A Caregiver's Guide to Stroke Recovery

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A CAREGIVER’S GUIDE TO STROKE RECOVERY A CAREGIVER’S GUIDE TO STROKE RECOVERY The Stroke Survivor Saluting Anna, Len, and Jeff are survivors of stroke and while their experiences are unique, they share with your loved one stories of unexpected, life-changing events. Stroke

As stroke survivors, these individuals have shared their personal stories in the hopes of providing caregivers and their loved ones with stories of inspiration, motivation, and perseverance. They demonstrate that stroke recovery is possible and people living Caregivers with the effects of stroke can go on to live happy and fulfilled lives.

More than 400,000 Canadians live stroke survivors, and maintain healthy relationships, existing aphasia camps, and other helpful resources. You will also find 4 with the long-term effects of a stroke. inspiring real-life stories about other caregivers and stroke That means there are potentially more survivors that will encourage you to see that there is life for everyone after stroke. “Fifteen years ago, I woke up “My stroke story begins on “One minute I was painting than 400,000 caregivers who also need The human brain is much more adaptive than once believed. to find the course of my life a beautiful island in the a ceiling in my home, help and support. Advances in our knowledge of neuroplasticity – the brain’s changed forever. Bahamas. lifelong ability to reorganize neural pathways based on new and the next I was on the ground, Sometimes we forget that the caregivers themselves have experiences – suggests our brains are not hardwired with fixed The day before, I was a physically I was there enjoying a much-needed experiencing pain like I had never felt experienced significant life changes after their loved one 5-7 before. I was terrified, felt helpless neuronal circuits; rather, they are responsive and flexible. active, healthy person leading the vacation with my two children and has suffered a stroke. They too struggle with meeting new and thought this was the end. I don’t This provides hope to stroke survivors and their caregivers. normal life of a father of two young my pet when the unimaginable challenges and are searching for new paths to happiness, really remember the next few hours, Recovery is always possible. sons, 7 and 10 years old. Overnight, happened. I was struck by a massive health, and independence. In order for caregivers to effectively but when I awoke I was lying in a I had a severe brain stem stroke brain stem stroke.” help with their stroke survivor’s rehabilitation and life Stroke Recovery Canada is dedicated to supporting caregivers hospital bed with doctors standing that left me unable to walk, to talk, circumstances, they must first look after their own physical and stroke survivors alike. We hope this guide can serve as a - ANNA over me. I had suffered a massive brain and completely paralyzed on my and mental wellbeing. tool to help you through your journey as a caregiver. Please right side.” stem stroke that left me completely contact us to find programs and services in your community. paralyzed on my right side and unable A caregiver’s attitude is important to the health and - LEN to speak, swallow, eat or breathe on wellbeing of the person for whom they care for. As a my own.” caregiver, it is important for you to take care of yourself, as “A key to the quality of recovery is well as your stroke survivor. Eat well, get enough sleep, - JEFF manage stress, and continue to make time for the things you support from fellow stroke survivors enjoy. You are not being selfish by tending to your own needs, and their caregivers…the people who rather you are ensuring that you can be the best possible have first-hand experience. caregiver without compromising your own wellbeing. This peer support was instrumental for me. And that is Table of Contents Our second issue of A Caregiver’s Guide To Stroke Recovery what March of Dimes Stroke Recovery Canada® is all offers useful information to help you be the best caregiver about…reaching out to other stroke survivors and giving Saluting Stroke Caregivers 3 Aphasia Camps for Community Support 20–21 to your loved one. In this guide, you will find information on them understanding, knowledge, and hope.” - LEN Life as a Caregiver 4–5 Creating a New Environment 22 stroke recovery and spasticity, how to communicate with The Impact of Stroke on Your Loved One 5 Capitalizing on Health Benefits 23 Recognizing and Managing Spasticity After Stroke 6–8 Stroke Recovery Canada 24 Spasticity Rehabilitation for Your Stroke Survivor 9–13 Caregiver Survival Checklist 25 Occurs when a stroke damages a part of the brain that controls certain muscles in the body and the 26 Stroke Recovery and Community Reintegration 14–15 Helpful Resources muscles become tight and stiff and resist being stretched.1 Dealing with the Other Side of Grief 16 Canadian Rehabilitian Firms 27–28 Aphasia 29 Building and Maintaining Healthy Relationships 17 Recovery for Stroke Survivors A brain injury, such as a stroke, can damage the left side of the brain. This damage can cause aphasia. A Closer Look at Aphasia & Communication Disabilities 20–21 References 30–31 People with aphasia may have difficulty talking, understanding speech, reading and/or writing.3

3 A CAREGIVER’S GUIDE TO STROKE RECOVERY The Stroke Survivor Saluting Anna, Len, and Jeff are survivors of stroke and while their experiences are unique, they share with your loved one stories of unexpected, life-changing events. Stroke

More than 400,000 Canadians live stroke survivors, and maintain healthy relationships, existing aphasia camps, and other helpful resources. You will also find 4 with the long-term effects of a stroke. inspiring real-life stories about other caregivers and stroke That means there are potentially more survivors that will encourage you to see that there is life for everyone after stroke. “Fifteen years ago, I woke up “My stroke story begins on “One minute I was painting than 400,000 caregivers who also need The human brain is much more adaptive than once believed. to find the course of my life a beautiful island in the a ceiling in my home, help and support. Advances in our knowledge of neuroplasticity – the brain’s changed forever. Bahamas. lifelong ability to reorganize neural pathways based on new and the next I was on the ground, Sometimes we forget that the caregivers themselves have experiences – suggests our brains are not hardwired with fixed The day before, I was a physically I was there enjoying a much-needed experiencing pain like I had never felt experienced significant life changes after their loved one 5-7 before. I was terrified, felt helpless neuronal circuits; rather, they are responsive and flexible. active, healthy person leading the vacation with my two children and has suffered a stroke. They too struggle with meeting new and thought this was the end. I don’t This provides hope to stroke survivors and their caregivers. normal life of a father of two young my pet when the unimaginable challenges and are searching for new paths to happiness, really remember the next few hours, Recovery is always possible. sons, 7 and 10 years old. Overnight, happened. I was struck by a massive health, and independence. In order for caregivers to effectively but when I awoke I was lying in a I had a severe brain stem stroke brain stem stroke.” help with their stroke survivor’s rehabilitation and life Stroke Recovery Canada is dedicated to supporting caregivers hospital bed with doctors standing that left me unable to walk, to talk, circumstances, they must first look after their own physical and stroke survivors alike. We hope this guide can serve as a - ANNA over me. I had suffered a massive brain and completely paralyzed on my and mental wellbeing. tool to help you through your journey as a caregiver. Please right side.” stem stroke that left me completely contact us to find programs and services in your community. paralyzed on my right side and unable A caregiver’s attitude is important to the health and - LEN to speak, swallow, eat or breathe on wellbeing of the person for whom they care for. As a my own.” caregiver, it is important for you to take care of yourself, as “A key to the quality of recovery is well as your stroke survivor. Eat well, get enough sleep, - JEFF manage stress, and continue to make time for the things you support from fellow stroke survivors enjoy. You are not being selfish by tending to your own needs, and their caregivers…the people who rather you are ensuring that you can be the best possible have first-hand experience. caregiver without compromising your own wellbeing. This peer support was instrumental for me. And that is Table of Contents Our second issue of A Caregiver’s Guide To Stroke Recovery what March of Dimes Stroke Recovery Canada® is all offers useful information to help you be the best caregiver about…reaching out to other stroke survivors and giving Saluting Stroke Caregivers 3 Creating a New Environment 20 to your loved one. In this guide, you will find information on them understanding, knowledge, and hope.” - LEN Life as a Caregiver 4–5 Capitalizing on Health Benefits 21 stroke recovery and spasticity, how to communicate with The Impact of Stroke on Your Loved One 5 Stroke Recovery Canada 22 Recognizing and Managing Spasticity After Stroke 6–8 Caregiver Survival Checklist 23 Spasticity Rehabilitation for Your Stroke Survivor 9–13 Helpful Resources 24 Occurs when a stroke damages a part of the brain that controls certain muscles in the body and the Stroke Recovery and Community Reintegration 14–15 Canadian Rehabilitian Firms 25–26 muscles become tight and stiff and resist being stretched.1 Dealing with the Other Side of Grief 16 Recovery for Stroke Survivors 26 Aphasia Building and Maintaining Healthy Relationships 17 References 27 A brain injury, such as a stroke, can damage the left side of the brain. This damage can cause aphasia. Aphasia Camps for Community Support 18–19 People with aphasia may have difficulty talking, understanding speech, reading and/or writing.3

3 • Loss of control of movement and/or feeling in some parts of the body o This usually occurs on the side of the body opposite from the side of the brain affected Aby CAREGIVER’S stroke GUIDE TO STROKE RECOVERY • Changes in muscle tone on the side affected by trokes o Some stroke survivors may lose the ability to contract their Carol refers to herself as being at the Catherine’s Story: advancing, and Catherine’s quality of life bottom of a mountain and looking up New Opportunities continues to improve.” muscles, while others may experience involuntary muscle con- at how long and hard her climb would Catherine Eustace was only 14 years tractions A stroke may change what a person be. With the help of friends and family old when she had a massive stroke. • Difficulty sitting, standing orwalking can do, but everyone has different she was given the strength to put one Although her parents, Micheline and Ed, talents and strengths. So it becomes • Reduced ability to balance foot in front of the other, and began the were divorced, they quickly committed a process of rediscovery. “I had to give • Problems with speaking and/or understanding speech seemingly impossible and exhausting to working together to help their up snowboarding,” says Catherine, climb to the mountain top. A pivotal daughter. Catherine’s stroke made her • Confusion and/or poor memory “but I discovered painting and golf. moment in Carol’s caregiver journey parents realize that nothing in life can • Reduced control over their bladder or bowel Immediately after the stroke, I was occurred when a social worker told her be taken for granted, and that every • Difficulty swallowing scared, and then depressed, but when I that he didn’t know how to help her. She moment must be cherished. saw my parents full of hope and fighting • Reduced control over emotions was in terrible grief, and didn’t know of Ed, Micheline, and Catherine’s older for me, I also committed to my recovery. The Impact of Stroke any support groups that existed. Not sister Anne-Marie, took turns being with I had to work hard at physical therapy long after that, Carol connected with Catherine at the hospital, and later and at restarting my education after on Your Loved One the Guelph Wellington Stroke Recovery at the rehabilitation centre, and then a two-year delay. At times, my life felt Chapter, which was in the early stages at home. It hasn’t been easy, but nine like constant work. But things are really A stroke can cause damage to the brain of starting a caregiver group. years later, Catherine has overcome looking optimistic now. I learned that tremendous challenges, and is preparing “I will be forever grateful for the hard work and commitment can make either by interrupting blood flow to the brain to go to university. caregiver group that virtually saved me a big difference.” or by causing the blood vessels in the from feeling alone with this terrible thing When asked what helped, Micheline Catherine and her parents demonstrate brain to rupture. Life as a called stroke, and handed me a bucket says, “We considered ourselves part of that love, commitment and optimism for my tears with compassion and the rehabilitation team, together with Caregiver can help to better manage the shock This type of damage to the brain cells may impair their function, understanding. You see, they knew doctors, nurses, and therapists. and life change caused by stroke. which may result in the loss of movement, sensation, and/or thought just how I felt, and what I was going We constantly tried to learn as much as Carol’s Story: The Climb A stroke can bring people together processes, including speech.8 through.” we could about stroke, and advocated “I have climbed three-quarters of the and encourage new opportunities and on our daughter’s behalf, asking medical The effects of a stroke vary, and the outcome depends on the area of way up the mountain, and have picked Carol talks about her feelings of grief, interests. You have the ability as a staff to find solutions for various the brain affected and the degree of damage. Individuals who have up along the way a toolbox of coping and how she seemed to dwell on caregiver to inspire your loved one with problems. To receive help, most often survived a stroke may experience any of the following symptoms:8 skills and many loyal friends that will blaming herself and taking on her strength, optimism and opportunity, we only needed to ask, but sometimes be there for me to share and use when husband’s hardship. She was grieving and you can choose to become a part • Loss of control of movement and/or feeling in some parts of we had to be more persistent. I climb to the top of the mountain with the loss of certain pieces of the man she of the rehabilitation team and make the the body We also sought and accepted support the unknowns yet to come.” once knew and loved, and was learning most out of a difficult situation. - This usually occurs on the side of the body opposite from the side from everyone: our family, hospital, to accept the changes that came with of the brain affected by stroke Six and a half years ago Carol Miller-Hall rehabilitation centre, and Catherine’s him having a stroke. Carol encourages • Changes in muscle tone on the side affected by stroke received a phone call that would change school. That way, the responsibilities other caregivers to accept all the help - Some stroke survivors may lose the ability to contract their her life in ways she never imagined. were spread out, and nobody that is offered to them and learn to ask muscles, while others may experience involuntary muscle contractions At the age of 49, her husband had burned out.” suffered a stroke while driving a van. questions, and recommends joining a • Difficulty sitting, standing, or walking With that one phone call Carol went support group to help with the journey The key lesson Ed learned as a caregiver • Reduced ability to balance from being a typical spouse, just and all that comes along with being a was to never give up and that • Problems with speaking and/or understanding speech going about her every-day life, to caregiver. As Carol expressed, you will improvement is always possible. • Confusion and/or poor memory reach points throughout your climb as a • Reduced control over their bladder or bowel being blindsided from this tragedy and “For nine years, Catherine had spasticity caregiver where it may seem impossible • Difficulty swallowing becoming a caregiver to her husband. in her left wrist and ankle, interfering to continue. It is during these times • Reduced control over emotions Just a year and a half after her with her ability to use her left hand and of struggle and doubt that you must husband’s stroke, Carol found herself walk,” he says. speaking to a group of people telling her reach out and accept the support and story - something she never imagined love that groups, resources, and other “We didn’t have a treatment for this. “At the age of 36, I now had to learn even she would be doing. caregivers have to offer. You can rest Only last year, Catherine’s godmother, assured that you will one day reach the a nurse, learned about some of the the basics because the stroke had also “I had struggled to breathe, let alone top of your own mountain, and maybe, newer methods to treat spasticity, and caused a severe left side neuropathy and put into words my experience and how like Carol, you will be able to share your we obtained a referral to a spasticity even damaged my vocal chords. I came to be a caregiver. I was still very climbing tools with others. clinic. Now Catherine can raise her left much feeling raw with hurt. I learned arm above her head, and her left hand My days of being a busy mom, carpooling, and taking my from my caregiver support group that is stronger. She also walks with less of children to their sporting events were now replaced with I was still in the very early stages of this a limp. It just goes to show you that learning how to conquer the most elementary tasks: learning change in my life, and that time was rehabilitation techniques are always how to walk, write, and even see.” - ANNA needed to heal. They were so, so right.”

