunteers Attendees want to know who the facilitators are and why they are involved in LEAP, Facilitators should share a little information about themselves professional experience and some personal information about their involvement with stroke and stroke survivors. A personal story always helps break the ice and develop an early bond between the facilitators and the class. Make every effort to begin learning attendees' names without looking at name tents. Attendee Introductions Once facilitators and volunteers have been introduced, a facilitator should ask the participants to identify themselves by providing the following information: Their name Whether they are attending alone or with a caregiver How long ago their stroke occurred Ice breaker question: Name your favorite fruit (or another easily identifiable trivia question that can be answered in one word) Optional question: What do you hope to gain in attending LEAP? Facilitators need to be watchful for attendees who have a verbal or physical disability that makes sharing information difficult. Be encouraging by providing your own eyes and ears to the situation and helping people share in whatever manner they are able. Housekeeping and Ground Rules After the introductions is a good time to explain housekeeping details and ground rules. These items may include but are not limited to the following details: Location of handicap-accessible or family restrooms and water fountains Mention that coffee, water and a healthy snack will be served at break time, which should occur at every class Class always begins and ends on time Questions are welcome and encouraged at any time. There is no such thing as a bad or stupid question.
RELAXATION EXERCISE With lights dim or off, and instrumental music softly playing in the background, guide attendees through the exercise described below. Centering is a procedure that brings a person's mind back from thinking about the past or the future and into the present. Explain that at each class, before the formal presentation, a centering exercise will be used as a way of providing a focused, relaxed transition from the normal day's activities. Teach the significance of breathing by using the metaphor of a car: gas in, fumes out. The body is like a car and needs the constant energy of oxygen in and carbon dioxide out. Dim the lights and ask participants to find a comfortable position with feet flat on the floor and hands loosely in their laps. If they are comfortable doing so, they might close their eyes. Playing soft music during the breathing exercise is recommended. What follows is a breathing exercise. Close your eyes and relax. Place your hands in your lap with your feet flat on the floor. Now slowly take a deep breath in, breathing in through your nose and then breathe out through your mouth, with an open throat. As you breathe in, relax your nostrils and allow oxygen to flow in. As you breathe out, visualize your body releasing carbon dioxide. Fully fill your lungs with oxygen as I count to six, letting the air completely fill your belly while breathing in through your nose. 1, 2, 3, 4, 5, 6. Hold that breath for a few moments. Now release the breath through your mouth as you listen to me count to six 1, 2, 3, 4, 5, 6. If you find yourself thinking too much or worrying, take another deep breath in, hold it and then let the air out while releasing that thought. Continue to inhale through your nose as you count to six in your mind, hold the breath for few moments, then exhale through your mouth as you slowly count to six again. Sit very still as you continue to breathe to the slow count of six. Feel yourself releasing any tension in your shoulders. Release tension down through your abdomen, your legs and out the bottoms of your feet. Return to normal breathing and take a moment to recognize how you feel right now. And say to yourself as you are ready to return to class:. Breathing in, I breathe fresh oxygen. Breathing out, I release carbon dioxide. Breathing in, I am calm. Breathing out, I smile.
After completing the exercise, turn the lights back up and give people a few moments to reacquaint themselves with their surroundings. Emphasize that this exercise is a natural tranquilizer for the nervous system. Unlike tranquilizing drugs, which are often effective when you first take them but then lose their power over time, this exercise is subtle when you first try it but gains in power with repetition and practice. Encourage class members to try to do a breathing exercise at least once a day. OVERVIEW OF COURSE MATERIALS What is LEAP? LEAP, the Lifelong Education and Advocacy Program, is a structured education program offered in a supportive environment and designed to meet the needs of stroke survivors who have completed their initial acute rehabilitation program and are attempting to find ways to be self-sufficient and reintegrate themselves into their community. LEAP is made up of four modules; each module has specific topics with measurable objectives, presentation materials and handouts. This program is intended to be offered in a community-based setting. The educational materials presented at each class have a wellness focus, promote self-care and foster improved quality of life for stroke survivors. Modules 1 through 4: Topics and Objectives Use this time to briefly go over the theme of the four modules and the dates the program will be held. Module 1: Learning About Stroke Module 2: Empowering Yourself Recovery Is a Lifelong Process Module 3: Awareness Emotions, Communication, Intimacy and Self-esteem Module 4: Positively Surviving Explain to the attendees the importance of attending each module. Review handouts, including evaluations, folders, etc. Evaluations Attendees will be asked to complete an evaluation before they leave each module AND twoweeks after the end of the program. Explain that in order to plan affectively for future classes, the facilitators need to know what parts of the modules were most and least successful. Encourage attendees to include personal comments on the evaluation forms. If time permits, Facilitators might elicit discussion from the group about what worked and/or what didn t work for them in the class.
