Diagnosis

• n/a

Investigation

• n/a

Management

• MDT stroke rehabilitation team should comprise the following with expertise in stroke rehab:
  • Consultant physicians
  • Nurses
  • Physiotherapists
  • Occupational therapists
  • Speech and language therapists
  • Clinical psychologists
  • Rehabilitation assistants
  • Social workers
• Transfer from Hospital
• Offer early supported discharge if able to transfer from bed to chair independently or with assistance, as long as a safe and secure environment can be provided
• Before transfer from hospital to home or care setting, discuss & agree a health and social care plan, and that they have a safe and enabling home environment (i.e. adaptations made)

Stroke Rehabilitation

• Screen for:
  • Orientation
  • Positioning, moving and handling
  • Swallowing
  • Transfers (for example, from bed to chair)
  • Pressure area risk
  • Continence
  • Communication, incl. ability to understand, follow instructions and convey needs wishes
  • Nutritional status and hydration
• Perform full medical assessment: incl. cognition, vision, hearing, tone, strength, sensation, balance
• National Institutes of Health Stroke Scale
• Barthel Index
• Goal Setting: Meaningful and relevant focussing on activity and participation
• Offer initially at least 45 minutes of each relevant stroke rehabilitation for min 5 days/week

Cognitive Functioning

• Screen for cognitive defects
• Assess visual neglect and offer interventions to help scan to neglected side e.g. highlighting
• Assess memory and offer interventions such as elaborative techniques, diaries, lists
• Attention deficit

Emotional function

• Refer to appropriate services, manage anxiety and depression

Visual problems

• Eye movement therapy or orthoptic assessment

Swallowing

• Offer swallowing therapy 3 x week, for as long as they make functional gains

NICE Source: CG162 Stroke rehabilitation in adults. Summary compiled by Dr D P Sheppard MBBS.