4 5 • Loss of control of movement and/or feeling in some parts of the body o This usually occurs on the side of the body opposite from the side of the brain affected Aby CAREGIVER’S stroke GUIDE TO STROKE RECOVERY • Changes in muscle tone on the side affected by trokes o Some stroke survivors may lose the ability to contract their Carol refers to herself as being at the Catherine’s Story: advancing, and Catherine’s quality of life bottom of a mountain and looking up New Opportunities continues to improve.” muscles, while others may experience involuntary muscle con- at how long and hard her climb would Catherine Eustace was only 14 years tractions A stroke may change what a person be. With the help of friends and family old when she had a massive stroke. • Difficulty sitting, standing orwalking can do, but everyone has different she was given the strength to put one Although her parents, Micheline and Ed, talents and strengths. So it becomes • Reduced ability to balance foot in front of the other, and began the were divorced, they quickly committed a process of rediscovery. “I had to give • Problems with speaking and/or understanding speech seemingly impossible and exhausting to working together to help their up snowboarding,” says Catherine, climb to the mountain top. A pivotal daughter. Catherine’s stroke made her • Confusion and/or poor memory “but I discovered painting and golf. moment in Carol’s caregiver journey parents realize that nothing in life can • Reduced control over their bladder or bowel Immediately after the stroke, I was occurred when a social worker told her be taken for granted, and that every • Difficulty swallowing scared, and then depressed, but when I that he didn’t know how to help her. She moment must be cherished. saw my parents full of hope and fighting • Reduced control over emotions was in terrible grief, and didn’t know of Ed, Micheline, and Catherine’s older for me, I also committed to my recovery. The Impact of Stroke any support groups that existed. Not sister Anne-Marie, took turns being with I had to work hard at physical therapy long after that, Carol connected with Catherine at the hospital, and later and at restarting my education after on Your Loved One the Guelph Wellington Stroke Recovery at the rehabilitation centre, and then a two-year delay. At times, my life felt Chapter, which was in the early stages at home. It hasn’t been easy, but nine like constant work. But things are really A stroke can cause damage to the brain of starting a caregiver group. years later, Catherine has overcome looking optimistic now. I learned that tremendous challenges, and is preparing “I will be forever grateful for the hard work and commitment can make either by interrupting blood flow to the brain to go to university. caregiver group that virtually saved me a big difference.” or by causing the blood vessels in the from feeling alone with this terrible thing When asked what helped, Micheline Catherine and her parents demonstrate brain to rupture. Life as a called stroke, and handed me a bucket says, “We considered ourselves part of that love, commitment and optimism for my tears with compassion and the rehabilitation team, together with Caregiver can help to better manage the shock This type of damage to the brain cells may impair their function, understanding. You see, they knew doctors, nurses, and therapists. and life change caused by stroke. which may result in the loss of movement, sensation, and/or thought just how I felt, and what I was going We constantly tried to learn as much as Carol’s Story: The Climb A stroke can bring people together processes, including speech.8 through.” we could about stroke, and advocated “I have climbed three-quarters of the and encourage new opportunities and on our daughter’s behalf, asking medical The effects of a stroke vary, and the outcome depends on the area of way up the mountain, and have picked Carol talks about her feelings of grief, interests. You have the ability as a staff to find solutions for various the brain affected and the degree of damage. Individuals who have up along the way a toolbox of coping and how she seemed to dwell on caregiver to inspire your loved one with problems. To receive help, most often survived a stroke may experience any of the following symptoms:8 skills and many loyal friends that will blaming herself and taking on her strength, optimism and opportunity, we only needed to ask, but sometimes be there for me to share and use when husband’s hardship. She was grieving and you can choose to become a part • Loss of control of movement and/or feeling in some parts of we had to be more persistent. I climb to the top of the mountain with the loss of certain pieces of the man she of the rehabilitation team and make the the body We also sought and accepted support the unknowns yet to come.” once knew and loved, and was learning most out of a difficult situation. - This usually occurs on the side of the body opposite from the side from everyone: our family, hospital, to accept the changes that came with of the brain affected by stroke Six and a half years ago Carol Miller-Hall rehabilitation centre, and Catherine’s him having a stroke. Carol encourages • Changes in muscle tone on the side affected by stroke received a phone call that would change school. That way, the responsibilities other caregivers to accept all the help - Some stroke survivors may lose the ability to contract their her life in ways she never imagined. were spread out, and nobody that is offered to them and learn to ask muscles, while others may experience involuntary muscle contractions At the age of 49, her husband had burned out.” suffered a stroke while driving a van. questions, and recommends joining a • Difficulty sitting, standing, or walking With that one phone call Carol went support group to help with the journey The key lesson Ed learned as a caregiver • Reduced ability to balance from being a typical spouse, just and all that comes along with being a was to never give up and that • Problems with speaking and/or understanding speech going about her every-day life, to caregiver. As Carol expressed, you will improvement is always possible. • Confusion and/or poor memory reach points throughout your climb as a • Reduced control over their bladder or bowel being blindsided from this tragedy and “For nine years, Catherine had spasticity caregiver where it may seem impossible • Difficulty swallowing becoming a caregiver to her husband. in her left wrist and ankle, interfering to continue. It is during these times • Reduced control over emotions Just a year and a half after her with her ability to use her left hand and of struggle and doubt that you must husband’s stroke, Carol found herself walk,” he says. speaking to a group of people telling her reach out and accept the support and story - something she never imagined love that groups, resources, and other “We didn’t have a treatment for this. “At the age of 36, I now had to learn even she would be doing. caregivers have to offer. You can rest Only last year, Catherine’s godmother, assured that you will one day reach the a nurse, learned about some of the the basics because the stroke had also “I had struggled to breathe, let alone top of your own mountain, and maybe, newer methods to treat spasticity, and caused a severe left side neuropathy and put into words my experience and how like Carol, you will be able to share your we obtained a referral to a spasticity even damaged my vocal chords. I came to be a caregiver. I was still very climbing tools with others. clinic. Now Catherine can raise her left much feeling raw with hurt. I learned arm above her head, and her left hand My days of being a busy mom, carpooling, and taking my from my caregiver support group that is stronger. She also walks with less of children to their sporting events were now replaced with I was still in the very early stages of this a limp. It just goes to show you that learning how to conquer the most elementary tasks: learning change in my life, and that time was rehabilitation techniques are always how to walk, write, and even see.” - ANNA needed to heal. They were so, so right.”

4 5 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Recognizing and Managing Spasticity After Stroke

Recognizing spasticity Spasticity refers to a condition when Treatment for spasticity • Botox ® injections– Botox® can block After a stroke, damage to the brain can the muscles become tight and stiff There are many strategies and the chemicals that make muscles tight block messages between muscles and and resist being stretched. The degree Spasticity can treatments for spasticity. In order to the brain causing arm and leg muscles of spasticity may vary from mild achieve the best results possible, a “Since the treatment is worsen over time, to cramp or spasm, kind of like a bad muscle stiffness to severe, painful, and mixture of therapies and medications designed to reach charley horse. uncontrollable muscle spasms. and therefore it is are often used to treat spasticity. This post-stroke condition can limit Generalized spasticity specific goals in terms Some available options include:11 coordination and muscle movement, important as a Spasticity affecting the • Braces – Putting a brace on an of a patient’s function, and can make daily activities such as caregiver that you whole body.2 affected limb bathing, eating, and dressing more botulinum toxin A Studies show that • 9,10,11 watch for spasticity Exercises – Range-of-motion exercises difficult. The restriction of movement Focal spasticity ® • Stretching– Gentle stretching of (Botox ) injections are spasticity affects can make day-to-day life a struggle for in your stroke survivor Impairment and activity tighter muscles both the stroke survivor and caregiver.1 limitation around the joints.2 used as a first-line more than 65% of and inform his • Movement– Frequent repositioning Spasticity can cause long periods of of body parts treatment for focal stroke survivors, usually or her doctor so strong contractions in major muscle • Medications – Medications are spasticity,” says Dr. Farooq within weeks or months groups, causing painful muscle spasms, they can receive available to treat the effects of following a stroke.1,12 which can produce:10,11 generalized spasticity Ismail, physiatrist at West Park • A tight fist appropriate care as Healthcare Centre in Toronto. • Bent elbow .1 soon as possible • ITB Therapy– A programmable, • Arm pressed against the chest battery-powered medical device • Stiff knee that stores and delivers medication • Pointed foot (known as foot drop) to treat some of the symptoms of • Stiffness in the arms, fingers, or legs severe spasticity • Surgery– Surgery on the muscles or tendons and joints may block pain and restore movement

6 7 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Recognizing and Managing Spasticity After Stroke

6 7 A CAREGIVER’S GUIDE TO STROKE RECOVERY

“These injections are a simple, effective treatment with virtually no side effects. When Botox® is injected into specific muscles, it promotes muscular relaxation, thereby reducing spasticity and helping the patient function more normally. To enable a patient to hold a spoon, these injections may have to be administered in varying amounts for different fingers. The effects are reversible after about three months, allowing the spasticity balance to be modified to the desired level. Botox® injections are usually followed by intensive physical therapy, which involves determining ‘anti-spastic’ body positions (in which the spastic muscles are stretched) and Rehabilitation doing stretching and range of motion exercises.” Help for spasticity for Your Stroke “A patient with spasticity may require a great deal of assistance with daily living because his or her abilities are limited. A very spastic patient may even require several people to complete morning and evening routines,” says Dr. Ismail. Survivor “In milder cases, spasticity can affect a person’s balance, making it difficult to walk. Spasticity can make it impossible for a stroke survivor to drive, or even unclench an affected Beyond Stroke Website Presently, many stroke survivors hand. If a clenched fist cannot be opened to be washed, In addition to your loved one, a skin infection may result.” who suffer from spasticity remain approximately 400,000 other Canadians Managing spasticity with assistive devices, aids and home untreated or undertreated, adaptations can help ensure your loved one’s safety and even though effective therapy are living with the effects of stroke. reduce their risk of spasticity-related falls. Physical and occupational therapists will recommend the appropriate aid(s) is available. There are many resources that exist to provide support as well as safety procedures, maintenance, and proper for stroke survivors and their caregivers. The website, fit. Some modifications that can be made to the home to improve safety include:11  www.beyondstroke.ca • Ramps • Grab bars was created to help you better understand the • Raised toilet seats physical challenges many people face after they have • Shower or tub bench had a stroke. While support for stroke survivors and • Plastic adhesive strips on the bottom of the bathtub Once the acute crisis of a stroke their caregivers tends to be greatest immediately after • Braces, canes, walkers, and wheelchairs has passed, the long process of a stroke, many find it becomes more difficult to find the right kinds of support weeks, months, and even Talking to a doctor recovery begins. Stroke rehabilitation therapy Stroke rehabilitation therapy years after a stroke has occurred. “Spasticity is often overlooked because stroke survivors have many other problems,” says Dr. Ismail. However, it shouldn’t For many stroke survivors, this includes the hard work of, This website offers advice and reassurance as to be. The caregiver should alert the medical team to potential and commitment to, rehabilitation. how best to deal with long-term physical challenges spasticity and ask for a referral to a spasticity clinic. Physiatry Physiatry associated with stroke, and provides information on: Often, therapy involves both inpatient and outpatient If you suspect your loved one has excessive spasticity, talk to care at a rehabilitation centre. As a caregiver, you will need • What may be causing the physical challenges his or her doctor and ask for a referral to a spasticity clinic. Social Work to understand what rehabilitation services are offered, after a stroke Social Work Describe the symptoms you have observed and how they which service will best benefit your stroke survivor’s specific • How physical challenges might be treated interfere with daily activities. Try to be very specific. Occupational needs, what actions need to be taken, whereOccupational to go for • How Stroke Rehabilitation Physicians can help Physiotherapy Physiotherapy Avoid general statements such as “I would like my stroke therapy information, and who to contact when you havetherapy questions. • How you can get the additional help you need survivor to be able to move.” Instead, use specific observations Podiatry Common forms of therapy include physiatry, physiotherapy, The website also provides a search tool to help you Podiatry such as “his nails are digging into his palm” or “her elbow is occupational therapy, podiatry, and social work, all of locate a Stroke Rehabilitation Physician by region. twisted, and she has difficulty dressing herself.” Describing which are described here in detail. Community reintegration specific concerns will help your doctor understand the  See the HELPFUL RESOURCES section to locate is also an important aspect of rehabilitation and is also impact of spasticity on your and the stroke survivor’s lives, a physician in your region. discussed at the end of this section. and will enable your stroke survivor to receive an appropriate assessment.

