10 commandments for a placement in Stroke Early Supported Discharge - Joshua Chacko

1: APPROACH TO NEURO THERAPY = There are a range of approaches you may see, depending on your educator. It may be the Bobath concept which appears to have a big emphasis on facilitation, functionality and individually tailored interventions for each patient. It's also good to be aware of the various other approaches such as Cognitive Behavioural Therapy (CBT), treadmill training and mirror therapy.

2: HOME VISITS = unlike a ward setting, visiting patients at home is a totally new world for a student. When completing home visits I would recommended that you consider accessibility, further equipment needs such as hand rails, who else lives with the house, pets and the general environment.

3: SETTING SMART GOALS = This involves having individually tailored goals for each patient while also applying this to their home environment. At the end of the day it is all about what the patient wants to achieve. However make sure that it is realistic and the patient is aware of the recovery process following their stroke.

4: MULTI DISCIPLINARY TEAM = just like in any environment it's crucial to coordinate your visits with the rest of your MDT team. I was fortunate enough to work in a team where the Occupational Therapists led on upper limb rehab and Speech and Language Therapists took the lead on communication.

5: COMMUNICATION = following on from commandment 4, communication is key within the MDT and also between patient and therapist. Everyone needs to be on the same page. It's also good to keep in mind that you will come across patients with expressive and receptive dysphasia so adapting the way you communicate is crucial.

6: PREPERATION: similar to outpatients, more often than not you will know the patients that are to be seen a week in advance. So preparing in terms of learning what stroke they are effected by and the symptoms they present with are crucial in terms of how you approach each patient.

7: GET INVOLVED = when opportunities arise, grab it with both hands. Don't be shy, ask your educator to see if you can spend a day on the ward in the acute and hyper acute stroke units or even shadowing any other Neuro based therapist including your MDT members. Leading your own learning is very important on placement and failure to do so will mean that your overall experience won't be as rich as it should have been.

8: FEEDBACK = I have seen a lot of students complain at the end of their placement regarding the final feedback they receive. Firstly, the students never ask their educator for weekly feedback. Secondly, they never actually put an action plan in place to improve upon following previous feedback. Do not be this person. Ask for feedback and do something about the areas that you are lacking in. Feedback is not negative, it is there for you to improve upon from the previous week.

9: EMOTIONAL SUPPORT = having a stroke can be a shocking event for many people. As physiotherapist make sure you don't forget about the mental health aspects of the patient when treating the physical side. Most patients are distraught and have feelings of sadness many weeks down the line. It is important to make sure their mental health is considered as much as their physical capabilities.

10: BE YOU: one of the worst pieces of advice I have been given so far is to "turn on a professional manner" while in practice. The actual reality is that showcasing part of your personality is extremely beneficial in professional practice. No one wants to be like a bland chicken with no spice. Show your individual qualities and be yourself.

Joshua Chacko