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Information for parents and carers

Stroke Patient Information Leaflet

Rehabilitation Medicine
Community & Therapy Services

This leaflet has been designed to


give you important information
and to answer some common
queries you may have.

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
The Stroke Pathway What can relatives do to help?
All patients presenting with a suspected Please feel free to keep nursing staff and
stroke in the North and North East therapists informed of any concerns that you
Lincolnshire areas are initially taken to the might have so that they are able to reassure
‘Hyper acute Unit’ (HASU) at Scunthorpe you or answer any questions you many have.
General Hospital.
You are a vital link with our patient. You
From there, ongoing rehabilitation could have a unique insight into the personality of
occur at either Scunthorpe, Goole or your relative and as such are very valuable
Grimsby hospitals, a community to us so that we have a full picture of the
rehabilitation facility or at home. individual. Your information is particularly
important if your relative can not
Rehabilitation communicate very well after their stroke.
Following your stroke there may be activities The therapists are keen to support you if you
that you are no longer able to carry out. would like a more active role in your relatives
These activities may be things which you rehabilitation, they can advise you of any
previously did easily and without thinking. specific activities you can undertake with
them.
Rehabilitation is aimed at helping you to
achieve independence in carrying out these
activities again.
Dietitians
This may involve many different types of The dietitian will work with you if you have
treatment and therapy requiring hard work any ‘special’ dietary needs, are unable to eat,
and commitment by you as well as your need a modification to the texture of your
carers and health workers. food, have a poor appetite or need to reduce
or avoid certain foods in your diet.
The rehabilitation team is made up of many
professionals who will work together with you The nursing staff will undertake a nutrition
and your carer to help you to regain as much screening assessment (MUST) when you are
admitted, giving you a score at the end of the
independence as possible in the activities
which are important to you. assessment. This includes measuring your
height and weight - don’t worry if you can’t
Treatments may include physiotherapy, recall these or are unable to get out of bed
occupational therapy, speech and language the nursing and carers will be able to use
therapy and dietetics. The rehabilitation plan other tools to estimate what they need.
devised for you may be delivered by
If you have a high nutritional risk score or if
therapists, therapy assistants or nursing staff
in conjunction with you and your carers. you, your relatives / carers or nurse feel that
you are having difficulties with the amounts
This may involve therapists showing you and or types of food you eat, you will be referred
your family how you can practice activities or to a dietitian who will assess your diet and
exercises within your daily routine to help discuss with you how you can make
you achieve maximum benefit. alterations to your food and drinks.
The dietitians’ assessment will include asking
you questions about your weight, weight

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
loss, appetite, meal routine and types / Clinical psychologists specialise in the
amounts of foods and drinks you normally relationship between our minds and our
have at home. With your consent a relative bodies. They use talking therapies to give
or carer can be present to help you recall the people the chance to talk about their
amounts and types of food and drinks that difficulties since their stroke and the effect of
you usually have. stroke on their day to day lives. They aim to
help people develop skills to cope with these
Dietitians work closely with the nurses,
speech and language therapists and catering changes and assist in their emotional
adjustment to a stroke.
staff to ensure that the correct types and
amounts of food are provided for you. If you They also offer specialist assessment and
are unable to eat or drink enough and are rehabilitation of cognitive difficulties following
losing weight, we will discuss with you the a stroke. This could include problems with
types of snacks you could manage between attention, memory, planning and problem
meals, or supplementary drinks (build-up / solving. Occupational therapists are also
enriched milk drinks) that you would be able routinely involved in identifying cognitive
to take. difficulties and may refer to clinical
psychology for further input with complex
If it is not safe for you to eat or drink because
of swallowing difficulties, the dietitian can difficulties.
discuss with you a different way to give your They generally work one to one with people
body the nourishment and fluids it needs. For following a stroke; however in some
example, by using a nasogastric tube (fine situations may also work with family or other
tube inserted into the stomach from the professionals to offer support.
nose) liquid nutrients, medication and fluid
can be given through this tube after the Specialist Stroke Nurses
dietitian has calculated how much you
“The role of the specialist stroke nurse is vital
require and so prevent further weight loss.
within this team to ensure patients receive
This form of feeding is short term and lasts the specialist care needed to make the best
no more than 4 weeks. If you are still unable recovery possible.”
to eat or drink after this then a PEG tube
(quote by: John Barrick, Stroke Association)
(tube positioned directly into the stomach)
may need to be discussed with you and your • Stroke Responders assess potential
family or carers. patients, either in the emergency
department at Scunthorpe, or the wards
Clinical Psychology around Scunthorpe hospital
Clinical psychologists work with the • Arrange timely investigations and assess
emotional, behaviour and cognitive changes whether the patient could potentially
that people can experience following a receive a clot busting drug
stroke. Clinical psychologists help people to
• Organise appropriate transfer to Hyper
achieve a greater understand of themselves,
acute Stroke Unit
while enhancing self-respect and self-
esteem. • They also monitor your identified stroke
risk factors including signs of infections,

