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 range of potential impacts of stroke on the patient, carer, and family
e10k_2:
the psychological and emotional effects of stroke including, but not limited to: depression; suicidality; emotionalism; anxiety; fear of falling; low self-esteem; confidence and well-being; traumatic stress; behaviours that challenge
e10k_3:
the functional activity and social participation effects of stroke including, but not limited to: relationships, pets, support network, community groups; return to meaningful occupation (employment, volunteering, study); leisure; carers; respite; finances; community access; return to driving; transport; activities of daily living
e10k_4:
the communication effects of stroke including, but not limited to: aphasia; dysarthria; articulatory dyspraxia
e10k_5:
the physiological and motor effects of stroke including, but not limited to: feeding, nutrition and hydration; skin integrity; mobility; balance; incontinence; bladder and bowel management; swallowing; sexual dysfunction; motor control; spasticity
e10k_6:
the sensory effects of stroke including, but not limited to: visual field deficits; hemianopia; pain, including shoulder pain, and central post-stroke pain; hyperacusis / noise sensitivity; reduced hearing
e10k_7:
the medical and neurological effects of stroke including, but not limited to: medication; comorbidities; medical complications; seizures; sleep disorders; respiratory disorders
e10k_8:
the neuropsychological (cognition and perception) effects of stroke including, but not limited to: anosognosia / lack of awareness; agnosia; reduced processing speed; spatial awareness neglect/inattention); attention; memory; praxis; dyscalculia; executive functions
e10k_9:
the causes of, and interplay between, the above-described effects of stroke, and how to assess, manage, and treat them using a range of evidence-based therapy interventions
e10k_10:
the impact of the above-described effects of stroke on stroke rehabilitation interventions, rehabilitation outcomes, and activities of daily living
e10k_11:
the principles and techniques of multidisciplinary stroke assessment and rehabilitation and how these are applied in practice
e10k_12:
when and how to use relevant screening measures and assessments
e10k_13:
safe moving, handling, and positioning
e10k_14:
the range of methods, resources, and approaches available to facilitate communication with those affected by stroke
e10k_15:
health promotion approaches and how to embed them in stroke rehabilitation to identify and manage risks for further vascular events
e10k_16:
strategies to enable those affected by stroke to: take an active role in their recovery; support the adoption of healthy behaviours; and improve the degree of engagement with the rehabilitation process - including the application of personalised care principles for example: behaviour change, goal setting, coaching, supported self-management, personalised care and support planning, shared decision making
e10k_17:
pharmacological and non-pharmacological interventions for secondary prevention and to promote recovery after stroke; and their potential adverse effects
e10k_18:
medication adherence: how to assess it; how it is affected by individual preference; how to motivate; and how to facilitate improved engagement
e10k_19:
the full range of local and national resources and services available for those affected by stroke - particularly those relating to rehabilitation, self-management, equipment, adaptations, and psychological care - including: health, social, voluntary, and independent; how to facilitate access and length of referral time
e10k_20:
the equipment, adaptations, and assistive technology available to support rehabilitation
e10k_21:
the implications of stroke for lifestyle; driving; occupation, including voluntary work or education; and social participation
e10k_22:
the process of transfer to the community including discharge planning, long-term management, further rehabilitation, and supporting social participation
Skills and ability to...
e10s_1:
take and interpret a thorough medical history to inform specialist stroke rehabilitation, including information from carers, family and other agencies where possible, and carry out decision-specific mental capacity assessments as appropriate
e10s_2:
recognise the signs, symptoms and impact of the psychological and emotional effects of stroke including, but not limited to: depression; suicidality; emotionalism; anxiety; fear of falling; low self-esteem; confidence and well-being; traumatic stress; behaviours that challenge
e10s_3:
recognise the signs, symptoms and impact of the functional activity and social participation effects of stroke including, but not limited to: relationships, pets, support network, community groups; return to meaningful occupation (employment, volunteering, study); leisure; carers; respite; finances; community access; return to driving; transport; activities of daily living
e10s_4:
recognise the signs, symptoms and impact of the communication effects of stroke including, but not limited to: aphasia; dysarthria; articulatory dyspraxia
e10s_5:
recognise the signs, symptoms and impact of the physiological and motor effects of stroke including, but not limited to: feeding, nutrition and hydration; skin integrity; mobility; balance; incontinence; bladder and bowel management; swallowing; sexual dysfunction; motor control; spasticity
e10s_6:
recognise the signs, symptoms and impact of the sensory effects of stroke including, but not limited to: visual field deficits; hemianopia; pain, including shoulder pain, and central post-stroke pain; hyperacusis / noise sensitivity; reduced hearing
e10s_7:
recognise the signs, symptoms and impact of the medical and neurological effects of stroke including, but not limited to: medication; comorbidities; medical complications; seizures; sleep disorders; respiratory disorders
e10s_8:
recognise the signs, symptoms and impact of the neuropsychological (cognition and perception) effects of stroke including, but not limited to: anosognosia / lack of awareness; agnosia; reduced processing speed; spatial awareness neglect/inattention); attention; memory; praxis; dyscalculia; executive functions
e10s_9:
determine, plan, and initiate the appropriate assessments and investigations, and interventions and treatments
e10s_10:
use a range of communication methods, resources, and approaches to ensure the patient, carer, and family are fully involved in the decision making process and their care
e10s_11:
provide a psychologically-informed, patient-centred assessment, formulation and intervention for behaviours that challenge after stroke
e10s_12:
recognise stroke-related communication difficulties and adapt methods of communication to discuss with the patient, carer, and family: current event; risk of future vascular event; need for and timeframes of assessments and investigations; rationale for interventions and treatments, their timeframes, and possible side effects; and provide timely information, advice and support
e10s_13:
identify and use safe methods of moving, handling, and positioning depending on the individual patient or staff needs, and that will help with the optimum return of functional abilities
e10s_14:
provide a range of stroke-specialist rehabilitation techniques and the clinical rationale for the selection and administration of a specific technique
e10s_15:
assess readiness for behaviour change and, in conjunction with those affected by stroke, assist in the development of a management or maintenance plan using patient-centred goal-setting and outcomes; identify resources to facilitate and continue participation and inclusion
e10s_16:
assess, discuss, and review rehabilitation progress with those affected by stroke
e10s_17:
assess motivational issues (e.g. post-stroke apathy, low motivation to engage with rehabilitation, possible depression or anxiety); where appropriate, use techniques to enhance motivation (e.g. identifying patient's values and preferred activities; goal-setting; motivational interviewing; discussion of barriers); and agree, or change, a maintenance or management plan
e10s_18:
assess medication adherence and facilitate improved engagement
e10s_19:
assist, encourage, and facilitate post-stroke physical, social, and cultural reintegration, to help the patient, carer, and family to: cope and manage; build self-esteem and confidence; encourage recovery and maximise potential
e10s_20:
provide advice and support on driving and refer to specialist centres as required
e10s_21:
identify the full range of local and national resources and services available to support rehabilitation, in hospital and after discharge, for those affected by stroke; assess their relevance and suitability for the patient, carer, and family; liaise with services, working across agencies and sharing information where appropriate; communicate referral arrangements, availability and waiting times
e10s_22:
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)
