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The Stroke Guidelines Explained

The brain is involved in almost everything we do, so injury to the brain through trauma or illness can have a wide range of effects. These vary from person to person, depending on the exact nature and severity of the injury.

The Stroke Guidelines

What are the stroke guidelines?

The stroke guidelines are clinical recommendations that aim to improve the quality of care for every adult and young person aged over 16 who has a stroke in the United Kingdom and the Republic of Ireland.

The guidelines offer advice for clinicians, families, and stroke survivors on three key questions: how people with stroke and suspected stroke should be cared for, when this care should be provided, and why it’s important at all levels of care, from pre-hospital treatment to long-term support.

Who made the guidelines?

The stroke guidelines were made by the Royal College of Physicians and the Intercollegiate Stroke Working Party. To create the updated guidelines, the team consulted medical literature from around the world and charities, health and social care professionals, university researchers, and people affected by stroke from Scotland, Ireland, England, Wales, and Northern Ireland.

What are the latest updates on when people suspected of, and after a stroke should be cared for?

After medical intervention, an appropriate rehabilitation pathway, as determined by patients’ goals and keeping in mind their impairments, should be selected on a needs-led basis. The multidisciplinary team, the individual and their family should be included in considering if a standard rehabilitation service or alternative arrangements would be the best course of action.

The updated guidelines emphasize that patients with comorbidities like dementia and others can still be considered for rehabilitation, as these conditions cannot be the sole cause of not pursuing a referral.

Patients with transient* or minor ischemic stroke should receive guidance to support them in preventing the recurrance of another stroke, like modifying lifestyle factors, and access to anticoagulant, statin, or blood-pressure-lowering therapies as recommended by their stroke team.

The latest updates to stroke guidelines highlight that the potential for people to benefit from rehabilitation does not have an expiration date. The guidelines call for improving survivor’s ability to reaccess services.

The latest evidence shows that significant improvements in people’s function can happen even years after a stroke. It’s never too late to rehab.

What are the latest updates on how people after a stroke should be cared for?  

The core principle of rehabilitation is to “promote recovery and reduce disability” through holistic and personalised care depending on the individual’s goals. The guidelines emphasize that rehabilitation goals should be set in a way that is meaningful to the individual, in their best interest, and with the appropriate involvement of their loved ones at the person’s request or if they cannot consent to care**.

Stroke survivors should be screened for delirium and cognitive problems as soon as medically possible. Other psychological symptoms like depression and anxiety are recommended to be routinely assessed using reliable tools, as they impact the individual’s wellbeing including fatigue levels, which can in turn make it more difficult for the person to engage with their rehabilitation plan.

The updated guidelines also underscored that rehabilitation services should deliver a range of personalised one-to-one therapy, and offer the use of different rehabilitation spaces like gyms and kitchens to assess activities of daily living wherever possible.

 

What are the latest updates on why people after a stroke should be cared for in this way?

The latest evidence shows that the superior approach to rehabilitation is thought to be multi-faceted and personalised. Greater amounts of physical therapy, are associated with better recovery for those with mobility goals.

This is true for motor recovery, with challenging, motivating tasks and variable training schedules leading to the best results. For example, improvement in spasticity, meaning less stiff muscles, can help someone progress from needing to use a wheelchair, to walking with assistance or independently again after a stroke.

Less is known about the impact of rehabilitation intensity on progress within psychological, cognitive, or sensory domains after stroke, and more research needs to be done in this area to offer practice guidance.

The importance of the content of therapy also cannot be understated, as ineffective therapies will not benefit patients. For this reason, the updated guidelines also highlight the critical importance of evaluation, to identify which approaches require improvement, and research to innovate new therapies.

Where can I find out more about stroke guidelines?

You can read more about the stroke guidelines on their website here. Versions of the guidelines for clinicians and patients/family members are also available.  

*a stroke that only lasts a few minutes.  

**a person’s informed consent is needed for treatment. If they are unable to provide informed consent, a representative such as a family member or legal representative will be consulted and a decision in their best interest is made. 

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