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

4.15 Early mobilisation 56
4.16 Positioning 57
4.17 Nutrition: feeding, swallowing and hydration 57
4.18 Bowel and bladder 58
5 Secondary prevention 61
5.0 Introduction 61
5.1 Identifying risk factors 61
5.2 A personalised, comprehensive approach 62
5.3 Lifestyle measures 63
5.4 Blood pressure 65
5.5 Antithrombotic treatment 66
5.6 Lipid-lowering therapy 70
5.7 Carotid stenosis 72
5.7.1 Management of symptomatic carotid stenosis 72
5.7.2 Management of asymptomatic carotid stenosis 74
5.8 Treatment of unusual causes of stroke 75
5.8.1 Vertebral artery disease 75
5.8.2 Intracranial arterial disease 75
5.8.3 Patent foramen ovale 75
5.8.4 Cerebral venous sinus thrombosis 76
5.8.5 Cervical artery dissection 76
5.8.6 Antiphospholipid syndrome 76
5.9 Oral contraception 77
5.10 Hormone replacement therapy 77
6 Recovery phase from impairments and limited activities: rehabilitation 79
6.0 Introduction 79
6.1 General principles of rehabilitation 79
6.2 Rehabilitation treatment quantity (intensity of therapy) 80
6.3 Evaluating and stopping treatments 80
6.4 Motor control – reduced movement, weakness and incoordination 81
6.5 Sensation 81
6.6 Exercise 82
6.7 Arm re-education 83
6.8 Gait retraining, treadmill retraining, walking aids (including orthoses) 84
6.9 Balance impairment and risk of falling: assessment and intervention 85
6.10 Impaired tone – spasticity and spasms 87
6.11 Splinting (to prevent and treat contractures) 88
6.12 Biofeedback 89
6.13 Neuromuscular electrical stimulation (including functional electrical stimulation) 90
6.14 Acupuncture 90
6.15 Robotics 91
6.16 Repetitive task training 91
Contents
© Royal College of Physicians 2012 v