​Generally a stroke is caused by a clot blocking the flow of blood to the brain or a blood vessel bursting and bleeding (less common) into the brain.

A stroke can be fatal or can affect your ability to walk, talk, see, read or do things you used to do.
 
In atrial fibrillation the electrical signals near the heart’s pacemaker, the sinus node, becomes erratic causing the heart to beat out of rhythm and beat faster (the rate).  It prevents the smaller atrial chambers from pumping properly resulting in the risk of blood clots.  These clots may travel to the brain and cause a stroke.  

​People with atrial fibrillation are five times more likely than others to have a stroke. To help prevent a stroke from atrial fibrillation:
 

• get your heart rate and rhythm tested by a health professional at least yearly
• if you feel your heart is racing get it checked by a health professional
• don’t smoke
• exercise regularly
• avoid sitting for long periods
• get enough sleep
• eat fresh foods
• reduce your alcohol intake

 
Atrial fibrillation can be treated with medication and with other procedures. Reduce your risk of a stroke and keep an eye on your heart.
 
If you need help changing your diet or getting into exercises our friendly therapist can help. Just contact Therapy Professionals, Phone: 377 5280, Mobile:  027 435 8970, Email: [email protected]
 
 
 

​Promoting functional mobility with movement strategies

1. To overcome the person’s fear/reluctance of standing up, place the back of a stout dining chair in front of him, but not so close that he can pull himself up on it.  
 
 
 
 
 
 
 



2. To facilitate chair to chair transfers, use a dining chair as in 1. To fill the place in front of the person and offer reassurance during the manoeuvre.  

3. To facilitate rising to standing from the edge of a bed or settee: the carer(s) seated beside the person use their thighs as substitute chair arms for him to push against.  They both/all rise “in unison’.  Use a dining chair to fill the space in front, as in 

4. To encourage even strides while walking, close assistance is given and the carer(s) step/s ‘in unison’ with the person, with both/all using the same foot at the same time.  

5. To achieve moving from the front to the back of a chair, demonstrate the side to side rocking movement required in front of the person.  Ensure that both his hands are placed on the arms of his chair.  

6. To encourage walking, place a chair as a visible goal to mark the required distance.  

​Communication Strategies
 
Treat the person as an individual with feelings and emotions.

• Approach the person slowly from the front.
• Respect his personal space.
• Attract his attention by addressing him by name and making eye contact.
• Keep your body and hand movements smooth and unhurried.
• Make use of facial expression.
• Speak clearly in a manner acceptable to an adult.

Verbal Strategies
 

• Use short sentences.
• Limit your requests to one at a time.
• Give the person plenty of time to understand.
• Repeat what you say using different words.
• Use words and expressions likely to be familiar to the person.
• Phrase requests positively eg ‘stay standing’ instead of ‘don’t sit down’.
• Tell the person politely and pleasantly what to do, rather than asking ‘would you like to do it?’  Offer choice when there is one.
• Use a goal-based request eg ‘come and have breakfast’ involves rising to standing, walking and sitting down to eat at the table.
• Give step by step instructions if helpful.

 
           

​                                                    T          -           time                                                                         
                                                    R         -           reassurance                                                                         
                                                    R         -           repetition
 THE PERSON NEEDS             E          -           empathy
                                                    C         -           courtesy                                                                                     
                                                    C         -           consistency
 

Non-verbal strategies and cues
 
To produce movement in a specific direction

• Invade personal space of person seated on edge of bed by moving up close against him and asking him to ‘move along’.

• Use gestures  to indicate direction: up or down, along or across.

• Touch cue to encourage standing up, sweep your hand lightly but positively up                                                                                  the person’s upper back, apply gentle pressure with your                                                                                                        hand in a forward and upward direction to indicate the direction of                                                                                      the movement.

• Touch cue to indicate which way he must turn to sit down, give gentle                                                                                                             intermittent pressure on the side of his hips.

• Auditory cue: to reinforce the request to ‘lie down please’ and to encourage                                                                                                        correct alignment along the length of the bed, slap the pillows on                                                                                       the end to make a ‘pillow noise’. Having attracted his attention to                                                                                        the pillows, encourage him to feel them.

• Auditory cue: to attract the person’s attention and to reinforce the request ‘sit                                                                                                     here please..in this chair’, pat the chair seat hard to make a ‘chair                                                                                     noise’. 

