ADVANCED COMMUNITY
REHABILITATION
ASSISTANT
WORKBOOK
1
TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................... 2
THE WORKBOOK ................................................................................................... 3
Background - COMMUNITY REHABILITATION WORKFORCE PROJECT ..... 4
THE ADVANCED COMMUNITY REHABILITATION ASSISTANT (ACRA) ROLE . 6
RESPONSIBILITIES .......................................................................................... 11
CHART DOCUMENTATION .............................................................................. 14
CONFIDENTIALITY
........................................................................................... 17
COMPUTER SKILLS
......................................................................................... 18
HOME OR COMMUNITY VISITS
...................................................................... 21
CULTURAL DIVERSITY AND AWARENESS ....................................................... 23
EQUIPMENT .......................................................................................................... 24
EQUIPMENT USED IN SCREENING TOOLS ....................................................... 26
COMMUNITY REHABILITATION COMPETENCY DOMAINS .............................. 27
MOTIVATING CLIENTS TO ACHIEVE THEIR GOALS ........................................ 30
PRIORITISATION OF WORKLOAD ...................................................................... 32
ACQUIRED BRAIN INJURY AND STROKE ......................................................... 34
ACKNOWLEGEMENTS ......................................................................................... 36
ATTACHMENT A – TRAINING SCHEDULE ......................................................... 38
ATTACHMENT B - ABBREVIATIONS .................................................................. 43
ATTACHMENT C- HOME VISIT POLICY OR PROCEDURE ............................... 44
ATTACHMENT D – UNDERSTANDING BEHAVIOUR CHANGES (BY ABIOS) .. 45
ATTACHMENT E –COMMUNICATION PROBLEMS FOLLOWING A STROKE
(SPEECH PATHOLOGY AUSTRALIA FACT SHEET) .......................................... 46
ATTACHMENT F – GLOSSARY ........................................................................... 47
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THE WORKBOOK
This workbook has been developed to help you develop and/or improve skills that
you will need to function as an advanced assistant working in community
rehabilitation (CR). The various sections give you an overview of the topic and in
many instances direct you to where you can access further training. Some of the
sections also contain an activity for you to complete to assist in your understanding
of the topic. You should discuss your progress with on a regular basis with your
supervisor, ideally at your weekly/fortnightly supervision sessions. Aim to cover one
section of the workbook prior to each session. Your Performance, Appraisal and
Development (PAD) sessions would provide further opportunities to discuss these
activities with your supervisor.
Whilst this workbook has been developed to meet your training needs as an
advanced assistant in CR, much of the information will be relevant to your
colleagues working as assistants in other areas. So feel free to share!
The sections in the workbook that are marked with this symbol,
sections and should be completed first.
, are priority
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Background - COMMUNITY REHABILITATION WORKFORCE PROJECT
The Community Rehabilitation Workforce Project (CRWP) aims to optimise the
capability of the current and future workforce to develop, implement and evaluate CR
programs to meet the current and emerging health needs of the Queensland
community.
The key target group of the CRWP includes nursing, occupational therapy, speech
pathology, physiotherapy and support level staff working in community rehabilitation or
community based services in Queensland. The CRWP works with both government
(eg. Queensland Health, Disability Services Queensland) and non-government
organisations (eg. Blue Care, Spiritus, private practitioners).
An audit of the training and education needs of staff working in CR in Queensland was
conducted by Griffith University in February 2006. The audit revealed ten key
competency domains that were relevant to good CR practice in Queensland. These
are:
1. Frameworks of understanding
2. Consumer engagement
3. Holistic focus
4. Service continuity
5. Networks
6. Cultural Awareness
7. Community Engagement
8. Boundaries and Safety
9. Reflective Practice
10. Systems Advocacy
Community Rehabilitation Assistant Workforce Project
The Community Rehabilitation Assistant Workforce Project (CRAWP), a major initiative
of the CRWP, aims to develop, implement and evaluate new roles for assistant level
health workers in community rehabilitation, including appropriate support, education
and training.
A literature review completed in 2006 by the University of South Australia showed that
assistants are a critical part of current and future health service delivery, particularly in
CR. However it also stated that work is required to develop clear roles, boundaries,
scope of practice and training. The CRAWP has since identified the roles for
assistants and advanced assistants working in CR and has outlined the scope and
boundaries of these roles. The project is also looking at exactly what training is
needed, including TAFE courses and in-house training.
Training and Development Officers
CRWP Training and Development Officers work across Queensland to develop
and deliver training that disseminates community rehabilitation principles and
competencies to the Queensland workforce. Training is delivered by
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videoconference, face to face and online. You should attend as many of these
sessions as possible. Look at the training schedule (Attachment A) with your
supervisor and discuss the relevance of each session to you.
5
THE ADVANCED COMMUNITY REHABILITATION ASSISTANT (ACRA) ROLE
As the ACRA role has been developed as part of a project, and tasks and duties will modified to meet the needs of the team and clients as the project
progresses. Below is a list of duties you will be required undertake.
ACRA TASK LIST- NORTHSIDE HEALTH SERVICE DISTRICT
Task List
Clinical
Participate in information gathering for assessment as directed
by treating therapist, including administering screening tools
Steps Involved
MMSE/MSQ

Ensure client wearing hearing aid or glasses where
appropriate

Ensure no distractions

Administer MMSE/MSQ as per guidelines

Score the MMSE/MSQ and record results
Training Requirements/Professional Development
MMSE training session
Observation of an MMSE/MSQ being conducted Competence
evident by direct observation and questioning of knowledge base
Grip Strength (Jamar Dynamometer)

Instruct client on correct technique for using Jamar
dynamometer

Ensure client in correct position and monitor this
position throughout the screening

Conduct grip strength test using Jamar Dynamometer

Record information appropriately
Jamar Dynamometer practical training session
Competence evident by direct observation of technique and
queuing
Pinch Strength (Pinch Gauge)

Instruct client on correct technique for using Pinch
Gauge

Ensure client in correct position and monitor this
position throughout the screening

Conduct pinch strength test using Pinch Gauge

Record information appropriately
Pinch Gauge practical training session
Competence evident by direct observation of technique and
queuing
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6 Minute Walk Test

Instruct client on the process of the 6 minute walk test

Conduct the 6 minute walk test and record the required
data (ie. Heart rate, O2 sats, distance walked, rests
breaks needed, Borg scale)

Record information appropriately
Participate in the clients’ rehabilitation programme by conducting
independent home visits to assist in monitoring the home
program established by the treating health professional.
Evaluate the ongoing effectiveness of the rehabilitation plans and
feedback to the treating health professional/s

