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

Primary care concise guide for stroke 2012
National clinical guideline for stroke
should be assessed by a therapist with
experience in neurological rehabilitation.
Pain management (6.19.1.1)
B All patients complaining of, or experiencing
pain, should have the cause of the pain
diagnosed.
C Patients should be referred to a specialist pain
service if, after the local service has tried
management, the patient’s pain is:
● still severe and causing distress and not
controlled rapidly, or
● still leading to significant limitation on
activities or social participation.
Neuropathic pain (central post-stroke
pain) (6.19.3.1)
A Every patient whose pain has been diagnosed
by someone with appropriate expertise in
neuropathic pain should be given oral
amitriptyline, gabapentin or pregabalin as firstline
treatment.
Musculoskeletal pain (6.19.4.1)
A Any patient with musculoskeletal pain
should be carefully assessed to ensure that
movement, posture and moving and
handling techniques are optimised to reduce
the pain.
B Any patient continuing to experience pain
should be offered pharmacological treatment
with simple analgesic drugs taken regularly.
Swallowing problems: assessment and
management (6.21.1)
I Any stroke patient discharged from specialist
care services with continuing problems with
swallowing food or liquid safely should:
● be trained, or have carers trained, in the
identification and management of
swallowing difficulties
● should have regular reassessment of their
dysphagia beyond the initial acute
assessment to enable accurate diagnosis and
management
● should have their nutritional status and
dietary intake monitored regularly by a
suitably trained professional.
Nutrition: assessment and management
(6.23.1)
C Nutritional support should be initiated for all
stroke patients identified as malnourished or at
risk of malnutrition. This may include
specialist dietary advice, oral nutrition
supplements, and/or tube feeding.
Bowel and bladder impairment (6.24.1)
D Stroke patients with troublesome constipation
should:
● have a prescribed drug review to minimise
use of constipating drugs
● be given advice on diet, fluid intake and
exercise
● be offered oral laxatives
● be offered rectal laxatives only if severe
problems remain.
Extended activities of daily living
(domestic and community) (6.26.1)
A Any patient whose activities have been limited
should be:
● assessed by an occupational therapist with
expertise in neurological disability
● taught how to achieve activities safely and
given as many opportunities to practise as
reasonable under supervision, provided
that the activities are potentially
achievable
● assessed for, provided with and taught how
to use any adaptations or equipment
needed to perform activities safely.
Driving (6.27.1)
B The person or team responsible for any stroke
patient who wishes to drive should:
164 © Royal College of Physicians 2012