It has been six months since 34-year-old Terrilyn McLaren had a stroke while on a solo vacation in Vienna Austria.
Earlier this year, we introduced Terrilyn and shared her story while she rebuilt her strength and coordination at Providence Care Hospital as an inpatient. Once discharged, Terrilyn was one of eight stroke survivors who was able to participate in a new pilot project called the Outpatient Stroke Rehabilitation Program.
“Having this pilot helped me find a level of normalcy relatively quickly. Having rehab sessions so frequently got me really pushing myself and I went from having trouble walking to now running, jumping, and strength building. My clinicians could see what I was feeling and verbalize why certain things are difficult for me. I’m so grateful,” says Terrilyn.
The pilot ran for 12 weeks out of Providence Care Hospital’s outpatient facility from February to the end of April. It was funded by CorHealth Ontario and Ontario Health, with the goal to increase access to intensive patient-centered stroke rehabilitation.
“A lot of my research has been to ring the alarm about the gap that exists for stroke patients once they leave inpatient, hospital rehab,” says physiotherapist and pilot program coordinator, Olivia Manning. “The pilot existed to help us understand how we can better transition stoke patients into the community.”
What sets the Outpatient Stoke Rehabilitation Program apart from regular outpatient rehabilitation, is the number of appointments and the type of rehabilitation patients receive. Usually stroke patients receive physiotherapy one to two times per week. In this pilot, patients were receiving physiotherapy, occupational therapy and speech therapy in back-to-back appointments up to three times a week.
“This pilot was meant to be a place where someone could come after they have left hospital and get connected with a team of knowledgeable clinicians working in tandem. The idea is you have access to all the services you need under one roof within the same day,” says Olivia.
Therapists involved in the pilot used their individual expertise to build the program for patients from the ground up. Of the eight patients involved, four were inpatients of Providence Care Hospital and met with Olivia before they were discharged to discuss what their outpatient care-plan would look like.
“Patients were leaving hospital with a plan which helps to ease the transition,” says Olivia. “Patients were also seen 72 hours within being discharged, so there was a quick turnaround and no down time, which is important when trying to optimize recovery.”
Terrilyn worked with a physiotherapist and occupational therapist doing activities in the therapy gym and therapy pool.
“During the month of March I was still not able to walk quite well but I moved into my own place and got a second dog. I said I want to walk my dog and they put me on a treadmill and had something that simulated me walking a dog, which really helped me live normally,” explains Terrilyn.
“The team that we have is integrated, so they’re always communicating with each other,” says Olivia. “We had weekly meetings as a team to discuss our patient’s progress and their goals, so that we’re all on the same page and working with the patient on what they want to work on. Another big goal too, was to talk about the transition with patients after our program.”
Olivia’s team met with individuals from the Stroke Network of South Eastern Ontario (SNSEO) and Stroke Services at Greater Kingston Victoria Order of Nurses (GK VON) to discuss referrals to community support programs and services.
“As a therapist in hospital, you are not always aware of community supports,” says Olivia. “It was great for our team to connect with these organizations and learn more so we could make the right suggestions for next steps for our patients.”
Emilia Leslie is the Stroke Services Coordinator with GK VON and says educational resources, programs and support groups are offered free of charge to anyone affected by stroke and their caregivers to those in the Kingston area and surrounding region.
“Many of our stroke survivors involved in our programming have told me it can feel isolating in the recovery journey once you leave hospital. Our services are designed to build community, provide information about stroke recovery, provide practical solutions for activities of daily living, and make recommendations for resources and overall support in the journey of wellness and recovery.”
Currently, there are over 108,707 new strokes in Canada annually. According to the Ontario Stroke Network at least every 30 minutes, there is one new stroke victim in Ontario. Its data that reinforces the need for more coordinated care just like the Outpatient Stroke Rehabilitation Pilot Program.
“Stroke recovery is an ongoing process. No one can really say ‘you’re finished recovering’. When a patient leaves the inpatient unit it’s definitely not- ‘you’re better now and this is as good as it’s going to get,’” says Olivia. “There is evidence to show that a patient can improve for many, many months and even years after a stroke. So it’s trying to support the patient optimize their recovery.”
The pilot has had very positive feedback and Olivia says her team is now working on submitting a funding proposal and business case to turn the pilot into the new normal for outpatient stoke rehabilitation.
“There is also lots of potential for cost savings if we’re able to reduce people getting readmitted to hospital. Stroke survivors could leave acute care and come straight to our program, skipping a post-acute rehabilitation stay in Providence Care Hospital for example. It’s a big cost savings on the health care system but it’s also better for the patient. People don’t want to be in hospital unless they need to.”
As for Terrilyn, she is driving again and continuously working on the things she loves, like piano and basketball. She hopes to connect with GK VON’s community services and become a mentor for other young stroke survivors, putting her lived experience as a survivor into something meaningful.