What we provide
Our supported discharge service covers a wide range of therapies that are important to helping you recover after a stroke.
Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. It helps to encourage development and facilitate recovery, enabling people to continue or return to their normal activities while helping them to remain independent for as long as possible.
Rehabilitation will focus on enabling you to return to the activities you enjoyed prior to stroke.
Physiotherapists work in a variety of settings, including hospitals, community, and private practice, and will have experience across a wide range of specialities such as muscles and bones, breathing functions, the brain and nervous system, care of the elderly, emergency treatment, and mental health.
Our physiotherapists are specialists in neurology – the brain and nervous system - and stroke care. A neurological physiotherapy assessment will look at muscle power, muscle tone, range of movement, coordination, posture, sensation, proprioception (spatial awareness and perception), pain, and function.
It also involves a thorough assessment of your balance and mobility as well as your ability of carry out specific functions, for example, stairs or car transfers.
Physiotherapists build their interventions around a concept called ‘Neuroplasticity’. This is the scientific basis of rehabilitation and one model of recovery following a stroke.
Neuroplasticity refers to the potential ability of the brain to reorganise by creating new neural pathways to adapt, as it needs.
Neuroplasticity is about building new connections within your nervous system. In a similar way to when learning something new, the more you focus and practice something, the better you become at the new skill that you are learning or an obstacle you are trying to overcome. By doing this, new neural pathways are created in the brain as connections that don't usually work together start to do so, which help us to sharpen our new skill.
After a thorough neurological assessment and working jointly with you to identify your personal goals, your physiotherapist will support you to achieve your objectives by designing a rehabilitation programme that can include:
- Individualised home exercise programme
- Mobility and stairs practice
- Balance retraining
- Task practice
- Functional strength retraining
For more information of how physiotherapy can improve your strength, balance and walking following a stroke please click here.
An occupational therapist has different roles depending on what setting they work in. Our therapists role is to help you to participate in activities that have been affected by your stroke.
These may include:
- Getting in and out of bed
- Getting washed and dressed
- Gardening and other hobbies and interests
- Returning to work
How does occupational therapy work in stroke recovery?
We will complete an in-depth assessment with you where we work out how the stroke has affected you and we can start to agree your goals. These are likely to be short term, looking at the next two to four weeks. We can also start working towards any longer term goals but they are likely to be passed onto other rehabilitation services for completion.
We may assess certain skills or activities in more detail. Examples include observing you get dressed, cook a meal, take a trip to the shops or complete a specific task; this helps us see what aspects of the task are most difficult and how we can best help you.
Our rehab assistants will work with you to complete a treatment plan, and our therapists will review and update the plan as you meet your goals.
What might an occupational therapy treatment plan may look like?
- We may loan you equipment to make a task safer and easier.
- We may set exercises for a specific skill or ability, for example your arm, your vision, your concentration.
- We may suggest you practice specific activities to regain or learn a new way of completing a task. Our rehabilitation assistants might help you to do this.
- We hope to teach you how the stroke has affected you and what you and your family can do to help you now and to prepare for the future.
- What we set will be individual to you, aimed at what you want to achieve and using our stroke specialist knowledge and experience, and how best to help you get there.
For more information please read the Stroke Association factsheet.
Speech and language therapy
Speech and language therapy provides treatment and support for adults who have difficulties with communication, or with eating, drinking and swallowing following a stroke. We work closely with family, carers and other professionals, such as occupational therapists, physiotherapists and doctors to tailor the care they provide for you as you recover.
How we can help?
There are a number of areas we can help you with. This includes:
- Aphasia: a language problem that happens after stroke when certain parts of the brain are damaged. Everyone with aphasia is different. This is because everyone’s brain is slightly different. Some areas are more important for language – a stroke in these areas will cause more problems. A larger stroke will cause more damage. Aphasia is worst immediately after a stroke. It improves over the weeks, months and years that follow and continues to improve for the rest a person’s life. The greatest recovery usually happens sooner after the stroke. However not everyone is ready to work on improving their communication straight after their stroke.
