Find out more about the experiences of current and former students, and how courses offered by the Melbourne School of Health Sciences have benefitted them.
Cassandra Sim graduated from the Master of Social Work in 2015 from the University of Melbourne. Cassandra completed her undergraduate degree in the Bachelor of Commerce. Here in this video, Cassandra shares about student life and experience as a Social Work student. Hear why she has chosen Social Work as a postgraduate pathway.
Chris Graven, a physiotherapist at St. Vincent’s Hospital, is enrolled in the Department of Social Work in the Melbourne School of Health Sciences. Even though she is a physiotherapist, the issues around depression and participant engagement and support are central to her PhD, meaning that this PhD also aligns well with the field of social work.
Targeting meaningful goals to facilitate recovery after stroke
Chris Graven, PhD graduate, Melbourne School of Health Sciences
Level of disability after a stroke may range from mild impairment, to more debilitating cognitive and physical deficits that can render people unable to talk, walk, sit, or even roll in bed. Unsurprisingly, this can have and impact on people’s mood and depression is common post-stroke.
The good news: targeted rehabilitation services that aim to assist people to resume meaningful activities and screen for arising issues can aid people in their recovery after stroke.
The bad news: feeling down can impact rehabilitation and recovery – and yet often healthcare professionals are reluctant to open that ‘can of worms’, and when they do, they do not always know how to address the situation.
This is one of the findings that has arisen out of Chris Graven’s PhD, entitled: ‘From rehabilitation to recovery: a model to optimise consumer and carer involvement’.
Chris, a physiotherapist at St. Vincent’s Hospital, is enrolled in the Department of Social Work in the Melbourne School of Health Sciences. Even though she is a physiotherapist, the issues around depression and participant engagement and support are central to her PhD, meaning that this PhD also aligns well with the field of social work. She encourages people to think broadly when approaching supervisors with their potential PhD topic – and not necessarily consider only the school or department of their particular discipline. Students considering a graduate research degree do not need to have a particular topic in mind, but can talk broadly about their research interests with staff in the School of Health Sciences, with the option of joining in with an established research group and program in the School.
Chris was approached to do her PhD by Associate Professor Lynette Joubert, the chief investigator of the ARC funded project, and Dr Kim Brock, an experienced researcher and clinician at St. Vincent’s Hospital. Chris has had the benefit of working in many hospital and community-based multi-disciplinary teams, such as rehabilitation units, aged care settings, and Polio Services Victoria. “If you keep the patient and their goals at the centre of your work, it is easier to work in multidisciplinary teams, as these inform your common direction. Patient-centred practice is a key concept in rehabilitation practice”, she says.
In the course of her PhD, Chris has conducted a randomised control trial, monitoring 110 patients for a year after the event of their stroke. She is based at St. Vincent’s Hospital and has individually followed up each of the patients in the intervention arm of the study.
“Our main interest has been in monitoring depression and participation status as an indicator of recovery in the first year after the stroke. Patients are also screened for adverse sequelae and how they are going generally in terms of falls, complications, and their mood. We are taking a more holistic approach to get an overview how people are managing after stroke” she explains.
The Geriatric Depression Scale was used to screen people, placing them on a scale from 1 – 15. “It’s not a definitive diagnosis of depression but is an indicator of low mood. We’ve found that if you don’t ask, people won’t readily tell you if they are feeling down or depressed” says Chris. “Management of post-stroke depression is important, and collaborative goal-setting and ongoing facilitation to achieve these goals may provide an element of hope and support, which may have implications on a person’s overall mood.”
Another aspect of Chris’ PhD has been to explore the concept of ‘recovery’ in focus groups. Chris explains “As therapists treating stroke patients, we can become very focused on a person’s basic mobility and self-care activities”. A clinician may note in a patient’s assessment: “increased spasticity in the right arm”, but for that patient it means “I can’t cook any more.” Goals, and hence interventions, need to be framed around pursuing activities that are valued and intrinsically motivating for that individual, whilst concurrently also addressing underlying impairments. The challenge is to align clinicians’ management and interventions with patients’ concepts of recovery.
Chris Graven’s research findings have helped to inform and develop a Chronic Stroke Resource Kit – with sponsorship from the Victorian Stroke Clinical Network. “This is also an attempt to guide clinicians in the management of patients in the chronic phase post-stroke, and to rethink how they set goals during community-based episodes of care,” says Chris. As it is not possible to go out and educate all rehabilitation clinicians, a ‘train the trainer’ forum was recently held, and a pilot study has been commenced to evaluate the effectiveness of the toolkit. Hopefully this resource kit will make this knowledge accessible to all clinicians, including those working in regional and rural centres, so that optimal management and outcomes are achieved for patients experiencing ongoing issues related to their stroke.
Another aspect that has been of interest during Chris’ PhD is the role that carers undertake after stroke. “Carers can be integral for a successful recovery and we encourage them to participate in collaborative goal-setting, and remain engaged in the rehabilitation process” says Chris.
“The majority of carers do an amazing job, but they can also be a barrier to recovery,” she adds. “By trying to prevent risk, they may curtail a person’s activities and prevent them from trying to do things which they may still be capable of doing,” she says. “As appropriate, carers should to be included in the goal-setting process, so that they can support rather than hinder the pursuit of goals, and share the journey towards recovery.”
Chris was attracted to the idea of doing a PhD when her three children were young as a way to continue working and furthering her career. “It’s been challenging at times to keep everything in balance and the PhD has taken somewhat longer than I would have liked, but the workplace and University have been very supportive,” Chris says.
Chris, who continues to work four days a week in clinical practice, has been bitten by the research bug: “It’s opened my eyes to the possibilities in answering difficult questions in the clinical setting and to what’s really important. Additionally, the challenge continues to lie in translating research into meaningful practice. It’s about developing a questioning attitude,” she says.