8 9 Stroke rehabilitation therapy Stroke rehabilitation therapy

Physiatry Physiatry

Social Work Social Work Occupational Physiotherapy Physiotherapy Occupational therapy therapy Podiatry Podiatry A CAREGIVER’S GUIDE TO STROKE RECOVERY

8 9 Stroke rehabilitation therapy Stroke rehabilitation therapy

Physiatry Physiatry

Social Work Social Work Occupational Physiotherapy Physiotherapy Occupational therapy therapy Podiatry Podiatry A CAREGIVER’S GUIDE TO STROKE RECOVERY

Physiatry Furthermore, physiotherapists improve With guidance from a physiotherapist provinces:  http://physiocanhelp.ca/ Physiatrists are physicians who specialize in physical medicine stroke survivor satisfaction by promoting and other members of the healthcare find-a-physio-therapist-2/.  See the and rehabilitation, a medical specialty that deals with the social engagement and supporting team, most individuals continue to HELPFUL RESOURCES section to locate evaluation and treatment of stroke survivors whose functional self-management strategies resulting in improve their performance of functional a physiotherapist in your region. abilities have been impaired.13 improvements in quality of life.8,16 tasks and aerobic capacity for up to one year following a stroke. At this point, Occupational Therapy The role of physiatry in stroke recovery Physiotherapists are specifically trained the rate of recovery usually slows down Occupational therapy is defined by the A physiatrist will help the stroke survivor to regain function to assess movement difficulties and/or but may continue for an extended Canadian Association of Occupational after the stroke by leading a team of healthcare professionals sensory loss that may occur as a result period of time thereafter. After discharge Therapists as “the art and science that may include rehabilitation nurses, physical therapists, of a stroke. Through movement from the hospital, a rehabilitation of enabling engagement in everyday occupational therapists, speech therapists, therapeutic re-education, the physiotherapist program may continue through home living”.17 recreational specialists, and social workers. These works to retrain mobility and functional care physiotherapy or an out-patient rehabilitation specialists work together to improve the stroke activities such as walking, standing up “Occupation” refers to everything that physiotherapy clinic.8 survivor’s recovery with the goal of restoring as much of from sitting and using the affected arm people do during the course of everyday their independence as possible.14 and leg.8 Several of the movement A stroke survivor may choose to life.17 re-education aspects that physiotherapists receive physiotherapy at home or at a When to see a physiatrist concentrate on include:8 clinic even if they had initially received Help is available for people who have had a stroke, even many Physiatry in Canada treatment in the hospital, but were years later. There are specially trained Stroke Rehabilitation • Mobility and strengthening exercises The Canadian Association of Physical Medicine and not referred for further therapy after Occupational therapy Physicians who treat people dealing with the aftermath of for the affected arm and leg Rehabilitation (CAPM&R) is a member service organization discharge. A stroke survivor does not stroke every day. • Trunk stability and strengthening that represents Canadian physiatrists and promotes their need to be referred by a doctor in order enables people to • Balance retraining to improve pursuit of excellence in the field of physical medicine and to see a physiotherapist. perform and participate rehabilitation. The CAPM&R was founded in 1952 and has over stability and movement coordination 400 members today. The CAPM&R website provides links to • Improving exercise tolerance and to their full potential It is important to have your stroke regional physiatrists listed by province:  http://capmr.ca/ endurance in the daily occupations about-capmr/what-is-a-physiatrist/.  See the HELPFUL • Functional activities to promote 18 survivor assess any physical RESOURCES section to locate a physiatrist in your region.13 independence and participation in of life. challenges caused by their stroke daily activities Physiotherapy • Gait retraining to promote safe and so they can receive any necessary Physiotherapists are primary healthcare professionals who functional walking treatment. combine their in-depth knowledge of the physical body and • Sensory retraining to help compensate For a stroke survivor, this may translate how it works with specialized hands-on clinical skills to assess, for altered or reduced sensations into difficulty moving (particularly one You can have your loved one answer the following 8,15 side of the body), severe stiffness (also diagnose, and treat symptoms of illness, injury, or disability. When to see a physiotherapist assessment questions on a repeated basis to get known as spasticity) and abnormal After receiving medical attention, a sense of how their post-stroke symptoms are The role of physiotherapy in stroke recovery movement patterns, difficulty speaking a stroke survivor will ideally begin a progressing.1 Physiotherapists play an essential role in the rehabilitation of (also known as aphasia), difficulty rehabilitation treatment program with a stroke survivors, helping them return to their highest level of understanding and processing 1. Since your stroke or last assessment, do you have 8,16 physiotherapist as soon as possible while activity and function. Physiotherapists help to improve physical information, difficulty seeing, difficulty more difficulty walking or moving safely from bed in hospital. If medically stable, physicians Physiotherapy in Canada mobility of arms, hands, and legs to recover functional activities understanding where the body is in to chair? quite often refer stroke survivors to a The Canadian Physiotherapy Association such as dressing, feeding, hygiene, transferring, and walking. space, or difficulty recognizing objects  YES  NO physiotherapist for treatment within (CPA) represents physiotherapists, and altered sensation. These deficits 48 hours of having a stroke. Some physiotherapist assistants and 2. Since your stroke or last assessment, do you have may impact your stroke survivor’s people recover from the effects of a physiotherapist students across Canada. more stiffness in your arms, hands, and/or legs? daily activities, such as the ability to stroke within days, but in most cases, CPA members are rehabilitation  YES  NO Physiotherapists promote exercise, wash, dress and feed him or herself, improvement occurs gradually over the professionals dedicated to the health, walk or run, communicate, function 3. Is this interfering with activities of daily living, sleep course of a rehabilitation period.8 mobility, and fitness of Canadians.8 education, and lifestyle at work, use a computer or cell phone, or causing pain? drive, participate in leisure activities,  YES  NO modifications in stroke survivors Canada has more than 20,000 following a stroke and encourage registered physiotherapists who work in and to be intimate with their partner.  If your stroke survivor answers “YES” to any of While improvement is private clinics, general and rehabilitation Occupational therapists (OTs) assess the questions above, he or she may benefit from the adoption of healthy behaviours, hospitals, community health centres, all of these areas of a person’s life and seeing a Stroke Rehabilitation Physician. always possible, most residential care and assisted-living provide treatment, as well as strategies, which can reduce a stroke survivor’s assistive technologies and interventions Ask your loved one’s doctor for a referral to a recovery is based on facilities, home visit agencies, risk of having a subsequent stroke or workplaces, and schools.8,15 that promote health and wellbeing specialist. Most doctors will be more than willing to persistence, practice, 1 The CPA endorses the Physio Can and allow one to engage in all of their send a referral. suffering other cardiovascular events. and patience. Help website, which provides links to chosen activities of daily living, and physiotherapists located in several to go back to leading productive and satisfying lives.

10 11 A CAREGIVER’S GUIDE TO STROKE RECOVERY

impaired, the OT may assess him or her increases, or if any other concerning The role of podiatry in stroke recovery When to see a social worker for a mobility device, such as a walker, issue arises, then they can ask their Stroke symptoms can affect the Social work treatment begins during an manual wheelchair, scooter, or power doctor for a referral for outpatient mechanics of the foot and may include initial interview with the stroke survivor wheelchair. If memory or the ability to occupational therapy in a hospital muscle wasting, loss of nerve control and his or her family. At this time, a concentrate or do simple calculations outpatient program or at a and sensations, or altered sensations. psychological evaluation is completed has been affected, the OT will work with private clinic. These symptoms can lead to understand the person’s history prior individuals to overcome or manage to conditions such as foot drop and to the stroke, in addition to any social, Occupational therapy in Canada these issues. In the later stages the OT spastic paralysis.23 emotional, and economic problems In October 2011, the CIHI (Canadian may assess a stroke survivor’s home created or intensified by the stroke. Institute for Health Information) Spasticity is a form of paralysis that and work environments and prescribe The social worker will inquire about the reported over 13,000 registered affects roughly 40% of stroke survivors safety devices such as grab bars, raised stroke survivor’s goals in life and may occupational therapists in Canada.19 and is characterized by stiff or tight toilet seats and/or specialized door advise on how they may be redirected. The Canadian Association of muscles. The tight muscles constrict Social work operators, work tools, or adaptive They will also learn about the meaningful Occupational Therapists (CAOT) is the movement, making it difficult to lift Social work is a profession concerned equipment. If a person can no longer people in the stroke survivor‘s life and The role of occupational therapy in sole accrediting agency in Canada which things, walk or perform daily activities with helping individuals, families, access their computer or mobile phone, their relationships with those people, stroke recovery currently has the mandate through the of living.22 Foot drop, also known as groups, and communities to enhance the OT will help to provide alternative along with the individual’s personality OTs are a vital part of the stroke team, regulatory bodies for the accreditation drop foot, is a general term that refers their individual and collective wellbeing. access technologies, such as specialized traits and personal strengths.27 and provide programs to promote of all occupational therapy educational to difficulty lifting the front part of the It aims to help people develop their switches, voice activation, eye gaze and overall physical and mental health to programs.20 foot. Someone with foot drop may drag skills and their ability to use their own Social work in Canada other technologies. Furthermore, if an improve function and engage in the the front of their foot as they walk.24 resources and those of the community Social workers operate in a variety individual is having difficulty driving or Although the CAOT is the national occupations of life. The process involves Without early intervention, such as to resolve problems.26 of settings, such as family services coping, the OT can provide strategies to association, each province and territory assessment, intervention, and evaluation orthotic bracing, spasticity can develop agencies, general and psychiatric increase independence and quality of life. has its own provincial association and The role of social work in related to occupational performance in quickly, leading to impaired mobility and hospitals, school boards and federal and regulating body. The CAOT website stroke recovery self-care, work, study, and leisure. When to see an occupational therapist significant disability.25 provincial departments. An increasing provides a helpful search tool for Social work treatment plays a As soon as possible, ideally within 48 number of social workers work in private In the early stages of stroke an OT locating local occupational therapists A podiatrist can offer footwear advice, significant role in stroke rehabilitation. hours after the occurrence of a stroke, practice. In Canada, the social work will assess a stroke survivor’s ability to by region:  www.caot.ca/default. orthotic therapy and custom ankle foot an OT will assess a stroke survivor’s profession is provincially legislated and complete basic self-care activities of asp?pageid=3622.  See the HELPFUL orthoses.22 For example, a podiatrist ability to perform the basic activities of regulated. The Canadian Association daily living, such as toileting, washing, RESOURCES section to locate an may provide a stroke survivor suffering daily living (ADL), such as transferring of Social Workers website recommends bathing, dressing, eating, etc. occupational therapist in your area. from foot drop with a brace for their out of bed, balance and walking, A social worker helps visiting the individual province websites For instance, if an individual has ankle that will allow them to hold their bathing, dressing, toileting, brushing to locate a social worker in your encountered physical effects such as Podiatry foot in a normal position.23 the stroke survivor, his teeth, and eating. Once the individual region. Their website also provides links spasticity or contractures (abnormal Podiatrists are highly trained medical has gained some recovery, the OT will When to see a podiatrist or her family, and the to government websites, volunteer specialists who focus specifically then assess their instrumental activities A stroke survivor can see a podiatrist organizations, education contacts, on the foot and ankle. Their area of rehabilitation team to of daily living (IADL), which include any time they experience sore feet or and other resources: expertise includes diagnosis, treatment, tasks that enable independent living symptoms of spasticity in the foot. An work together to reach  www.casw-acts.ca/en/need- and helping to keep feet in a healthy As recovery progresses, such as managing medication, using individual does not need to be referred social-work-services/looking-social- condition.21 realistic goals that an OT will look at the telephone or computer, shopping, by a doctor in order to see a podiatrist, work-services.  See the HELPFUL cooking, keeping track of finances, and you can contact a podiatrist’s office are specific to each RESOURCES section for more ways to ensure that driving, working and productivity, and directly to make an appointment. individual case. information on social work in the stroke survivor leisure activities. your region.26 Podiatrists play an Podiatry in Canada can complete other Many stroke survivors improve enough The Canadian Podiatric Medical Community reintegration to go home and will only require help important role in Association (CPMA) is a non-profit Once the medical intervention that daily tasks that The knowledge and skills of the social with one or two of their IADLs, in which examining and treating organization consisting of more than accompanies a stroke is finished, promote productivity. case the healthcare team may refer the 400 premier foot specialists.21 worker are directed toward helping the recovery continues. Part of this includes person to a home care or outpatient the biomechanical The CPMA website provides links to stroke survivor and caregivers in the being reintegrated into the community, program. Some stroke survivors will regional podiatrists listed by province: adjustment process and to facilitate the and there are many resources to require more rehabilitation and will complications that  www.podiatrycanada.org/useful- individual’s return to the community at support both stroke survivors and their patterns of movement like a flexed often be referred to an inpatient stroke victims have.22 links/.  See the HELPFUL RESOURCES the highest possible level of emotional, caregivers during the reintegration elbow or fisted hand), an OT may work rehabilitation program where they will section to locate a podiatrist in social and economic functioning.27 process. Many of the resources listed in with the physician and physical therapist see an OT as part of their recovery team. your region. A social worker can help answer the HELPFUL RESOURCES section of this to provide splints, range of motion, Once discharged, either from an acute questions about insurance and other guide offer information on community and functional exercises to reduce the hospital or rehabilitation setting, if a financial issues and can arrange for a reintegration. The following section will spasm. If a stroke survivor’s balance and person continues to have difficulties variety of support services. They may also discuss reintegration in more detail. coordination or ability to walk has been completing daily tasks, if spasticity also provide or arrange for counseling to help cope with any emotional problems.28