- Dysarthria: difficulty saying words because of problems with the muscles involved in talking. Dysarthria can occur when certain parts of the brain are damaged in the stroke. It may take more effort to speak clearly. There are many ways in which dysarthria can affect saying words and dysarthria can be different from person to person. Dysarthria can be a frustrating or embarrassing communication difficulty.
- Swallowing: strokes can cause the muscles in the throat and mouth, lips or tongue to become weak and uncoordinated. Some people can’t feel where food or drink is in their mouth or throat. This can make eating and drinking difficult. For some people their swallowing problem means food can go down the wrong way or make them choke. We can assist with improving writing and spelling, using alternative ways to communicate (e.g. with a computer tablet or using gestures). We can help with social communication and problem-solve communication difficulties in the community.
How can I help my friend or partner recover?
After a stroke the brain makes new connections to replace the connections that have been damaged. Conversations with other people can help people with aphasia to make connections as they work hard to get their message across. Using the strategies suggested by the speech and language therapist will help your loved on join in as much as they are able to. Using their communication in conversations will help it improve.
You can support them to resume their usual routines or establish new ones. Think about how you can both get back to your usual activities- perhaps by doing things in a different way. Doing things together will give you more to talk about which will help communication.
Speech and Language Therapy (SLT) is one part of your loved one’s recovery. The time they spend having conversations with you, friends and family members is equally valuable in their recovery. If your significant other agrees they can be referred for more support from another team. We will let you know which team they have been referred to, and give you the team’s contact details. (You can contact them to find out how long the waiting time is likely to be.) If they decide that they do not want further therapy we will provide you with contact details so that can access help in the future
Both you and your loved one can access support from the Stroke Association’s Communication Support service. Relatives are often concerned that progress will slow or be lost while their loved one is not receiving SLT. Generally after a stroke, patients with aphasia make gradual improvements and setbacks can usually be explained by other factors such as another illness, a period of significant stress or fatigue. If their aphasia becomes suddenly worse you should phone 999 as they may be having another stroke.
People with aphasia can benefit from a time of intensive therapy such as that offered during early supported discharge. Lower intensity forms of therapy and structured breaks to allow consolidation of what has been learnt are also important elements of rehabilitation for people with aphasia. In the early days after a stroke we do not usually ask close relatives to help with completing speech and language exercises. It is more important to focus on re-establishing helpful communication patterns. Doing exercises together can put yourself and your loved one into different roles which can be problematic for your relationship especially in the early days after a stroke. Some people with aphasia can benefit from exercises to complete on their own on a computer, tablet or with a pen and paper at some point in their rehabilitation. The therapists providing care for your significant other will let you know if this is the case. They will also advise you if the time is right to do exercises together or with another supportive friend or family member.
- Support your loved one to get their message across using any method they can such as pointing to pictures, words or objects, writing words, drawing, using gesture and facial expression.
- Turn off the TV or radio when you are talking together. It is easier to talk and listen with no background noise.
- Wear glasses, hearing aids and dentures if you need to.
- If you have tried and could not understand your loved one, then come back to it later.
- Show friends, family and the wider community how to use communication strategies and supporting them so that everyone can be included.
- Have conversations one to one and gradually build up to joining small and larger groups. People with aphasia usually find it difficult having conversations in larger groups. It can be helpful to invite fewer friends over at once until they are ready to communicate in larger groups
- Fatigue is common after a stroke. It will improve with time. Communication will be better when your loved one is rested. Try to plan times of rest into your day. Try to have important conversations at times when they have the most energy.
In healthcare settings, clinical psychologists work alongside individuals, their families and the teams they work in to help support patients to understand, adjust and cope with mental health difficulties accompanying recovery from health conditions.
