Stroke rehabilitation in adults - NICE guideline

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Stroke units

• People with disability after stroke should receive rehabilitation in a dedicated stroke inpatient unit and subsequently from a specialist stroke team within the community.

The core multidisciplinary stroke team

• A core multidisciplinary stroke rehabilitation team should comprise the following professionals with expertise in stroke rehabilitation:

  • consultant physicians
  • nurses
  • physiotherapists
  • occupational therapists
  • speech and language therapists
  • clinical psychologists
  • rehabilitation assistants
  • social workers.

Health and social care interface

• Health and social care professionals should work collaboratively to ensure a social care assessment is carried out promptly, where needed, before the person with stroke is transferred from hospital to the community. The assessment should:

  • identify any ongoing needs of the person and their family or carer, for example, access to benefits, care needs, housing, community participation, return to work, transport and access to voluntary services
  • be documented and all needs recorded in the person's health and social care plan, with a copy provided to the person with stroke.

Transfer of care from hospital to community

• Offer early supported discharge to people with stroke who are able to transfer from bed to chair independently or with assistance, as long as a safe and secure environment can be provided.

Setting goals for rehabilitation

• Ensure that goal-setting meetings during stroke rehabilitation:

  • are timetabled into the working week
  • involve the person with stroke and, where appropriate, their family or carer in the discussion.

Intensity of stroke rehabilitation

• Offer initially at least 45 minutes of each relevant stroke rehabilitation therapy for a minimum of 5 days per week to people who have the ability to participate, and where functional goals can be achieved. If more rehabilitation is needed at a later stage, tailor the intensity to the person's needs at that time.

Cognitive functioning

• Screen people after stroke for cognitive deficits. Where a cognitive deficit is identified, carry out a detailed assessment using valid, reliable and responsive tools before designing a treatment programme.

Emotional functioning

• Assess emotional functioning in the context of cognitive difficulties in people after stroke. Any intervention chosen should take into consideration the type or complexity of the person's neuropsychological presentation and relevant personal history.

Swallowing

• Offer swallowing therapy at least 3 times a week to people with dysphagia after stroke who are able to participate, for as long as they continue to make functional gains. Swallowing therapy could include compensatory strategies, exercises and postural advice.

Return to work

• Return-to-work issues should be identified as soon as possible after the person's stroke, reviewed regularly and managed actively. Active management should include:

  • identifying the physical, cognitive, communication and psychological demands of the job (for example, multi-tasking by answering emails and telephone calls in a busy office)
  • identifying any impairments on work performance (for example, physical limitations, anxiety, fatigue preventing attendance for a full day at work, cognitive impairments preventing multi-tasking, and communication deficits)
  • tailoring an intervention (for example, teaching strategies to support multi-tasking or memory difficulties, teaching the use of voice-activated software for people with difficulty typing, and delivery of work simulations)
  • educating about the Equality Act 2010 and support available (for example, an access to work scheme)
  • workplace visits and liaison with employers to establish reasonable accommodations, such as provision of equipment and graded return to work.

Long-term health and social support

• Review the health and social care needs of people after stroke and the needs of their carers at 6 months and annually thereafter. These reviews should cover participation and community roles to ensure that people's goals are addressed.

You can read the guideline on NICE's website.