Rehab training brings stroke survivors’ plight home

Just more than three years ago Florence Rasmeni, who works as a community healthcare worker at the Boland Hospice in Worcester, would look on helpless and anxious whenever a stroke patient was wheeled into the facility.

As the mother of three and her colleagues had no formal training in caring for stroke survivors, they couldn’t help these physically impaired patients, and the hospice had no choice but to refer them to a nearby clinic to receive rehabilitative care. But today not only is Rasmeni confident in assisting stroke patients and giving them basic rehabilitation, she also imparts her training to patients’ family members, who often feel overwhelmed by their new role as carers.

Rasmeni’s empowerment is thanks to Stellenbosch University researcher and physiotherapist Elsje Scheffler, who offered training to rural caregivers as part of her PhD research.

“When you deal with stroke patients you don’t just handle them anyhow, as by doing that you may end up doing even more damage. These patients often have neurological damage that results in physical impairment, so even moving them on the side and transferring them from a bed into a wheelchair can hurt them and possibly delay their rehabilitation if it’s not done correctly,” she said.

Stroke, a serious medical condition that affects blood supply to the brain, either by blockage to an artery in the brain or the rapture of an artery in the brain, and leads to the sudden onset of weakness of the face, limbs and impaired speech and vision, kills about 25,000 people in SA every year. It is a leading cause of disability, death and dementia in the world. Africa has some of the highest stroke rates, with at least 23% of Africans at risk at some point in their life.

Scheffler said once stroke survivors were back in their communities, access to rehabilitation resources was often “extremely limited due to poverty, no access to transport and limited service capacity, with some patients waiting weeks or months to access services”. She said in some districts, stroke survivors were referred to community healthcare workers, “most of whom are ill-equipped to assist”.

Having worked with SA stroke survivors as a physiotherapist for more than two decades, Scheffler was aware of the challenges that stroke survivors went through and developed a home-based stroke rehabilitation training programme for low-resourced communities.

Working through the department of family medicine and primary care, Scheffler conducted her research in the Cape Winelands district, which was known for a high incidence of stroke. Together with the local district’s therapy, home- and community-based services, Scheffler led the development and implementation of a training programme. The ultimate aim was to give family caregivers the skills and tools they desperately needed to assist the stroke survivors in their care.

Community healthcare workers were trained on handling the patients, including dressing, positioning, rehab exercises, communication, and emotional and social wellbeing.

Scheffler said the study demonstrated how local healthcare services at primary level could design appropriate and contextually relevant community-orientated interventions. “Unlike many caregiver training interventions in developing countries, which focused on a home-based rehabilitation exercise intervention, this training programme included minimal teaching of home exercises to ensure that the content was aligned with the community healthcare workers’ scope of practice and avoided overlap with the scope of future mid-level rehabilitation workers.

“The training significantly changed the community healthcare workers’ ability to assist the caregivers. The family caregivers were also much more motivated than before.”

Scheffler said now it was up to local, provincial and national government and other stakeholders to address the challenges in service coordination.

“Although the structure of the training programme for community healthcare workers followed a specific sequence and duration, the training of caregivers would be tailored to the stroke survivor’s specific level of functioning and care needs, similar to most training programmes. Each lesson plan also provided guidance on how to further adapt the training to the local setting,” Scheffler said.