12 13 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Exercise and Mobility Social Interaction and Recreation Healthy Lifestyle Physical activity plays an important role in helping Family and friends are important to all of us. Encouraging healthy eating habits for your stroke 1 your stroke survivor regain function after stroke and 3 So are hobbies, interests, and recreational activities. 6 survivor will help him or her to achieve the best in maintaining general health. Do your best to These aspects of life give us a sense of purpose recovery possible. The healthier your stroke survivor Stroke incorporate exercise into your stroke survivor’s daily and belonging, and they are important parts of is, the better equipped they will be to cope with routine. Set specific and achievable goals that life before a stroke and continue to be just as their recovery and symptoms of stroke. are tailored to their current situation. Start small important after a stroke. Stroke survivors and their There are many recommendations that can be Recovery and and be consistent. Getting your loved one to walk caregivers may both have difficulties reclaiming followed to maintain or improve your loved one’s for 10 minutes six times per week can be more their social lives, but it is possible and should lifestyle, such as: physically and mentally beneficial than running a become an intentional goal. Do not be afraid to ask Community • Reducing cholesterol 60-minute marathon. Encourage him or her to take for help, whether it be help with transportation for • Limiting caffeine and alcohol consumption on activities that they enjoy to help alleviate their your stroke survivor or caregiving relief. You might • Avoiding or quitting smoking and/or other Reintegration stress, and remember that it takes time to develop be surprised at how willing people are to lend a hand. tobacco products good habits. Support groups exist for both stroke survivors and • Reducing stress by talking about your problems, The 7 steps to stroke recovery29 caregivers. As a caregiver, becoming part of a concerns, or worries that arise with a doctor, support group may bring a lot of value and can religious leader, friend, counsellor, or peer Communication and Language help to strengthen your social life. Whatever you do, support group Some stroke survivors develop aphasia, a speech There is nothing quite as scary engaging with your friends, family, and community 2 and language impairment that can affect will benefit you tremendously. as the unknown, particularly understanding, listening, speaking, reading, and System and Resource Navigation writing. Aphasia usually presents at its worst when it involves a health crisis like Finding the right services and support is a critical immediately after the stroke, and over time most Cognitive Challenges 7 step that will immensely enhance your stroke a stroke. stroke survivors will improve a little, while some will Most stroke survivors experience some cognitive survivor’s recovery and wellbeing. Numerous improve a lot. Communicative disorders present 4 effects, either temporarily or permanently. They resources, many of which are included in this As a caregiver, your most pressing questions will likely particular challenges for caregivers. involve what to expect as your loved one recovers, may find it hard to remember things, or pay guide, are available to help you and your loved one and how to adapt at each stage. The seven steps to If you and your stroke survivor are struggling to attention, and they may have difficulty learning new navigate and manage this new life circumstance. stroke recovery may provide you with some answers communicate, you may find the following things. Your stroke survivor’s perception, the way they and insight to help you and your stroke survivor as tips helpful: make sense of the world, can also be affected. you work to reintegrate into your home community • Try all kinds of means of communication and use The following tips may help you to manage and and daily life activities. anything that helps you communicate with the assist your loved one with some of these challenges: stroke survivor, such as props and “I always say recovery never ends. I find • Simplify – Keep activities and information as non-verbal communications: there are things I can do now that I simple as possible - Write down key words couldn’t do six months ago. • Repeat – Learning after stroke requires repetition - Draw pictures or diagrams and practice - Point to objects • Structure – Weekly and daily schedules are helpful Stroke recovery is a journey. The key to my recovery - Refer to pictures, maps, or calendars • Consistency – Do things the same way every time has been to understand the importance of medication - Use facial expressions or gestures • Compensate – Change habits, routines, and maintenance, staying active with the help of my • Remember that understanding can be difficult methods to adapt to your stroke survivor’s family, and doing all that I can to stay committed to and every person’s communication and language new challenges my recovery.” - ANNA problems are different. So don’t rush. Be natural and patient. Don’t speak too quickly, and say one Caregiver’s Support thing at a time. Do not yell and don’t pretend you Although your loved one suffered the stroke and understand. It can help to recap discussions and 5 they require an incredible amount of support interactions to make sure that everyone is on the No one can predict exactly how a stroke from all aspects, you as a caregiver also need same page. support. This new role is demanding and, at times, survivor’s recovery will progress. All you can be very overwhelming. No caregiver should can do is make the most of each stage, feel they need to endure this experience entirely by themselves. Joining a support group will greatly and celebrate the milestones, both big benefit you, as it can offer a circle of peers who and small, with your loved one. understand what you are going through. A support group can help you solve problems and find answers to your questions, find useful information, boost your morale, and allow you to express your emotions in a supportive environment.

14 15 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Building and Maintaining Healthy Relationships

Focus on communication Communication is crucial to establishing and maintaining the health of any relationship. As a caregiver, you and your stroke survivor may need to find new ways of communicating and connecting. This is especially true if the stroke survivor develops aphasia or has difficulty expressing emotion ( see the STROKE RECOVERY AND REINTEGRATION section of this guide for tips on dealing with these outcomes).

Like many aspects of stroke recovery, communication requires adaptation and effort.

“Just attending the meetings and If you and your stroke survivor are hearing what other caregivers have struggling with communication, to share assisted me in working Dealing with the you both may find the following through a situation. I don’t feel so isolated in my role as caregiver.” exercise helpful: - RITA LOEB, Caregiver Other Side of Grief • Sit with your partner in a comfortable and quiet space. Set a timer for 3 minutes. When we talk about grieving, it is usually You may experience some or all of these common stages, • As the caregiver, you go first. For 3 uninterrupted Alleviate stress and you may not experience them in any particular order. minutes, simply talk about what is on your mind, in the context of death, wherein we grieve It can be difficult to maintain any relationship and keep it Some caregivers will resent their new role and the changes such as the events of the day or something you healthy if you are under a lot of stress. Caregiving, while the loss of a friend or loved one. that come with it. If you find this to be you, do not feel guilty have been keeping to yourself for some time. recognized as a kind and loving act, can also be incredibly and know that it is okay to feel this way. Your life has been • Once your 3 minutes are up, allow your stroke demanding and can easily lead to burnout that will negatively But there are other forms of loss we need to grieve. drastically altered, and you need time and support to survivor up to 3 minutes to reflect and respond to impact your relationship with your stroke survivor. When someone survives a stroke, for instance, many things navigate this new reality. what you talked about. Remember to reach out to others by joining a peer support change for them and their caregivers. These changes can be • Next it is your stroke survivor’s turn to speak, Many caregivers respond by initially setting impossible goals group or making a weekly coffee date with a close friend. Find interpreted as losses for both the stroke survivor and the uninterrupted, for 3 minutes. for themselves. Some people have an ideal standard of care solitary activities that you can do to help you relax, such as caregiver. Stroke survivors may need to communicate • You then have 3 minutes to reflect and respond to and want to provide it immediately and with absolute meditation, yoga, reading a book, listening to your favourite differently or require mobility aids. Living spaces need to be what your stroke survivor shared. perfection. Then once reality sets in and things do not go song, or watching funny videos on YouTube. Anything that modified and relationships between stroke survivors and according to plan, caregivers feel guilty for falling short.  After sharing for a few minutes, how did you feel? takes your mind off your stressors can serve to give you a caregivers may develop and/or change in unexpected ways. These feelings are also acceptable, and if this is you, just Did you spend the whole time complaining or asking breather and some relief. These changes may be temporary, as a part of rehabilitation remember to set reasonable goals, and ask for help when you questions? Did hidden feelings come to light? and recovery, or they may be permanent. need it. You cannot do it all and neither can anyone else. Did you both get a chance to respond to one Most importantly, don’t forget to ask for help! Most people do not know what you need, but will be happy to assist if you ask All of these changes, such as the loss of independence, another? The most important thing to remember is that everyone them to. Having someone different assist with chores or daily control, and function, represent losses for the caregiver, just reacts differently. There is no correct emotional response. activities can also provide you and your stroke survivor with as much as the survivor. Similar to when a person needs time Becoming a caregiver to someone you love is a difficult, and a break from each other, which may be necessary and is to grieve the loss of a friend or family member, a caregiver often sad process, and you have the right to grieve and completely acceptable. also needs time to grieve the changes and losses that have experience the emotions of anger, guilt, and failure. Although most of time we feel we ‘listen’ to what the other suddenly come about. person is saying, more often than not we are not ‘hearing’ Access your resources The good news is that with time, acceptance, and resources, what they are actually saying. Rather, we are thinking about As a caregiver, you may find you experience one or all of the By taking care of yourself, you will be able to support your the grieving can end. You have the opportunity to reach a what to make for dinner, what happened at work, or how five most common stages of grief: stroke survivor and maintain a happy, healthy relationship place where caregiving becomes part of a full, rewarding life to respond based on our automatic reactions. The fact is, at the same time. • denial for both you and your stroke survivor. everyone needs to clear the air sometimes and deserves the • anger opportunity to be heard. In order to really communicate, you  See the HELPFUL RESOURCES section at the end • bargaining and your stroke survivor both need to hear what the other of this guide for a list of websites that focus on • depression is saying. assisting caregivers. • acceptance

16 17 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Building and Maintaining Healthy Relationships

Like many aspects of stroke recovery, communication requires adaptation and effort.

