Stroke Rehabilitation

Most patients come to us weeks or even months after their stroke. Increasingly, stroke is managed as an acute illness (“Brain Attack”), and newer treatments, if given within a few hours of onset, have proven effective in reducing overall disability for some people. Ideally, those patients who need to be admitted to hospital should be admitted to a stroke unit staffed by a coordinated multidisciplinary team with a special interest in stroke care, where a well-organised multidisciplinary model of care exists.

Your brain is an amazingly adaptable organ, and we are only now learning how incredibly versatile each part of your brain is. What this means for stroke patients is that we now understand that with specialist interventions and hard work, even after a major stroke, the healthy parts of your brain are capable of taking over the work of damaged regions. Getting you into a comprehensive Stroke Rehabilitation programme, as soon as possible, is now recognized as being essential if you are to enjoy as full and rapid a recovery as possible.

Our Multidisciplinary Stroke Rehabilitation Team
O ur core multidisciplinary Rehabilitation Medicine team includes experts in stroke medicine, psychology, nursing, physiotherapy, occupational therapy, and speech and language therapy – all working under the medical guidance of a consultant in Rehabilitation Medicine. Patients and carers are also members of this team, and we encourage early active involvement in the rehabilitation process, both within hospital settings and beyond. Our stroke specialists conduct at least one formal multidisciplinary meeting each week, at which medical and therapeutic problems are identified, rehabilitation goals are set, progress is monitored and discharge and vocational plans are agreed. Members of the multidisciplinary stroke team have been recruited from the best teaching hospitals in London, and they undertake a continuing programme of specialist training and education.

Our Philosophy of Stroke Rehabilitation Care
W e use only those treatments which are supported by the best medical evidence. It is now understood, for example, that stroke patients should be mobilised as early as possible after their stroke, and that those who cannot get up should be sat upright as soon as their medical condition allows. We insist that our patients are up, groomed, dressed and ready for therapy early each morning, to make the most of their busy rehabilitation schedule – whether in hospital or at home. We promote healthy life-style changes, for example smoking cessation, healthy diet, regular activity – and we consider our programme to be only the beginning of your life-long journey of recovery.

Our Multidisciplinary Rehabilitation Programme
Before commencing therapies, each patient is examined by our consultants. Only then is a comprehensive abilities assessment performed by our multidisciplinary therapy team.
Each patient has unique abilities and needs, but some fundamental components of a typical rehabilitation programme are as follows:

  1. Personal Activities of Daily Living (ADL) training, managed by an Occupational Therapist
  2. Physiotherapy, provided by our Neuro-Physiotherapists, with particular expertise in stroke. Interventions are selected according to the individual needs of the patient
  3. Gait-oriented physical fitness training as tolerated, aiming to improve functional ambulation as well as enhance overall well-being
  4. Repetitive task-training to improve gait speed, walking distance, functional ambulation, transfers, or sit-to-stand-to-sit
  5. Stroke patients with severe language or speech problems (dysphasia or dysarthria) receive intensive one-on-one and group speech and language therapy
  6. Formal swallowing assessment at the start of the programme, using imaging as required, and strategies to improve safe swallowing are introduced. A nutritional assessment is also conducted
  7. Mood assessment: up to one half of stroke patients develop depression. We use a combination of enablement strategies and psychological interventions, before sometimes prescribing anti-depressant medications to permit active engagement in therapies
  8. Muscle strength and coordination training
  9. Orthoses (splints) provided by OT or an orthotist
  10. Mobility aids, customized and adapted by specialist services
  11. Communication aids, including computerized systems

    12. Recognising the individual needs of our patients, we offer a variety of additional rehabilitation services on an as-needed basis, for example

  12. Treadmill training, for those who are independent in walking at the start of treatment, but who aim improve gait speed and stability
  13. EMG biofeedback to enhance gait or balance
  14. Balance platform training with visual feedback for higher-level gait, balance or mobility problems
  15. Functional electrical simulation as a treatment for drop-foot, where the aim of treatment is the immediate improvement of walking speed, safety, and/or efficiency
  16. Constraint induced movement therapy for carefully selected individuals with at least 10 degrees of finger extension, intact balance and cognition
  17. Electromechanical/robotic devices to improve arm motor function and motor strength
  18. Use of a resting splinting for the upper limb to reduce spasticity in the wrist and finger flexors
  19. Shoulder strapping, corticosteroid injection, electrical stimulation to the supraspinatus and deltoid
  20. Spasticity management including precision treatment with botulinum toxin