PRESENTATION 1: STROKE 101 Facilitators The facilitators introduction of the guest speaker should include a brief background of that person's qualifications and their experience with stroke survivors and commitment to stroke education. Facilitators are responsible for watching the time and making certain the presenter closes at the appropriate time while still allowing the opportunity for questions from the attendees. The facilitators should provide the guest speaker with background information on LEAP, a profile of the class members and an outline of the talking points the speaker should cover. For the Speaker Talking Points What is a stroke Different types Stroke prevalence What happens Why it happens, risk factors Signs and symptoms Diagnosis and treatment Call 9-1-1 Use of diagnostic tools (CT, MRI, carotid angiogram, echocardiogram, etc.) tpa, surgical procedures, risk factor reduction through lifestyle changes and/or medications Preventing a recurrent stroke Recognizing symptoms (FAST) Brief overview of clinical trials and their importance Allow time for questions and answers.
BREAK Suggested items: Coffee and tea, ice water, sugar-free juice and a nutritional snack (fruit, crackers and cheese trays) The time of day when classes are held will vary based on the needs of facilitators and attendees. In all cases, however, because many stroke survivors are also diabetic, a break which includes a healthy snack is highly recommended at every module. This first break is another opportunity for facilitators to circulate among the group to make personal contact with each attendee. Getting to know people on a first-name basis and providing one-on-one support and encouragement is a key to helping attendees feel accepted in the group. Make certain that your volunteers are circulating and providing assistance where necessary. PRESENTATION 2: FALL PREVENTION, FATIGUE MANAGEMENT AND EXERCISE Facilitators The facilitators introduction of the guest speaker should include a brief background of that person's qualifications and their experience with stroke survivors and commitment to stroke education. Facilitators are responsible for watching the time and making certain the presenter closes at the appropriate time while still allowing the opportunity for questions from the attendees. The facilitators should provide the guest speaker with background information on LEAP and a profile of the class members. For the Speaker Bring a variety of therabands for attendees to use and take home. Demonstrate simple strengthening exercises they can do at home. Also, demonstrate other exercises that can be performed easily at home without special equipment. In addition, discuss the importance of exercise in reducing the risk of recurrent stroke. Reference National Stroke Association s Hope: A Stroke Recovery Guide for sample at-home exercises. Discuss falling and what they can do to prevent it. Reference National Stroke Association s Hope: A Stroke Recovery Guide for instructions for getting up from a fall.
PRESENTATION 3: ROLE OF NUTRITION Facilitators The facilitators introduction of the guest speaker should include a brief background of that person's qualifications and their experience with stroke survivors and commitment to stroke education. Facilitators are responsible for watching the time and making certain the presenter closes at the appropriate time while still allowing the opportunity for questions from the attendees. The facilitators should provide the guest speaker with background information on LEAP, a profile of the class members and an outline of the talking points the speaker should cover. For the Speaker Review the registration forms to determine attendees knowledge of nutrition and tailor the talk based on the information requested. Talking Points Various dietary restrictions: diabetic, lower calories, low cholesterol, low salt (treat high blood pressure) Restrictions of certain foods when on cholesterol-lowering drugs and/or anti-clotting drugs How to shop and read a food label How to include more fiber Instead of, try What are superfoods?
SUMMARY AND CLOSING Take a moment to emphasize that everyone's stroke experience is different even though they are all part of the program because they or someone close to them has had a stroke. The important part is to understand their stroke and the actions they can take to become more selfsufficient, to enhance their quality of life and prevent another stroke. Preparation for Module 2 Just as LEARNING was the focus of the first class, EMPOWERMENT will be the focus of the second class. This means finding ways to give yourself the power to advance individual rehabilitation and recovery goals and view recovery as a lifelong process. M&Ms (Meaningful Messages) Pass out Meaningful Messages to each attendee. Explain that each module will feature its own take home message. Attendees are encouraged to place the M&M in a location at home where they will see it often. As a group, repeat the message out loud two or three times. I CAN DEAL WITH ANYTHING THAT COMES MY WAY. Ask them to repeat it to themselves several times a day. Affirmations take hold when they are repeated often. MODULE EVALUATION Ask attendees to complete the evaluation that was passed out at registration and return it to the facilitator before departing. Convey to the attendees that the evaluations are a way for the facilitators to analyze the attendees thoughts of the information presented and decide if the materials are appropriate to their needs. Note to facilitators: One of the biggest variables from class to class is the presentation by the guest speakers. For this reason, any comments regarding the guest speakers material and delivery is especially important as it will guide facilitators in securing future speakers in the delivery of LEAP.