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 am very aware that all the responses thus far are from clinicians, researchers and medics. I don't fully understand them but I will respond as a former brainstem stroke survivor with locked in syndrome. (Diagnosis: Right vertebral artery dissection and occlusion on 7/2/10 with an acute infarction of the pons.) See my 1st book Running Free (Amazon). I am a patient ADVOCATE. See fighting Strokes Page on Facebook.

Inpatient Stroke units ESSENTIAL.

Core multi disciplinary stroke team - Essential

Health & social care interface at 6 monthly intervals, including emotional support, online proactive support groups, help everyone affected by stroke understand the stroke impact.

Do not discharge patients too soon to the community.

Setting goals - patient-centred. Family &/or Friends, dont assume 'next of kin'. Patient-life centred. Establish self-help goals for patients. YOU MUST GET TO UNDERSTAND PATIENT MOTIVATIONS & THEIR PRE-STROKE LIFE. We can all lead a horse to water but they must want to drink it!

Do not end therapy session if muscles fatigue. Rest for 10 mins, then start again if the patient wants.


Emotional functioning - very important to assess.

Inpatient stroke unit should include vision, optectrics and psychological advice.
TELL ALL PATIENTS as part of their rehab that 'THEY WILL NEVER LOSE A (VOLUNTARY) PATHWAY IF IT RETURNS (Very powerful for the patient and their loved-ones) & to work damn hard. If they want to improve, they must be willing to work hard and as soon as possible after the stroke.

Finally, I have to take issue with the comment about FES. Perhaps people confuse the jargon. Electrical therapy stimulation helped me re-route my brain. FACT. It didn't just help me strengthen my muscles and prevent tendon shortening, it helped me bring my whole upper left side back to life. What's more seeing my arm flicker gave me huge, tangible and very real HOPE. I totally disagree and want to see more of the electrical therapy offered to stroke survivors.


Competing interests: No competing interests

09 July 2013
Kate F Allatt
Fighting Strokes CEO/Author/Speaker
Neurological Alliance
Sheffield S17