F16 Physiotherapy after stroke - referenced

If a stroke causes damage to the part of your brain that controls movement, you may experience weakness or paralysis on one side of your body, and problems with moving and carrying out everyday activities. 1 This factsheet explains how physiotherapy can help your recovery, what your treatment might involve and how you can see a physiotherapist. feeling as though water is running down their limb. 'ccasionally these sensations can be painful.( ou may have problems with your posture and balance, making it difficult to stay upright and you may be more likely to have a fall.) Joints on your affected side, such as your shoulder, may be vulnerable to in%ury, for example if your arm is pulled or its weight is allowed to *drag.+ This can cause a partial dislocation !called subluxation" or *fro,en shoulder, where your shoulder becomes painful and difficult to move.&ome muscles on the affected side may become stiff !most often at the wrist, fingers and the ankle" which can limit the movement at the %oint and some people may develop muscle spasms or a type of stiffness called spasticity..

How can stroke affect my movement?

A stroke can cause a number of different physical effects: ou may experience weakness, or even complete paralysis !called hemiplegia" in the muscles of one side of your body. This can make it difficult to move or use your limbs and get about. our limbs may move in a different way when you try to use them. #or example your hip may move upwards when you want to step forwards, or your elbow may move out to the side when you want to lift something.$ The affected side of your body may feel different. our limbs may feel heavy because the weakness makes them difficult to move, or they may feel numb !like after you have had an in%ection at the dentist". &ome people have more unusual sensations such as pins and needles, hot and cold sensations or

ou can read more about these effects of stroke in our factsheets #(( Physical effects of stroke and 1

&troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

#$$ Balance problems after stroke.

hat is physiotherapy?
1hysiotherapy is an important part of rehabilitation2. Techni3ues such as e!ercise, manipulation, massa"e, skills trainin" and electrical treatment are used to help you heal and recover your movement.4,5 The main focus of physiotherapy after your stroke is to help you learn to use both sides of your body again and regain as much strength and movement as possible.1/ 11 #europhysiotherapy is a type of physiotherapy designed to treat problems that originate within the brain, and it is important that you receive this for at least part of your recovery.1$ A neuro6 physiotherapist is trained to understand and treat the changes caused by neurological conditions, !ones that affect the nervous system, including stroke"..1(

to make sure they can help with the range of problems that stroke can cause. The team may consist of occupational therapists, speech and language therapists, doctors, nurses and social workers !plus other specialists". This team is called the multidisciplinary stroke rehabilitation team.1. 12 ou may like to see our factsheets #1) Speech and language therapy after stroke and #12 Occupational therapy after stroke for more information. 7epending on your needs, your physiotherapist will: help the stroke nurses set up your plan of care to keep you as well as possible and avoid any complications that might slow down your recovery14 advise on how you should be positioned when lying or sitting, and how often you need to be moved15 decide when you should begin to get up out of bed and start walking and what e3uipment !if any" is needed to move or support you$/ motivate you to be actively involved in your physiotherapy sessions to help you relearn normal patterns of movement$1 offer therapy to strengthen your limbs and teach you how to move again as 2

How can physiotherapy help?

After a stroke, our brains cannot grow new cells to replace the ones that have been damaged so your recovery depends on your brain+s ability to re6organise its undamaged cells and make up for what has been lost.1) This is called neuroplasticity. 1hysiotherapy can provide expert practical guidance to help1-. 1hysiotherapists often work with other members of the stroke team

&troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

independently as possible.$$
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work together with the rehabilitation team, and your carer, family or friends to support your recovery in a co6ordinated way $) advise you, your family and any carers how you can do as much as possible for yourself and move around as much as possible.$-

were admitted to hospital following your stroke, your physiotherapy will begin there with exercises in bed and moving around on the ward.(/ 'nce you are ready, you should progress to more active sessions, which you will probably receive in a rehabilitation area or special physiotherapy gym.(1 ou may be moved out of the stroke unit to a different ward or rehabilitation unit to continue your treatment.($,((In some places a specialist community rehabilitation team will support you to continue your recovery at home.() 'ther places offer a transition period between hospital and home in an intermediate care centre.(-, (. If you had a transient ischaemic attack !often called a TIA or mini stroke", you can still have physiotherapy even if you were not admitted to hospital, or didn9t see a therapist while in hospital. Ask your :1 to refer you to a hospital stroke team or community rehabilitation team for help with any persisting problems. ou may also be able to refer yourself. (2

