CONCEPTUALISING STROKE REHABILITATION

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CONCEPTUALISING STROKE REHABILITATION

• Marisa Rose
• Acute Stroke Lead NEL Cardiac and stroke network
• Marisa.rose_at_bdpct.nhs.uk
• Sue Winnall
• Head Occupational therapist Rehabilitation
  Mile End Hospital
• Sue.winnall_at_thpct.nhs.uk

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Having a stroke
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Role of acute care in this instance

• Investigation into cause and nature of stroke
• Reduce your risk of having it again
• Preventing secondary medical complications
• This is all done you still have trouble getting
  out the chair, you still bump into things on the
  right, you still dont understand what people are
  saying to you, you can still not find the toilet,
  you can not recognise the toilet or undress
  yourself

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What about thrombolysis?
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How many people need rehab?

• Of people who survive a stroke
• Only 20 with have full recovery in 2 weeks
• 60 will require rehabilitation of varying levels
  and intensity
• 20 will be severely functionally dependent

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Intervention over time

• Blue- Medical
• Red- Therapy

Intervention amount
72h
4 weeks
12 weeks
Long term
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Rehabilitation
Stroke rehab
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Stroke rehabilitation evidence

• Stroke Rehabilitation Units reduce disability and
  institutionalisation
• More intensive OT and physio result in improved
  functional outcomes
• Early intervention result in better functional
  outcomes
• Gains made in rehabilitation are maintained over
  time

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What is stroke rehabilitation?

• Physical
• Sensory
• Cognitive
• Perceptual
• Emotional
• Focus on activities and roles important to people
• Structured by personal goals
• Support
• Information

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Anyone for tennis?
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The phases of rehab

• Semantics lets clear this up first
• Not just about location

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Hyperacute stroke
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Acute stroke
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Inpatient rehabiliation
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Early supported discharge
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Community rehabiliation
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Long term rehabiliation
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Long term follow up
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In summary

• Rehabilitation is specialist
• Rehabilitation is complex
• Stroke is complex
• Stroke is not cardiac very different rehab
  needs
• Stroke is very multi disciplinary
• Stroke goes on a long way past the hyper acute
  and acute phase