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Information for parents and carers
swallowing problems and pain motivated to continue with rehabilitation
management and therapy
• They also provide close monitoring of • Patients who requires 24 hour care in a
patients in HASU Residential care or Nursing care setting
will be assessed for a short stay
Rehabilitation Assistants and placement
Health Care Assistants The social work practitioner provides a
Therapy Assistants and Health care seamless discharge process for stroke
Assistants work with nurses and therapists to patients. They will be followed up in the
support the rehabilitation plans for every community and their needs will be reviewed
patient, helping to maximise their recovery. in conjunction with the wider multidisciplinary
You may see them as part of your recovery. team as their rehab progresses.
Patient and family can request a referral to
Social Work Team the social worker.
The social work provision for stroke services
is provided by a specialist practitioner for Speech and Language Therapy
stroke. Speech and language therapists are trained
The social work practitioner is part of the to provide support to people with swallowing
acute stroke multidisciplinary team at and communication difficulties.
Grimsby, Goole and Scunthorpe. The After a stroke people can have difficulties
practitioner also visits patients in out of area with swallowing and / or communication.
hospitals when required. Patients who are
referred to the social work practitioner will be Recovery varies. Some people only recover
assessed on the stroke unit to determine a little and take a long time to recover
what their social care needs are. Through (months and years), some people recover
multidisciplinary team working risks are fully and quickly.
identified and plans made toward reducing This depends upon the type of stroke, how
these to facilitate safe discharge. severe it is and how well you are able to
An agreed discharge process might include: participate in rehabilitation.

• A care package can be requested for Swallowing


patients who can return home but need
support and assistance to enable then to The Risks of Swallowing Difficulties:
safely return home and continue to live • The coordination and / or strength of the
independently in the community swallowing process can be affected by
• Patients who are identified as needing a stroke
short period of further rehabilitation will • Some people cannot swallow at all and
be referred to a community rehabilitation many people will be able to swallow but it
facility. This is a time limited service and will not be a safe swallow. Also, some
patients have to meet the criteria to be people will be able to swallow safely
referred and demonstrate that they are without any difficulties

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Information for parents and carers
• The possible risks from swallowing If you are given advice like this the
difficulties are: recommendations will be placed by the bed.
1. ‘Aspiration’ - This is when food and The advice will be reviewed regularly by the
fluid falls into the airway and / or Speech and language therapist.
lungs. It can lead to chest infections
or pneumonia which can be severe Things You Can Do to Help
and in some cases fatal It is very important that you follow advice
2. Choking - This is when something provided.
solid falls into the airway and blocks
• Relatives and friends can sometimes
it. This can also be fatal
come and help at mealtimes. This
• Because of the risks, swallowing should be discussed first with nursing
difficulties are dealt with cautiously staff
• Relatives and friends should also check
How Speech and Language what is suitable before bringing food and
Therapists Might Help drinks in if you have difficulties
The Speech and language therapist swallowing
assesses and advises on how to manage • Completing any exercises regularly can
swallowing difficulties. Advice is individual, help. Relatives and friends can
but could include the following: sometimes help with this
1. Nothing to eat or drink for a while (Nil
by mouth, ie: NBM). In this case you General Advice
may be given fluids via a drip or given If you have swallowing difficulties, the
liquid food through a tube. following advice may help:
The doctors, nurses, speech and
language therapists and dietitians can • Make sure you are sitting upright, with
give you more information about this your head in an upright position
2. Thickening drinks • Try to have your meals in a quiet room
and avoid distractions
3. Modifying your food. For example
pureeing, mincing or mashing food or • Allow plenty of time - eat and drink slowly
just sticking to food that is soft, moist and
• Try to relax
easy to chew
You may be advised to eat and drink a
particular way, for example, putting your
head in a special position or consuming
everything using a teaspoon or a special cup.
You may be given exercises for your
swallowing. These will need to be completed
very regularly.