16 17 Like many aspects of stroke recovery, communication requires within the community at large.37

A CAREGIVER’S GUIDE TO STROKE RECOVERY

Building and Maintaining A Closer Look at Aphasia Healthy Relationships & Communication Disabilities

The role of Speech-Language Pathologists The Role of Speech-Language Pathologists in stroke recovery when aphasia and in Stroke Recovery A Speech-Language Pathologist can assess and treat communication disabilities occur. communication, cognitive/thinking skills (e.g., attention, ( see the STROKE RECOVERY AND REINTEGRATION section memory, organization, reasoning, judgment) and of this guide for tips on dealing with these outcomes). Aphasia and Communication Disabilities swallowing disorders (e.g., ensuring that an individual is on a safe diet and not at increased risk for choking). When a stroke damages the area of the brain that controls language, it may cause aphasia.31 Aphasia is a chronic Speech and Language Pathology therapy may include: communication disability that affects about one third of • Providing the stroke survivor with specific therapies and Providing the stroke survivor with specific therapies and stroke survivors.32 Although aphasia is usually the lasting strategies to improve his/her communication and/or strategies to improve his/her communication and/or result of a stroke or brain injury, it may also be caused by swallowing skills, including practice opportunities in a swallowing skills, including practice opportunities in a If you and your stroke survivor are other neurological conditions.33 There are over 100,000 variety of settings and situations. variety of settings and situations. 32 struggling with communication, Canadians living with aphasia. Educating the stroke survivor’s family and other • Educating the stroke survivor’s family and other caregivers on the individual’s abilities and challenges and you both may find the following People living with aphasia are intelligent. They know what caregivers on the individual’s abilities and challenges and on how to use various alternative/augmentative they want to say, have the desire to socialize, and are on how to use various alternative/augmentative communication strategies/devices to help compensate for exercise helpful: capable of participating in decisions that pertain to them, communication strategies/devices to help compensate for difficulties. • Sit with your partner in a comfortable and quiet but they may have difficulty expressing themselves.33 They difficulties. Recommending strategies or changes to enhance the space. Set a timer for 3 minutes. may also have difficulty understanding speech, reading, • stroke survivor’s ability to participate at home, at work and Recommending strategies or changes to enhance the • As the caregiver, you go first. For 3 uninterrupted and/or writing. In some cases, aphasia may also affect within the community at large.37 stroke survivor’s ability to participate at home, at work and minutes, simply talk about what is on your mind, one’s memory because we remember through using within the community at large.37 language.34 such as the events of the day or something you have been keeping to yourself for some time. Reasons to See a Speech-Language Pathologist People with aphasia often have other communication • Once your 3 minutes are up, allow your stroke problems, such as dysarthria (weak speech muscles that • Difficulties with reading, writing, word-finding, expressing survivor up to 3 minutes to reflect and respond to make speech sound slushy), and apraxia (problems making needs/wants and feelings, answering questions, what you talked about. the movements needed for speech such as starting the understanding instructions or following directions, as well • Next it is your stroke survivor’s turn to speak, movement, planning the movement, and getting the as slurred or hesitant speech or stuttering. uninterrupted, for 3 minutes. movements in the right order).34 • You then have 3 minutes to reflect and respond to • Avoidance of social interaction as a result of what your stroke survivor shared. The needs of people with communication disabilities are communication difficulties. often less well understood than the needs of those living  After sharing for a few minutes, how did you feel? • Hoarse voice or persistent loss of voice. with other disabilities. People living with aphasia and other Did you spend the whole time complaining or asking communication disabilities therefore often experience • Coughing, choking, or throat clearing when eating or questions? Did hidden feelings come to light? major barriers when communicating, such as not being drinking, “gurgly”/wet sounding voice during or after eating Did you both get a chance to respond to one provided with the tools needed for them to communicate or drinking, complaints of food getting stuck in the throat or another? effectively, being ignored and/or being talked about to a going down the wrong way and repeated bouts of family member instead of being talked to directly, and not pneumonia.37 being given sufficient time to process and/or respond.35 what they are actually saying. Rather, we are thinking about Increased education about aphasia and other depression Although most of time we feel we ‘listen’ to what the other communication disabilities, and the effective use of person is saying, more often than not we are not ‘hearing’ communication strategies, to both the person living with aphasia and his/her communication partners, can result in By taking care of yourself, you will be able to support your improved communication and quality of life.36 “Just attending the meetings and stroke survivor and maintain a happy, healthy relationship at the same time. hearing what other caregivers have Speech-Language Pathologists to share assisted me in working  See the HELPFUL RESOURCES section at the end Speech-Language Pathologists (SLPs) have specialized through a situation. I don’t feel so of this guide for a list of websites that focus on knowledge, skills, and clinical training in assessment and assisting caregivers. management of communication and swallowing disorders. isolated in my role as caregiver.” - RITA LOEB, Caregiver 18 17 

A CAREGIVER’S GUIDE TO STROKE RECOVERY

Helpful Aphasia Resources Canadian Rehabilitian Companies For more information on where to find aphasia support services. This list of helpful resources represents a sampling of resources, and is not exhaustive. Inclusion in the list is for informational Below is a list of a number of rehabilitation companies available throughout Canada. purposes only. It does not constitute an official endorsement by March of Dimes Canada. In addition to providing information on recovery and therapy for your stroke survivor, many of these resources also offer For aphasia support services by province: For more information on where to information on community reintegration. This list of Canadian rehabilitation companies represents a sampling of resources, and find a speech-language pathologist is not exhaustive. Inclusion in the list is for informational purposes only. It does not constitute an official endorsement by March Nova Scotia by province: of Dimes Canada. Nova Scotia Aphasia Association (NSAA) www.nsaphasia.homestead.com Nova Scotia Speech and Hearing Association of Nova Scotia National Quebec Inter-Action Rehabilitation Inc. InteRACT: Intensive Residential Aphasia Communication www.shans.ca Bayshore Home Health AMS Medical & Rehabilitation Centre Toronto, 416-445-5125 Therapy, Dalhousie Aphasia Clinic, School of Human Mississauga, 416-992-4280 Dorval, 514-700-2012 www.interactionrehab.com Communication Disorders (Halifax) Prince Edward Island www.bayshore.ca Physicentrix Kawartha Therapy Services www.dal.ca/diff/inteRACT.html Prince Edward Island Speech and Hearing Association CBI Health Group Montreal , 514-737-7246 Peterborough, 705-874-1072 Québec www.peispeechhearing.ca Toronto, 416-231-0078 www.physicentrix.ca www.kawarthatherapy.com Quebec Association for People with Aphasia www.cbi.ca New Brunswick Liberty Mutual Vocational Rehabilitation /Association québécoise des personnes aphasiques New Brunswick Association of Speech-Language Centric Health Corporation Ontario Mississauga, 1-866-666-6052 www.aphasie.ca Pathologists and Audiologists Toronto, 416-485-7798 Access Rehab www.cascadedisability.com www.nbaslpa.ca Ontario www.centrichealth.ca Markham, 416-987-8092 Medcare Canada Aphasia and Communication Disabilities Program Newfoundland and Labrador PT Health Care Solutions www.accessrehab.ca Vaughan, 416-277-1777 (ACDP), March of Dimes Canada Newfoundland and Labrador Association of Hamilton, 866-749-7461 Altum Health www.medcarecanada.com (Greater Toronto Area, Maple, Newmarket, Speech-Language Pathologists and Audiologists www.pthealth.ca Toronto, 416-603-5185 Peterborough, Stouffville, Vaughan, Whitby) Neuro-Rehab Services Inc. www.nlaslpa.ca www.altumhealth.com www.marchofdimes.ca/ACDP Concord, 905-669-0011 Quebec Newfoundland Arvan Rehab Group Inc. www.neurorehab.ca Aphasia Centre of Ottawa Association québécoise des orthophonistes et Dynamic Physio & Wellness Toronto, 416-593-8464 Novus Rehabilitation www.aphasiaottawa.org audiologistes St. John’s, 709-738-3962 www.arvangroup.com St. Thomas, 519-637-0981 Aphasia Institute (Toronto) www.qaslpa.ca www.dynamicnl.ca Brain Injury Community Re-entry www.novusrehab.ca www.aphasia.ca Ontario (Niagara) Inc. Pathways Therapy Halton Aphasia Centre (Burlington, Oakville, Ontario Association of Speech-Language Nova Scotia St. Catharines, 905-687-6788 Pathologists and Audiologists Waterloo , 519-885-4211 Brampton, Milton, Mississauga) Advantage Rehabilitation www.bicr.org www.osla.on.ca www.pathwaystherapy.ca www.h-pcap.com Consultants Ltd. Closing the Gap Healthcare Group Quinn Rehab Services Alberta Dartmouth, 902-434-4077 SAM (Seniors Activation Maintenance Program) Mississauga, 905-306-0202 Barrie, 705-726-2362 Alberta College of Speech-Language www.advantagerehab.com Aphasia Program (Hamilton and Waterdown) www.closingthegap.ca Pathologists and Audiologists www.quinnrehab.com www.samprograms.ca Sage Rehabilitation & Management www.acslpa.ab.ca CVE Inc. Rehab First Inc. Consulting Inc. Waterloo Wellington Regional Aphasia Program, Ottawa, 613-237-7368 x237 London, 519-646-2949 British Columbia Dartmouth, 902-469-1325 St. Joseph Health Centre (Guelph) www.cve.ca www.rehabfirst.ca British Columbia Association of Speech-Language www.sage1.ca www.sjhcg.ca/community-outreach-services Pathologists and Audiologists D&D Disability Management Rehabilitation Management Inc. /aphasia-program The Physioclinic www.bcaslpa.ca Vaughan , 416-633-8124 Toronto, 416-365-0010 Halifax, 902-453-2627 Alberta www.dddisability.com www.rehabilitation.ca Yukon www.physio.ca Calgary Aphasia Centre Yukon Speech-Language Pathology and DMARehability Rejuvenate Health Services www.calgaryaphasia.com Audiology Association London, 519-452-0046 London, 519-652-0740 www.yslpaa.org Prince Edward Island www.dmarehability.com www.rejuvenate-hs.ca Manitoba Charlottetown Physiotherapy DriveAgain Westman Aphasia Inc. Charlottetown, 902-566-2700 Theraputix - The Wellness Centre Inc. Toronto, 416-640-0292 www.westmanaphasia.ca www.charlottetownphysio.ca North York www.driveagain.ca 416-444-4411 British Columbia IME Plus Evaluations Ltd. www.theraputix.ca New Brunswick iTAWC - Intensive Treatment for Aphasia Mississauga, 905-214-8000 Advanced Health & Physiotherapy Voc Rehab Canada in Western Canada (Vancouver) www.imeplus.ca www.itawc.com Moncton, 506-204-6622 Oshawa, 905-443-0477 www.advanced-health.ca Independent Rehabilitation www.vrcan.ca Management Inc. Thunder Bay, 807-346-2713 www.independentrehab.com 19 25 A CAREGIVER’S GUIDE TO STROKE RECOVERY It showed me and my wife that she can still be involved in many activities she used to do. I think she was surprised at what she was able to do - CAREGIVER PIECE I feel this experience has given me awareness, practical tools and Seeing persons with strategies, and confidence aphasia interact and in interacting with people enjoy themselves, with aphasia be independent, be - VOLUNTEER included, be heard - VOLUNTEER

This experience has solidified my future career plans to work with people with aphasia I enjoyed being connected - STUDENT VOLUNTEER to others who have a love “Opportunity to meet other of breaking down communication barriers caregivers and for my spouse to - VOLUNTEER do independent activities” - CAREGIVER PIECE Aphasia Camps for “Seeing my wife enjoy herself Community Support and interact with other people” Aphasia is a communication disorder - CAREGIVER that can result from stroke or brain injury. “As a stroke survivor, I can tell you firsthand that recovery is a lifelong Aphasia can affect a person’s ability to speak, read, write, process. or understand the speech of others. People who live with I truly credit March of Dimes Canada and aphasia may also have a physical disability as a result of their stroke recovery programs with giving their stroke. me goals and a sense of motivation. I have March of Dimes Aphasia Camps offer a relaxing weekend learned to walk and talk again, and while in an aphasia-friendly and accessible communication I still have some weakness on my right side, environment. Campers are welcome to bring a friend, I make strides every day. As happy as I am family member, or caregiver. Activities include yoga, with my progress, I also know that nothing canoeing, arts and crafts, nature walks, and other adapted will truly be as it was before. The key to recreational and therapeutic activities. These camps provide improvement is with continued therapy.” an opportunity for stroke survivors and their caregivers to - JEFF enjoy nature while they connect with a network of people “It will help me to take a Aphasia Camps are offered in British Columbia, Alberta, who understand what they are going through. Ontario, and Nova Scotia. more comprehensive It also offers the chance to engage in fun rehabilitation with For information on dates and locations, March of Dimes Canada staff and volunteers. person-centred approach or for more details, please contact:

as a clinician” - VOLUNTEER Gemma Woticky  [email protected]

20 19 A CAREGIVER’S GUIDE TO STROKE RECOVERY It showed me and my wife that she can still be involved in many activities she used to do. I think she was surprised at what she was able to do - CAREGIVER PIECE I feel this experience has given me awareness, practical tools and Seeing persons with strategies, and confidence aphasia interact and in interacting with people enjoy themselves, with aphasia be independent, be - VOLUNTEER included, be heard - VOLUNTEER

as a clinician” - VOLUNTEER Gemma Woticky  [email protected]

18 21 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Capitalizing on Health Benefits

Registered Disability Savings Plan Canadian Disability Savings Grant Registered Disability Savings Plans The Canada Disability Savings Grant (RDSPs) help Canadians with (CDSG) is another way for the federal disabilities and their families save government to contribute money to toward long-term financial security. an RDSP.

An RDSP is a special program that helps Canadians with When a contribution is deposited into the RDSP, the federal disabilities and their families save for long-term financial government will also put in some money. The amount of the needs such as future medical and living costs. Like a CDSG is based on the beneficiary’s family income:30 Registered Education Savings Plan (RESP), the investment income is tax-deferred and you may be eligible for Beneficiary's family income: $89,401* or less government assistance.

