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

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Index A activities of daily living 104–106 extended 105 personal 104 acupuncture 90–91, 100 acute care 15, 20, 37–59 adaptations (personal and environmental) 109–111 adaptations/aids 14, 105 computers 98 walking 84, 86 aerobic fitness 82–83 alcohol 64 alteplase see thrombolysis amphetamine 123 anticoagulation 50–51 acute arterial dissection 50 atrial fibrillation 40, 51, 68 cerebral venous thrombosis 52 contraindications 69 deep vein thrombosis 55 new oral anticoagulants 45, 51, 69 reversal 48 secondary prevention 69 sinus rhythm 69 antidepressant drugs 114, 123 emotionalism 115 antihypertensive treatment 53, 65 antiphospholipid syndrome 76–77 antiplatelet treatment acute arterial dissection 50 acute ischaemic stroke 46 atrial fibrillation 69 secondary prevention 68, 69 transient ischaemic attack 42 anti-spastic drugs 88 antithrombotic treatment see anticoagulation and antiplatelet treatment secondary prevention 66–70 anxiety 57, 93, 113–114, 115 self-efficacy training 93 aphasia 97–98 assessment 97 psychological assessment modification 112 approach to therapy 31–34 goal setting 31–32 intensity 32–34 apraxia 121 apraxia (of speech) 99–100 arm slings 94 arm re-education 83–84 bilateral arm training 84 constraint induced movement therapy 84 arterial dissection 50, 76 anticoagulation 69 aspiration feeding 58 positioning 57 prehospital 39 silent 100 specialist assessment 101 aspirin atrial fibrillation 51, 69 deep vein thrombosis 55 intra cranial arterial disease 75 prehospital 39 pulmonary embolism 55 secondary prevention 51, 68 TIA 40, 42 atrial fibrillation 50, 67, 75 anticoagulation 51, 68 carotid artery stenosis 73 prehospital 39 secondary prevention 68 TIA 40 attention 117–118 audit 2, 16, 24, 28–29, 43, 73 B balance impairment 85–87 biofeedback 89–90 dysphagia 100 biopsychosocial 111 bladder management acute care 54, 58–59 continence aids 104 persistant urinary incontinence 21, 103–104 urinary catheter 59 blood glucose 19 physiological monitoring 53 blood pressure 19 physiological monitoring 53 secondary prevention 65–66 thrombolysis 53 TIA 43 body weight support 84 botulinum toxin 87 bowel management acute care 58–59 persistent faecal incontinence 104 brain imaging cerebral venous thrombosis 52 diagnosis of TIA 41 differentiation of TIA and stroke 4 intracerebral haemorrhage 48 timing 21, 44 bromocriptine 123 © Royal College of Physicians 2012 203
National clinical guideline for stroke C cardioembolic causes of stroke/TIA atrial fibrillation see atrial fibrillation patent foramen ovale 75–76 prosthetic heart valves 51 care home 128–129 carers 129–130 communication training 98, 99 discharge involvement 27 feeding guidance 101 goal setting 31 informal, unpaid 129–130 information giving 27, 28, 128 involvement with therapy 33 oral hygiene 102 stroke liaison worker 127 support needs 127–128 training/education 27, 79, 81, 98, 101 views of patients and carers 29 carotid angioplasty 73 carotid duplex ultrasound 73 carotid endarterectomy asymptomatic carotid stenosis 74 carotid imaging 42 carotid stenosis measurement 43 secondary prevention 72–74 timing 43 carotid stenosis blood pressure target 65 carotid endarterectomy see carotid endarterectomy carotid stenting 73, 74 asymptomatic carotid artery stenosis 74 casting spasticity 87 cerebral oedema 15 cerebral venous sinus thrombosis 52, 76 anticoagulation 69, 76 cholesterol dietary modification 64 target blood level 71 TIA 43 lowering drugs 71 clinical audit 2, 16, 24, 28–29, 73 clinical psychologist 23, 108 clopidogrel 75 secondary prevention 68 TIA 40 cognitive impairment apraxia 121 attention 117–118 executive functioning 122 general 116–117 memory loss 118–119 perception 120–121 screening 112, 117 spatial awareness (eg neglect) 119–120 commissioning 13–18 communication 96–100 aids 14, 98, 99, 100 aphasia 97–98 apraxia of speech 99–100 cognitive assessment 117 dysarthria 98–99 social interaction 108 support services 81 compression stockings 55 computed tomography 41, 45 TIA 41 consciousness level 44 aspiration risk 39 subarachnoid haemorrhage 4 consistency of fluids 101 constraint induced movement therapy arm training 84 continence aids 104 contraception 77 contractures 57, 87 splinting 88–89 cost effectiveness 15 acute care 16, 20 alteplase 47 counselling 27, 127 cueing 83 D data collection 28, 29 tools 26, 30 deep vein thrombosis 55–56 anticoagulants 55 aspirin 55 graduated support stockings 55 haemorrhagic stroke 56 prophylaxis 55 depression 34, 57, 108, 113–114 fatigue 115 pain 93 self-efficacy training 93 diabetes mellitus 44, 53 diagnosis acute ischaemic stroke 44–45 pre-admission 37–39 subarachnoid haemorrhage 49 TIA, specialist 41 TIA, initial 39–41 diet 58, 64, 101, 103 dietitian 23 dipyridamole secondary prevention 68 discharge 14, 27–28, 113 capacity for self-medication 62 early supported 27 equipment/aids 15, 27 home visits 27 palliative care 34 patients who remain dependent in some activities 27 patients with cognitive impairments/mood disorders 113, 117 patients with incontinence 104 protocols 27 transfer of care principles 26–27 204 © Royal College of Physicians 2012
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National clinical guideline for str
