national-clinical-guidelines-for-stroke-fourth-edition

B Any patient found to have memory impairment causing difficulties in rehabilitation
or undertaking activities should:
6.40.2 Sources
● be assessed medically to check that there is not another treatable cause or
contributing factor (eg delirium, hypothyroidism)
● have their profile of impaired and preserved memory abilities determined (as well
as the impact of any other cognitive deficits on memory performance, for example
attentional impairment)
● have nursing and therapy sessions altered to capitalise on preserved abilities
● be taught approaches that help them to encode, store and retrieve new information,
for example, spaced retrieval (increasing time intervals between review of
information) or deep encoding of material (emphasising semantic features)
● be taught compensatory techniques to reduce their prospective memory problems,
such as using notebooks, diaries, electronic organisers, pager systems and audio alarms
● have therapy delivered in an environment that is as similar to the usual
environment for that patient as possible.
A Consensus
B Hildebrandt et al 2006; Hildebrandt et al 2011; das Nair and Lincoln 2007; Fish et al
2008; consensus
6.41 Spatial awareness (eg neglect)
Disturbance of spatial awareness refers to a group of behaviours where the patient acts as
if they had reduced or absent knowledge about (or awareness of) some part of their
person or environment, usually the left side. Other terms used include neglect,
visuospatial neglect, and sensory inattention. It is more common in people with right
hemisphere brain damage, and is usually associated with hemianopia.
Evidence to recommendations
Recommendations have not changed greatly since the previous edition of the National
clinical guideline for stroke (2008) when they were based on consensus opinion and one
Cochrane review (das Nair and Lincoln 2007). Eight trials have since been published: four
testing visual scanning training, and four using eye patching or prisms to alter the visual
image. Some of these suggest promise, in terms of short-term changes on impairment but
not activity level measures. However, they are mostly small (underpowered) pilot trials,
lacking longer-term follow-up, functional measures, and clear reporting of research
methods (high risk of bias). Adequately powered randomised controlled trials, including a
usual care comparator, would greatly improve the evidence base.
6.41.1 Recommendations
6 Recovery phase from impairments and limited activities: rehabilitation
A Any patient with a stroke affecting the right cerebral hemisphere should be considered
at risk of reduced awareness on the left side and should be tested formally if this is
suspected clinically.
© Royal College of Physicians 2012 119