The benefits of a Registered Disability Savings Contribution Grant Maximum Plan include: Government assistance: First $500 $3 for every $1,500 To help your savings grow faster, the government provides $1 contributed grants and bonds (see CDSG section in next column). Next $1,000 $2 for every $2,000 Tax-deferred growth: $1 contributed While contributions to the RDSP are not eligible for a tax deduction, income earned grows on a tax-deferred basis Beneficiary’s family income: More than $89,401* until the funds are withdrawn. Upon withdrawal, the Creating a New amount is taxed as income. Contribution Grant Maximum No annual contribution limit: Environment Contributions can be up to a lifetime limit of $200,000. First $500 $1 for every $1,000 In addition, anyone can contribute with the written permission $1 contributed Stroke survivors may need to modify their compromised her right arm. DesignAbility volunteers designed of the plan holder. Contributions can be made up until the a cutting board with an adjustable holding mechanism and a end of the year when the beneficiary turns 59. *The beneficiary family income thresholds are indexed each year to inflation. environment to accommodate a new clamp so it could be attached to any table or countertop. Ability to make withdrawals: The income thresholds shown are for 2015. The DesignAbility program is based on specificity and level of function. There are two ways a beneficiary of an RDSP can withdraw addresses each customer according to their unique situation. funds: This can be an enormous task, and one that often becomes This makes it an excellent option for stroke survivors, since they are all affected differently and to different degrees. 1. Annual withdrawals the responsibility of the caregiver. If you are unsure of where For more information on how to help your stroke survivor It is also helpful for caregivers, since the program supports • Also known as Lifetime Disability Assistance Payments to start, there are useful resources available to help guide you make the most of their health benefits please contact: through the process. you through a needs assessment all the way to the (LDAPs) manufacture of your customized solution. Small changes, • Begin by the end of the year in which the beneficiary Daniella Stretenovic, Associate Director, Individual Giving One helpful resource is March of Dimes Canada’s or a simple adaptive device, can significantly improve turns 60  1-800-263-3463 ext. 7338 DesignAbility program. DesignAbility pairs skilled volunteers everyone’s quality of life. • These annual payments will then continue for the life  [email protected] with people who need assistive devices or modifications to of the beneficiary function as independently as possible. With this program, DesignAbility is available in Ontario, and is expanding across you and your stroke survivor will work with the DesignAbility Canada. The design and construction of your devices are 2. One-time withdrawal • team to assess your needs and develop a device to meet both free, but consumers are asked, if possible, to pay for materials, Also known as a Disability Assistance Payment • your requirements. or to make a small donation to the program. Can be paid to the beneficiary any time after the RDSP is established The types of devices required will depend entirely on your For more information on the DesignAbility program: circumstances. For example, one DesignAbility customer  www.marchofdimes.ca/DesignAbility needed help moving around her kitchen, so volunteers created a custom stool equipped with four legs and locking casters.  1-800-263-3463 ext. 7211 A stick allowed her to lock the casters while seated, which  [email protected] created a stable support for standing. Another customer needed an “extra hand” while cooking, after a stroke

22 21 A CAREGIVER’S GUIDE TO STROKE RECOVERY

Capitalizing on Health Benefits

20 23 

A CAREGIVER’S GUIDE TO STROKE RECOVERY

Stroke Recovery Canada

Caregiver Support Services Caregivers must also care for themselves Stroke can permanently alter the mind and body of a person and has the potential to impact family dynamics Caregiver Survival and change day-to-day life forever.

Stroke requires that caregivers must somehow set aside their own shock Checklist and fear to support the survivor, whose needs may seem to outweigh their own. Caregivers need However, caregivers need to look after • Information about stroke and its impacts, prognosis, and the rehabilitation process their own needs first. Otherwise, the • Education about the physical and psychological needs of stroke survivors quality of care that they are capable of • Practical assistance in enhancing caring and coping skills giving, their relationship with the stroke • Increased awareness of available therapeutic and social service supports for themselves survivor, and their own quality of life and their loved one can suffer greatly. • The opportunity to share ideas, information, and coping methods with others dealing with similar issues Stroke Recovery Canada is a one-stop resource for: • Emotional support and the opportunity to speak with other caregivers who are dealing with Use the Caregiver Survival Checklist as a tool to ensure you similar issues get all of the resources and support that you need: • Practical help in enhancing caring and coping skills  Take it one day at a time • Increased awareness of available  therapeutic and social service Accept your limitations supports  Learn to ask for help and accept any help offered • Education about the physical and psychological needs of stroke  Have a daily routine and stick to it survivors  Don’t bottle up negative feelings – talk about them with someone you trust • Information about stroke Other Key Services Offered rehabilitation options Stroke survivors are not alone  Take time for yourself every day Stroke Recovery Canada can link stroke survivors with peer support groups.  Keep your sense of humour “I didn’t have a stroke, These groups help survivors cope with what is often a long process of recovery my entire family had and rehabilitation. A peer support group can be a tremendous source of strength,  Look after your health – get plenty of rest, exercise daily, eat a nutritious optimism, and support for its members. diet, and see your doctor a stroke.” Education and Information  Take advantage of local support groups like those offered by Stroke Said Lloyd MacDonald, a Stroke Recovery Stroke Recovery Canada provides free and easy access to information on medical Recovery Canada Member from Regina, Saskatchewan, treatments, rehabilitation options and support resources. In addition to distributing  Remain socially active “This national program helps to connect information to members, Stroke Recovery Canada offers additional services on its everyone affected by a stroke with the website and through seminars, conferences, and its newsletter, The Phoenix.  Find a caregiver respite program in your community support they need.” Warmline: 1-888-540-6666  Consider modifications to your home and assistive devices The Warmline is a confidential, toll-free peer support line for those affected by stroke. As a non-medical and non-crisis resource, the Warmline offers information  Consider nursing and housekeeping services and support to stroke survivors, family members, and caregivers. The volunteer at the other end of the line is typically a stroke survivor, a family member of a survivor, or another member of the community who is familiar with the stroke experience.

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A CAREGIVER’S GUIDE TO STROKE RECOVERY

Stroke Recovery Canada

22 25 

A CAREGIVER’S GUIDE TO STROKE RECOVERY

Helpful Resources Canadian Rehabilitian Companies You may find some of the resources below helpful to you and your stroke survivor. This list of helpful resources represents a sampling of resources, and is not exhaustive. Inclusion in the list is for informational Below is a list of a number of rehabilitation companies available throughout Canada. purposes only. It does not constitute an official endorsement by March of Dimes Canada. In addition to providing information on recovery and therapy for your stroke survivor, many of these resources also offer For more information on stroke For more information on where to Quebec information on community reintegration. This list of Canadian rehabilitation companies represents a sampling of resources, and rehabilitation: find a physiotherapist by province: Association québécoise des is not exhaustive. Inclusion in the list is for informational purposes only. It does not constitute an official endorsement by March orthophonistes et audiologistes Beyond Stroke website Newfoundland of Dimes Canada. www.beyondstroke.ca www.physiotherapy.ca/Atlantic- www.qaslpa.ca Ontario Branches/Newfoundland National Quebec Inter-Action Rehabilitation Inc. For more information on caregiving: Ontario Association of Speech- Nova Scotia Alberta Caregivers Association Language Pathologists and Bayshore Home Health AMS Medical & Rehabilitation Centre Toronto, 416-445-5125 www.physiotherapyns.ca/index.php/ www.albertacaregiversassociation.org Audiologists www.osla.on.ca Mississauga, 416-992-4280 Dorval, 514-700-2012 www.interactionrehab.com site/find-a-physio www.bayshore.ca Canadian Caregiver Coalition Alberta Physicentrix Kawartha Therapy Services Prince Edward Island www.ccc-ccan.ca Alberta College of Speech-Language CBI Health Group Montreal , 514-737-7246 Peterborough, 705-874-1072 www.physiotherapy.ca/Atlantic- Pathologists and Audiologists Toronto, 416-231-0078 www.physicentrix.ca www.kawarthatherapy.com Canadian Virtual Hospice Branches/Prince-Edward-Island www.acslpa.ab.ca www.cbi.ca Liberty Mutual Vocational Rehabilitation www.virtualhospice.ca New Brunswick British Columbia Centric Health Corporation Ontario Mississauga, 1-866-666-6052 Caregiver Connect www.physiotherapy.ca/Atlantic- British Columbia Association of www.caregiver-connect.ca Branches/New-Brunswick?lang=en-ca Toronto, 416-485-7798 Access Rehab www.cascadedisability.com Speech-Language Pathologists and www.centrichealth.ca Markham, 416-987-8092 Medcare Canada Caregivers Nova Scotia Quebec Audiologists www.bcaslpa.ca oppq.qc.ca/en/finding-a-professional PT Health Care Solutions www.accessrehab.ca Vaughan, 416-277-1777 www.caregiversns.org Yukon Hamilton, 866-749-7461 Altum Health www.medcarecanada.com Caring Bridge Ontario Yukon Speech-Language Pathology and publicregister.collegept.org/Public www.pthealth.ca Toronto, 416-603-5185 www.caringbridge.ca Audiology Association www.yslpaa.org Neuro-Rehab Services Inc. Services/Start.aspx www.altumhealth.com Concord, 905-669-0011 Family Caregivers Association of BC For information on drug coverage Manitoba Newfoundland Arvan Rehab Group Inc. www.neurorehab.ca www.familycaregivers.bc.ca in your region: www.mbphysio.org/find-a- Dynamic Physio & Wellness Toronto, 416-593-8464 Ontario Novus Rehabilitation Family Caregivers Network Society physiotherapist www.thehealthline.ca St. John’s, 709-738-3962 www.arvangroup.com St. Thomas, 519-637-0981 www.virtualhospice.ca Saskatchewan Manitoba www.dynamicnl.ca Brain Injury Community Re-entry www.novusrehab.ca Long Term Care Planning Network saskphysio.org www.gov.mb.ca/health/pharmacare (Niagara) Inc. Pathways Therapy www.ltcplanningnetwork.com Alberta Saskatchewan Nova Scotia St. Catharines, 905-687-6788 Waterloo , 519-885-4211 www.physiotherapyalberta.ca www.saskatchewan.ca/residents/ Advantage Rehabilitation www.bicr.org www.pathwaystherapy.ca For more information on where health/prescription-drug-plans- British Columbia Consultants Ltd. to find an occupational therapist and-health-coverage Closing the Gap Healthcare Group Quinn Rehab Services bcphysio.org Dartmouth, 902-434-4077 by region: Mississauga, 905-306-0202 Barrie, 705-726-2362 Alberta www.advantagerehab.com Yukon www.closingthegap.ca Canadian Association of Occupational www.health.alberta.ca/services/ www.quinnrehab.com Therapists www.community.gov.yk.ca/ Sage Rehabilitation & Management drug-coverage-services.html CVE Inc. Rehab First Inc. www.caot.ca/default.asp?pageid=3622 physiotherapists/index.html Consulting Inc. Ottawa, 613-237-7368 x237 London, 519-646-2949 British Columbia Dartmouth, 902-469-1325 For more information on social work For more information on where to www2.gov.bc.ca/gov/content/health/ www.cve.ca www.rehabfirst.ca www.sage1.ca in your region: find a speech-language pathologist health-drug-coverage/ D&D Disability Management Rehabilitation Management Inc. Canadian Association of Social Workers by province: pharmacare-for-bc-residents The Physioclinic Vaughan , 416-633-8124 Toronto, 416-365-0010 www.casw-acts.ca Newfoundland and Labrador Halifax, 902-453-2627 Yukon www.dddisability.com www.rehabilitation.ca Association of Speech-Language www.hss.gov.yk.ca/pharmacare.php www.physio.ca For more information on where to Pathologists and Audiologists DMARehability Rejuvenate Health Services For support services: find a physiatrist by region: www.nlaslpa.ca London, 519-452-0046 London, 519-652-0740 Assistive Devices Program Prince Edward Island Canadian Association of Physical Nova Scotia www.dmarehability.com www.rejuvenate-hs.ca Medicine & Rehabilitation www.marchofdimes.ca/adp Charlottetown Physiotherapy Speech and Hearing Association of DriveAgain capmr.ca/about-capmr/what-is- Home and Vehicle Modification Program Charlottetown, 902-566-2700 Theraputix - The Wellness Centre Inc. Nova Scotia www.shans.ca Toronto, 416-640-0292 a-physiatrist www.marchofdimes.ca/hvmp www.charlottetownphysio.ca North York

Prince Edward Island www.driveagain.ca 416-444-4411 March of Dimes Canada For more information on where to Prince Edward Island Speech and IME Plus Evaluations Ltd. www.theraputix.ca www.marchofdimes.ca New Brunswick find a podiatrist by region: Hearing Association Mississauga, 905-214-8000 Voc Rehab Canada www.peispeechhearing.ca Stroke Recovery Canada Advanced Health & Physiotherapy Beyond Stroke website www.imeplus.ca Oshawa, 905-443-0477 New Brunswick www.marchofdimes.ca/src Moncton, 506-204-6622 www.beyondstroke.ca/Locator www.advanced-health.ca Independent Rehabilitation www.vrcan.ca New Brunswick Association of MODC Aphasia and Communication Canadian Podiatric Medical Association Management Inc. Speech-Language Pathologists and Disabilities Program (ACDP) www.podiatrycanada.org/useful-links Audiologists www.nbaslpa.ca www.marchofdimes.ca/ACDP Thunder Bay, 807-346-2713 www.independentrehab.com 26 25 

A CAREGIVER’S GUIDE TO STROKE RECOVERY

Helpful Resources Canadian Rehabilitian Companies

You may find some of the resources below helpful to you and your stroke survivor. Below is a list of a number of rehabilitation companies available throughout Canada.

