national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
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3.5.1 Recommendation<br />
3.5.2 Source<br />
A Any patient with a <strong>stroke</strong> who cannot be admitted to hospital and who is not<br />
receiving palliative care should be seen by the specialist teams at home or on an<br />
outpatient basis within 24 hours <strong>for</strong> diagnosis, treatment, rehabilitation, and risk<br />
factor reduction at a standard comparable to other patients.<br />
A Consensus<br />
3.6 Stroke services <strong>for</strong> younger adults<br />
Stroke occurs at all ages and a significant number (about 25%) are aged under 65 years.<br />
Some younger adults feel that general <strong>stroke</strong> services, of which the majority of users are<br />
older adults, do not meet their needs. For example, younger adults are more likely to have<br />
a specific and unusual cause <strong>for</strong> their <strong>stroke</strong>, prognosis may be different, rehabilitation<br />
may require specific and specialised attention to work prospects and bringing up<br />
children, and social needs may be different.<br />
Thus, although all <strong>stroke</strong> services should respond to the particular needs of each<br />
individual patient, regardless of age or other factors, it is appropriate to draw attention<br />
to this group of patients. A separate guideline covering <strong>stroke</strong> in children has been<br />
produced (Paediatric Stroke Working Group 2004).<br />
3.6.1 Recommendations<br />
A Younger adults who have had a <strong>stroke</strong> should be managed within specialist medical<br />
and rehabilitation services that:<br />
● recognise and manage the particular physical, psychological and social needs of<br />
younger patients with <strong>stroke</strong> (eg vocational rehabilitation, childcare activities)<br />
● are provided in an environment suited to their specific social needs.<br />
B People who had a <strong>stroke</strong> in childhood and require healthcare supervision on reaching<br />
adulthood should have their care transferred in a planned manner to appropriate<br />
adult services.<br />
3.6.2 Sources<br />
A Consensus<br />
B Consensus; Department of Health 2005<br />
3.6.3 Implications<br />
3 Organisation of <strong>stroke</strong> services<br />
These recommendations can most easily be fulfilled by a specialist neurological<br />
rehabilitation service as such services generally, though not exclusively, focus on people of<br />
working age. Each locality (health economy) should already have a specialist neurological<br />
rehabilitation service (<strong>for</strong> example to comply with the NICE guidance on services <strong>for</strong><br />
people with multiple sclerosis (National Institute <strong>for</strong> Health and Clinical Excellence<br />
© Royal College of Physicians 2012 25
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