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
Swallowing Difficulties

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
Communication Speech sounds distorted. Intonation
may sound different. Speech will usually
What is communication? sound as though it is made with effort.
Communication is about someone conveying
a message and someone receiving that How the Speech and Language
message. Therapist Might Help
People communicate in many different ways: The Speech and language therapist:
• Understanding what other people say • Will assess your communication if you
have been found to have some
• Speaking
difficulties
• Reading
• Will explain the difficulties to you and
• Writing your family
• Non-verbal communication - These • Will give you some advice / strategies to
include facial expression, body help make communication a little easier
orientation and posture, gesture and
• Will set some goals with you and help
pointing, intonation, eye contact
you to work towards these
• Using objects and pictures / drawings
• May give you some therapy work /
exercises to do to achieve your goals
How can communication be
affected by stroke? • May give you some alternative methods
of communication
The main types of communication difficulty
after stroke are as follows: • May help you to practice strategies to
help you get your message across
• Aphasia / dysphasia - This is a difficulty
with language. It can include difficulty Things You or Friends and Family
understanding others when they speak,
difficulty reading, problems thinking of
Can Do to Help
the correct word for things, difficulty The Speech and language therapist can give
making a coherent sentence and you some specific advice about things that
problems spelling / writing sentences can help your individual difficulties.
• Dysarthria - This is when the muscles Here are some general tips to help with
used for speaking are weak and communication:
therefore speech sounds slurred.
• Encourage and accept any way that
Speech may also sound too loud or too helps get the message across, for
quiet, it may sound ‘nasal’ or be too fast
example facial expression, gesture,
or too slow drawing, writing words down
• Dyspraxia - This is when the person is
• Take time to talk. Don’t rush the
able to think of the right words to say and conversation
has the muscle strength to speak, but
has difficulty coordinating the muscles.

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
• Allow time for what you’ve said to be
understood
• Allow time to respond
• Talk in a quiet, calm environment
• Talking to one person is often easier
than several at once
• Gain and maintain eye contact
• If it is difficult to think of the word, ask
questions which only need a “yes” or “no”
response
• Do activities that don’t rely on talking,
e.g. looking at magazines / photographs,
holiday postcards, hand massage /
manicure, listening to music

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
Physiotherapy • Advising on positioning in lying or sitting
and how often you need to be moved
Following your stroke you may experience
difficulty moving your body (see Physical • Evaluate when you should get out of bed
effects of a stroke, Stroke Association and start walking and what equipment (if
Factsheet 33). A stroke may cause any) is needed to move and support you
weakness, where the muscles are not
• Motivate you to be actively involved in
receiving the messages from the brain. Your
sessions to help relearn normal patterns
body may feel differently, your brain may not
of movement
be interpreting the sensory messages
correctly, making it more difficult to know • Offer therapy to strengthen your limbs
where your body parts are, or causing and teach you how to move again as
difficulty when trying to distinguish between independently as possible
different shapes or textures.
• Work together with the rehab team and
You may experience problems with your your carer, family or friends to support
posture and balance (Stroke Association, your recovery
Factsheet 22) and your joints maybe more
It is important for you to be as active as
vulnerable to problems due to loss of
possible as soon as you can; the team will
supportive muscles. Sometimes a stroke can
encourage you to get up and about as much
cause joints and muscles to feel stiff and you
as you are able to, whether this is continuing
may develop muscle spasms or spasticity.
your previous activity or just sitting in a chair.
What is physiotherapy and how can it
In the early stages and for people with
help?
relatively mild problems, physiotherapy will
Physiotherapy uses a combination of focus on preventing complications and
exercises, manipulation, massage, skills restoring your abilities to move and be active
training and electrical treatment, to help heal again, as time goes on, and for people with
and recover movement. The main focus is to more severe problems, a full recovery is less
help you learn to use both sides of your body likely so physiotherapy focuses on helping
again and regain as much strength and you to become more independent and do
movement as possible. A physiotherapist what is important to you, for example using
will undertake an initial assessment and a equipment or doing things in a different way.
treatment plan will be formulated which may
Therapy will begin soon after your admission
include some or all of the following:
to hospital. Initially this may be exercises in
• Helping stroke nurses set up a plan of bed and moving around the ward or it may
care to keep you as well as possible and take place in rehabilitation areas, such as the
avoid complications that may slow down gym. Physiotherapy will continue, if required,
your recovery, such as minimising joint if you move wards, hospitals, or go on to a
stiffness or muscle tightness by providing rehabilitation unit; and in the community,
appropriate movement and support, or therapy may take place in your own home, or
offer advice on how to keep your lungs a clinic / outpatient setting. Whatever the
clear and reduce the risk of infection setting your therapist will work with you to set
a number of goals, which should be agreed
with you and take into account your priorities,

