Occupational Therapy News OTnews November 2019 | Page 44

FEATURE REHABILITATION Having a break and a cup of tea is therapy when wearing the mitten. the patient’s personal coach, time keeper or personal motivator. Further feedback from patients was that it gave them a sense of control, understanding and ownership. This was because they had been so heavily involved in the programme design and a lot of its delivery was dependent on their engagement. Patient narrative Using patient narrative was key to designing individualised, tailored CIMT programmes. It involved the patient thinking about what they normally did in their daily routine, what they wanted to be able to do and when they might need to take the mitten off. For example, one of the patient’s goals was to return to fishing. To help him achieve this goal one of his shaping tasks was to see how many hooks, floats and sinkers he could pick up and put into his tackle box in one minute. Heightening neuron activity can be achieved through participation in meaningful occupation. Therefore my scientific reasoning skills were essential when collaboratively agreeing the intervention with a patient. Patient participation was guided by my ethical, pragmatic and narrative reasoning skills. A key pragmatic factor to consider was having a supportive family. I noticed patients with families involved found it easier to have control measures in place to manage risk. They also found it easier to cope with the demands of the intense CIMT programme. Having family members involved was not essential for a patient to be included in the CIMT programme, but helped the patient cope with its demands. Key to success I have continued to use the CIMT format, becoming more experienced with it, enabling me to be more confident identifying appropriate patients and more 44 OTnews November 2019 efficient at letting the patients guide its delivery. I am keen to get other members of our community stroke team involved and to develop the CIMT programme within our service. I have completed the CIMT programme jointly with a mixture of my physiotherapy and occupational therapist colleagues to help encourage the wider team to implement CIMT as an upper limb treatment tool. A key to the success of the CIMT programme was having access to rehabilitation assistants. As a service we have the capacity to provide therapy seven days a week, but this is only possible when using rehabilitation assistants, so educating them on implementing the CIMT programme was a pragmatic factor to service delivery. They were involved with implementing, guiding and supporting patients through their CIMT programme on a daily basis, which was essential to patients with a limited family structure. While not involved in the programme design, they help provide the intensity and emotional support day by day, which qualified members of the team found often difficult to provide within the service capacity. Future plans I have been using CIMT in the northern region of the county and the community stroke team is confident in using it, and an aim for the future is to roll it out more widely. I have completed in-service training to the community stroke team in the south and inpatient setting and the plan is to integrate into the wider stroke pathway in Worcestershire. As the CIMT programme has indicated positive outcomes and is becoming more established, it would be beneficial to invest in the official CIMT mitten to control the long-term costs of buying disposal mittens and to manage infection control better. For future practice I aim to explore alternative outcome measures and assessments, to help promote this intervention further. I hope to share my findings with other teams across the region to establish partnerships that will benefit our patients moving forward. References Royal College of Physicians Intercollegiate Stroke Working Party (2016) National clinical guidelines for stroke, RCP. Available online at: https://www.strokeaudit.org/ Guideline/Full-Guideline.aspx [accessed 20 July 2019] Jenny Merchant, occupational therapist, Community Stroke, Worcestershire Health and Care NHS Trust, email: [email protected]