It is important to be as active as possible as soon as you can after your stroke, so the team will encourage you to get up and about as much as you are able to, whether this is continuing with your previous activities or %ust sitting in a chair. $. In the early stages, and for people with relatively mild problems, physiotherapy will focus on preventin" complications and restorin" your ability to move and be active again. $2 As time goes on, and for people with more severe problems, a full recovery is less likely and so physiotherapy focuses on helping you to become more independent and do what is important to you, for example using e3uipment or doing things a different way.$4

hat does physiotherapy involve?

%arly assessment and care #ollowing your stroke, you should be assessed by a physiotherapist as soon as possible after being admitted to hospital. This assessment should take account of any pre-e!istin" health problems you had before your stroke(4,(5 and 3

here will $ have therapy?

8here therapy will take place will depend on how severe your stroke is and how your local rehabilitation services are organised.$5 If you

&troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

should make sure that any movement problems are identified at the start, so that care can be organised to give you every chance of making a good recovery.)/ :ood care in the early days is important to help prevent &oint stiffness or muscle ti"htness.)1 If you are confined to a bed or chair, the therapist will start by changing your position to improve your posture and balance, and make you feel more comfortable.)$ If you have one6sided paralysis, correct positionin" is important to prevent spasm or in%ury.)( If you are unable to move, you will need a special mattress and the nurses may need to move you at regular intervals !usually every two hours" to prevent bed sores.)) If you are unable to move, you may be given chest physiotherapy to keep your lungs free of infection.)If possible, you should be helped to sit up, as this will help avoid blood clots in your legs, improve your breathing and help your recovery.).
)2

The more therapy you have and the more active you are after a stroke, the better. :uidelines recommend that while undergoing rehabilitation in hospital, you should receive at least () minutes of physiotherapy per day !plus any other types of therapy you need". -/.-1 'nce you are medically stable, the aim will be to get you movin" as soon as possible.-$ This will include moving around your bed, then from bed to chair, sitting to standing, walking with and without support and finally climbing stairs. This is likely to be a gradual process, and it is important to get each step right, so that you will end up with a balanced way of moving.-( It is more difficult to sit up safely in bed than in a chair, so you may soon find yourself sitting in a suitable bedside chair with your affected side supported by pillows.-) This will help re6establish your balance and a sense of your mid6line !the imaginary line that divides the body into left and right sides".-8hen you are ready, the therapist will get you onto your feet using a hoist or two or three extra helpers. -. This will give you a chance to support your own weight and encoura"e you to use the muscles of your trunk, hips and legs.-2 our therapist may not encourage you to walk straightaway if you need time to recover your strength and flexibility..-4 4

If you+re still having ma%or problems after $) hours, then you will need a full multi6disciplinary assessment by the rehabilitation team, ideally within five working days.)4

'ovin" a"ain If your symptoms don+t improve in a few days and you are medically stable, your physiotherapist will use more active therapy to teach you how to do the things you are having difficulty with and get your limbs moving again.)5 &troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

%!ercises ;esearch has shown that the most effective types of physiotherapy are e!ercises and practisin" specific tasks that you aren+t able to do well. &o if you are having difficulty keeping your balance when standing you need practise standing up a lot< if you have difficulty lifting your arm you need to practise doing activities which make you lift your arm, and if you are having difficulty walking you need lots of walking practice.-5 There are many ways to do this. ou will work on a one6to6one basis with a physiotherapist, particularly on the tasks and the movements you are %ust learning to do. ou may also work with a physiotherapy assistant, in a group, or have tasks and activities for you to practice on your own outside of therapy sessions../ ou may be offered treadmill trainin" or intensive training programmes for your upper limb such as constraint induced movement therapy = where your *good+ arm is restrained so you have to carry out tasks with your affected arm..1