This list of helpful resources represents a sampling of resources, and is not exhaustive. Inclusion in the list is for informational In addition to providing information on recovery and therapy for your stroke survivor, many of these resources also offer purposes only. It does not constitute an official endorsement by March of Dimes Canada. information on community reintegration. This list of Canadian rehabilitation companies represents a sampling of resources, and is not exhaustive. Inclusion in the list is for informational purposes only. It does not constitute an official endorsement by March For more information on stroke For more information on where to For more information on where to of Dimes Canada. rehabilitation: find a physiotherapist by province: find a podiatrist by region: Beyond Stroke website Newfoundland Beyond Stroke website National Quebec Inter-Action Rehabilitation Inc. www.beyondstroke.ca www.physiotherapy.ca/Atlantic- www.beyondstroke.ca/Locator Bayshore Home Health AMS Medical & Rehabilitation Centre Toronto, 416-445-5125 Branches/Newfoundland Canadian Podiatric Medical Association Mississauga, 416-992-4280 Dorval, 514-700-2012 www.interactionrehab.com For more information on caregiving: Nova Scotia www.podiatrycanada.org/useful-links www.bayshore.ca Physicentrix Kawartha Therapy Services Alberta Caregivers Association www.physiotherapyns.ca/index.php/ CBI Health Group Montreal , 514-737-7246 Peterborough, 705-874-1072 www.albertacaregiversassociation.org site/find-a-physio For information on drug coverage Toronto, 416-231-0078 www.physicentrix.ca www.kawarthatherapy.com Canadian Caregiver Coalition Prince Edward Island in your region: www.cbi.ca Liberty Mutual Vocational Rehabilitation www.ccc-ccan.ca www.physiotherapy.ca/Atlantic- Ontario www.thehealthline.ca Centric Health Corporation Ontario Mississauga, 1-866-666-6052 Canadian Virtual Hospice Branches/Prince-Edward-Island Toronto, 416-485-7798 Access Rehab www.cascadedisability.com www.virtualhospice.ca Manitoba New Brunswick www.centrichealth.ca Markham, 416-987-8092 www.physiotherapy.ca/Atlantic- www.gov.mb.ca/health/pharmacare Medcare Canada Caregiver Connect www.accessrehab.ca Branches/New-Brunswick?lang=en-ca PT Health Care Solutions Vaughan, 416-277-1777 www.caregiver-connect.ca Saskatchewan Hamilton, 866-749-7461 Altum Health www.medcarecanada.com www.saskatchewan.ca/residents/ Caregivers Nova Scotia Quebec health/prescription-drug-plans- www.pthealth.ca Toronto, 416-603-5185 www.caregiversns.org oppq.qc.ca/en/finding-a-professional Neuro-Rehab Services Inc. and-health-coverage/extended- www.altumhealth.com Concord, 905-669-0011 Ontario Caring Bridge benefits-and-drug-plan Newfoundland Arvan Rehab Group Inc. www.neurorehab.ca www.caringbridge.ca publicregister.collegept.org/Public Services/Start.aspx Alberta Dynamic Physio & Wellness Toronto, 416-593-8464 Novus Rehabilitation Family Caregivers Association of BC www.health.alberta.ca/services/ St. John’s, 709-738-3962 www.arvangroup.com Manitoba St. Thomas, 519-637-0981 www.familycaregivers.bc.ca drug-coverage-services.html www.dynamicnl.ca www.mbphysio.org/find-a- Brain Injury Community Re-entry www.novusrehab.ca Family Caregivers Network Society British Columbia physiotherapist (Niagara) Inc. Pathways Therapy www.virtualhospice.ca www2.gov.bc.ca/gov/content/health/ Nova Scotia St. Catharines, 905-687-6788 Saskatchewan health-drug-coverage/ Waterloo , 519-885-4211 Long Term Care Planning Network Advantage Rehabilitation www.bicr.org saskphysio.org pharmacare-for-bc-residents www.pathwaystherapy.ca www.ltcplanningnetwork.com Consultants Ltd. Closing the Gap Healthcare Group Quinn Rehab Services Alberta Yukon Dartmouth, 902-434-4077 www.physiotherapyalberta.ca Mississauga, 905-306-0202 Barrie, 705-726-2362 For more information on where www.hss.gov.yk.ca/pharmacare.php www.advantagerehab.com www.closingthegap.ca www.quinnrehab.com to find an occupational therapist British Columbia Sage Rehabilitation & Management CVE Inc. by region: bcphysio.org For support services: Rehab First Inc. Assistive Devices Program Consulting Inc. Ottawa, 613-237-7368 x237 Canadian Association of Occupational Yukon London, 519-646-2949 www.marchofdimes.ca/adp Dartmouth, 902-469-1325 www.cve.ca Therapists www.community.gov.yk.ca/ www.rehabfirst.ca www.caot.ca/default.asp?pageid=3622 www.sage1.ca physiotherapists/index.html Home and Vehicle Modification Program D&D Disability Management Rehabilitation Management Inc. www.marchofdimes.ca/hvmp The Physioclinic Vaughan , 416-633-8124 Toronto, 416-365-0010 For more information on social work Halifax, 902-453-2627 For more information on where to March of Dimes www.dddisability.com www.rehabilitation.ca in your region: www.physio.ca find a physiatrist by region: www.marchofdimes.ca/EN/Pages/ Canadian Association of Social Workers DMARehability Rejuvenate Health Services Canadian Association of Physical default.aspx www.casw-acts.ca/en/need-social- London, 519-452-0046 London, 519-652-0740 Medicine & Rehabilitation Prince Edward Island work-services/looking-social-work- capmr.ca/about-capmr/what-is- Stroke Recovery Canada www.dmarehability.com www.rejuvenate-hs.ca Charlottetown Physiotherapy services a-physiatrist www.marchofdimes.ca/src DriveAgain Charlottetown, 902-566-2700 Theraputix - The Wellness Centre Inc. Toronto, 416-640-0292 www.charlottetownphysio.ca North York www.driveagain.ca 416-444-4411 IME Plus Evaluations Ltd. www.theraputix.ca New Brunswick Mississauga, 905-214-8000 Advanced Health & Physiotherapy Voc Rehab Canada www.imeplus.ca Moncton, 506-204-6622 Oshawa, 905-443-0477 www.advanced-health.ca Independent Rehabilitation www.vrcan.ca Management Inc. Thunder Bay, 807-346-2713 www.independentrehab.com 24 27 A CAREGIVER’S GUIDE TO STROKE RECOVERY

WRI Group Alberta British Columbia Woodbridge, 905-851-9391 Altius Rehabilitation Group Inc. Back in Motion Rehab Inc. References www.wrigroup.ca Calgary, 888-654-8727 Surrey, 604-575-7745 1. Beyond Stroke website. www.beyondstroke.ca/. 16. The value of physiotherapy - Cardiovascular rehabilitation. www.altrehab.com www.backinmotion.com Accessed on 23 February, 2016. Canadian Physiotherapy Association (2012). Available Manitoba Khan Communication Services JR Rehab Services 2. International Brain Injury Association website. Focal and from: www.physiotherapy.ca/getmedia/56822362- Enabling Access Inc. Edmonton, 780-440-3251 Vancouver, 604-254-0444 multi-focal problems of spasticity. www.internationalbrain. a600-4fa7-a32f-2eb4494e249a/CPA_TheValueOf Winnipeg, 204-475-0433 www.khancommunicationservices.com www.jrrehab.ca org/articles/focal-and-multifocal-problems-of-spasticity/. Physio2012_CardioRehab-v1_1.pdf.aspx. Accessed on www.enablingaccess.ca LifeMark Health Providence Health Care Accessed on 17 March, 2016. February 10, 2016. Pathway Rehabilitation Calgary, 800-665-9947 Vancouver, 604-806-9090 3. What is Aphasia? March of Dimes Canada website. 17. Canadian Association of Occupational Therapists website. Winnipeg, 204-272-9500 www.lifemark.ca www.providencehealthcare.org www.caot.ca/default.asp?pageid=1344. Accessed on 01 www.pathwayrehabilitation.com www.marchofdimes.ca/EN/programs/ydac/Pages/ Optional Rehabilitation Services Inc. WhatisAphasia.aspx. Accessed on 11 March, 2016. March, 2016. Calgary, 403-236-8802 4. Heart and Stroke Foundation website (2015). 18. Townsend EA, & Polatajko, H. J. Enabling occupation II: Saskatchewan www.optionsrehab.org STATISTICS. www.heartandstroke.com/site/c. Advancing an occupational therapy vision for health, Bridges Health Peak Rehabilitation Consultants Inc. ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm. well-being & justice through occupation. Ottawa: Saskatoon, 306-222-0999 Calgary, 403-730-8273 Accessed on February 19, 2016. Canadian Association of Occupational Therapists. 2007 www.bridgeshealth.com www.peakrehab.ca 5. Brain Plasticity and Stroke Rehabilitation. American Heart 19. Occupational Therapists in Canada, 2010 National and SMRC Association & American Stroke Association. Retrived from Jurisdictional Highlights and Profiles. October 2011. Saskatoon, 306-244-9944 http://stroke.ahajournals.org/content/31/1/223.full. Retrived from http://cotm.ca/upload/2010_OT_in_Canada.pdf. www.smrcrehab.com 6. Neuroplasticity. www.stroke-rehab.com/neuroplasticity. 20. CAOT Academic Accreditation Standards and Self-Study html. Accessed on 31 March, 2016. Guide (2011). Canadian Association of Occupational Therapists. Retrived from www.caot.ca/acc/CAOT-%20Ac- 7. Mang CS, Campbell KL, Ross CJ, et al. Promoting creditation%20Self-Study%202011%20(rev.%202014).pdf. neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic 21. Canadian Podiatric Medical Association. variation on brain-derived neurotrophic factor. Phys Ther www.podiatrycanada.org/. Accessed on 24 February, 2016. Recovery for Stroke Survivors is Possible 2013;93:1707-16. 22. Feet in Stroke Patients. Senior Foot Care website. with the Help and Support of Caregivers, Stroke Recovery Canada 8. Stroke - How physiotherapy can help. Physio Can Help www.seniorfootcare.com.au/feet-in-stroke-patients/. Accessed on 24 February, 2016. and March of Dimes Canada! website. http://physiocanhelp.ca/stroke-how- physiotherapy-can-help/. Accessed on February 10, 2016. 23. Feet in Stroke Patients. MyFootDr Podiatry Centres web- 9. NINDS Spasticity Information Page. National Institute of site. www.myfootdr.com.au/conditions-treated/about- Neurological Disorders and Stroke website. www.ninds.nih. conditions-treated/feet-in-stroke-patients.aspx. gov/disorders/spasticity/spasticity.htm. Accessed on 23 Accessed on 24 February, 2016. February, 2016. 24. Foot Drop. MayoClinic website. www.mayoclinic.org/ 10. Mobility After Stroke: Issues facing stroke survivors and diseases-conditions/foot-drop/basics/definition/ “Of course, my recovery hasn’t “It’s been five years since my “With the encouragement of their families. National Stroke Association (2011). Available con-20032918. Accessed on 24 February, 2016. been without many serious stroke, and I am so thrilled to March of Dimes Canada, I from: www.stroke.org/sites/default/files/resources/NSA_ 25. Woods RJ, Cervone RL, Fernandez HH. Common trials, but today I am an active, be here today to tell you that started the Hamilton Young Mobility_brochure.pdf. Accessed on 23 February, 2016. neurologic disorders affecting the foot. J Am Podiatr Med Assoc 2004;94:104-17. I am living a full, active life! Stroke Survivors Group (HYSS). 11. Spasticity. National Stroke Association website. engaged contributor to my community www.stroke.org/we-can-help/survivors/stroke-recovery/ 26. Canadian Association of Social Workers website. and an advocate for others with Thanks to Stroke Recovery Canada® I wanted other young survivors just post-stroke-conditions/physical/spasticity?pagename= www.casw-acts.ca/en. Accessed on 24 February, 2016. disabilities. Through hard work and a I am blessed to be back as a hands-on like me to come to a place where they spasticity#symptoms. Accessed on 23 February 2016. positive attitude, I am living a full life parent to my two teenage girls, all the could learn how to make strides in 27. Ue B. Social work and the stroke patient. Clin Orthop Relat and encourage others to volunteer, get while attending classes, applying for their road to stroke recovery… as a 12. Gallichio JE. Pharmacologic management of spasticity Res 1978:101-3. involved and support March of Dimes admittance in a full-time college place where they could feel at ease to following stroke. Phys Ther 2004;84:973-81. 28. Stroke Rehabilitation. National Caregivers Library website. Canada.” program, and volunteering with March be themselves, try new things, and not 13. Canadian Association of Physical Medicine & www.caregiverslibrary.org/caregivers-resources/grp- - LEN of Dimes Canada’s Peers Fostering be afraid to make a mistake.” Rehabilitation website. http://capmr.ca/. Accessed on diseases/hsgrp-stroke/stroke-rehabilitation-article.aspx. Hope Program, a local network - JEFF 24 February, 2016. Accessed on 24 February, 2016. of support.” 14. Stroke Rehabilitation Specialists. Cleveland Clinic website. 29. 7 Steps to Stroke Recovery. Stroke Recovery Association - ANNA https://my.clevelandclinic.org/health/diseases_ of BC (June 2014). Available from: www.youtube.com/ conditions/stroke/hic_Stroke_Rehabilitation_Specialists. watch?v=GHJL42xFuz8. Accessed on February 22, 2016. Accessed on 24 February, 2016. 30. Canadian Revenue Agency website. www.cra-arc.gc.ca/ 15. About physiotherapy. Canadian Physiotherapy Association menu-eng.html. Accessed on 22 March, 2016. website (2012). www.physiotherapy.ca/about- 28 physiotherapy.aspx. Accessed on February 10, 2016. 27 A CAREGIVER’S GUIDE TO STROKE RECOVERY