• Visual cue: to correct poor alignment of a person who has risen rom lying to                                                                                       sit on the edge of the bed, place his shoes on the floor in such a                                                                                                     position that when he puts his feet into them he will become correctly                                                                                                  aligned.
• Visual cue: to indicate the change in level of a step or kerb, move in advance of the                                                                                     person being assisted.

General considerations

• To avoid having your hand painfully squeezed when giving assistance, use the palm-to-palm thumb hold. The person can only grip your thumb, and it is easy for you to slide it out should you wish to release it. Or, adapt the palm to palm hold and keep your thumb close beside your fingers.

• To prevent the person from gripping onto the chair arms and impeding the rising movement, use the palm-to-palm thumb hold.  Then place the back of your hand against the chair arm - your hand is now between his and the chair arm.

 

• To overcome misjudgements when sitting down, allow the person to keep the chair/seat in sight throughout the movement and to sit down onto it sideways.

 

• To minimise the fear that may be experienced during changes of position, explain simply and clearly what you intend to do, reassure the person and then carry out the movement slowly and smoothly. 

​

​What is Mindfulness?
 
Mindfulness is an ancient Buddhist practice, which is very relevant for life today. Mindfulness is a very simple concept.  Mindfulness means paying attention in a particular way:  on purpose, in the present moment, and non-judgementally.  This increases awareness, clarity and acceptance of our present-moment reality. 
Mindfulness does not conflict with any beliefs or tradition, religious, cultural or scientific.  It is simply a practical way to notice thoughts, physical sensations, sights, sounds, smells - anything we might not normally notice.  The actual skills might be simple, but because it is so different to how our minds normally behave, it takes a lot of practice.  
I might go out into the garden and as I look around, I think "that grass really needs cutting, and that vegetable patch looks very untidy".  My young daughter on the other hand, will call over excitedly, "Mummy - come and look at this ant!"  Mindfulness can simply be noticing what we don't normally notice, because our heads are too busy in the future or in the past - thinking about what we need to do, or going over what we have done. 
Being mindful helps us to train our attention.  Our minds wander about 50% of the time, but every time we practise being mindful, we are exercising our attention "muscle" and becoming mentally fitter.  We can take more control over our focus of attention, and choose what we focus on...rather than passively allowing our attention to be dominated by that which distresses us and takes us away from the present moment.
​Mindfulness might simply be described as choosing and learning to control our focus of attention.

​Automatic Pilot
In a car, we can sometimes drive for miles on “automatic pilot”, without really being aware of what we are doing.  In the same way, we may not be really “present”, moment-by-moment, for much of our lives:  We can often be “miles away” without knowing it.
On automatic pilot, we are more likely to have our “buttons pressed”:  Events around us and thoughts, feelings and sensations in the mind (of which we may be only dimly aware) can trigger old habits of thinking that are often unhelpful and may lead to worsening mood.
By becoming more aware of our thoughts, feelings, and body sensations, from moment to moment, we give ourselves the possibility of greater freedom and choice; we do not have to go into the same old “mental ruts” that may have caused problems in the past

​Mindful Activity
 
When I wash the dishes each evening, I tend to be "in my head" as I'm doing it, thinking about what I have to do, what I've done earlier in the day, worrying about future events, or regretful thoughts about the past.  Again, my young daughter comes along.  "Listen to those bubbles Mummy. They're fun!"  She reminds me often to be more mindful.  Washing up is becoming a routine (practice of) mindful activity for me. I notice the temperature of the water and how it feels on my skin, the texture of the bubbles on my skin, and yes, I can hear the bubbles as they softly pop continually.    The sounds of the water as I take out and put dishes into the water.  The smoothness of the plates, and the texture of the sponge. Just noticing what I might not normally notice.
A mindful walk brings new pleasures. Walking is something most of us do at some time during the day.  We can practice, even if only for a couple of minutes at a time, mindful walking.  Rather than be "in our heads", we can look around and notice what we see, hear, sense.  We might notice the sensations in our own body just through the act of walking.  Noticing the sensations and movement of our feet, legs, arms, head and body as we take each step.  Noticing our breathing.  Thoughts will continuously intrude, but we can just notice them, and then bring our attention back to our walking.
The more we practice, perhaps the more, initially at least, we will notice those thoughts intruding, and that's ok.  The only aim of mindful activity is to continually bring our attention back to the activity, noticing those sensations, from outside and within us.