There are many different ways that you can do these exercises. ou may exercise under the supervision of the physiotherapist and? or an assistant, attend a group exercise or circuit training class, or work individually in a gym or independently in your own time outside a formal therapy session. *alk to your physiotherapist about what is suitable for you.-. #or more general information about exercise see our resource sheet ;2 Exercise and stroke. %+uipment Although most people regain the ability to walk, some do not and others are only able to walk short distances such as around the house. If this is the case for you, your physiotherapist and occupational therapist will get a wheelchair for you and teach you and your carers and how to use it... They will also arrange for any other e+uipment you may need !after a thorough assessment" such as a hoist to help you get in and out of a chair or bed, or adaptations to the house when you go home = such as a ramp or wider doors..2

1hysiotherapists can provide other e+uipment to help you "et about ;esearch clearly shows that the more easily such as walking main physical problem facing frames, rollators !walking frames stroke survivors is weakness in with wheels" and sticks..4 their limbs, and that this can be our physiotherapist can also improved with stren"thenin" provide or refer you for more e!ercises. .$ .(,.) >xercise to build specialist help. If you have drop up your stamina and stretching foot !a condition where you cannot exercises to prevent muscle and lift your toes properly when %oint stiffness are also beneficial. walking" this could include an ankle6foot orthosis !a type of splint" or #unctional >lectrical &timulation &troke Association April $/1$ 5 &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

!using an electrical current to stimulate the muscles in the ankle". If you have spasticity, it could include prescribing @otox in%ections and?or a stretching regime. If your physiotherapist does not provide this service directly, they will be able to refer you to another specialist service..5 ,our hopes and plans our therapist will work with you to set a number of goals.2/ This will also take into account your priorities, hopes and plans and is a way to make sure that your treatment is focussed on the things that are important to you. 21 our goals will depend on how severe your stroke is, your previous abilities, and the life you hope to lead in the future.2$ our goals may be small to start with and involve a simple task, such as reaching for and grasping an ob%ect. >ach goal you achieve will be a positive step forward and will help to keep you motivated.2( 2) 2-

If you need help with daily tasks such as getting dressed, getting in and out of bed or going up and down stairs, your physiotherapist !and other members of the team" will teach your family or carer how to help and use any e3uipment you have been given. 25

hat happens when $ leave hospital?

If you need further therapy after leaving hospital, there are many options available. If you can+t get around very easily or you need a lot of support, you can be referred to a community rehabilitation team who will see you in your home. If you only re3uire physiotherapy and?or you are able to travel easily then you may be referred to a physiotherapist based in the outpatients department of the local hospital.4/ 8here you continue your therapy depends on your abilities, your needs and preferences, and how services are organised locally. This should be explained and discussed with you. 8herever you are referred for on6going physiotherapy, the referral should be made before you leave hospital and you should be given a named person and number to contact.41 8hen you get home, try to keep as active as you can to look after your health and reduce your risk of having an accident or fall.4$ our physiotherapist can advise you about ways to continue improving your strength and overall health, 6

How can my family or carer help?

It is possible for members of your family and?or carers to attend rehabilitation sessions with you.2. They can be involved in your on6 going exercises and rehabilitation after you have left hospital. our physiotherapist may also show your family or carer how to help you practise your exercises and include them in everyday activities.22 24

&troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

and activities you can do to help you stay healthy4(. &ome areas have an -e!ercise referral scheme. where you can exercise in your local gym or leisure centre under the guidance of a fitness instructor who has been trained to help people with disabilities.4)

old ones resurface, you can ask your :1 or consultant to refer you back to a physiotherapist for a reassessment. Aany services now operate a *direct referral+ system, where you can contact the team or department directly to make an appointment without having to go through your doctor.5/

hen will therapy end?

