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Stroke and transient ischaemic attack - Management
To which specialists should I refer people who have specific problems following a stroke?
- The GP is responsible for the general medical care of people who have had a stroke and been discharged from hospital. They should ensure that problems related to stroke are detected early and, when necessary, referred to the appropriate community health service, local social services, voluntary services, and specialists in secondary care.
- Only general guidelines for referral can be given for referral to specialist services because the service organization and provision of stroke aftercare vary with locality:
- Information on local specialist stroke rehabilitation and support services in the community should be available from the primary care trust.
- Community services include a community stroke team, a community stroke coordinator, communication groups, stroke support groups, and stroke exercise groups.
- Secondary care services used by people who have had a stroke are diverse and may include gastrostomy clinics, spasticity clinics, and pain clinics.
- The following is an incomplete list of specialist services to which referral may be useful for people who have had a stroke:
- A chiropodist can assess the need for, and provide, foot care for people who have problems caused by paralysis and lack of movement.
- A community or district nurse can make regular home visits, for example to:
- Arrange for equipment, such as a wheelchair, commode, or hoist, to be provided through social services.
- Take blood pressure measurements.
- A community matron may be the appropriate referral for people with high-intensity needs. They can coordinate inputs from all other agencies.
- A community psychiatric nurse service may be the appropriate initial referral for people with depression, mood swings, and personality changes.
- A continence adviser can assess and treat people who have urinary or faecal incontinence.
- A dietitian can provide advice on a healthy diet. This is especially useful for people who have difficulty swallowing or are fed artificially, are underweight or overweight, or have diabetes.
- An occupational therapist can assess, advise, and provide aids, equipment, or adaptations for people who have problems with everyday activities at home or work.
- An orthotist can provide braces which support and control weak or paralysed limbs and improve function and prevent muscles tightening.
- A physiotherapist can assess and treat mobility and movement problems caused by paralysis, muscle weakness, or poor balance.
- A speech and language therapist can assess and treat:
- Communication and language difficulties.
- Swallowing problems.
Basis for recommendation
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