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Information for parents and carers
hopes and plans. These should be reviewed Occupational therapy can also help you with
throughout your journey and this is intended thinking skills, memory and attention. We can
to make sure your treatment is focused and also support you with any vision problems,
working on the things that are important to anxiety or changes in your mood.
you.
The practice of activities of daily living is
Tips for recovery: likely to be ongoing in order to improve your
independence which is often the end goal of
• Practise the exercises your therapist set
therapy. Occupational Therapists work in the
everyday
Hyper Acute, Acute and Community teams.
• Use a notebook to remind you, what you
To help with your rehabilitation please have
need to do and record your progress
day clothes and toiletries available on the
• Involve and move your affected side as unit, if possible.
much as possible A treatment programme specific to your
• Be patient with yourself, aiming for long needs will be individually devised with you
term rather than immediate results and your Occupational Therapist. This will
be in conjunction with other members of the
• Resume sports and activities that you multi-disciplinary team such as
enjoy or try new activities that will help physiotherapists, speech and language
you to maintain or improve your therapists, nursing, doctors, social worker
recovery. Many people worry that being and psychologist. All the team work closely
active might cause another stroke, this is together to meet your needs. In addition,
very unlikely, but if you are concerned clear therapy goals are set with you and
speak to a health professional (see updated as required.
Exercise and Stroke, Stroke Association
resource sheet) A Home visit may be necessary as part of
your in patient stay. Typically there are two
Information adapted from Stroke Association types of home visit:
Factsheet 16, Physiotherapy after stroke
(April 2012) An Access visit is a visit carried out without
you. The therapist will meet with your
Occupational Therapy representative to assess the environment at
your property to assess suitability and need
Following a stroke, people may have for any adaptation or equipment to meet your
problems with some aspects of daily living needs.
skills.
A Home Assessment visit is a visit to your
We help you to regain the ability to complete home with you. On the visit you will be able
everyday tasks independently. This can to experience the variety of tasks that you
include activities like getting dressed, might normally need to perform on a typical
cooking, getting about, or gardening. If day in your home (i.e. walking around your
appropriate, once home, we can support property, getting on / off bed, chair and toilet,
your return to a previous hobby, return to making a hot drink, amongst other things).
employment or return to driving. At the end of the visit, prior to returning to
hospital, there will be a chance to discuss

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk
Information for parents and carers
your progress and plan how your needs can Northern Lincolnshire and Goole NHS
be met ready for discharge from hospital. Foundation Trust
On discharge from the acute stroke ward you Diana Princess of Wales Hospital
may return home with / without support and Scartho Road
with / without ongoing rehabilitation. You may Grimsby
be transferred to a hospital nearer your own DN33 2BA
home. You may be discharged to another 01472 874111
rehabilitation facility for further rehabilitation if Scunthorpe General Hospital
this is deemed appropriate by you and the
Cliff Gardens
team. These are all dependent on individual
Scunthorpe
needs.
DN15 7BH
The occupational therapist will always liaise 01724 282282
with the team who are going to be providing
Goole & District Hospital
any ongoing therapy to ensure seamless
Woodland Avenue
care. Goole
DN14 6RX
Concerns and Queries 01405 720720
If you have any concerns / queries about any www.nlg.nhs.uk
of the services offered by the Trust, in the
first instance, please speak to the person Date of issue: February, 2017
providing your care.
Review Period: February, 2020
For Diana, Princess of Wales Hospital –
Author: Operational Lead for Stroke
you can contact the Patient Advice and
Liaison Service (PALS) on (01472) 875403 IFP-942
or at the PALS office which is situated near
the main entrance. © NLGHT 2017

For Scunthorpe General Hospital – you


can contact the Patient Advice and Liaison
Service (PALS) on (01724) 290132 or at the
PALS office which situated on C Floor.
Alternatively you can email:
nlg-tr.PALS@nhs.net

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk