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

medically unstable, by an appropriately trained
healthcare professional with access to
appropriate equipment.
C People with stroke should be offered frequent
opportunity to practise functional activities
(eg getting out of bed, sitting, standing, and
walking) by an appropriately trained healthcare
professional.
Positioning (4.16.1)
A Healthcare professionals should be given
training on how to position patients correctly
after stroke.
B When lying and when sitting, patients should
be positioned in such a way that minimises the
risk of complications such as aspiration and
other respiratory complications, shoulder
pain, contractures and skin pressure
ulceration.
C People with acute stroke should be helped to
sit up as soon as possible.
Lifestyle measures (5.3.1)
B All patients should be advised to take regular
exercise as far as they are able:
● Exercise programmes should be tailored to
the individual following appropriate
assessment, starting with low-intensity
physical activity and gradually increasing to
moderate levels.
● All adults should aim to be active daily
and minimise the amount of time spent
being sedentary (sitting) for extended
periods.
● For adults over the age of 19 years, this
activity should add up to at least 150
minutes of moderate intensity, over a week,
in bouts of 10 minutes or more (eg 30
minutes on at least 5 days per week). They
should also engage in muscle strengthening
activities at least twice per week.
● For older people at risk of falls, additional
physical activity which incorporates balance
and coordination, at least twice per week, is
also recommended.
Evaluating and stopping treatments
(6.3.1)
C When a therapist or team is planning to stop
giving rehabilitation, the therapist or service
should:
● discuss the reasons for this decision with
the patient and carer
● ensure that any continuing support that the
patient needs to maintain and/or improve
health is provided
● teach the patient and, if necessary, carers
how to maintain health
● provide clear information on how to
contact the service for reassessment
● outline what specific events or changes
should trigger further contact
● consider referral to communication support
services, if the patient has persistent
aphasia, to pursue compensatory strategies
to enhance their communication.
Motor control – reduced movement,
weakness and incoordination (6.4.1)
A All patients should be assessed for motor
impairment using a standardised approach to
quantify the impairment, eg the Motricity
Index.
B All patients with significant loss of motor
control (ie sufficient to limit an activity)
should be assessed by a therapist with
experience in neurological rehabilitation.
C Any patient with persistent motor impairment
should be taught exercises or activities that will
increase voluntary motor control and strength.
Sensation (6.5.1)
Physiotherapy concise guide for stroke 2012
A All patients should be assessed for alteration in
sensation. If indicated, a more formal
assessment of sensory loss should be
undertaken (eg using the Nottingham Sensory
Assessment, Erasmus medical centre version).
B Any patient who has sensory loss should be
taught how to take care of the limb and avoid
injury.
© Royal College of Physicians 2012 155
Physiotherapy concise guide for stroke 2012