E10: Specialist rehabilitation

People who have had a stroke access high-quality rehabilitation and, with their carer, receive support from stroke-skilled services as soon as possible, in hospital, immediately after transfer, and for as long as needed. (Key: e = element | k = knowledge | s = skill)

Knowledge and understanding of…

e10k_1:
The impact of stroke on the individual, carer and family
e10k_2:
Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations
e10k_3:
The implications of stroke for lifestyle, driving, work, family and acceptance in the community
e10k_4:
MDT assessment: the principles of stroke rehabilitation and rehabilitation referral; therapy techniques and their application
e10k_5:
A range of neurological treatment approaches and their applications
e10k_6:
Psychological and emotional problems after stroke (e.g. depression, emotionalism, anxiety, self esteem, confidence, well-being, challenging behaviour)
e10k_7:
Social and relationship problems after stroke (e.g. sex, lifestyle, work, housing, driving, transport, leisure, financial/ income, work/employment, children, family, support network, carers, respite, pets)
e10k_8:
Cognitive and communication problems after stroke (e.g. spatial awareness (neglect/inattention); visual field deficits; hemianopia; memory; attention; praxis; executive function; aphasia, dysarthria, articulatory dyspraxia)
e10k_9:
Physiological, physical and functional problems after stroke (e.g. rest and sleep; respiratory, mobility; balance; senses; incontinence; bladder and bowel management; swallowing; feeding, nutrition and hydration; skin integrity; sexual; motor control; ADL)
e10k_10:
Neurological, visual and sensory impairments and pain problems (e.g. shoulder pain, central post-stroke pain, spasticity, seizures)
e10k_11:
Medical problems (e.g. medication, comorbidities, complications)
e10k_12:
The process of transfer to the community (e.g. discharge planning, long-term management, further rehabilitation, social function)
e10k_13:
The causes of, and how to assess, manage and treat, problems after stroke: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical
e10k_14:
The impact of problems after stroke on day-to-day and outdoor functioning: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical
e10k_15:
Methods that will support those affected by stroke with their recovery and help them to cope with problems after stroke: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical
e10k_16:
Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities)
e10k_17:
Pharmacological and non-pharmacological interventions for secondary prevention that will also help recovery after stroke, and their side effects
e10k_18:
Any support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self-management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport)
e10k_19:
Methods to facilitate communication with those affected by stroke
e10k_20:
Therapeutic moving and handling
e10k_21:
Methods of changing behaviour
e10k_22:
The use of assessments and measures
e10k_23:
The principles of goal setting
e10k_24:
Assistive technology and other therapy interventions (e.g. functional electrical stimulation, orthotics)
e10k_25:
Equipment and adaptations
e10k_26:
Concordance: how to assess; how it is affected by individual preference; how to motivate; how to manage non-concordance

Skills and ability to...

e10s_1:
Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity
e10s_2:
Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)
e10s_3:
Provide a range of neurological intervention processes and to be able to clinically reason the selection and administration of an approach
e10s_4:
Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support
e10s_5:
Assess, discuss and review with those affected by stroke, including client-centred goal-setting and outcomes
e10s_6:
Identify rehabilitation and support services in hospital and after discharge: inform the individual about services and how to access them; check availability and agree referral
e10s_7:
Identify need and when to refer for more specialist or differing treatments where necessary: also agree referral (e.g. assistive technology, major adaptations to the home, disability employment adviser)
e10s_8:
Provide advice and support on driving and refer to specialist centres as required
e10s_9:
Identify local services and resources (e.g. health, social, voluntary, independent sector; equipment and adaptations, rehabilitation, psychological, educational, employment, housing, transport) to overcome barriers, facilitate participation and inclusion: also identify waiting times and implications for those affected by stroke
e10s_10:
Monitor progress and agree or change a maintenance or management plan
e10s_11:
Identify resources to help with participation and inclusion
e10s_12:
Assess motivation and take steps to augment management
e10s_13:
Assess and help with concordance
e10s_14:
Identify and use therapeutic methods of moving and handling the patient that are safe, depending on the individual patient or staff needs and aspirations, and that will help with the optimum return of functional abilities
e10s_15:
Assist, encourage and facilitate post-stroke physical, social and cultural reintegration
e10s_16:
Recognise the signs, symptoms and impact of psychological and emotional problems after stroke (e.g. depression, emotionalism, anxiety, self esteem, confidence, well-being, challenging behaviour) and to help patients and their families to cope and manage; build self-esteem and confidence, encourage recovery and maximise potential
e10s_17:
Recognise the signs, symptoms and impact of social and relationship problems after stroke (e.g. lifestyle, work, housing, driving, transport, leisure, financial/income, work/employment, children, family, support network, carers, relating, respite, pets) and to help patients and their families to cope and manage; encourage recovery and maximise potential
e10s_18:
Recognise the signs, symptoms and impact of cognitive and communication problems after stroke (e.g. spatial awareness (neglect/inattention); visual field deficits; memory; attention; praxis; executive function; aphasia, dysarthria, articulatory dyspraxia) and to help patients and their families to cope and manage; encourage recovery and maximise potential
e10s_19:
Recognise the signs, symptoms and impact of physiological, physical and functional problems after stroke (e.g. rest and sleep; respiratory, mobility; balance; senses; incontinence: bladder and bowel management; swallowing; feeding, nutrition and hydration; skin integrity; sexual; motor control; ADL) and to help patients and their families to cope and manage; encourage recovery and maximise potential
e10s_20:
Recognise the signs, symptoms and impact of neurological, visual and sensory impairments and pain problems (e.g. shoulder pain; central post-stroke pain; spasticity, seizures) and to help patients and their families to cope and manage; encourage recovery and maximise potential
e10s_21:
Recognise the signs, symptoms and impact of medical problems (e.g. medication, comorbidities, complications) and to help patients and their families to cope and manage; encourage recovery and maximise potential
e10s_22:
Use a range of communication resources and approaches to ensure that patients and their carers are fully involved in the decision making process and their care
e10s_23:
Provide a client-centred approach to care and manage any challenging behaviour