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Conduct home visit to supply, instruct and monitor client with
the use of an aid/equipment prescribed by the treating health
professional
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Work with client, their family and carers to support community
access in accordance with goals in their rehabilitation plan
developed by the treating Health Professional
6 Minute Walk test training session, including training in the use
of a pulse oximeter and the Borg Scale. Training in the
identification of signs of fatigue.
Competence evident by direct observation of skill and
questioning of knowledge base
Contact client and arrange home visit
Assist client with the established home programme
Monitor the clients’ progress in accordance with
guidelines/checklist established by the treating therapist
Progress clients’ home program in accordance with the
rehabilitation plan when client achieving benchmarks
that have been determined by treating therapist
Comply with District’s home visiting policy and
procedure
Feedback to treating health professional/s
On the job observation and training around the clients’ exercises
Training session on home visits
ACRA workbook
Take prescribed equipment to client’s home if delivered
to the hospital
Adjust equipment, if necessary, to fit client (eg. Height
of frame etc)
Instruct client in use of equipment
Ensure client can use equipment safely in their
home/community environment
On the job observation and training around equipment (correct
use, maintenance of, and adjusting equipment to “fit” client)
Training session on home visits
ACRA workbook
Accessing Public Transport

Assist/teach client how to obtain information about the
local public transport eg. Timetables

Instruct client in preparing for using public transport eg.
Time management, Having money ready, purchasing
ticket, finding correct train platform or bus stop
 Assist client to actually make a trip on public transport
Training on using QHEPS and the Internet as research/resource
tool if necessary
On the job observation and training around coping strategies
developed for the client by the Health Professional
Reviewing current community resource materials
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Access Local Shopping Centre

Assist client in researching what local shopping centres
are available

Assist client to prepare for trip eg. Develop shopping
list, ensure have money

Assist client in deciding how will get to shop

Accompany client on visit to shopping centre and ensure
they can navigate the area safely

Help client to implement strategies developed by Health
Professional (eg. Scanning) and possibly “grade” them
Work with client, their family and carers to carry out functional
daily activities in accordance with goals in their rehabilitation
plan
Access and Participate in Leisure Activities

Assist client in identifying local clubs/groups available in
their area

Assist client to contact group and arrange for visit

Assist client in determining how will get to club/group

Assist and train client in how to prepare for club/group
eg. money, appropriate dress, equipment

Assist client to attend group/club
Training on using QHEPS and the Internet as research/resource
tool if necessary
On the job observation and training around coping strategies
developed for the client by the Health Professional
On the job observation and training in grading
Reviewing current community resource materials
Training on using QHEPS and the Internet as research/resource
tool if necessary
On the job observation and training around coping strategies
developed for the client by the Health Professional
On the job observation and training in grading
Reviewing current community resource materials
Working towards independence in ADLs
Advocate for client including assisting client to navigate the
health care system
Work as a member of a multi-disciplinary team
Assist client to complete forms, eg.

Centrelink forms

Taxi subsidy forms
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Pension application forms
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Work with all the Health Professionals in the team as
needed
Provide feedback to treating health professionals on
clients’ progress
Participate in case conferences and provide updates on
clients you have been working with
On the job observation and training around the participation in
case conferences
Session with Health Professional to develop communication plan
and discuss respective parties roles and expectations
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Document client interventions in the clients’ medical records

Document home visits in client’s medical record on day
the day of the visit, in accordance with District policies
and procedures
Record results of screening tests on appropriate forms
or in medical chart
Record telephone calls made to clients (other than those
made to arrange appointments) in medical chart
Review of District’s policy and procedure on Documentation
ACRA workbook
Training session with HIU
On the job observation and training around the recording of
exercise programs and screening tools

Update clients’ home program record when a change
has been made, for example, if there has been an
increase in the number of repetitions of an exercise or if
the program has been progressed in accordance with
the rehabilitation plan
On the job observation and training around the recording of
exercise programs

Record statistics as per organisational guidelines
On the job observation and training around the recording of
statistics
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Maintain an accurate record of programs undertaken by client
Participate in administrative functions required by the
department appropriate to an Advanced Community
Rehabilitation Assistant
Participate in the development of community rehabilitation
services, including resource development
Undertake continuing education activities
Resource Development

Assist in co-ordination of CBRT’s community resource
manual

Access resource information eg. from QHEPS, ILC,
catalogues, supplier websites, other community
services, leisure groups

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Participate inservices, teleconferences,
videoconferences and other education provided
appropriate to the Advanced Community Rehabilitation
Assistant role
Read the Workbook developed for ACRAs and complete
the included activities
Computer training if needed
Training provided by the Training & Development Officers as part
of the Community Rehab Workforce Project
A record of training and education undertaken
Participation in the Performance Appraisal & Development
process
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Assist with orientation and training of new staff, relievers and
students with respect to the Advanced Community Rehabilitation
Assistant role
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Participate in reflective practice and strive for excellence in
service delivery
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Knowledge of and compliance with organisational and service
specific policies and procedures
Participate in quality assurance and quality management
practices
Orientate new staff and students to the role of the ACRA
role and how it differs to the role of the Therapy
Assistants
Orientate and train relievers to the ACRA role and
tasks/duties performed
Orientate relievers to procedures applicable to the ACRA
role
Make daily entries in the electronic Daily Diary for
ACRAs
Independently reflect on your work and identify
strengths, weaknesses and areas for improvement
Participate in the Performance Appraisal and
Development Process with your supervisor
Familiarise yourself and comply with District and departmental
policies, procedures and practices. Pay particular attention to
the following areas:

Human Resource Management issues, including
workplace health and safety, equal employment
opportunity, anti-discrimination and ethical behaviour as
applied in the working environment

Home visiting

Documentation

Confidentiality
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CBRT Orientation to service folder