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The Royal College of Physicians The
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The Intercollegiate Stroke Working
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Conflicts of interest All working p
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Key recommendations Number Recommen
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Acknowledgements The Intercollegiat
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Glossary ABCD2 score Prognostic sco
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2 Commissioning of stroke services
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2.1.2 Implications needed by patien
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2.4 Commissioning rehabilitation se
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3 Organisation of stroke services 3
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symptoms who screen positive using
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● nursing staff specifically trai
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3.5.1 Recommendation 3.5.2 Source A
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3.8 Transfers of care - discharge f
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B Clinicians in all settings should
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E have protocols to guide the use o
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Evidence to recommendations It is r
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evidence from randomised trials is
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4 Acute phase care 4.0 Introduction
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E All patients with residual neurol
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esources to respond to the need. Pr
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D People with an acute non-disablin
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D Consensus; quality marker eight o
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[K] Any person with acute ischaemic
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prevent rebleeding are urgent. CT s
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anticoagulants including direct thr
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Evidence to recommendations Studies
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● risk of developing skin pressur
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4.16 Positioning Impairment of moto
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section covers only the immediate,
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7 Long-term management 7.0 Introduc
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● where appropriate refer the per
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experience appropriate to meet thei
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Profession-specific concise guideli
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● ensure that all relevant inform
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C People with stroke should be offe
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● avoiding the use of overhead ar
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Carers (informal, unpaid) (7.6.1) A
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● any continuing specialist treat
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Lipid-lowering therapy (5.6.1) B Al
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Occupational therapy concise guide
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C Bilateral arm training involving
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● be referred to a specialist in
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Page 176 and 177: Physiotherapy concise guide for str
Page 178 and 179: medically unstable, by an appropria
Page 180 and 181: numerical rating scale), the modifi
Page 182 and 183: Cognitive impairments - general (6.
Page 184 and 185: E Patients with suspected TIA who a
Page 186 and 187: Lipid-lowering therapy (5.6.1) A Al
Page 188 and 189: ● ask about and identify any abso
Page 190 and 191: formal review at least every 6 mont
Page 192 and 193: Depression and anxiety (6.35.1) A A
Page 194 and 195: Perception (6.42.1) A Any person wh
Page 196 and 197: days per week, at a level that enab
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Page 200: ● organising and supporting venue
Page 204 and 205: Appendix 1 Evidence table reviewers
Page 206 and 207: Appendix 2 Peer reviewers Commissio
Page 208 and 209: Dr Katerina Hilari City University
Page 210 and 211: QM7 Urgent response All patients wi
Page 212 and 213: References Abbott AL (2009) Medical
Page 214 and 215: Cirstea MC, Levin MF (2007) Improve
Page 216 and 217: Fung TT, Chiuve SE, McCullough ML,
Page 218 and 219: Koyuncu E, Nakipoglu YG, Dogan A, O
Page 220 and 221: Mitchell PH, Veith RC, Becker KJ, B
Page 222 and 223: Rothwell P, Eliasziw M, Gutnikov S,
Page 224: therapy for stroke inpatients. Clin
Page 229 and 230: National clinical guideline for str
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