Tom Vluggen Tom Vluggen foto: Sacha Ruland

’Together Strong after a Stroke’

In Body
Written by  Femke Kools Wednesday, 16 March 2011 10:53

Study into optimising aftercare of the elderly after a stroke

The moment that elderly people after a CVA (Cerebro Vascular Accident, a stroke), leave the rehabilitation department of a nursing home to go back home, the aftercare remains insufficient. They often come back ‘through the back door’. The home situation does not take into account the patient’s sudden limitations and the care plan does not meet these needs. With the programme Samen Sterk na een Beroerte (Together Strong after a Stroke), Maastricht University (UM) is studying how the support of CVA patients and the aftercare can be improved. This is to ensure that once the patient leaves the nursing home he or she does not need to return.

“The idea actually came about when in 2010 I was still working full-time as a physiotherapist at Vivre,” says Tom Vluggen, PhD student at the UM. “In daily practice we saw patients suffering relapses after being discharged from nursing homes. They were for example not able to perform normal everyday tasks, they had an inactive lifestyle, and an overworked informal carer, no guidance in starting up a hobby or had cognitive problems that could lead to depression, relationship problems or social isolation. In October 2010 we collaborated with Adelante and Vivre in starting up an (after)care programme Samen Sterk na een Beroerte (Together Strong after a Stroke) in order to examine how we could optimally support these patients in their new home situation. Here the project team continually asks itself the question: How can we provide support in such a way that makes the process clear for both patient and case manager? How can we make sure that patients no longer have to return to the nursing home and reduce the workload of the informal carer?”

Dialogue with the patient

The programme has clearly arisen from the needs of patients and informal carers. When a patient arrives at Vivre for rehabilitation approximately 10 days after admission to the University Hospital Maastricht, the intervention of the patient commences. Vluggen: “We take a good look at the profile and needs of the patient. If the person is in a wheelchair we first of all see if we can get them to stand. In this way we have a better idea of what the patient can and wants to do. Dialogue with the patient is essential in this. The informal carer, who can be a spouse or family member, is immediately involved in this.”


Self-management and making choices

Samen Sterk na een Beroerte (Together Strong after a Stroke) is a treatment and case management process for elderly persons with CVA to help them to gain control of their lives again and to make their own choices. During the admission in the nursing home the treatment is very much to the fore, whereas after being discharged and back at home it becomes less prominent. “What we want to see is the patients regaining control of their lives. Self-management. We want patients to ask themselves: ‘How do I want it to be and what can I still do? How can I still walk the dog with a partial paralysis and what aids do I need to keep hold of the dog’s leash?’ Such questions are important for promoting the patient’s quality of life.”


Care Guide for the Elderly with CVA

The study started in South Limburg in collaboration with three large care centres, namely nursing home Klevarie (Vivre), Hamboskliniek Kerkrade (Meander) and the rehabilitation department De Eik (Cicero). Depending on the situation of the patient, the programme takes two to six months and is conducted in six nursing homes with a CVA rehabilitation department. At present there are 16 people with CVA in the study, but the study needs 256 patients. 128 are supported following the new programme, whilst others stick to the old method. The study has three parts to it: rehabilitation in the nursing home and at home, self-management and learning to cope with any disability and lastly, the educational programme for the patient as well as the informal carer. Vluggen: “We measure on three separate occasions a number of health-related factors among patients, such as the activity level, their social participation and the quality of life. But we also measure the care load and quality of life of the informal carer. A Care Guide will be published in which the patients are informed about the specific aftercare. This can be compared to a council guide.”


Multidisciplinary programme

The patients in the study are all people who have recently had a stroke. They have arrived from the University Hospital Maastricht at a nursing home and are 65 years of age or older. “We deliberately made this selection for our study. This way we can provide customised care. The programme starts already in hospital. There the care consists of a number of steps before the patient can go home. The steps the patients go through depend on the possibilities offered by the hospital. Within the programme the doctor of the nursing home will determine the care path of the patient. As various specialists contribute to the care process we refer to this as a multidisciplinary care programme. With Samen Sterk na een Beroerte (Together Strong after a Stroke) we want to show that through better aftercare people can be in control of their own lives again. They will have some of their independence back. Changes in the care provision are badly needed to give them quality of life again.’’

Tom Vluggen is physiotherapist at the Vivre Foundation in Maastricht and PhD student within the study project Samen Sterk na een Beroerte (Together Strong after a Stroke) at Maastricht University. The study will run for three years. The first results are expected to be available at the end of 2012. The study receives financial support from the Nationaal Programme Ouderenzorg (NPO, National Programme for Elderly Care) of ZonMW (The Netherlands Organisation for Health Research and Development) and is embedded within the Academisch Centrum Zorg Innovatie Ouderen (ACZIO, Academic Centre for Care Innovation for the Elderly). For further information regarding the study: If you would like to contact the researcher: This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it.

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