Aost people recover 3uickly in the first weeks after their stroke. After approximately three months, the recovery period usually slows down. 4- After this time, improvements usually happen because you have become fitter, stronger and more able to use your body, rather than due to recovery from the damage caused by the stroke itself. *his does not mean that you cannot benefit from physiotherapy after this time, but the improvements are usually a matter of getting better at what you can already do, rather than gaining new skills. 4. It is recommended that if you have ongoing difficulties resulting from your stroke, you should continue to have rehabilitation !including physiotherapy" for as long as you need. This means for as long as you have clear "oals and the therapy is helping you make progress towards them. 42 44

How can $ find a private therapist?

ou may wish to consult a private physiotherapist, for instance if you feel you could benefit from further therapy after yours has ended, or if you want to supplement any B0& treatment. This is allowed under current guidelines.51 /et your #H0 therapist know you plan to do this, both as a courtesy and to ensure you continue your treatment and goals. Check that the private therapist has substantial e!perience of stroke rehabilitation and the appropriate 3ualifications< look for the initials AC&1 !Aember of the Chartered &ociety of 1hysiotherapy" and &;1 !&tate ;egistered 1hysiotherapist" after their name. Also ensure that you understand their fee structure, how many sessions are likely to be involved and whether you can be treated at home.5$ #or further information, see our resource sheet ;1/ Private treatment.

ou should also be reassessed si! months after your stroke to 1ractise the exercises your see if you need further treatment = therapist has set you. or a change to your treatment plan 45 Deep to a routine of exercising = and then annually after that. At at a regular time each day. any time, if new problems arise or &troke Association April $/1$ 7 &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

*op tips for recovery

;emember the more you do the better, so try to exercise every day or at least three times a week. Ese a notebook to remind you what you need to do and record your progress. ;emember to involve and move your affected side as much as possible. @e patient with yourself. ou are aiming for long6term rather than immediate results. Aany people worry that being active might cause another stroke. This is very unlikely but if you have any pain or are excessively breathless !getting a little out of breath is a good thing" then stop. If this does not subside after a short rest then seek medical attention. If you suffer from post6stroke fatigue, exercise can help but start slowly and build it up gradually. Choose a good time of day to exercise when you are feeling relatively lively. ;ecognise that you may need to rest afterwards. Take steps to keep to a sensible weight. Foin an exercise group or stroke club to meet and be encouraged by other people. Contact us for details of clubs in your area. Ask your physiotherapist about resuming sports and activities that you en%oy. Try new activities that will help you to maintain or improve your recovery. 5(

0troke 2ssociation 0troke Helpline3 /(/( (/(( 1// %mail3 infoGstroke.org.uk ebsite3 www.stroke.org.uk Contact us for information about stroke, emotional support and details of local services and support groups. 4hartered 0ociety of Physiotherapy *el3 /$/ 2(/. .... %mail3 en3uiriesGcsp.org.uk ebsite: www.csp.org.uk 0as a register of therapists who are members of the Association of Chartered 1hysiotherapists interested in Beurology !AC1IB". Physio First *el3 /1.)/ .4) 5./ ebsite: www.physiofirst.org.uk 0as an online database of 3ualified physiotherapists, which can be searched by location and specialism. 5isclaimer3 The &troke Association provides the details of other organisations for information only. Inclusion in this factsheet does not constitute a recommendation or endorsement.

1seful or"anisations
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1roduced by the &troke Association+s Information &ervice. #or sources used, visit stroke.org.uk H &troke Association #actsheet 1., version 1, published April $/1$ !next review due 7ecember $/1(".
&troke Association is a Company Iimited by :uarantee, registered in >ngland and 8ales !Bo .1$2)". ;egistered office: &troke Association 0ouse, $)/ City ;oad, Iondon >C1J $1;.;egistered as a Charity in >ngland and 8ales !Bo $11/1-" and in &cotland !&C/(2245". Also registered in Borthern Ireland !KT((4/-" Isle of Aan !Bo 5)-"and Fersey !B1' (.5".

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6eferences

&troke Association April $/1$ &troke 0elpline /(/( (/ (( 1// website stroke.org.uk

