Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Rehabilitation after stroke: summary of NICE guidance

BMJ 2013; 346 doi: (Published 12 June 2013) Cite this as: BMJ 2013;346:f3615

Rapid Response:

Re: Rehabilitation after stroke: summary of NICE guidance

I find it rather extraordinary that recent NICE guidelines have not mentioned the use of Botulinum Toxin in patients with Stroke spasticity. This is a well-recognised treatment of stroke spasticity and is of benefit to certain patients. The Royal College of physicians have published its guidelines in 20091.

Unfortunately not all goals in rehabilitation are quantifiable and necessarily replicated in all patients and spasticity in stroke falls into one such group. I find it even more bizarre that there are Research recommendations for Functional electrical stimulation (FES).

In the same vein, I have found no mention of oral care and hygiene including tooth decay as a part of stroke rehabilitation. There is a conspicuous absence of Dental surgeon in Guidelines development Group (CDG) 2. It is a well recognised complication of post stroke patients and I was hoping NICE would address this issue.

I am not sure now that current NICE Guidelines are comprehensive enough to include all aspects of stroke rehabilitation, but more worrying is that there is no acknowledgement as such about its remit and limitation.




Dr Sreeman Andole
Lead Physician in Stroke
Barking Havering and Redbridge University Hospitals NHS Trust

Competing interests: No competing interests

07 July 2013
Sreeman N Andole
Lead Physician in Stroke Medicine
Barking Havering and Redbridge Hospitals NHS Trust
Romford RM7 0AG