A valuable lesson in stroke care

Since it began accepting patients in the spring of 2015, The Program in Occupational Therapy’s student-run stroke clinic has offered free services for under-resourced clients to help increase their safety and independence following a stroke. Initially developed as a doctorate project in 2014, the clinic has experienced steady growth and now partners with the program’s Community Practice to further enhance its services. In only its third semester, the clinic has more than doubled the number of patients it serves each week.

Meghan Doherty, MSOT, OTR/L, the primary supervising clinician for the stroke clinic, notes the importance of flexibility as the clinic evolves. “We continue to learn and adapt as we go along,” says Doherty. “As the numbers of students and clients flux, we respond by shifting our model of supervision and support. Our goal is to grow in a manageable way. We have more student interest now and our new class has eleven students in the lab, so Duana Russell-Thomas, MSOT, OTR/L, will be stepping in as another clinical supervisor. Additionally, one of our second-year students is offering a free chronic disease self-management class to our stroke clinic and other OT clients this spring, so that’s a new component as well.”  

Staffed by students, the clinic serves those who have suffered a stroke and are either uninsured or underinsured. Second-year students provide weekly one-on-one care to patients for a period of 12 weeks. Oversight is provided by third-year students, as well as a licensed clinician, during each session. That consistency helps clients build a relationship with the student and results in better care, says second-year student Mackenzie Schaefer, MSOT/S ’16. Schaefer has been paired with Dorothy Edwards, who suffered a stroke in August 2014, and the two are now in their second semester of working together.

“Since we work with the same client each time, we get to know them extremely well. The experience mimics what we would find in the real-world, where we form that ongoing relationship with a client,” shares Schaefer. It’s the real-world experience that drew Schaefer into this particular learning track as she pursues her degree. “Before coming to WashU, I worked in an outpatient clinic and I was able to work one-on-one with clients. I loved everything about it. The stroke clinic is where I can have a client of my own; it’s a place where I can get hands-on knowledge. I really enjoy being able to take what I learned from lectures and implement it into working with Dorothy each week.”

Edwards’ stroke impacted her balance and mobility. She had to give up much of what she loved doing, including gardening, yardwork, upholstery and bible class. Upon being referred to the stroke clinic, Edwards began working with Schaefer on setting goals and developing strategies to help her return to the activities she loves. “I like working with Mackenzie because she explains things to you well and helps you do the stuff you can’t do and try to do. She encourages you to take baby steps and try again,” says Edwards. “I recently started back to bible class and am getting to a place where I can do a little yardwork.” The pair continue to work on balance with the goal of Edwards returning to yardwork this summer.

Schaefer enjoys seeing the progress Edwards makes from week-to-week. “What I really enjoy about working with Dorothy is seeing the confidence she gains after trying something new and doing it successfully. Though she might initially hesitate or doubt her abilities, once we work through something and try it, I think she always surprises herself on what she’s capable of doing.”

Prior to each session, Schaefer creates a treatment plan for Edwards, follows that plan during the weekly session, and then documents her progress via a “SOAP note,” or progress note, which is later reviewed by the supervising doctoral student(s) and clinician. “I definitely think I’ve improved tremendously on writing stronger SOAP notes and being able to perform assessments. It’s a great basis to learn what you’re going to need to learn and get the practice you need with a real person, because sometimes it’s hard to get that practice in the classroom alone,” shares Schaefer. “After working in the stroke clinic, I feel like I’ve gained so much more confidence in myself.”

Seeing Edwards progress as they work together inspires Schaefer. “I’ve seen Dorothy’s balance and confidence improve so much since my first visit with her last semester. We’ve done numerous activities that challenge her to practice gardening skills, since gardening safely is one of her goals. She’s been able to come up with strategies herself to make sure she’s safe and able to do these things at home, and it’s nice to see that change in her, and see what she can do,” she says.

Edwards is thrilled with her progress as well, and admits that the stroke clinic has enabled her to “do more things, participate…and not feel left out.” These are essentially the goals that the clinic has for each of its patients.

As the clinic continues to grow each semester, the team welcomes new clients and referrals. “I wish everyone knew about our stroke clinic,” says Doherty. “We are serving a very important population of people who want to get back to living out their roles with family and friends in their communities.”

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