national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
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6.3.2 Sources<br />
● teach the patient and, if necessary, carers how to maintain health<br />
● provide clear in<strong>for</strong>mation on how to contact the service <strong>for</strong> reassessment<br />
● outline what specific events or changes should trigger further contact<br />
● consider referral to communication support services, if the patient has persistent<br />
aphasia, to pursue compensatory strategies to enhance their communication.<br />
A–B Consensus; see section 3.12<br />
C Consensus<br />
6.3.3 Implications<br />
Stopping treatment when it is no longer beneficial should save resources. Circumstances<br />
may alter so it is essential to have a simple method whereby the patient can return <strong>for</strong><br />
reassessment. The existence of such a system will facilitate the stopping of therapy but it<br />
has implications <strong>for</strong> the commissioning of services. The NICE multiple sclerosis guideline<br />
(National Institute <strong>for</strong> Health and Clinical Excellence 2003) has a similar<br />
recommendation.<br />
6.4 Motor control – reduced movement, weakness and incoordination<br />
Impaired motor control after <strong>stroke</strong> includes sequelae such as lack of coordination in<br />
movement, loss of selective movement, and lack of motor control. Weakness (impaired<br />
motor control) on one side (hemiparesis) is a hallmark of <strong>stroke</strong>, but in fact only affects<br />
80% of patients. Nonetheless, it is probably the single most disabling factor, certainly in<br />
terms of limiting mobility.<br />
6.4.1 Recommendations<br />
A All patients should be assessed <strong>for</strong> motor impairment using a standardised approach<br />
to quantify the impairment, eg the Motricity Index.<br />
B All patients with significant loss of motor control (ie sufficient to limit an activity)<br />
should be assessed by a therapist with experience in neurological rehabilitation.<br />
C Any patient with persistent motor impairment should be taught exercises or activities<br />
that will increase voluntary motor control and strength.<br />
6.4.2 Sources<br />
A–C Consensus<br />
6.5 Sensation<br />
6 Recovery phase from impairments and limited activities: rehabilitation<br />
Sensory loss after <strong>stroke</strong> is a recognised impairment. Reported prevalence rates vary,<br />
some estimating that up to 80% of people have loss or alteration in various somatic<br />
sensations – touch, position sense, temperature, pain, etc (Doyle et al 2010). The severity<br />
of sensory loss is associated with the extent of motor loss, and so the independent<br />
© Royal College of Physicians 2012 81
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