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

days per week, at a level that enables the
patient to meet their rehabilitation goals for as
long as they are continuing to benefit from the
therapy and are able to tolerate it.
B The team should promote the practice of skills
gained in therapy in the patient’s daily routine
in a consistent manner and patients should be
enabled and encouraged to practise that
activity as much as possible.
C Therapy assistants and nurses should facilitate
practice under the guidance of a qualified
therapist.
Prehospital care (4.1.1)
E All patients with residual neurological signs
and symptoms should remain nil by mouth
until swallow screening has been conducted.
Initial, early rehabilitation assessment
(4.13.1)
A All patients should be assessed within a
maximum of 4 hours of admission for their:
● ability to swallow, using a validated swallow
screening test (eg 50 ml water swallow)
administered by an appropriately trained
person
● immediate needs in relation to positioning,
mobilisation, moving and handling
● bladder control
● risk of developing skin pressure ulcers
● capacity to understand and follow
instructions
● capacity to communicate their needs and
wishes
● nutritional status and hydration
● ability to hear, and need for hearing aids
● ability to see, and need for glasses.
Nutrition: feeding, swallowing and
hydration (4.17.1)
A Patients with acute stroke should have their
swallowing screened, using a validated
screening tool, by a trained healthcare
professional within 4 hours of admission to
Speech and language therapy concise guide for stroke 2012
hospital, before being given any oral food,
fluid or medication, and they should have an
ongoing management plan for the provision
of adequate hydration and nutrition.
B All patients should be screened for
malnutrition and the risk of malnutrition at
the time of admission and at least weekly
thereafter. Screening should be undertaken by
trained staff using a structured assessment
such as the Malnutrition Universal Screen
Tool (MUST).
C All people with acute stroke should have their
hydration assessed on admission, reviewed
regularly and managed so that normal
hydration is maintained.
F Nutritional support should be initiated for
people with stroke who are at risk of
malnutrition. This may include oral
nutritional supplements, specialist dietary
advice and/or tube feeding.
G People with dysphagia should be given food,
fluids and medications in a form that can be
swallowed without aspiration following
specialist assessment of swallowing.
[H] Routine oral nutritional supplements are not
recommended for people with acute stroke
who are adequately nourished on admission
and are able to take a full diet while in
hospital.
General principles of rehabilitation (6.1.1)
A All patients entering a period of rehabilitation
should be screened for common impairments
using locally agreed tools and protocols.
B Patients should be informed of realistic
recovery prospects and should have realistic
goals set.
C Specific treatments should only be
undertaken in the context of, and after
considering, the overall goals of rehabilitation
and any potential interactions with other
treatments.
D For any treatments that involve significant
risk/discomfort to the patient and/or resource
use, specific goals should be set and
© Royal College of Physicians 2012 173
Speech and language therapy concise guide for stroke 2012