Understand QA processes and identify areas of
improvement
Participate at an individual or team level in assessment,
evaluation, monitoring and review processes
Review of relevant policies, procedures and work practices
Attend District mandatory training sessions
ACRA workbook
On the job observation and training
Attend District staff forums
Attend District education activities relating to QA including
inservices
Access relevant training provided by the Training & Development
Officers as part of the Community Rehab Workforce Project
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RESPONSIBILITIES
It is important that in your role as an ACRA you carry out your work in a manner that
reflects well upon yourself and our service, and promotes a safe environment for
clients. To assist in achieving this, the points below need to be considered.
Supervision
Due to the nature of the ACRA role, it is likely that you will have more than one
supervisor. You should have one person assigned as your operational line
manager, the person who approves leave application forms and so on. You will
also have clinical supervisors, and as ACRAs work with multiple disciplines (eg.
Occupational Therapy, Physiotherapy, Speech Therapy, Nursing), there will be
multiple clinical supervisors. How often you meet with your supervisor/s will vary
depending on your experience, geographical location and so on. You may meet
with your line manager once a week, once a fortnight or once a month. This should
be a regular meeting. Reporting back to your clinical supervisors should occur as
needed after each task. This is very important for feedback.
For the purpose of this section, we will look at clinical supervision. In order for
supervision to be effective and beneficial, it is essential that everyone understands
what their responsibilities are. It is the responsibility of your clinical supervisor/the
treating Health Professional to ensure that the task they ask you to do is an
appropriate one. For example, it would not be appropriate for a Speech Pathologist
to ask you to create a program of swallowing exercises for a client to do at home, as
this task clearly falls under the scope of a registered Speech Pathologist. However,
it would be appropriate for you to implement a program once it has been developed
by the Speech Pathologist. Your supervisor also needs to make sure you have the
appropriate qualifications or training to carry out the task they are delegating.
Good communication is essential for the supervisory relationship to work. Your
supervisor needs to ensure the task and their expectations are clearly explained to
you. It is you’re your supervisor’s and your responsibility to make sure that you
understand what is being asked of you. By agreeing to carry out a task, you are
accepting accountability for that duty. If you feel you do not have the appropriate
skills or training to carry it out, it is important that you tell the Health Professional. It
is okay to tell them that you would not feel comfortable in undertaking that task as
you do not feel experienced enough, or that you don’t believe you have enough
training in that area.
Feedback is a very important part of the communication process that cannot be
overlooked. Due to the nature of community rehabilitation, as an ACRA you will
often be working with clients in their home independently. It is your responsibility to
provide feedback to the treating health professional regarding the client’s progress.
You may not necessarily be in contact with your supervisor everyday, so
routine client updates may only occur every few days or even once a week.
However if there was a safety issue or if an incident had occurred, this would
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need to be reported to the treating health professional as soon as possible. For
example, if a client had a fall whilst you were working with them, the supervisor
would need to be informed as soon as the client had been attended to. Whilst the
supervisor will not always be physically there, you should always be able to contact
them. If a supervisor is not going to be available, another health professional
should be assigned as the contact person. It is therefore essential that you work
with your supervisor to develop a communication plan that is going to work for both
of you.
Scope of the ACRA role
As this is a new role, and an advanced one, there will be certain tasks and duties
that you will undertake as an ACRA that other support level workers cannot. Having
this advanced role is a wonderful opportunity as it will allow a better and more
efficient service delivery. However it is essential that you have a clear
understanding of the limits of your role so that you do not perform tasks outside
your scope. In addition to your ACRA Role Description/Position Description, you
should also have access to a task list. These two documents should clearly outline
what tasks or duties are within the scope of your role. When starting in the ACRA
role, it would be a good idea to go through these documents with your supervisor so
that you are clear with what is expected. You can also always refer back to these
documents if you are unsure about a task.
Professional Conduct
There are many behavioural aspects that contribute to working in a professional
manner. Some of these include;
 Respect for your colleges and clients
 Confidentiality- refer to the section in this workbook on confidentiality
 Professional Boundaries- It is inappropriate to enter into a personal
relationship with a client. If you develop strong positive or negative feelings
towards a client, this could impact upon the service you provide and could be
detrimental to the client’s health care. If you find yourself in this situation you
should discuss it with your supervisor as it may be in the client’s best interest
if you cease working with them.
 A commitment to professional development- ACRAs have a responsibility to
maintain their level of clinical competence and strive to continually improve
their level of skill and knowledge.
Activity
Consider the tasks listed below and whether you think they fall into the role of the
Health Professional or the ACRA or both. Write the Health Professional tasks in the
circle on the left and the ACRA tasks in the circle on the right. List the tasks that are
within the scope of both Health Professionals and ACRAs, in the overlapping section.
Discuss your responses with your supervisor.
Tasks:
 Initial Assessment of a client
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Conducting screening test eg. 9 hole peg test
Home visits
Discharging a client
Referral to a Doctor
Monitoring of a home programme
Assisting client to access public transport
Writing discharge report
Documenting a client visit in the medical chart
Reporting on client progress at case conference
Work with client to achieve leisure goals
Health Professional
ACRA
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CHART DOCUMENTATION
Documenting client interventions is an important part of our job. It allows all
members of the team to keep up-to-date with the progress of a client and informs
them of any important occurrences. A client’s medical record is a very important
document and provides a basis for a number of purposes including:
 Effective communication within the health team
 Evaluation of patient care
 Research
 Quality assurance
 Risk management
 Medico-legal defence
 Administration
 Best clinical practice.
It is therefore important to ensure that all chart entries are in accordance with the
District’s standards. This document will help to familiarise you with these standards.
The Format of a Chart Entry
 Ensure every page/form you write on has a client ID sticker placed in the
allocated spot in the top right hand corner.
 All entries and alterations are to be made in blue or black ball point pen. Do not
use ink, pencil or liquid. Writing must be clearly legible.
 The date and time (24 hour time) of the chart entry is to be written in the left
hand margin provided, at the start of the entry. Your designation should be
written at the start of the entry.
 At the end of the chart entry sign your name, followed by your surname printed
in brackets
 If you make an error, draw a single line through each line of the entry, making
sure the original inaccurate notation is still legible. Date and initial the change.
In the margin state the reason why the entry has been replaced. Eg. Written in
error, wrong/ different client.
 At the end of a paragraph, or where nothing else is to be written, a line should
be drawn to the edge of the page.
What to Include
 When and where the client intervention occurred. For example in the clients
home at 1430HRs on the 23/6/07; or a telephone conversation at 0945Hrs on
the 06/06/07.
 The name of the treating therapist who asked you to see the client
 Be sure to document any reaction a client may have and how you addressed it
 Only standard, approved abbreviations and symbols from The Australian
Dictionary of Clinical Abbreviation, Acronyms and Symbols are to be
used.
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What Not to Include
 Any interpretation of clinical assessments (this is the role of the therapist)
 Any subjective comments, entries are to be kept objective. For example, it
would be inappropriate to write “Mr Jones was grumpy today” but it is okay to
write “Mr Jones told me he was irritable today”.
 Any derogatory or unprofessional comments
**Did you know …?
Patients can access their medical chart under the Health Information Disclosure &
Access
Policy or the Freedom of Information Act. This means clients can
read anything you write about them in the chart. Another important point to
remember is that anything you write could potentially be read in court.
Activity
Look up your District’s policy and procedure on clinical documentation
 Clinical Documentation Policy RCHSDPol0054
 Clinical Documentation Procedure RCHSDProc00110v2
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Sample Chart Entry
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CONFIDENTIALITY
As health care providers we are privy to a lot of personal and private information
about our clients. It is very important that we respect our clients’ privacy and do not
divulge any confidential information without their consent. Consider the following
example:
You are conducting a home visit to a client, Mrs Hamilton. One of her
neighbours, Mr Baker, is also a client of yours. Mr Baker has multiple
sclerosis which has recently flared up and has required him to use a
wheelchair. During Mrs Hamilton’s home visit, she appears to be very
concerned about her neighbour and says to you, “I saw you visit Mr Baker
yesterday and I noticed that he is in a wheelchair! He’s such a lovely man, I
hope he’s okay. What happened to him?”
How do you think you would respond to Mrs Hamilton? Even though you think she
is a very kind and caring lady and appears genuinely concerned about Mr Baker, it
would be a breach of confidentiality to tell Mrs Hamilton anything about Mr Baker’s
situation. Write down what you think you would say to Mrs Hamilton.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Some other points that are important to remember with respect to patient
confidentiality are:
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Ensure medical charts are not left in public areas where anyone could
access them
If discussing a client’s progress with another member of the team, ensure the
discussion cannot be overheard by others
Do not discuss any aspects of a client’s condition or rehabilitation plan with
anyone outside the team without the client’s consent
If you ever become concerned or suspicious that a client (or a child living
with the client) is being abused, you should raise the matter with the treating
health professional immediately
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COMPUTER SKILLS
With technology and computer literacy an increasingly crucial aspect of everyday
life, it's becoming more important to stay current with this essential technology.
Having a basic understanding of a computer and electronic services can help you to
work more efficiently and effectively.
What sort of tasks would an Advanced ACRA use the computer for?
 Communicate and network via email
 Accessing information about the district and Queensland Health eg. Policies
and procedures, district forms, complete PRIME Clinical Incidents forms etc
 Create resources for clients eg. handouts
 Participate in education by accessing or developing a power point
presentation
 Record data on a spreadsheet
… the list could go on forever! However if you’re not very confident with your
computer skills, there is no need to be concerned because training is available.
What training is available?
Queensland Health provides training sessions on the use of the electronic
resources available to staff. Some of the courses available are:

Computer Awareness
o Differentiate between the different components of the computer/network
setup
o Understand procedure to gain access to the network
o Log in/out of the network
o Understand data saving fundamentals
o Demonstrate good posture while keyboarding
o Understand the importance of regular rest breaks and exercises for
keyboard work
o Identify the different keypads on the keyboard
o Identify standard features on the desktop
o Activate shortcut menus
o Search on-line help
o Basic file management

Novell GroupWise
o Identify different components of Novell GroupWise
o Understand and be able to send Electronic Email
o Create and edit a Group
o Receive and respond to information sent through GroupWise
o Maintain received items
o Tracking items
o Understand and send notes and tasks
o Maintain a personal calendar
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o Set preferences for User Access
o Proxy into other user’s calendar

QHEPS (Queensland Health Intranet)
o Demonstrate search function
o Demonstrate the use of ADOBE ACROBAT
o Discuss favourite function
o Create folders and items in favourites folder
o Print information from the database
o Discuss approved Internet sites
o Overview of District Policies and Procedures
o Overview of Industrial Relations manual

Microsoft Word Basic
Getting to know your way around a document including –
o Creating, opening, saving and closing a document
o Modify page set-up and insert and modify tabs
o Layout and design
o Work in different views
o Formatting/improving the presentation of a document
o Open, work within and close multiple documents
o Format characters, align, indent, bullet and number paragraphs
o Border and shade paragraphs, use AutoCorrect and format Painter
features

Microsoft Excel Basic
o Getting started
o Creating, opening, saving and closing your workbook
o Working with multiple workbooks
o Selecting cells and moving around your workbook
o Creating and utilising Auto-fill features
o Formatting your worksheet
o Sizing, inserting and deleting rows, cells and columns
o Constructing basic formulae
o Layout
o Viewing the work sheet and preparing your workbook to print
o Customising the header and footer
 Microsoft PowerPoint
o Create presentation using the Auto Content Wizard
o View your presentation in different ways
o Create, open, save and close presentations
o Format your presentation
o Add, delete and copy slides
o Customise individual elements
o Apply global changes to your presentation
o Apply transitions and builds to your presentation
o Work with pictures, drawing objects and colour schemes
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o Electronic presentation effects
o Printing your presentation
Contact your District Library or local Facilitator for session details.
Activity
1. The following websites, which are very relevant to the ACRA position, can be
accessed either through QHEPS or via the internet. Access each of the websites
and have a look at the information and services they provide;
 National Stroke Foundation
 Disability Services Queensland
 TransLink
 Life Tec
2. Develop a short PowerPoint presentation (maximum of 5 slides) on your role (ie.
an ACRA) and present it to the team you work with.
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HOME OR COMMUNITY VISITS
Conducting home and community visits will be an important part of your role as an
ACRA. When going on home visits it is important to remember that you are a guest
in the client’s home and you need to respect their home and its contents. When
conducting visits, safety must be given the highest priority for staff and clients. You
will, at times, need to be particularly flexible, resourceful and self-sufficient.
A lot of planning and organisation is involved when preparing for a home or
community visit. The following checklist will help you ensure the visit runs smoothly.
Preparing for the visit
 Contact client to arrange a time for the visit and explain the purpose of the visit
to them
 Request that any dogs be restrained for the visit
 Book a car for the visit
 Prepare any equipment and documentation required
 Ensure you have a street directory or map of the area and a mobile phone
 Take contact phone numbers for clients and emergency contact phone
numbers
 Leave details of your travel destination your expected time of return at your
work base. Also ensure they have your mobile contact details
When on a visit it is important to watch for hazards to your own and/or others’ health
and safety. Appropriate action should be taken to control risk in accordance with
your District’s policies and procedures.
When returning from a visit, ensure that you notify your workplace of your return.
You should then document all aspects of the home visit in line with organisational
protocol. Be sure to promptly report any areas of concern to the treating Health
Professional. Any arrangements for follow up visits should also be recorded.
Important information, particularly for rural and remote visits
You may be visiting clients where you will need to travel large distances away from
your work base, and where there are few people. It is necessary, therefore, to be
prepared before you leave your work base and have a good understanding of the
area you are to travel. It would also be an advantage if you have some working
knowledge of vehicle maintenance including how to change a tyre, and check the oil
and water levels of your vehicle
Below is a safety check list which should be covered prior to leaving for a home or
community visit:
 Check distances to travel and expected time of travel
 Take relevant road map/directory
 Check Mobile phone coverage or take satellite phone if necessary
 Check UHF radio channels and channels for area ( if needed)
21





Know the type of roads that have to be traveled e.g. bitumen/dirt/gravel/all
weather
Contact client/family member and give them an estimated time of arrival
Check that you have all necessary equipment ( as it will be too far to go back
to get it, if forgotten)
Prior to leaving ,check safety of travel due to rain/other poor weather
conditions
Prior to leaving, check that your car is well serviced, has a good spare tyre
and full of fuel
Always take with you:
 Road map/directory of area you are traveling in
 List of Outreach towns/indigenous communities serviced (if applicable)
 List of phone contacts in each town/community
 List of relevant client phone contacts
 Mobile/satellite phone
 UHF radio (if necessary)
Activity
Read your District’s policy on home and community visits (see attachment C)
22
CULTURAL DIVERSITY AND AWARENESS
Australia has a diverse population with a wide range of needs. In the past
Australians expected other people to conform to the dominant Anglo-Australian
culture, but now cultural differences are celebrated.
In Queensland in 2002 the population was made up of:






people from 117 birthplaces
3.1% indigenous peoples
16% of people born overseas
7.3% people from a Non English Speaking Background
11.5% of people who spoke a language other than English at home
and 17.2% of Queenslanders had one or more parents born overseas
(http://www.health.qld.gov.au/sop/content/cultural_diversity.asp 2.10.2007)
Culture and past experience can result in people viewing health and illness in varied
ways and with different expectations. When providing a health care to a client,
aspects to consider include the way a client is addressed, culturally significant
events or situations and who is present during this intervention.
Queensland Health has developed the Aboriginal and Torres Straight Islander
Cultural Awareness Program, with training mandatory for all staff. The aim is to
equip staff with the cultural knowledge required to provide appropriate health care to
Indigenous clients. If you haven’t done this training you will need to do it as soon as
possible.
The website www.health.qld.gov.au/multicultural/ contains some useful links
relevant to cultural diversity, including information about specific cultural groups.
23
EQUIPMENT
You are going to come across a lot of equipment during your work as an Advanced
Assistant. Below are some photos of some of the equipment you are likely to
encounter frequently. Keep in mind that as there are many brands of equipment, the
aids used by your team might look quite different to the photos below!
Walking Sticks/Canes
Wheelchairs
Wheeled Walker
Over toilet frame
Shower Chairs
24
Toe Wiper
Pick Up Frame
Bath Board
Canadian Crutch
Activity Life Tec provides information and advice on
assistive technology available to help individuals improve
their quality of life and remain independent. If you are in
Brisbane, a visit to the centre would be very informative. www.lifetec.org.au
Axillary Crutches
25
EQUIPMENT USED IN SCREENING TOOLS
Grip Strength Dynamometer
Pinch Gauge
Pulse Oximeter with Finger Probe
Activity Go to the equipment area in your department and identify what each piece of
equipment is used for.
26
COMMUNITY REHABILITATION COMPETENCY DOMAINS
Competency Domain
Descriptors
-
1
2
Frameworks of understanding
Consumer Engagement
-
-
3
4
Holistic Focus
-
Service continuity
-
Understanding, implementing and evaluating practice against recognised theoretical frameworks
that underpin CR e.g. The ICF
Understanding, implementing and evaluating practice using recognised models of delivery e.g.
case management/case coordination
Recognising the client as central to every process
Promoting client understanding, choice, control and engagement in their own health and
wellbeing
Incorporating consumer need and consumer preference
Recognising that needs of individuals extend beyond immediate physical health issues and
incorporate social and emotional health
Recognise situational, environmental, family, Carer and community influences on Consumers
Incorporate clients’ physical, emotional and social needs in the specific context, environment or
situation
Coordination of support for Clients through transition points e.g. discharge from hospital,
metropolitan back to rural community
27
5
6
7
8
-
Ability to identify and mitigate risks in transition
Ability to incorporate following-up and monitoring with recognition of long-term outcomes
-
Ability to engage and work in a teams
Ability to build partnerships/establish networks - share information, and collaborate
Ability to practice in inter-disciplinary ways that capitalise on the strengths of other disciplines
and recognise the limitations of one’s own capacity.
Coordination of whole packages of service delivery and addressing gaps in service systems
Cultural Awareness
-
Demonstrating an awareness of cultural differences
Practicing in ways that accommodate culture and local knowledge
Adapting and accommodating to different knowledge-bases or perspectives
Accepting and valuing different styles of living.
Community Engagement:
-
Engaging with local communities in a respectful and trusting way
Understanding and investing in the local community to become a trusted partner
Recognising how individuals live and function within a community
Appreciating a collective way of operating and investing in the community
-
Maintaining professional boundaries and keeping a “separateness of self” within one’s practice of
CR (despite consumer and community engagement)
Ability to work safely and prevent injury or illness arising from work by applying good workplace
health and safety principles
Networks
Boundaries and Safety
-
28
9
Reflective Practice
-
Managing competing demands on one’s time, recognising constraints and limitations, monitoring
and prioritising workload while maintaining the principles of CR
-
Thinking creatively to solve problems, prioritise, and plan through difficult and diverse tasks by
using local solutions, a creative use of resources and a flexible approach to problems
Ability to manage complicated tasks such as supervising and training family members, Carers or
support personnel
Acquiring knowledge to support good practice, and disseminating knowledge meaningfully in the
community
-
10
Systems Advocacy
-
Advocating to make changes that improve services for client
Recognising that community rehabilitation requires advocates who can lobby systems for
recognition, resources and respect
29
MOTIVATING CLIENTS TO ACHIEVE THEIR GOALS
Goal setting is an important part of any rehabilitation plan. Goals extend beyond
physical health issues to social and emotional health needs. They also recognise
environment, family and community influences. Research has shown that involving
clients in the setting of goals for their rehabilitation program has many benefits.
Some of these include:

Creating a focus for the client

Facilitating the communication between the health care provider and
the client

Providing a way to measure progress

By involving the client in the goal setting process they are more likely
to take ownership of the goal and have the motivation to work towards
achieving it

Giving clients some control and engagement in the management of
their health
Being able to achieve goals after an injury is an important step towards
independence.
It is the responsibility of the treating Health Professionals to establish rehabilitation
goals with the clients. As an ACRA, an important part of your role will be to
motivate, encourage and work with clients to achieve these goals.
Motivation can mean many things. It can be a desire to act on a goal and to have
the energy to do it, or to have an attitude to do something and want to do it. It can
be about commitment and drive, achievement, success and change. Levels of
motivation can fluctuate and often depends on the importance of the issue or task at
hand.
Motivational interviewing is a specialised technique that can be use to help motivate
people to change and might be effective with some clients who have behavioural
barriers to achieving their potential in rehabilitation. It relies very much on the client
coming to a commitment to change themselves. The therapist’s or health worker’s
opinions are not made apparent and in fact they speak very little. It involves probing
the client on an issue to bring about self –confrontation and then resolution to
change.
There are a number of other communication strategies that you should use when
working with clients. Some of these include:
1. Listen to the client. In order for a client to open up to you, they need to know that
you are listening to them.
Active listening and reflective listening are two very useful techniques that allow
you to convey to the client that you are listening as well as clarifying and
checking the meaning of what the client has said. Active listening involves
you repeating back in your own words what the client has said to ensure you
30
understand them. This doesn’t mean you agree with them, just that you
understand what was said. Unfortunately when working with clients, we can
misinterpret what they say, or even just assume what they need. Reflective
listening acknowledges that the client has a deep understanding of themselves
allows you to convey empathy. In reflective listening you may use phrases such
as “So you feel..”, “It sounds like…” or “You’re wondering if…” to check the
meaning of what a client has said and to clarify their feelings.
2. Show acceptance and understanding. Whilst a client’s values and beliefs may
differ to your own, it is important to respect and accept their decisions and not to
judge them.
3. Refer to the goals. During sessions, reinforce the importance of what you are
doing by discussing how it will help to achieve the goals the client set with the
health professional. Discuss the consequences of not doing the rehabilitation
plan and give the responsibility back to the client.
4. Avoid arguments or resistance. In order to get the most out of your sessions with
a client, it is important to foster a positive relationship.
Activity
Book into one of the Goal Setting or Motivational Interviewing training sessions run
by the Training and Development Officers – refer to Appendix A.
Try to put reflective listening into practice in everyday conversations. Next time you
find yourself in a conversation with someone where you have differing views,
instead of arguing with them, pause for a moment and try reflecting back to them
what they are saying. Whilst doing this, also ask a question or two until they are
satisfied that you have heard them accurately. Hopefully you will find that two
things have occurred, firstly, the person may be more willing to hear your point of
view. Secondly, you will have a better understanding of theirs.
31
PRIORITISATION OF WORKLOAD
In your role as an ACRA it is likely that you will be working with a number of clients
as part of your case load, as well as carrying out other activities as part of your
duties. Working with multiple health professionals means that you will often have
several people requesting you to do tasks on the same day. In order to address
this, priortising and planning your workload will be an important activity you will
need to do every day. Prioritisation can assist with:

managing your workload;

time management; and

ensuring clients with the greatest need are seen first.
Without prioritisation, it is easy to feel stressed in the face of so many tasks that
need to be done.
When priortising your caseload and planning your day, there are a few questions
you should ask yourself:

Does this request/job fall within the scope of my role?

Will the safety of this client be at risk if this task is put off until later?

Did the health professional who asked me to do this task say it was urgent?

Does the team use prioritisation categories and if so what is the category of
this task?
Learning to prioritise is a skill that develops with education and experience. If you
are unsure about the urgency of a task, discuss the job with the treating health
professional or your supervisor, in relation to the rest of your workload.
Communicating with your team about your workload is important as it enables them
to see what tasks you have been given by other the other health professionals and
helps them to avoid overloading you. If at any stage you are feeling overloaded or
stressed due to your workload, be sure to raise the issue with your supervisor or
line manager.
Activity
You work in a multidisciplinary team and each health professioal has given you a
task to undertake (listed below). You realise that you will not be able to get to all of
the tasks that day so you decide to prioritise your workload to help you plan your
day. Prioritise the list and explain your reasoning.

The Occupational Therapist has asked you to conduct a community access
visit with a client, to assist them to access the local library.

There is a weekly Assistants meeting where you discuss procedural
matters. It is not a clinical meeting.
32

The Speech Therapist has asked you to research what communication
groups exist in the local area and compile a list for the community resource
folder.

The Physiotherapist has asked you to conduct a home visit to deliver a
mobility aid to a client who has had a number of falls, and instruct them on
how to use it.

The Team Leader has suggested you visit Life Tec to see what aids and
supports are available to clients.
__________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
33
ACQUIRED BRAIN INJURY AND STROKE
There are a number of medical conditions that you will encounter whilst working
with clients in community rehabilitation. Acquried brain injury or ABI is a term used
to describe all types of brain injuries that occur after birth. Some of the more
common ABIs include stroke, brain tumours and traumatic brain injuries.
A stroke, also now as a cerebrovascular accident (CVA), refers to a group of
diseases that affect the arteries that supply blood to the brain. There are two main
types of stroke:
1. Ischaemic stroke- when the artery supplying blood to the brain suddenly
becomes blocked by a clot or plaque. This accounts for about 85% of all
strokes
2. Haemorrhagic stroke- when the artery supplying blood to the brain suddenly
suddenly breaks or bursts and starts bleeding. This makes up around 15%
of all strokes.
When the blood supply to the brain is interrupted, brain cells begin to die and can
result in permenant brain damage. This area of dead brain cells is referred to as an
infarct.
A stroke can have many effects. Some of the common ones include:

Paralysis- A stroke will often cause weakness (hemiparesis) or paralysis
(hemiplegia) on one side of the body, usually on the opposite side to the
infarct. For example, if someone has a (L) CVA, it will usually be the right
side of their body that is affected.

Cognitive changes- changes in thinking skills/ memory/ concentration and
attention

Altered sensory awareness

Continence problems

Communication and swallowing difficulties – refer to Attachment D for a fact
sheet on communication problems following a stroke.

Balance and co-ordination difficulties

Altered behaviour- refer to Attachment D for a fact sheet on behaviour
changes following a head injury.

Emotional changes- depression/ problems adjusting to changes in abilities

Changes in personality
Recovery after a stroke can be a prolonged process however most of the brain’s
natural recovery process occurs within the first three to six months. This can be
enhanced by commencing therapy as soon as possible.
34
Following any form of ABI, a client may experience a number of changes and losses
in their life due to the effects of the injury. For example their ability to drive or work
may be affected. These changes further impact upon the client’s level of
independence and will also affect those close to them such as family members. It is
important to recognise that they are likely to experience a variety of emotions as a
part of their grieving process.
Infarcts due to stroke are often localised to one side of the brain, and may leave
many parts of the brain undamaged.
Injury to the brain due to trauma (TBI), such as that caused by a car accident or an
assault, is often more widesread and can affect many different parts of the brain.
Recovery after TBI is often slower than recovery after stroke. Most recovery still
occurs in the first 6 months after injury, but recovery can still be expected for a
further two years, or even more.
Many people with even a severe TBI make a good physical recovery, but are left
with ‘invisible impairments’, and in particular, permanent changes to thinking skills,
personality and behaviour. This means that you should not assume that a person
has had a ‘mild’ injury just because they look and sound fine.
Activity
1. Read the Understanding Behaviour Changes fact sheet by ABIOS
(Attachment D)
2. Read the Speech Pathology Australia Fact Sheet- Communication problems
following a stroke (Attachment E).
3. Refer to Attachment F for a glossary of terms commonly used when
discussing ABIs.
4. Explore the following websites

