Stroke information
Contents Page Stroke and rehabilitation 2 What is a stroke? 2 What is rehabilitation? 3 Members of the team 4 Doctors 4 Nursing care 4 Physiotherapy 6 Occupational Therapy 7 Speech and Language Therapy 8 Speech and Language Therapy - Communication 8 Speech and Language Therapy - Swallowing 8 Social Worker 9 Other members of the team 9 Preparing for leaving hospital 10 Useful contacts 11 The stroke journey 14 Your questions and notes 16 Further reading 17
Introduction This booklet contains information for people who have had a stroke. The booklet tells you about the team who will be involved in your care whilst in hospital. Not all of the information will be relevant to you, as strokes affect people in different ways. If you have any questions, please contact a member of staff. There are more leaflets available so please ask if you want further information. Trust website: www.derbyhospitals.nhs.uk Widgit Symbols Widgit Software 2002-2013 www.widgit.com www.widgit-health.com 1
Stroke and rehabilitation What is a stroke? When a person has a stroke, an area of the brain is suddenly affected. The cause is usually the blockage of a blood vessel, but sometimes a haemorrhage (bleeding) is responsible. Unless the stroke is very severe, most people should improve, but it is often difficult to tell how long this will take. A number of people can expect to achieve a full recovery. Cerebral hemisphere Cross section through the brain Basal ganglia Pituitary gland Cerebellum Brainstem Spinal cord The area of the brain that is affected generally causes problems in the opposite side of the body. The effect of the stroke on a person, depends on how much and which part of the brain has been affected. Your ability to move may be reduced, or even lost. You may not be able to feel parts of your body, such as your arm. You may have difficulties swallowing. You may have difficulties speaking and understanding what is said to you. Your vision may be different. You may feel very sleepy and get tired easily. You may have difficulty remembering information. You may notice some emotional changes. 2
All these changes can affect how you can do everyday activities. In the first 24 hours of coming to hospital, you will have a head scan and you may have other investigations such as a heart tracing and blood tests. This is to find out the type of stroke you have had and why it has happened. After the first few days following a stroke, people are left with a disability rather than an illness. Therefore, you should be able to begin active rehabilitation, unless there is a medical problem. What is rehabilitation? Rehabilitation involves you taking an active part with the rehabilitation team to achieve some recovery. Your progress will improve if you work with the team rather than expecting them to make you better. We will use goal setting to help facilitate your care. You will be assessed by various professionals to see what treatments may help you. There is a picture at the back of this booklet showing you who you may see. You may also need special equipment to enable you to become more independent. Recovery may be limited or take a long time, so we also want to help you to adapt to the changes. Your relatives (or friends) are always welcome to attend treatment sessions. The team will be happy to advise on ways to help your rehabilitation. Where will it happen? After you have been diagnosed with a stroke, you will be cared for on a specialist stroke ward or supported by a specialist stroke team in the hospital. Your rehabilitation may continue in a community hospital or other rehabilitation setting, if this suits your care needs better. How long will I be in hospital? It is difficult to predict the amount of progress that is likely to occur in the early stages, so the length of your stay can be variable. It could be a few days, weeks or a few months. Whilst you are in hospital, the team will help you to plan towards your transfer, whether that be to your home, alternative housing, a nursing home or residential care, and will help ongoing rehabilitation and support as needed. 3
Members of the team Many people will be involved with your treatment. They will work as a team with you and your relatives to identify goals to work towards. Doctors Whilst you are in hospital, you will be under the care of a medical consultant and a team of ward-based doctors. The doctors will monitor your recovery throughout the very early stages when some people may be fairly ill. As your condition becomes more stable, less monitoring will be needed, but the consultant will continue to see you regularly. You will be treated for any other problem that might arise, such as leg swelling, high blood pressure, urinary problems or pain. The doctors will advise you of what measures should be taken in order to prevent a further stroke. If you want to talk to the consultant or one of the team about your treatment and progress, an appointment can be made by speaking to your nurse or one of the therapists. When you leave hospital, your GP will be informed. Nursing care Your nursing care will be planned on an individual basis to allow specific problems to be dealt with. The aim is to minimise the risk of complications, by monitoring you closely for early signs of a problem and taking the appropriate action. This active approach is likely to increase the prospect of recovery. Rehabilitation Rehabilitation starts as soon as possible, usually when your condition has stabilised and you are able to co-operate with therapy. The role of the nurse/care assistant then changes from being a care provider to that of a facilitator. This is someone who is there to teach and encourage you and your relative to gradually take over the various aspects of your care. 4
