Rehabilitation

In the first few days after a stroke care focuses on the assesment and preventing further complications. When such care has meant the person is stable they are ready for rehabilitation.

Your stroke team will work out an individual rehabilitation programme.

Rehabilitation is there to make people regain as much independance as possible. It will help teach skills that you may have lost and learning new skills to help compensate for any permanent disabilities caused by stroke.

What will happen during Rehabilitation?

You will have regular sessions with the:

• Physiotherapist
• Occupational Therapist
• Speech and Language Therapist

Where will I go for my rehabilitation programme?

You may stay on the ASU for your rehabilitation.
You may transfer to another ward in the hospital.  The plan for your care is then passed on to the staff and your therapy continues.  This may be either on:
Kent Ward, 3rd Floor Atkinson Morley Wing, under the care of Dr Cloud
A medical ward, under the care of the doctors on that ward
Some people with fewer medical problems go to the Wolfson Neuro-Rehabilitation Centre in Wimbledon.
Some people continue rehabilitation at home with a community therapy team.
Older patients with other problems as well as their stroke may go to the geriatric rehabilitation ward.
Those living in Lambeth could be transferred to the Frank Cooksey Rehabilitation Unit in Dulwich.
Those living further away are transferred to their local hospitals nearer their home.

Your Rehabilitation Team

You will be seen and helped by the following professions

• Physiotherapists

Physiotherapy helps with balance, paralysis or muscle weakness. The physiotherapist will

1. Develop exercises to improve movement and stop weak limbs becomming stiff and painful

2. Help the person sit up, regain balance and move around safely

3. Ensure the person is always positioned correctly whether sitting, lying or standing

• Speech and Language Therapist

1. Offer solution to swallowing problems

2. Offer advice to family and friends on how best they can help aid your understanding and communication

3. Help with your talking, reading and writing skills

4. Help with Dysphasia

Dysphasia (also known as aphasia) is the difficulty using and understanding spoken and written language. Individuals may know what they want to say but cannot find the words to explain it. They may also have difficulties in understanding others

  5.  Help with Dysarthria

Dysarthria is when a stroke affects muscles in the face, making it difficukt to pronounce words

  6.  Help with Dyspraxia

Dyspraxia is having difficulty with complicated tasks. A person who finds it hard to speak or understand conversation.

  7.  Help with Dysphonia

Dysphonia is when a stroke affects the muscles in the voice box. This changes the way the voice sounds and makes it hard to moderate the voice.

• Dietician

A dietician will be available shoule the patient have difficulty in swallowing, has lost thier appetite, has diabetes or is underweight.

• Occupational Therapist

Occupational therapists can help with everday activities affected since time of stroke. They will

1. Teach you how to do things for yourself. Tasks such as shopping, cooking, dressing, washing and toileting. They can help you return to normal leisure activities and skills that may help them return to work. Problems with memory and concentration can be overcome through a range of techniques.

2. Advise on useful equipment to aid such tasks

• Ophthalmologist / Eye specialist

An ophthalmologist  will assess any sight difficulties and prescribe glasses or vision aids An orthoptist can help with eye movement problems and explain ways of coping with reading difficulties.

• Clinical Psychologist

1. Emotional problems such as tiredness, mood swings, depression, stress and anxiety.

2. Difficulties with mental processes such as reasoning, memory, recognition, concentration and planning.

There will be a structured time-table for rehabilitation activities. Lunchtime therapy groups are provided for some patients. The nursing staff encourage patients to use the skills they are learning when doing everyday activities, like getting in and out of bed and eating meals.

There are several options dependent on patients needs;

• They may stay on the ASU for their early rehabilitation.

• They may transfer to another ward in the hospital. The plan for care is then passed on to the staff and treatment and therapy continues. This may be either on:

  • Neighbouring Kent Ward, 3rd Floor Atkinson Morley Wing, under the care of Dr Cloud

  • A medical ward in St James' Wing under the care of the doctors who were the admitting team on the day the patient arrived at St Georges.

• Some people continue rehabilitation at home with a community therapy team.

• Older patients with other problems as well as their stroke may go to the Geriatric Rehabilitation Ward.

• Those living in Lambeth could be transferred to the Stroke Unit at St. Thomas' Hospital, central London, or to the Frank Cooksey Rehabilitation Unit in Dulwich.

• Those living further away are transferred to hospitals nearer their home.

