Foreword

vii

Editors and Contributors

xiii

1

Setting the Scene   Caroline Watkins and Michael Leathley

1

Introduction

1

Stroke Epidemiology

2

Stroke Policy

3

Stroke Management Strategies

8

Research and Education

11

Conclusion

13

References

13

2

Developing Stroke Services: A Key Role for Nursing and Nurses   Christopher R. Burton

17

Introduction

17

Service Development

17

The Nursing Contribution to Stroke Services

19

The Political Agenda Shaping Stroke Service Development

25

Conclusion

30

References

30

3

What is a Stroke?   Anne W. Alexandrov

33

Introduction

33

Stroke Development Processes

34

Risk Factors for Stroke

37

Anatomy, Physiology and Related Stroke Clinical Findings

37

Standardised Instruments for Acute Neurological Assessment

57

Conclusion

60

References

64

4

Acute Stroke Nursing Management   Anne W. Alexandrov

66

Introduction

67

Priorities in Acute Stroke Management

67

Hyperacute Stroke Management

68

Acute Stroke Management

80

Conclusion

85

References

85

5

Nutritional Aspects of Stroke Care   Lin Perry and Elizabeth Boaden

91

Introduction

92

Do Stroke Patients Experience Nutritional Problems Pre-Stroke?

92

How does Stroke Affect Dietary Intake?

95

How can Stroke Patients be Helped to Maintain Adequate Dietary Intake?

104

Conclusion

115

References

117

6

Promoting Continence   Kathryn Getliffe and Wendy Brooks

123

Introduction

124

Bladder Problems and Urinary Incontinence

127

Bowel Problems and Bowel Care

144

Conclusion

148

References

149

7

Management of Physical Impairments Post-Stroke   Cherry Kilbride and Rosie Kneafsey

152

Introduction

153

Movement

153

Moving and Handling People with Stroke

155

Therapeutic Positioning and Seating in the Acute Phase

157

Promoting Early Mobilisation

159

Falls Prevention

163

Restoration and Re-Education of Movement

164

Management of the Upper Limb

168

Further Rehabilitation Strategies and Novel Developments

171

Patients’ Perspective on Mobility Rehabilitation

174

Conclusion

175

References

176

8

Communication   Jane Marshall, Katerina Hilari and Madeline Cruice

184

Introduction

185

Communication Impairments Caused by Stroke

186

Language Minorities

196

The Role of the Speech and Language Therapist in Acute Stroke Care

197

Psychosocial Issues and Quality of Life

199

Conclusion

201

References

201

9

Mood and Behavioural Changes   Peter Knapp

205

Introduction

205

Psychological Reactions to the Onset of Stroke

206

Conclusion

218

References

219

10

Minimally Responsive Stroke Patients   Elaine Pierce and Aeron Ginnelly

222

Introduction

222

Definitions and Identification

223

Minimally Responsive State

224

‘Locked-In’ Syndrome

232

Conclusion

237

References

238

11

Rehabilitation and Recovery Processes   Jane Williams and Julie Pryor

241

Introduction

241

Initiation of Rehabilitation

244

Outcomes of Rehabilitation

246

Recovery Processes

249

Transfer to Rehabilitation

250

Rehabilitation Provision

252

Conclusion

256

References

256

12

Stroke and Palliative Care: a Difficult Combination?   Christopher R. Burton and Sheila Payne

263

Introduction

264

Palliative Care

264

Relevance of Palliative Care to Stroke

266

Organisational Challenges

271

Conclusion

271

References

272

13

Reducing the Risk of Stroke   Peter Humphrey, Jo Gibson and Stephanie Jones

275

Introduction

275

Primary Prevention

276

Secondary Prevention: Identifying those at Risk of Stroke

279

Public Awareness and Access to Services

296

Secondary Prevention of Stroke in Less Common Aetiologies and Patient Groups

297

Conclusion

299

References

299

14

Longer-Term Support for Survivors and Supporters   Louise Brereton and Jill Manthorpe

309

Introduction

309

Leaving Hospital

310

What is Required Longer Term?

313

What do Carers Want?

316

Conclusion

322

References

323

15

Stroke Resources for Professionals, Patients and Carers   Graham Williamson

331

National Associations

331

Resources for Patients and Carers

332

Other Resources and Organisations

333

Specialist International Journals

336

Non-Specialist Journals’ Stroke Collections

336

Clinical Practice Guidelines

337

Finding Current Stroke Research

338

Evidence-Based Practice Resources

338

Chapter Links

339

Index

343