Swallowing Many patients have difficulty swallowing after their stroke, which can increase the risk of malnutrition or other complications. There are nurses available who are trained to look for this problem and advise on the appropriate action. If the problem persists, you will be referred to a speech and language therapist for a more detailed assessment. Bladder control Another common problem that can occur after a stroke is loss of bladder control and less commonly loss of bowel control. This can be very distressing for the person concerned, but the problem usually resolves itself with time. If it does not, retraining programmes and/or appropriate medication may be helpful. Suitable clothing that allows people to use the toilet more easily can be important. Pressure care Your pressure areas (where your body is in contact with bed/ chair) will be checked to monitor any existing sore areas and to prevent pressure sores developing. You or your relative will be taught how to do this. Medication As you progress, the nursing team will help you to participate in managing your own medication. They will also offer advice on reducing any risk factors such as smoking and diet. The nursing team can offer guidance, reassurance and emotional support and gradually help you to improve your independence. The aim is to reinforce techniques taught by the therapists, in order to maintain a consistent approach. The nursing team will help you plan and co-ordinate your discharge, talk to your relative/carer, and arrange medication to take home. Any follow up care that may be needed such as a care assistant or district nurse will also be arranged. 5
Physiotherapy Following your stroke, a physiotherapist will assess your movement. If you have any movement difficulties, the physiotherapist will set up a treatment programme designed to improve them. It is likely that you will be seen by a number of different physiotherapists throughout your period of treatment. The main aim of physiotherapy following a stroke, is to make the most of the movement you have. Team approach Physiotherapists always work closely with other members of the multidisciplinary team. It is essential that skills learnt in physiotherapy are reinforced by the rest of the team over a 24 hour period. This will help your recovery. Positioning In the early stages, the physiotherapist will concentrate on assessing your position in bed and in a chair. A good position in the early stages is essential to the future recovery of movement. The physiotherapist will assess how you move from one position to another. In the early stages, you may need a hoist to help with this. The hoist will stop you having to use excessive effort that would be unsafe and would contribute to movement difficulties. Physiotherapy will always address both sides of your body, not just the weaker side. Recovery It is essential to be aware that your movement problems will be very different to other patients. Therefore you must not compare yourself to other patients. You will all have different problems and will all recover at different rates. A relative or friend can attend a physiotherapy session if this is helpful. They can often be shown how to help you to exercise in-between physiotherapy sessions, which can help your recovery. Your physiotherapist will always discuss the options for further physiotherapy when discharge is being planned. 6
Occupational Therapy There are lots of things you would normally do everyday (e.g. getting up in the morning, washing and dressing, preparing and eating a meal), but following a stroke, you may not be able to do some or all of these for yourself. Occupational therapists work with patients to enable them to live as independently as possible. They are interested in your normal routine and the everyday activities you do as part of this. The occupational therapist (OT) will find out about you and your lifestyle and will work with you to help you overcome your difficulties. An OT will assess and identify your specific problems. They will use everyday activities, such as getting dressed, as a way of teaching you to overcome these difficulties and be more independent. This may be through practicing new methods of doing things, providing equipment or modifying your environment. The OT s aim is for you to be able to carry out activities that are important and meaningful to you, and for you to be as independent as possible. Cognition and perception Cognition is a technical term for the thought process of the brain and the way the brain makes sense of what we see, hear and feel. It also covers our ability to concentrate and remember things. You may find that some of these areas have been affected by your stroke. Perception is a technical term for the process by which the brain makes sense of what it sees. Following a stroke, some patients experience difficulties in this area, such as: Difficulty judging distances. An inability to recognise familiar objects or what they are used for. An altered view of your body and you may ignore the affected side. Preparing for leaving hospital If appropriate, the OT may visit your home with you and your relative to assess any difficulties you may have in managing at home. The OT will work with you to find the best solution to any difficulties that you may have. They may work with Social Services if you require any adaptations to your home, special equipment or extra support. The OT will discuss options for further occupational therapy for when you leave. 7
