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Stroke and transient ischaemic attack - Management
How should I assess a person who has a history of stroke?
- When people with a history of stroke consult (for whatever reason), be alert for problems that may require new assessment and management:
- Neurological problems — balance, movement, tone, sensation, power.
- Pain — neuropathic, shoulder pain and subluxation, musculoskeletal pain.
- Mood and social interaction problems — depression, anxiety, emotionalism, disinhibition, aggression.
- Cognitive impairments:
- Attention and concentration.
- Memory.
- Disturbances of spatial awareness — neglect.
- Disturbance of perception — visual agnosia.
- Apraxia — loss of the conceptual ability to organize activities to achieve a goal.
- Planning, organizing, initiating, and monitoring behaviour (i.e. disturbances of executive functioning).
- Speech and communication difficulties — aphasia, dysarthria, apraxia of speech.
- Visual impairments and hemianopia.
- Bladder and bowel problems — urinary incontinence, faecal incontinence, constipation.
- Swallowing and nutrition problems — oral health, malnutrition, dehydration, artificial feeding.
- Sexual dysfunction.
- Difficulties with activities of daily living — personal, social, and vocational:
Clarification / Additional information
- Many of the problems require referral to a specialist service.
- Specialist services and the problems that they can manage are summarized in the section Referral guidance.
Basis for recommendation
- This section summarizes recommendations that the Royal College of Physicians Intercollegiate Stroke Working Party (RCP ICSWP) made on specific problems and complications of a stroke or transient ischaemic attack [Intercollegiate Stroke Working Party, 2008].
- Although people who have had a stroke will be followed up by specialist stroke services, regular and opportunistic assessment in primary care is required to assess for problems that have not been previously recognized or that require changes in management.
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