​Mindful Breathing
 
The primary focus in Mindfulness Meditation is the breathing. However, the primary goal is a calm, non-judging awareness, allowing thoughts and feelings to come and go without getting caught up in them. This creates calmness and acceptance.

• Sit comfortably, with your eyes closed and your spine reasonably straight.
• Direct your attention to your breathing.
• When thoughts, emotions, physical feelings or external sounds occur, simply accept them, giving them the space to come and go without judging or getting involved with them.

 

• When you notice that your attention has drifted off and becoming caught up in thoughts or feelings, simply note that the attention has drifted, and then gently bring the attention back to your breathing.

Breathing Meditation 1   (Kabat-Zinn 1996)
Assume a comfortable posture lying on your back or sitting.  If you are sitting, keep the spine straight and let your shoulders drop.
 Close your eyes if it feels comfortable.
 Bring your attention to your belly, feeling it rise or expand gently on the in breath and fall or recede on the outbreath.
 Keep your focus on the breathing, “being with” each in breath for its full duration and with each outbreath for its full duration, as if you were riding the waves of your own breathing.
Every time you notice that your mind has wandered off the breath, notice what it was that took you away and then gently bring your attention back to your belly and the feeling of the breath coming in and out.
 If your mind wanders away from the breath a thousand times, then your “job” is simply to bring it back to the breath every time, no matter what it becomes preoccupied with.
 Practice this exercise for fifteen minutes at a convenient time every day, whether you feel like it or not, for one week and see how it feels to incorporate a disciplined meditation practice into your life.  Be aware of how it feels to spend some time each day just being with your breath without having to do anything.

Breathing Meditation 2  (Kabat-Zinn 1996)
Tune into your breathing at different times during the day, feeling the belly go through one or two risings and fallings.
Become aware of your thoughts and feelings at these moments, just observing them without judging them or yourself.
At the same time, be aware of any changes in the way you are seeing things and feeling about yourself.

Using mindfulness to cope with negative experiences (thoughts, feelings, events)
As we become more practised at using mindfulness for breathing, body sensations and routine daily activities, so we can then learn to be mindful of our thoughts and feelings, to become observers, and subsequently more accepting.  This results in less distressing feelings, and increases our level of functioning and ability to enjoy our lives.
 
With mindfulness, even the most disturbing sensations, feelings, thoughts, and experiences, can be viewed from a wider perspective as passing events in the mind, rather than as "us", or as necessarily true.  By simply being present in this way, you support your own deep healing (Brantley 2003).                                           
When we are more practiced in using mindfulness, we can use it even in times of intense distress, by becoming mindful of the actual experience as an objective observer, using mindful breathing and concentrating attention on breathing with the body's experience, listening to the distressing thoughts mindfully, recognising them as merely thoughts, breathing with them, allowing them to happen without believing them or arguing with them.  If thoughts are too strong or loud, then we can move attention to our breath, the body, or to sounds in the environment.  We can use kindness and compassion for ourselves and for the elements of the body and mind's experience.  "May I be filled with peace and ease. May I be safe" (Brantley 2003). 

​Jon Kabat-Zinn uses the example of waves to help explain mindfulness.  Think of your mind as the surface of a lake or an ocean.  There are always waves on the water, sometimes big, sometimes small, sometimes almost imperceptible.  The water's waves are churned up by winds, which come and go and vary in direction and intensity, just as do the winds of stress and change in our lives, which stir up waves in our mind.  It's possible to find shelter from much of the wind that agitates the mind.  Whatever we might do to prevent them, the winds of life and of the mind will blow, do what we may. 
"You can't stop the waves, but you can learn to surf"   (Kabat-Zinn 2004).

Mindful Breathing
 
The primary goal of mindful breathing is simply a calm, non- judging awareness, allowing thoughts and feelings to come and go without getting caught up in them.

• Sit comfortably, with your eyes closed and your spine reasonably straight.

 

• Bring your attention to your breathing.

 

• Imagine that you have a balloon in your tummy. Every time you breathe in, the balloon inflates. Each time you breathe out, the balloon deflates. Notice the sensations in your abdomen as the balloon inflates and deflates. Your abdomen rising with the in-breath, and falling with the out-breath.

 

• Thoughts will come into your mind, and that’s okay, because that’s just what the human mind does. Simply notice those thoughts, then bring your attention back to your breathing.

 

• Likewise, you can notice sounds, physical feelings, and emotions, and again, just bring your attention back to your breathing.