Speech and Language Therapy The speech and language therapist deals with communication and swallowing problems. Communication Following a stroke you may have difficulty with: Speaking Understanding what is being said Reading Writing and spelling You may have mild difficulties or more severe problems. The speech and language therapist can carry out a range of assessments and plan treatment that is appropriate for you. Your relatives and friends may also be involved as part of the therapy. The aim is to help you and your family to be able to communicate together. The speech and language therapist will also work closely with the other members of the team to enable them to communicate with you. This will help you to understand what to do in therapy sessions. Swallowing Swallowing problems may occur after a stroke, which can affect whether you can eat and drink safely. It is also important to be able to eat enough to stay healthy. You may be seen by a nurse to check you are able to swallow properly. You may be put on a special diet to help you control the food and swallow safely. You may have to have your drinks thickened to help you control the liquid in your mouth. Sometimes, for your own safety, it is necessary that you do not eat or drink through your mouth. Other means of feeding will be considered so that you get your nutrition. Most people make good progress and are able to eat a normal diet and have normal drinks again. The speech and language therapist will discuss options with you for further help with your communication and/or swallowing if you need it when you leave hospital. 8
Social Worker A stroke may lead to changes in lifestyle and income. If you have any anxieties (even if they are not directly related to your stroke), the social worker will be happy to talk to you in confidence. Social workers can give you advice in a variety of areas including: Housing Residential homes Day care Practical support Child care Family and personal difficulties They can also offer advice about employment, allowance and benefits, finances and other issues. If a lot of care is needed on discharge, there are care managers who can use the funds provided by the Community Care Act to provide additional help. Other members of the team You may also be seen by: Dietitians Pharmacists Chaplains Other technical staff This will be explained to you. 9
Preparing for leaving hospital Preparing for your discharge starts as soon as possible after your admission to hospital, and as soon as the team can assess how much help you are likely to need, and what your goals might be. You and your relatives/carers will be closely involved in this process. A referral may be made to other services to continue with a rehabilitation plan. These services vary from one area to another, and referral will depend on what is most appropriate for you. Please ask the staff on the ward if you have any questions. Some people are unable to return home, at least not in the shortterm. These people will be given information and advice by various members of the team to reach an informed decision on the various options. This may mean being re-housed, going into a residential home, or into a nursing home. 10
Useful contacts There are many sources of help and support available both locally and nationally for people who have had a stroke. National organisations The Stroke Association 240 City Road London EC1V 2PR Telephone: 020 7566 0300 Helpline: 0303 303 3100 Website: www.stroke.org.uk Different Strokes Central Services 9 Canon Harnett Court Wolverton Mill Milton Keynes MK12 5NF Telephone: 0345 130 7172 Fax: 01908 313501 Website: www.differentstrokes.co.uk Local organisations Derbyshire Stroke Single point of Contact (for Derby and Derbyshire), providing advice, information and support to stroke survivors and their carers with contact from the Stroke Co-ordination and Support Team Telephone: 01332 258258 11
Derbyshire Stroke Clubs Network There are social clubs for anyone who has had a stroke and their partner or carers. These provide information, social activities and outings, and give an opportunity for friendship and mutual support. Autonomous groups run in the following areas: Ashbourne Chesterfield Ripley Bakewell Derby City Spondon Belper Ilkeston Swadlincote Castle Donington Long Eaton Telephone: Stroke Single Point of Contact on 01332 258258 for further information. Derbyshire Carers Association White House The Willows Slack Lane Ripley Derbyshire, DE5 3HF Telephone: 01773 743355 Email: info@derbyshirecarers.co.uk Website: www.derbyshirecarers.co.uk Derby Coalition for inclusive living (DCIL) Park Road Ripley Derbyshire, DE5 3EF General enquiries: 01773 740246 Counselling: 01773 740246 Direct Payments: 01773 742165 Accounts: 01773 746651 Email: info@dcil.org.uk Disability Direct The Enterprise Centre 20 Royal Scot Road Pride Park Derby DE24 8AJ Telephone: 01332 299449 Fax: 01332 404041 Website: www.disabilitydirect.com Derby DrivAbility Kingsway Hospital, Kingsway, Derby, DE22 3LZ Telephone: 01332 371929 12
Red Cross Red Cross House Matlock Green Matlock, DE4 3EG Telephone: 01629 582171 Speech & Language Therapy The Manor Store Manor Park Way Derby, DE22 3NB Tel: 01332 267976 Website: www.speech.derby.nhs.uk Amber Valley Community Transport Community Transport for Town & County 2 Long Close Cemetery Lane Ripley Derbyshire, DE5 3HY Telephone: 01773 746652 Erewash Community Transport Unit 1, Hallam Fields Road Ilkeston Derbyshire, DE7 4AZ Telephone: 0115 930 9134 Swadlincote Community Transport George Holmes Way Swadlincote Derbyshire, DE11 9DF Telephone: 01283 550764 13
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Your questions and notes 16
Further reading The Stroke and aphasia handbook Connect Press, 2004. Author: Susie Parr et al Stroke explained Altman Publishing, 2003. Authors: Fraser & MacWalter 17
P3108/0879/09.2017/VERSION11: Last reviewed 09.2017 Copyright. Any external organisations and websites included here do not necessarily reflect the views of the Trust, nor does their inclusion constitute a recommendation. www.derbyhospitals.nhs.uk