WRI Group Alberta British Columbia Woodbridge, 905-851-9391 Altius Rehabilitation Group Inc. Back in Motion Rehab Inc. References www.wrigroup.ca Calgary, 888-654-8727 Surrey, 604-575-7745 1. Beyond Stroke website. www.beyondstroke.ca/. 16. The value of physiotherapy - Cardiovascular rehabilitation. www.altrehab.com www.backinmotion.com Accessed on 23 February, 2016. Canadian Physiotherapy Association (2012). Available Manitoba Khan Communication Services JR Rehab Services 2. International Brain Injury Association website. Focal and from: www.physiotherapy.ca/getmedia/56822362- Enabling Access Inc. Edmonton, 780-440-3251 Vancouver, 604-254-0444 multi-focal problems of spasticity. www.internationalbrain. a600-4fa7-a32f-2eb4494e249a/CPA_TheValueOf Winnipeg, 204-475-0433 www.khancommunicationservices.com www.jrrehab.ca org/articles/focal-and-multifocal-problems-of-spasticity/. Physio2012_CardioRehab-v1_1.pdf.aspx. Accessed on www.enablingaccess.ca LifeMark Health Providence Health Care Accessed on 17 March, 2016. February 10, 2016. Pathway Rehabilitation Calgary, 800-665-9947 Vancouver, 604-806-9090 3. What is Aphasia? March of Dimes Canada website. 17. Canadian Association of Occupational Therapists website. Winnipeg, 204-272-9500 www.lifemark.ca www.providencehealthcare.org www.caot.ca/default.asp?pageid=1344. Accessed on 01 www.pathwayrehabilitation.com www.marchofdimes.ca/EN/programs/ydac/Pages/ Optional Rehabilitation Services Inc. WhatisAphasia.aspx. Accessed on 11 March, 2016. March, 2016. Calgary, 403-236-8802 4. Heart and Stroke Foundation website (2015). 18. Townsend EA, & Polatajko, H. J. Enabling occupation II: Saskatchewan www.optionsrehab.org STATISTICS. www.heartandstroke.com/site/c. Advancing an occupational therapy vision for health, Bridges Health Peak Rehabilitation Consultants Inc. ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm. well-being & justice through occupation. Ottawa: Saskatoon, 306-222-0999 Calgary, 403-730-8273 Accessed on February 19, 2016. Canadian Association of Occupational Therapists. 2007 www.bridgeshealth.com www.peakrehab.ca 5. Brain Plasticity and Stroke Rehabilitation. American Heart 19. Occupational Therapists in Canada, 2010 National and SMRC Association & American Stroke Association. Retrived from Jurisdictional Highlights and Profiles. October 2011. Saskatoon, 306-244-9944 http://stroke.ahajournals.org/content/31/1/223.full. Retrived from http://cotm.ca/upload/2010_OT_in_Canada.pdf. www.smrcrehab.com 6. Neuroplasticity. www.stroke-rehab.com/neuroplasticity. 20. CAOT Academic Accreditation Standards and Self-Study html. Accessed on 31 March, 2016. Guide (2011). Canadian Association of Occupational Therapists. Retrived from www.caot.ca/acc/CAOT-%20Ac- 7. Mang CS, Campbell KL, Ross CJ, et al. Promoting creditation%20Self-Study%202011%20(rev.%202014).pdf. neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic 21. Canadian Podiatric Medical Association. variation on brain-derived neurotrophic factor. Phys Ther www.podiatrycanada.org/. Accessed on 24 February, 2016. Recovery for Stroke Survivors is Possible 2013;93:1707-16. 22. Feet in Stroke Patients. Senior Foot Care website. with the Help and Support of Caregivers, Stroke Recovery Canada 8. Stroke - How physiotherapy can help. Physio Can Help www.seniorfootcare.com.au/feet-in-stroke-patients/. Accessed on 24 February, 2016. and March of Dimes Canada! website. http://physiocanhelp.ca/stroke-how- physiotherapy-can-help/. Accessed on February 10, 2016. 23. Feet in Stroke Patients. MyFootDr Podiatry Centres web- 9. NINDS Spasticity Information Page. National Institute of site. www.myfootdr.com.au/conditions-treated/about- Neurological Disorders and Stroke website. www.ninds.nih. conditions-treated/feet-in-stroke-patients.aspx. gov/disorders/spasticity/spasticity.htm. Accessed on 23 Accessed on 24 February, 2016. February, 2016. 24. Foot Drop. MayoClinic website. www.mayoclinic.org/ 10. Mobility After Stroke: Issues facing stroke survivors and diseases-conditions/foot-drop/basics/definition/ “Of course, my recovery hasn’t “It’s been five years since my “With the encouragement of their families. National Stroke Association (2011). Available con-20032918. Accessed on 24 February, 2016. been without many serious stroke, and I am so thrilled to March of Dimes Canada, I from: www.stroke.org/sites/default/files/resources/NSA_ 25. Woods RJ, Cervone RL, Fernandez HH. Common trials, but today I am an active, be here today to tell you that started the Hamilton Young Mobility_brochure.pdf. Accessed on 23 February, 2016. neurologic disorders affecting the foot. J Am Podiatr Med Assoc 2004;94:104-17. I am living a full, active life! Stroke Survivors Group (HYSS). 11. Spasticity. National Stroke Association website. engaged contributor to my community www.stroke.org/we-can-help/survivors/stroke-recovery/ 26. Canadian Association of Social Workers website. and an advocate for others with Thanks to Stroke Recovery Canada® I wanted other young survivors just post-stroke-conditions/physical/spasticity?pagename= www.casw-acts.ca/en. Accessed on 24 February, 2016. disabilities. Through hard work and a I am blessed to be back as a hands-on like me to come to a place where they spasticity#symptoms. Accessed on 23 February 2016. positive attitude, I am living a full life parent to my two teenage girls, all the could learn how to make strides in 27. Ue B. Social work and the stroke patient. Clin Orthop Relat and encourage others to volunteer, get while attending classes, applying for their road to stroke recovery… as a 12. Gallichio JE. Pharmacologic management of spasticity Res 1978:101-3. involved and support March of Dimes admittance in a full-time college place where they could feel at ease to following stroke. Phys Ther 2004;84:973-81. 28. Stroke Rehabilitation. National Caregivers Library website. Canada.” program, and volunteering with March be themselves, try new things, and not 13. Canadian Association of Physical Medicine & www.caregiverslibrary.org/caregivers-resources/grp- - LEN of Dimes Canada’s Peers Fostering be afraid to make a mistake.” Rehabilitation website. http://capmr.ca/. Accessed on diseases/hsgrp-stroke/stroke-rehabilitation-article.aspx. Hope Program, a local network - JEFF 24 February, 2016. Accessed on 24 February, 2016. of support.” 14. Stroke Rehabilitation Specialists. Cleveland Clinic website. 29. 7 Steps to Stroke Recovery. Stroke Recovery Association - ANNA https://my.clevelandclinic.org/health/diseases_ of BC (June 2014). Available from: www.youtube.com/ conditions/stroke/hic_Stroke_Rehabilitation_Specialists. watch?v=GHJL42xFuz8. Accessed on February 22, 2016. Accessed on 24 February, 2016. 30. Canadian Revenue Agency website. www.cra-arc.gc.ca/ 15. About physiotherapy. Canadian Physiotherapy Association menu-eng.html. Accessed on 22 March, 2016. website (2012). www.physiotherapy.ca/about- 26 physiotherapy.aspx. Accessed on February 10, 2016. 29 A CAREGIVER’S GUIDE TO STROKE RECOVERY

WRI Group Alberta British Columbia Woodbridge, 905-851-9391 Altius Rehabilitation Group Inc. Back in Motion Rehab Inc. References www.wrigroup.ca Calgary, 888-654-8727 Surrey, 604-575-7745 31. My Guide to Stroke Recovery, Toronto Stroke Network. www.altrehab.com www.backinmotion.com http://www.tostroke.com/wp-content/uploads/2012/12 Manitoba Khan Communication Services JR Rehab Services /my_guide_for_stroke_recovery_binder_-_11Nov.pdf Enabling Access Inc. Edmonton, 780-440-3251 Vancouver, 604-254-0444 Winnipeg, 204-475-0433 www.khancommunicationservices.com www.jrrehab.ca 32. Dickey, L., Kagan, A., Lindsay, M.P., Fang, J., Rowland, A., and Black, S. (2010). Incidence and profile of in-patient www.enablingaccess.ca LifeMark Health Providence Health Care stroke-induced aphasia in Ontario, Canada. Archives of Pathway Rehabilitation Calgary, 800-665-9947 Vancouver, 604-806-9090 Physical Medicine and Rehabilitation, 91, 196-202. Winnipeg, 204-272-9500 www.lifemark.ca www.providencehealthcare.org 33. Aphasia Institute (website) www.aphasia.ca/home- www.pathwayrehabilitation.com Optional Rehabilitation Services Inc. page/about-aphasia/what-is-aphasia/ Calgary, 403-236-8802 Saskatchewan www.optionsrehab.org 34. March of Dimes Canada, ACDP website, Aphasia Programs www.marchofdimes.ca/Aphasia Bridges Health Peak Rehabilitation Consultants Inc. Saskatoon, 306-222-0999 Calgary, 403-730-8273 35. Collier, B. 2012. Communication Access: Improving www.bridgeshealth.com www.peakrehab.ca Accessibility for People with Communication Disabilities SMRC CASLPO, Spring. 19-22. Saskatoon, 306-244-9944 36. Sorin-Peters, R. (2003). Viewing couples living with www.smrcrehab.com aphasia as adult learners: Implications for promoting quality of life. Aphasiology, 17(4) p. 405-416. 37. The Ontario Association of Speech-Language Pathologists and Audiologists (OSLA), Speech-Language Pathologists’ Roles and Services, Rehabilitation (Brochure) www.osla.on.ca Recovery for Stroke Survivors is Possible with the Help and Support of Caregivers, Stroke Recovery Canada and March of Dimes Canada!

“Of course, my recovery hasn’t “It’s been five years since my “With the encouragement of been without many serious stroke, and I am so thrilled to March of Dimes Canada, I trials, but today I am an active, be here today to tell you that started the Hamilton Young

I am living a full, active life! Stroke Survivors Group (HYSS). engaged contributor to my community and an advocate for others with Thanks to Stroke Recovery Canada® I wanted other young survivors just disabilities. Through hard work and a I am blessed to be back as a hands-on like me to come to a place where they positive attitude, I am living a full life parent to my two teenage girls, all the could learn how to make strides in and encourage others to volunteer, get while attending classes, applying for their road to stroke recovery… as a involved and support March of Dimes admittance in a full-time college place where they could feel at ease to Canada.” program, and volunteering with March be themselves, try new things, and not - LEN of Dimes Canada’s Peers Fostering be afraid to make a mistake.” Hope Program, a local network - JEFF of support.” - ANNA

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For an accessible version of this information, contact Tina Siegel Email: [email protected] Phone: 416-425-3463 ext. 7258

This publication was made possible by a grant from Allergan Canada NEURO-AS-073