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;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(62. 2 B0& Choices website !$/1/" &ymptoms and signs of stroke http:??www.nhs.uk?Conditions?&troke?1ages?&ymptoms.aspx reviewed 1- 'ct $/1/, accessed 11 Fuly $/11 3 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 4 &I:B !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. &I:B :uideline 114, section ).$/ #alls. Fune $/1/, accessed ) Fuly $/11. 5 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1--. 6 Chartered &ociety of 1hysiotherapy !$/11" &troke: 0ow can physiotherapy helpL http:??www.csp.org.uk?your6health?conditions?stroke accessed 15 Aug $/11 7 Chartered &ociety of 1hysiotherapy !$/11" &troke: 0ow can physiotherapy helpL http:??www.csp.org.uk?your6health?conditions?stroke accessed 15 Aug $/11 8 B0& Choices website !$/1/" 1hysiotherapy http:??www.nhs.uk?conditions?physiotherapy?pages?introduction.aspx reviewed, 15 #eb $/1/accessed 14 Fuly $/11 9 Chartered &ociety of 1hysiotherapy !$/11" :lossary of treatment terms http:??www.csp.org.uk?your6health?glossaryMmanual accessed 15 Aug $/11 10 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 11 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 12 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-( 13 Aanchester Beuro1hysio !$/1/" 8hat is neurological physiotherapyL http:??www.manchesterneurophysio.co.uk?physiotherapy6services?neurological6 physiotherapy.html accessed $$ Fuly $/11 14 Iindley, ; I !$//4" &troke: the facts. 'xford Eniversity 1ress, 141. 15 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-( 16 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 17 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection (.$, 1$46 $5 http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6522$d1d-(/1b.pdf accessed ) Fuly $/11 18 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(46(5 19 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 20 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 21 0arwood, 0uwe, and :ood !$nd edition, $/1/" &troke Care 'xford Care Aanuals, 'E1 115$. 22 &I:B !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. &I:B :uideline 114, section $.$. Fune $/1/, accessed ) Fuly $/11.
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0arwood, 0uwe, and :ood !$nd edition, $/1/" &troke Care 'xford Care Aanuals, 'E1 115$. 24 Iindley, ; I !$//4" &troke: the facts 'xford, 'E1, 15$ 25 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 26 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 27 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 28 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 29 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(5 30 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 31 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-( 32 ;oyal College of 1hysicians !$//4" Care after stroke: Information for patients and their carers 11) 33 &cottish Intercollegiate :uideline Betwork !$/1/" :uideline 114 Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. http:??www.sign.ac.uk?pdf?sign114.pdf 1-2, accessed $$ Fuly $/11 34 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, 1$16$$ 35 B0& Iive 8ell website !$//5" Intermediate care http:??www.nhs.uk?livewell?staywellover-/?pages?intermediatecare.aspx reviewed 15 Aug $//5, accessed $$ Fuly $/11 36 Age ED !$/1/" Intermediate Care #actsheet 2., 1(6) http:??www.ageuk.org.uk?documents?en6gb?fs2.N$/intermediateN$/careN$/december N$/$/1/.pdfLdtrkOtrue published 7ec $/1/, accessed $$ Fuly $/11 37 Age ED !$/1/" Intermediate Care #actsheet 2., 1(6) http:??www.ageuk.org.uk?documents?en6gb?fs2.N$/intermediateN$/careN$/december N$/$/1/.pdfLdtrkOtrue published 7ec $/1/, accessed $$ Fuly $/11" 38 &I:B !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. &I:B :uideline 114, section (, 'rganisation of services. http:??www.sign.ac.uk?pdf?sign114.pdf Fune $/1/, accessed ) Fuly $/11. 39 Iindley, ; I !$//4" &troke: the facts 'xford, 'E1, 141 40 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(46(5. 41 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(5 42 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-2 43 &I:B !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. &I:B :uideline 114, section ).1.( Therapeutic positioning. http:??www.sign.ac.uk?pdf?sign114.pdf Fune $/1/, accessed ) Fuly $/11. 44 0arwood, 0uwe, and :ood !$nd edition, $/1/" &troke Care 'xford Care Aanuals, 'E1 1-$.
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;oyal College of 1hysicians !$//4" Care after stroke: Information for patients and their carers 11( 46 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1(4. 47 Bational Institute for 0ealth and Clinical >xcellence !$//4" C:.4 &troke: full guideline 11/( http:??www.nice.org.uk?nicemedia?live?1$/14?)1(.(?)1(.(.pdf published $( Fuly $//4, downloaded - Fuly $/11 48 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection ).14. *Acute6phase care !Initial, early rehabilitation assessment"+ http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6522$d1d-(/1b.pdf accessed ) Fuly $/11 49 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 50 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection (.1(, 1(5 51 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection (.1(, 1(5 52 &I:B !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. &I:B :uideline 114, section ).1.$ >arly mobilisation. Fune $/1/, accessed ) Fuly $/11. 53 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-) 54 0arwood, 0uwe, and :ood !$nd edition, $/1/" &troke Care 'xford Care Aanuals, 'E1, 1-)6-2 55 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 56 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 57 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-$ 58 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-) 59 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 60 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 61 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 62 B0& Iive 8ell website !$/1/" ;ecovering from a stroke http:??www.nhs.uk?livewell?stroke?pages?lifeafterstroke.aspx reviewed $- &ept $/1/, accessed $$ Fuly $/11 63 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection ..$, 12(,2-, and 24 http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6 522$d1d-(/1b.pdf accessed $$ Fuly $/11 64 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1./ P .( 65 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-( 66 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk"
45