http://braininjury.org.au

http://www.health.qld.gov.au/abios/

http://www.strokefoundation.com.au/
35
ACKNOWLEGEMENTS
The Community Rehabilitation Workforce Project would like to acknowledge the
following resources in the development of this workbook.
Acquired Brain Injury Outreach Service (ABIOS) webite.
http://www.health.qld.gov.au/abios/ Accessed 17/12/2007.
Acquired Brain Injury Outreach Service (ABIOS). 2007. Goal Setting After Brain
Injury.
http://www.health.qld.gov.au/abios/documents/behaviour_mgt/goal_setting.pdf
Accessed 30/10/2007.
Ashton, L. and S. Myers. 2004. Serial Grip Strength Testing – Its Role in
Assessment of Wrist and Hand Disability. The Internet Journal of Surgery.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol5n2/strength.xml
accessed 22/10/2007.
Australian Physiotherapy Association Code of Conduct. 2007. Australian
Physiotherapy Association.
BrainLink website. http://www.brainlink.org.au/index.htm Accessed 17/12/2007.
Brain Injury Association of Queensland website. http://braininjury.org.au Accessed
7/1/2008.
Clinical Development Education Service website.
http://cdes.learning.medeserv.com.au/products/HI4390/HI4390_enrolled.cfm
accessed 1/10/2007.
Clinical Documentation Procedure, Redcliffe-Caboolture Health Service District,
2005.
Clinical Documentation Policy, Redcliffe-Caboolture Health Service District, 2005.
Code of Ethics. 2001. Occupational Therapy Australia.
Cultural Awareness Program website.
http://hi.bns.health.qld.gov.au/rbh/community_health/cap/cap_cultural_awareness.h
tm#Indigenous%20Culture%20Fact%20Sheet accessed 30/10/2007.
Cultural Diversity website.
http://www.health.qld.gov.au/sop/content/cultural_diversity.asp accessed
30/10/2007.
Daily Living Products website. http://www.ca.com.au/daily/wheels.html
accessed 22/10/2007.
36
Dunbar-Jacob, J. 2007. Models for Changing Patient Behaviour. American Journal
of Nursing. 107(6):20-25.
Mobility Store website.
http://www.mobilitystore.co.uk/catalogue/index.php?cPath=21_32
accessed22/10/2007.
Multicultural Health site. http://www.health.qld.gov.au/multicultural/default.asp
accessed 15/10/2007.
National Stroke Foundation website. http://www.strokefoundation.com.au/ accessed
7/1/2008.
Northside Health Service District Library site.
http://qheps.health.qld.gov.au/redcab/SDETU_Courses/Computer-training.pdf
accessed 10/9/2007.
Respironics website. http://model512and513.respironics.com/ accessed
22/10/2007.
Speech Pathology Australia fact sheet – Communication Problems Following A
Stroke
Wikipedia website. http://en.wikipedia.org/wiki/Pulse_oximeter accessed
22/10/2007.
37
ATTACHMENT A – TRAINING SCHEDULE
VIDEOCONFERENCE DATES
Expressions of Interest, including information about the course and how to enrol, will be
circulated closer to the training dates. For further information on the training please feel free
to email or call the contact person listed next to the training.
TOPIC
DATE
LOCATION
Preparing
Written
Material
Tuesday 13th
November
2007
Thursday 6
December
2007
Wednesday 30
January 2007
Videoconference 1pm –
3pm
CONTACT PERSON &
DETAILS
Rachael Byrne
Ph. 4920 7934
Videoconference 1pm –
3pm
Rachael_Byrne@health.qld.
gov.au
Thursday 14
February
Videoconference 10 am –
12pm
Tuesday 25
March 2007
Videoconference 10am –
12pm
Friday 18
April 2007
Videoconference 10am –
12pm
Wednesday 14
May 2007
Videoconference 1pm –
3pm
Videoconference 1pm –
3pm
38
TOPIC
DATE
Goal Setting
& Motivation
Wednesday
17th October
2007
Tuesday 11th
December
2007
Wednesday
30th January
2008
Tuesday 19th
February 2008
Wednesday
26th
March 2008
Tuesday 29th
April 2008
LOCATION
CONTACT PERSON &
DETAILS
Videoconference 10.30am- Faith Lucas
12.30pm
Ph. 3360 4802
Videoconference 10.30am- Faith_Lucas@health.qld.go
v.au
12.30pm
Videoconference 10.30am12.30pm
Videoconference 10.30am12.30pm
Videoconference 10.30am12.30pm
Videoconference 10.30am12.30pm
TOPIC
DATE
LOCATION
Demand
Management
Monday 19th
November
2007
Videoconference 10am
– 12pm
Wednesday
23rd January
2008
Videoconference 11.00
am – 1.00pm
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
Wednesday
5th March
2008
Videoconference 9am –
11am
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
Thursday 3rd Videoconference 10.30
April 2008
am – 12.30pm
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
Friday 2nd
May 2008
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
Videoconference
1.00pm – 3.00pm
CONTACT PERSON &
DETAILS
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
39
TOPIC
DATE
LOCATION
Community
Rehab/Research
and Evaluation
Friday 2nd
November
2007
Friday 9th
November
2007
Friday 7th
December
2007
Friday 14th
December
2007
Videoconference
Session 1
CONTACT PERSON &
DETAILS
Glenda Blackwell Ph. 4799
9538
Videoconference
Session 2
Glenda_Blackwell@health.
qld.gov.au
Videoconference
Session 1
Videoconference
Session 2
NB: There are two sessions within this topic; Session 1 – Introduction to Planning,
Session 2 – Introduction to Methods. It is not necessary to attend both sessions if you
are unable. The first session is not a prerequisite to attend the second.
TOPIC
DATE
LOCATION
CONTACT PERSON &
DETAILS
Margaret MacDonald
Ph. 4799 9535
A guide to
advocacy for
community
rehabilitation
workers
Monday 24th
September
2007
Tuesday 30th
October 2007
Tuesday 5th
February 2008
Tuesday 18
March 2008
Videoconference
10.30am – 12.30pm
Videoconference
1.00pm – 3.00pm
Videoconference
10.30am – 12.30pm
Videoconference
1.30pm – 3.30pm
Margaret_MacDonald@hea
lth.qld.gov.au
TOPIC
DATE
LOCATION
CONTACT PERSON &
DETAILS
40
Influencing those
who make policy
decisions: A
guide to systems
advocacy
Monday 12
November
2007
Tuesday 29
January 2008
Monday 25
February 2008
Friday 1 March
2008
Tuesday 1
April 2008
Tuesday 6 May
2008
Videoconference 10am
– 12noon
Madeline Avci
Ph. 3360 4802
Videoconference
10.30am – 12.30pm
Videoconference
1.30pm – 3.30pm
Videoconference
10am – 12pm
Videoconference
10.30am – 12.30pm
Videoconference
1.30pm – 3.30pm
Madeline_Avci@health.qld.g
ov.au
41
WORKSHOP DATES AND VENUES
Expressions of Interest, including information about the course and how to enrol, will be
circulated closer to the training dates. For further information on the training please feel free
to email or call the contact person listed next to the training.
TOPIC
DATE
LOCATION
Mental Health
Awareness in
the Physically
Impaired +
Mental Health
Act
Tuesday 23rd
October 2007
Tuesday 6th
November 2007
Tuesday 20th
November 2007
Tuesday 12th
February 2008
Tuesday 11th
March 2008
Cairns
Mt Isa
Toowoomba
Rockhampton
CONTACT PERSON &
DETAILS
Faith Lucas
Ph. 3360 4802
Faith_Lucas@health.qld.gov.au
Margaret Macdonald Ph. 4799
9535
Margaret_MacDonald@health.q
ld.gov.au
Brisbane
TOPIC
DATE
LOCATION
Networking &
Peer Group
Learning
Wednesday 17
October 2007
Wednesday 24
October 2007
Wednesday 31
October 2007
Thursday 1
November 2007
Brisbane
Rockhampton
CONTACT PERSON &
DETAILS
Karen Bell
Ph. 4616 5531
Karen_Bell@health.qld.gov.au
Cairns
Townsville
ONLINE TRAINING
The following package is available online for you to complete at your own pace, at a time
that suits you. For information about the package and how to log on click on the link below.
Clinical Education Training Package
http://qheps.health.qld.gov.au/ahwac/content/cetp.htm
UPCOMING WORKSHOPS/TRAINING SESSIONS
The following sessions will be added to the training schedule once dates and venues and
form of delivery have been decided upon.