Psychological effects of stroke: “I never thought it would happen to me…”
For many, a stroke is something that very much happens ‘out of the blue’ and once the sudden emergency subsides it can leave a mixture of worries and concerns about health, recovery and the future. When anyone experiences something traumatic in their lives, they naturally need a period of time to come to terms with what has happened. Some people may find it more difficult than others to adjust and this may be due to a number of reasons. People adjust in many different ways, however having the right amount of support can help this process. Many people might benefit from being able to talk about their experiences, or to have the support of family members and close friends.
Having a stroke can have a wide range of outcomes – some people may need a great deal of help with daily tasks or activities, others may require greater help with communication and their thinking skills. What we know is, in whatever way the stroke has affected someone, all people adjust and cope differently – and at their own pace. Research supports the need for people to be assessed in terms of their mood and coping given how significant and sometimes life-changing having a stroke can be. It is recommended that all individuals be screened for symptoms of anxiety and depression within the first six weeks after having a stroke (National Clinical Guideline for Stroke – 2016 Royal College of Physicians).
Family members and those close to the person following stroke may also experience difficulties and challenges as they come to terms with what has happened. The experience of supporting their loved one in hospital with the uncertainty of what may happen and then returning home and adjusting to life being different whilst trying to support their loved one with very little training, knowledge and support to start with. Family members and carers will require information, support and opportunity to ask questions at different stages. People have found asking questions to be most important, as well as accepting help and ‘time out’ for themselves to maintain their own well-being. Moving forward: support with coping and adjustment following stroke.
“I thought I’d be fine once I got home…”
Whilst being seen by the early supported discharge team, patients and their families are encouraged to discuss any worries or concerns with our therapists and rehabilitation assistants. In addition to this, all patients seen by the team will be screened for anxiety and depression using specially designed questionnaires called GAD-7 and PHQ-9. This check will be completed by either a rehabilitation assistant or therapist in the first two to three weeks of the patient’s time with the team. The questionnaires are used to help identify any significant symptoms that suggest someone is suffering from anxiety and/or depression. Having the opportunity to screen for mood can give patients a chance to discuss worries or concerns in more depth if they wish to. They may also wish to have more time to discuss things further with the Clinical Psychologist in the team.
What help is available from the clinical psychologist?
Our clinical psychologist can offer assessment and a range of support for patients and their families seen by the team such as:
- Assessment of anxiety and/or depression: for many the first few weeks of recovery can be a time of significant adjustment, however if someone is experiencing feelings of anxiety and/or depression that interfere with rehabilitation it can be useful to receive help and support at this stage.
- Joint assessment and support for patients and their partner/families: a person experiencing a stroke can be a significant challenge for their family also which requires a period of adjustment for them too. A joint or separate assessment can provide both people the space to discuss the difficulties and a plan to move forward.
- Assessment of cognition: changes to memory and thinking skills can range significantly. Within the first few weeks and beyond these aspects can change rapidly however patients can benefit from understanding about these early deficits to support their recovery.
- Psycho-education: the first few weeks of recovery can result in receiving much information and coming to terms with many things. The psychologist is able to spend time discussing concerns, helping with understanding and assisting with queries that may help adjustment.
Groups (when available) will be offered to provide patients and families with psycho-education about stroke as well as emotional and psychological support.
What would an assessment involve?
Assessment with a clinical psychologist would be completed in the patient’s own home and usually completed one-to-one, although individuals have the option to have someone with them. The assessment involves asking about what the main difficulties are and how these are affecting the person as well as how they are coping, strategies being used, and what wider support they may have. You may be asked some background information about yourself and lifestyle to help build a picture. Sometimes it may be helpful for the psychologist to speak with someone’s partner, close friend or family member who knows the person well, in order to help gain more information that will help determine the best way to help someone. This would only be with the patient’s consent.
The assessment provides a space for you to talk about things that is non-judgmental, confidential and without feeling rushed. Information is always kept strictly confidential which means information will not be shared with others without the individual’s permission. However where there is indication of harm towards self or others, the information will need to be shared with others that can help in order to keep everyone safe. Following the assessment a plan will be discussed and agreed to help assist further improvement with rehabilitation.