1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 68 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1.16.$ 69 1rofessor &arah Tyson, >xpert Advisory 1anel. !4 th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 70 &cottish Intercollegiate :uideline Betwork !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. http:??www.sign.ac.uk?pdf?sign114.pdf 1-4, accessed ) Fuly $/11 71 &cottish Intercollegiate :uideline Betwork !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. http:??www.sign.ac.uk?pdf?sign114.pdf 1-5, accessed $$ Fuly $/11 72 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection ..$ *;ecovery phase !>valuating and stopping treatments"+ http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6522$d1d-(/1b.pdf accessed ) Fuly $/11 73 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection ..$ *;ecovery phase !>valuating and stopping treatments"+ http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6522$d1d-(/1b.pdf accessed ) Fuly $/11 74 &cottish Intercollegiate :uideline Betwork !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. http:??www.sign.ac.uk?pdf?sign114.pdf 1-4, accessed ) Fuly $/11 75 &cottish Intercollegiate :uideline Betwork !$/1/" Aanagement of patients with stroke: ;ehabilitation, prevention and management of complications, and discharge planning. http:??www.sign.ac.uk?pdf?sign114.pdf 1(26(4accessed ) Fuly $/11 76 0arwood, 0uwe, and :ood !$nd edition, $/1/" &troke Care 'xford Care Aanuals, 'E1 1$1)6$177 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1)4 78 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1)4 79 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 80 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 81 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 82 Aarigold,7. &., >ng, F. F., 7awson, A. &., Inglis, F.T.,0arris, F. >., Q :ylfadottir, &. !$//-" >xercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke, Fournal of the American :eriatrics &ociety, vol. -(, no. (, 1)1.=)$(. 83 Eniversity of >dinburgh !$/1/" @est 1ractice :uidance for the 7evelopment of >xercise after &troke &ervices in Community &ettings 1261/ 84 Eniversity of >dinburgh !$/1/" @est 1ractice :uidance for the 7evelopment of >xercise after &troke &ervices in Community &ettings 1261/ 85 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-.
67

1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 87 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 88 ;oyal College of 1hysicians !$//4" Bational Clinical :uideline for &troke, &ection ..$ *;ecovery phase !>valuating and stopping treatments"+ http:??bookshop.rcplondon.ac.uk?contents?.ad/-aab64)//6)5)c64cf)6522$d1d-(/1b.pdf accessed ) Fuly $/11 89 ;udd, A, Irwin, 1, 1enhale, @ !$//-" &troke: At our #ingertips. $ nd >d. Iondon: Class 1ublishing, 1-. 90 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk" 91 7ept of 0ealth !$//5" :uidance on B0& patients who wish to pay for additional private care http:??www.dh.gov.uk?en?1ublicationsandstatistics?1ublications?1ublications1olicyAnd:uidanc e?70R/5.)$4 92 7ept of 0ealth !$//5" :uidance on B0& patients who wish to pay for additional private care http:??www.dh.gov.uk?en?1ublicationsandstatistics?1ublications?1ublications1olicyAnd:uidanc e?70R/5.)$4 93 1rofessor &arah Tyson, >xpert Advisory 1anel. !4th &eptember $/11" 1hysiotherapy after stroke 6 1ersonal email to 1. 7e &ou,a !paula.desou,aGstroke.org.uk"
86