Community/Consumer Engagement
Cultural Awareness
42
ATTACHMENT B - ABBREVIATIONS
Abbreviations can often be found in medical charts for frequently used words. Whilst
they can save time, it is very important that only approved and accurate abbreviations
are used, so that chart entries can be correctly understood. Below is a list of approved
abbreviations that you may frequently come across in Community Rehabilitation.
(Abbreviations obtained from The Australian Dictionary of Clinical Abbreviation,
Acronyms and Symbols).
Rx
PT
OT
CVA
MI
ABI
HI
SCI
W/C
PUF
SPS
ROM
Dx
DVA
R; (R); Rt; rt
L; (L); lt
R/V; RV
Mx
Hx
pt
HV
↑
↓
1/52
1/12
12/12
+ve
-ve
F; ♀
M; ♂
Treatment
Physiotherapy/Physiotherapist
Occupational Therapy/Therapist
Cerebrovascular Accident (Stroke)
Myocardial Infarct (Heart Attack)
Acquired Brain Injury
Head Injury
Spinal Cord Injury
Wheelchair
Pick Up Frame
Single Point Stick
Range of motion/movement
Diagnosis
Department of Veterans Affairs
Right
Left
Review
Management
History
Patient
Home Visit
Increase/Increasing
Decrease/Decreasing
One week
One month
One year
Positive
Negative
Female
Male
**NOTE: Neither CR for Community Rehabilitation, nor HEP for Home Exercise
Program are listed in The Australian Dictionary of Clinical Abbreviation, Acronyms and
Symbols and therefore CANNOT be used**.
43
ATTACHMENT C- HOME VISIT POLICY OR PROCEDURE
44
ATTACHMENT D – UNDERSTANDING BEHAVIOUR CHANGES
(ABIOS)
http://www.health.qld.gov.au/abios/documents/behaviour_mgt/understand_changes.pdf
45
ATTACHMENT E –COMMUNICATION PROBLEMS FOLLOWING A STROKE
(SPEECH PATHOLOGY AUSTRALIA FACT SHEET)
http://www.speechpathologyaustralia.org.au/library/31_FactSheet.pdf
46
ATTACHMENT F – GLOSSARY
(Definitions obtained from http://braininjury.org.au/portal/component/option,com_glossary/Itemid,363/ on 7/1/2008).
Agnosia -
A disorder of recognition from injury to higher order information
processing cells which can result in an inability to recognise or
distinguish faces or objects.
Agraphia -
Inability to write that can arise from trauma to areas of brain
responsible for cognitive or motor skills necessary to write.
Akinesia -
Inability to move ("freezing") due to problems selecting and activating
muscle programs in the brain.
Aphasia -
Difficulty understanding or expressing language as a result of damage
to the brain.
Apraxia -
Inability to voluntarily perform skilled movements.
Ataxia -
Abnormal movements due to the loss of coordination of the muscles.
Bradykinesia - The slowing down and loss of voluntary movement and speech.
Brain Stem - The lower extension of the brain where it extends to the spinal cord.
Neurological functions located in the brain stem include those
necessary for survival (breathing, heart rate) and for arousal (being
awake and alert).
Cerebral Cortex - The outer layer of the brain, responsible for cognitive processes
including reasoning, mood, perception of stimuli and other thought
processes.
Diffuse Brain Injury- Injury to cells in many areas of the brain rather than in one
specific location.
Disinhibition - Lack of control over impulses due to frontal lobe trauma. Anti social
behaviours that arise usually lead to social isolation.
Dysarthria - Speech impairment resulting from damage to the nerves and areas of
the brain that control the muscles used in forming words.
Dyskinesia - An impaired ability to make voluntary movements, resulting in
uncoordinated or involuntary movements.
Dysphagia - Difficulty with swallowing.
Dysphasia - Difficulty understanding or expressing language as a result of damage
to the brain.
Dyspraxia - Difficulty performing voluntary movements not due to weakness but
because of motor coordinating problems.
Emotional Lability - Repeated, rapid, abrupt shifts in emotion that are not related to
external stimuli.
Focal Brain Injury - Injury restricted to one region (as opposed to diffuse).
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Frontal Lobe - The region of the brain directly behind the forehead. Responsible for
planning, organising, problem solving, selective attention, personality
and a variety of “higher cognitive functions”. Damage can cause
changes to personality, problems with spoken language and impaired
social skills.
Haematoma - A collection of blood in an organ, space or tissue, due to a break in
the wall of a blood vessel.
Hemianopia - Blindness in the same sides of both eyes which can follow damage to
the brain. This can cause an inability to see on the left or right side.
Hemiparesis - Weakness, partial paralysis or loss of movement that only affects one
side of the body.
Hemiplegia - Paralysis of one side of the body. May be associated with spasticity increased muscle tension and spasms.
Hypoxia -
An insufficient supply of oxygen to cells of the body. May result in cell
death if severe.
ICP -
Intracranial Pressure: A measure of the amount of pressure inside the
skull from brain tissue, blood and cerebrospinal fluid. Increased
pressure is a sign of intracranial hemorrhage or cerebral swelling that
can lead to secondary brain injury.
Impulsivity - A tendency to rush into something without thinking or reflecting first.
Occipital Lobe - Region in the back of the brain which processes visual information.
Damage to this lobe can cause visual deficits.
Parietal Lobes - Left and right lobes located in the middle and top of the brain.
Responsible for visual attention and processing, spatial awareness,
touch perception and manipulation, voluntary movements, and the
integration of different senses. Damage can cause difficulty with
identifying or naming objects, difficulty with writing or mathematics and
difficulty with motor coordination or being aware of space and
distance.
Proprioception - The sensory awareness of the position of body parts with or without
movement.
Shunt -
An apparatus designed to remove excessive fluid from the brain. A
surgically placed tube which transfers fluid into either the abdominal
cavity, heart or large veins of the neck.
Spasticity -
An involuntary increase in muscle tone (tension). An involuntary
increase in muscle tone (tension).
Temporal Lobes - Two lobes, one on each side of the brain located at about the
level of the ears. Responsible for interpreting and understanding
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sounds, categorisation of objects, some visual processing and short
and long term memory. Damage can result in impaired memory,
hearing and recognition of objects.
Tracheostomy - This is a breathing tube inserted through the middle of the neck just
below the voice box. Through this tube an adequate air passage can
be maintained. It may be necessary to leave the tube in the windpipe
for a prolonged period.
Brain Map
(accessed from http://www.health.qld.gov.au/abios/asp/brain.asp on 7/1/2008).
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