 

• You don’t have to follow those thoughts or feelings, don’t judge yourself for having them, or analyse them in any way. It’s okay for the thoughts to be there. Just notice those thoughts, and let them drift on by, bringing your attention back to your breathing.
• Whenever you notice that your attention has drifted off and is becoming caught up in thoughts or feelings, simply note that the attention has drifted, and then gently bring the attention back to your breathing.

 
It's okay and natural for thoughts to enter into your awareness, and for your attention to follow them. No matter how many times this happens, just keep bringing your attention back to your breathing.
 
 
 
 
 
 
 

www.get.gg       www.getselfhelp.co.uk/mindfulness.htm
 
 
© Carol Vivyan 2009, permission to use for therapy purposes.
​

​
​Safety on the stairs
 
Lighting and handrails are important here, plus that good old rule – keep it slow.

• The more light the better.  If you can, install two lights over stairs and put light switches at the top and bottom so you won’t have to climb in the dark.

 

• Always use the handrail.  If you don’t have one, it’s easy to get one fitted – just make sure it extends past the end of the stairs.

 

• Clear the clutter – keep objects like toys, shoes, books and bags away from stairs.

 

• Try and go one step at a time to avoid slips and trips.

​Living room and hallway 
 
Our homes are our havens. Here’s few simple things to make your home safe and comfortable:

• Make sure you’ve got working smoke alarms in bedrooms, sleepouts, hallways and living rooms and test them regularly.

 

• Put safety catches on any windows children can reach. Make sure that you can still open them easily in case there’s an emergency, like a fire.

 

• If you have wooden floors, wear non-slip shoes or slippers rather than socks and take it slow.

 

• Try not use rugs or mats on wooden floors. If you do have them, stick them to the floor with Velcro or double-sided tape.

 

• Keep power cords away from walkways by taping them to skirting boards. Don’t put them under rugs or carpet as they can cause a fire. If you are building or renovating, install enough power points so cords don’t cross the room.

​
​Best bathroom behaviour
 
Keeping your bathroom tidy and dry is a great start to make it safe:

• Keep the floors dry – mop up water after baths and showers.

• Put towel rails close to the bath or shower to stop you having to lean to reach them.

• Clear the shower floor – put your shampoo and soap in a shelf or basket.

• Ask your pharmacist for child safety caps on all medicines.

• Get your hot water checked to ensure it’s at the right temperature. It should be 55oC at the tap and 60ºC at the cylinder.

• Use non-slip mats in the shower and bath and non-slip flooring for the rest of the room.

​
​Outside: garden, paths and shed 
 
As a nation we love our DIY. On a fine day, see which of these things can be tackled at your house:

• Keep your paths and steps clear of leaves and moss and be careful when it’s raining.

 

• Make sure your outdoor areas are well-lit with sensor lights, plus mark edges of steps and drops with white paint for better visibility.

 

• Grooved timber on decks gives better grip or try adding sand to deck paint to stop slips.

 

• Balconies need a solid safety barrier or fence that children can’t climb.

 

• Put stickers on any glass sliding doors or large glass panels – it’s a fun thing to do with the kids.

 

• Keep chemicals, solvents, paints and sprays out of sight and reach of children – ideally, lock them away in a cupboard.

 

• Keep three points of contact on ladders (e.g. two feet and a hand). Don’t reach over too far – keep your belt buckle within the sides of the ladder.

 
 
Kitchen safety 
 
Kitchens are often busy places and the heart of the home – just a bit of reorganising can make sure they’re easier to use and safe for all the family:

• Put safety catches on cupboards holding poisons or knives.

 

• Keep cupboard doors closed so you don’t walk into them.

 

• Keep heavy objects and things you use often in low cupboards so you can reach them easily.

 

• Use a step ladder rather than a chair to reach high shelves.

 

• Clean up any spills as soon as you see them.

 

• Dangling cords are dangerous – put appliances close to power points.

 

• If you can, put the fridge at the entrance to the kitchen, so people don’t have to walk through the kitchen to reach it.

 
 
How safe is your home?
 
In New Zealand, more injuries happen at home than at work, on the road, or while playing sport. In fact, on average, someone in New Zealand is injured at home every 48 seconds!
 
But it’s not all doom and gloom. The good news is, with just a few simple changes, you can make your home a safer place for you, your family, and any visitors.
 
These tips cover the main areas in most homes and are great place to start. 
 
 
Ref.: Acc booklet – “Safety begins at home”