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NICE guidance

Rehabilitation for patients after stroke

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NICE has issued guidance on how to support the long-term rehabilitation and care of people living with stroke

Citation: Thelwell S (2013) Rehabilitation for patients after stroke. Nursing Times; 109: 35, 17.

Author: Sue Thelwell is stroke services coordinator, University Hospitals Coventry and Warwickshire Trust.

Introduction

Stroke is a major health problem in the UK with approximately 125,000 people each year in England, Wales and Northern Ireland having a first or recurrent stroke. Most people survive a first stroke but often have significant morbidity. There are currently more than 900,000 people in England living with the effects of stroke.

Since the 1960s, the number of people who survive a stroke has been increasing steadily. This has largely been due to the development of stroke units, thrombolytic “clot-busting” drugs and the reorganisation of stroke services. Despite these improvements, over 30% of stroke survivors will have persisting disability and need effective rehabilitation services.

NICE guidance

The National Institute for Health and Care Excellence has developed a clinical guideline on long-term rehabilitation for people who have had a stroke (NICE, 2013). While it does not cover every aspect of rehabilitation in detail, the guideline reviews some of the available interventions that can be used in stroke rehabilitation.

Rehabilitation services

The guideline states that people with disability after stroke should receive rehabilitation in a dedicated stroke inpatient unit. They should also receive follow-up care from a specialist stroke team in the community. An inpatient stroke rehabilitation service should provide access to other services that may be needed, such as continence advice, dietetics, electronic aids (remote controls for doors, lights and heating, and communication aids), liaison psychiatry, orthoptics, podiatry, wheelchair services and a multidisciplinary education programme.

The guideline recommends that inpatient stroke rehabilitation services should be provided by a core multidisciplinary team who have the knowledge, skills and behaviours to work with stroke survivors and their families and carers to manage the changes experienced as a result of a stroke. The team should include nurses, physiotherapists, occupational therapists and speech and language therapists, as well as consultant physicians, clinical psychologists, rehabilitation assistants and social workers.

Admission

In order to ensure the immediate safety and comfort of patient with acute stroke, the guideline recommends that the following should be assessed and managed on admission to hospital as quickly as possible:

  • Orientation;
  • Positioning, moving and handling;
  • Swallowing;
  • Transfers (for example, from bed to chair);
  • Pressure area risk;
  • Continence;
  • Communication, including the ability to understand and follow instructions and to convey needs and wishes;
  • Nutritional status and hydration.

A full medical assessment of the patient should be performed; this should include assessment of cognition (attention, memory, spatial awareness, apraxia, perception), vision, hearing, tone, strength, sensation and balance.

Discharge

Early supported discharge is highlighted as a key part of a skilled stroke rehabilitation service. The guideline recommends that it should be offered to patients who are able to transfer from bed to chair independently or with assistance, as long as they are being discharged to a safe and secure environment. To that end, the guideline recognises the importance of health and social care professionals working collaboratively to ensure a social care assessment is carried out promptly, where needed, before stroke survivors are transferred from hospital to the community.

NICE also recommends that before transfer from hospital, a health and social care plan is discussed and agreed with the patient and family or carer, and provided to all relevant health and social care professionals.

In addition, the guideline recognises the importance of providing comprehensive information, including a summary of rehabilitation progress and current goals, functional abilities (including communication needs), cognitive and emotional needs and medication needs.

Summary

The guideline emphasises the importance of careful multidisciplinary assessment and treatment in stroke rehabilitation, and provides guidance to support the long- term rehabilitation and care of people living with the effects of stroke.

As well as recognising the benefits of a range of stroke rehabilitation interventions that are targeted and relevant to the individual, the guideline also highlights where there are gaps in the evidence to support best practice, and signposts the way for appropriate research projects to address these.

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Readers' comments (1)


  • Hello everyone.
    I want to use this medium to share of the Goodness of God in helping me recover of Stroke. In 2002 November 8 I had my first Stroke, After returning from my friends house, immediately I was rushed to the Community health Care. The neurologist said that I had been having "mini-strokes" or "Trans Ischemic Attacks (TIA's)" for years. All the physicians agreed that a congenital heart problem called Atrial Septal Defect was causing the strokes. After the first major stroke, however, I was not well enough to undergo the corrective heart surgery. First, I would have to build strength and endurance through physical therapy, The right-sided strokes had rendered the left side of my body numb to the touch, heavy, and extremely uncoordinated. Peripheral vision was permanently damaged. It was difficult to stay awake, least of all alert. The brain stem swelling caused imbalance, dizziness, and at times a slowing of respiration. Stroke affected vital pathways in my brain, causing constant electric-like pain on the left side of my body.

    After the second stroke,I was placed on machines aided life support and the doctors tried all they could but I wasn't recovering they decided i give a traditional herbal doctor a try, since all they have done to revive me was to no avail. My Children took me back home and reach out to my friends and family for help. luckily for them A college friend of mine had a uncle who was a traditional herbal doctor; "Dr kpomosa" he base in Indianapolis IN and has helped so many people all over the world with his herbal formula ; so they said. My Children were reluctant to give his herbal formula for stroke a try, they needed me to get well by any means necessary because there mum died of Cancer years Ago. They were willing to go any Length for a cure. Well to God be the Glory Dr kpomosa was a God sent, he placed me on his medication, although he wasn't present, but with his instructions my children where able to administer his medication that was sent via Transworld express delivery. His medication was a huge miracle, it was like he had my brain refreshed, my brain began to have control over my body system,3 months after completing dr kpomosa herbal formula, I regained the ability to walk, speak clearly and drive very well. To God alone I give all the glory and am for ever grateful to Dr kpomosa for being a hand of God in my Life.

    Sorry for the long note;
    I want people to think back to Natural herbs, that's why am sharing this.i believe God has hidden the solutions to all sickness and diseases in Natural herbs and root that we don't pay much attention to. Am a living testimony of Natural herbs and root. If you or a loved one is going through a deadly diseases that seems impossible to cure totally, believe me root and herbs is the Solution. You can reach Dr kpomosa on his Facebook page "Dr kpomosa home of relief" or his Whats-app +1(850)677-1291 for all in need of a permanent cure to stroke or any other Chronic disease like Cancer that took my beloved wife. Dr kpomosa is hope for all. Like Dr Kpomosa would say 'to every problem there is a solution".

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