• Some people with fewer medical problems go to the Wolfson Neuro-Rehabilitation Centre in Wimbledon.

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This is part of St Georges NHS Healthcare Trust. It provides specialist rehabilitation services for a range of neurological conditions, including stroke. Currently there are 11 beds for St Georges local patients (Wandsworth or Merton and Sutton). These are inpatient beds where people stay at night. Some people may only need a few weeks of assessment and rehabilitation (typically 4 weeks); some require more time (typically 8 -12 weeks). After leaving the Wolfson, most people continue their rehabilitation programme at home.

You are being transferred to the Wolfson Neurorehabilitation Centre. This is a purpose built unit, where some patients from  St George’s Hospital continue their rehabilitation. 
The consultant in charge of your care will be Dr Cloud.

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Rehabilitation at Home

This information is for patients who are leaving the inpatient stroke services in St Georges Hospital Trust and continuing their rehabilitation at home.  It tells you what to expect from the community neuro services, how they will make contact with you and how your treatment is planned.

Which community team will treat me?

In general, if your family doctor is in Merton you will be seen by the Sutton and Merton Community Neuro Therapy Team.  If your family doctor is in Wandsworth, the Wandsworth Community Neuro Team will see you.

How long will I have to wait before someone contacts me?

You will be contacted during your first week at home.

Who will contact me?

A team member will phone to discuss your case in detail. After this, a decision will be made about your level of need and what therapy can be offered.

When does therapy start?

Both teams operate a waiting list.  Usually the wait is not longer than five or six weeks; many people are seen before this.

How much therapy will I have?

Every person who has a stroke is different and as a result the amount and type of therapy required will vary. This will be discussed with you throughout your treatment.

In hospital I used to have therapy every day.  Will it be the same when I get home?

No, it is rare for anyone to be seen daily. Different therapists or nurses may each visit between once or twice a week.  Sessions take place within your own home and are usually based around everyday tasks. For example, therapy might include such activities as:

• Getting around the house
• Getting yourself washed and dressed
• Eating
• Managing roles and relationships
• Improving thinking skills.

For people who live in Wandsworth, as well as being seen at home, some sessions may be held at other places.  This allows you to benefit from purpose built equipment and a range of services.  Sessions might be at St John’s Therapy Centre, St John’s Hill, S.W.11, or at Queen Mary’s Hospital in Roehampton.  You could also be seen in any community setting (for example, your work place, local gym or Day Centre).

What can I expect to gain from Community therapy?

The focus, where possible, is on doing what you used to do before your stroke.  You will be expected to work on tasks outside the  sessions, either or on your own or with family or friends. The team will help you to identify realistic priorities and work with you towards these goals.  At regular intervals throughout the year, the Community Neuro Teams run a ‘Regaining Confidence after Stroke’ group. You may wish to discuss attending this group with the therapists who are treating you.

What should I wear for treatment sessions?

You should wear normal clothes in which you feel comfortable.

Will therapy make me tired?

Everyone who has had a stroke will feel more tired than usual. This can persist for several weeks or months. The team will try to pace the sessions and allow for enough time between visits to stop you getting over-tired.

How long will my treatment continue?

This depends on your needs and your rate of progress. From the beginning of therapy the team will prepare you for when we no longer visit.  By that stage you should be able to manage more independently and direct your own progress.  We expect that you will continue to improve long after your therapy stops. 

What happens if I think I need more treatment from the therapists?

Sometimes people do return to the team for a second time.  However, it might be that a different community service would help you more.  If you think that you require more treatment you should phone us and discuss this.

How do my relatives find out about my progress?

Relatives are encouraged to be involved with your treatment and can contact the team at any time. When treatment has finished we will send a summary of your achievements to your family doctor.   We ask you if you want to receive a copy of this letter which you can share with your relatives.

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• Practise Tasks

• Understand why each task has been set

This often helps you remain motivated. Recovery can be gradual but even when progress is slow it is worth persevering

• Don't Push People Away

Just being with and talking to others people even if you have difficulty in communocating can help you feel more positive, stop you becomming isolated and withdrawn.

• Stay Healthy

Plenty of sleep, a good diet and regular exercise are all important factors to aid your rehabilitation

• Don't Despair

If you cannot fully regain your previous abilities. Remain focussed on enjoying the best quality of life and independance that you can.