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

Occupational therapy concise guide for stroke 2012
National clinical guideline for stroke
receptive aphasia. In patients with more severe
aphasia, an assessment tool designed
specifically for this purpose, such as the SAD-Q
or DISCS, should be used. In patients with
aphasia or other impairments that complicate
assessment, careful observations over time
(including response to a trial of antidepressant
medication if considered necessary) should be
used.
F Within Step 2 care, patients identified as
having symptoms of mood disorder should be
offered a more detailed assessment, seeking
information on past history, potential causes
and impact, and treatment preferences.
G In patients with mild or moderate symptoms of
mood disorder, patients and carers should be
provided with information, support and advice
about the mood disorder as the first line of
intervention. This may be from within the
multidisciplinary team by nominated staff who
are suitably trained and supervised, and may
also involve the voluntary sector.
H Within Step 3 care, patients with severe or
persistent symptoms of mood disorder should
be considered for referral to a specialist in the
management of mood disorder in stroke.
J Any patient assessed as having a cognitive
impairment should be considered for referral
to a specialist in cognitive aspects of stroke.
K Patients identified as having cognitive
impairment or mood disorder should be
reassessed before discharge decisions are
taken.
Fatigue (6.37.1)
A Fatigue in medically stable patients should be
assessed particularly where engagement with
rehabilitation, or quality of life is affected.
B Patients with fatigue and their families should
be given information and reassurance that the
symptom is likely to improve with time.
Attention and concentration (6.39.1)
A Any person after stroke who appears easily
distracted or unable to concentrate should have
their attentional abilities (eg focussed,
sustained and divided) formally assessed.
B Any person with impaired attention should
have cognitive demands reduced through:
● having shorter treatment sessions
● taking planned rests
● reducing background distractions
● avoiding work when tired.
C Any person with impaired attention should:
● be offered an attentional intervention (eg
Time Pressure Management, Attention
Process Training, environmental
manipulation), ideally in the context of a
clinical trial
● receive repeated practice of activities they
are learning.
Memory (6.40.1)
A Patients who complain of memory problems
and those clinically considered to have
difficulty in learning and remembering should
have their memory assessed using a
standardised measure such as the Rivermead
Behavioural Memory Test (RBMT).
B Any patient found to have memory
impairment causing difficulties in
rehabilitation or undertaking activities should:
● 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
150 © Royal College of Physicians 2012