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What is a Stroke?
Simon Kirwilliam
Our Vision:
To lead out-of-hospital community healthcare
What is a Stroke?
A stroke happens when the blood supply to the brain is suddenly interrupted
85%
15%
What is a TIA?
A transient ischaemic attack (TIA) is sometimes referred to as a ‘mini-stroke’
It is not a full stroke
The symptoms are similar to a stroke, however, they are more mild and last
only 24 hours because the interruption of the blood supply is temporary
A TIA is a SIGNIFICANT warning sign and ALSO require seeking emergency
treatment at A&E
Within 3 months of a TIA, up to 15% of people will have a full stroke if left
untreated. Within 2 years, 25% of all people who have a TIA will have a stroke
if left untreated.
Risk Factors
Inherent risk factors
• Age – greater likelihood of a stroke over the age of 65 year
• Family history – if a close relative has had a stroke
• Ethnicity – people of South Asian, African, and Caribbean background due to rates of diabetes
However - stroke is largely preventable, simply by reducing controllable risk factors
Manageable risk factors
• Smoking
• Irregular heart beats, e.g. atrial fibrillation
• High blood pressure
• Other heart conditions, e.g. mitral valve disease
• Obesity
• High cholesterol levels
• Excessive alcohol intake
• Use of certain illicit drugs (e.g. cocaine)
PLEASE SEE YOUR GP IF YOU ARE
EXPERIENCING IRREGULAR HEART BEATS
Stroke prevention
The BIG four
1.
Eat a healthy diet
2.
Regular exercise – 150 minutes per week
3.
Do not smoke
4.
Avoid excessive alcohol consumption
Other good practices
1. Monitor your blood pressure
2. Take the medications prescribed by your doctors
3. See your GP if you are having irregular heart
beats or palpitations
4. Check blood sugars with GP
5. Seek help to manage diabetes
http://www.nhs.uk/LiveWell/
Stroke Symptoms
Immediate Symptoms
ACT
• FACE - drooping of the face, mouth, or around the eye.
• ARMS – unable to lift arms or keep them in the air
• SPEECH – speech may become slurred, they may not make sense when talking
• COGNITION – people can become confused and disorientated to where they are
Call 999 NOW
• PAIN – people may experience severe headaches
Ongoing Problems
Physical
Cognitive
Weakness in arms/legs
Fatigue
Mobility problems
Memory problems
Attention problems
Problem solving difficulties
Speech & Language
Emotional/Psychological
Problems speaking
Problems understanding others
Problems with reading
Behaviour/personality change
Fluctuating mood
Depression
CLCH stroke services
Nicola Lorena
Our Vision:
To lead out-of-hospital community healthcare
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Prevention services
• No one specific service focused on stroke
prevention
• Risk factors are minimised by a range of services
and programmes
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Stopping smoking
CLCH smoking cessation services
• A personal quit plan tailored to individual needs
• Prescription for stop smoking medications to help beat
cravings
• Motivational tips on how to stay on track
• Choice of the type of service: one to one, group, or
telephone support
• In Hammersmith & Fulham, Kensington and Chelsea,
Westminster; https://www.kick-it.org.uk/
• In Barnet; 0845 111 4000
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Eat a healthy diet
Group education and advice
• Cook and Taste – 6 week programme on planning
and preparing healthy meals - 0207 313 3024,
cook&taste@clch.nhs.uk
• Open Age – “Food and friends programmes
Individual tailored advice
• Nutrition Support Service. Need to be referred by
GP
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Regular exercise
Exercise on prescription
• The scheme is for adults who have some of the risk
factors associated with heart disease. This includes
being overweight, being a smoker, having high
cholesterol, high blood pressure or a very stressful
lifestyle.
• 2 sessions with a trainer,12 weeks of reduced gym
membership
• Referral via GP or Practice Nurse
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Health checks
• Regular visits to GP/Practice Nurse
• Monitor Blood pressure
• Monitor Blood sugar levels
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Stroke Rehabilitation
Services
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Stroke care pathway
HYPER-ACUTE
Emergency medical
attention
Thrombolysis
(drugs that dissolve
blood clots)
ACUTE
REHABILITATION
Continued medical
management and
start of
rehabilitation in the
hospital setting
Specialist
rehabilitation in a
hospital setting
ASU
Albany
UCLH
Edgware Community
Hospital
HASUs
UCLH
Charing Cross
Hospital
St. Mary’s Hospital
St. Thomas’
Chelsea &
Westminster
Hospital
Northwick Park
Northwick Park
Rehabilitation
COMMUNITY
REHABILITATION
Medically stable
Intensive rehabilitation
from a team of different
health professionals
Early Support Discharge
Team (ESD)
Athlone House
Community Neurorehabilitation
Stroke review (6 & 12
months)
HASU – Hyper acute stroke unit
ASU – Acute stroke unit
CLCH rehabilitation teams
Speech and
Language
Therapy
Rehabilitation
Assistants
Physiotherapy
Stroke Support
Workers
CLCH
Stroke
Rehab Teams
Clinical
Psychology
Occupational
Therapy
Dietetics
Goal focused rehabilitation
• Patient focussed and personalised approach to healthcare
• The patient chooses the focus of rehabilitation – whatever is
meaningful to them e.g. increasing mobility, managing daily
domestic tasks, getting back to work…..playing tennis!
• Requires close co-ordination of care across multidisciplinary health professionals in the rehabilitation teams
• NICE recommended and gold standard approach for stroke
rehabilitation
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Life after a stroke services
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Ongoing Support:
one to one
• Stroke reviews – 6 and 12 months
• Stroke support worker – support for up to 12
months
• Mood – brief therapy
• Peer mentoring
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Ongoing support:
groups
• Communication groups – Dysphasia group
• Exercise – Stroke exercise groups
• Stroke groups
• Different strokes group
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Stroke Support
Service
Our Vision:
To lead out-of-hospital community healthcare
What is Stroke Support?
Helps you and your family prepare for the
changes that happen because of a stroke,
with information about stroke, practical
advice and emotional support.
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When does stroke support start?
Hyper Acute
Stroke Units
Stroke
When Stroke
happen
HASUs
Charing
Cross
Hospital
Stroke Units
SUs
CXH and
CXW
At home
Rehab
At Rehab
Centre
Life
after
Stroke
Community
Stroke Support
(stroke survivor, family and carers)
Stroke Support
Advocacy
Support for you,
family &
carers
Depends on your
needs
Carers Support
STROKE
SUPPORT
Listening
Knowledge
&
Advice
About stroke
Referring
to other
services
Longer term
Support
Stroke Support Involves
•
•
•
•
•
•
•
Support when returning home
Benefits and welfare advice
Carer support
Social inclusion and community access
Peer support and groups
Health promotion
Stroke reviews
Brief Therapy for Stroke
Survivors
Primary Care Psychological Health
Lucy Mabbott – Mark McDonagh
Our Vision:
To lead out-of-hospital community healthcare
Joint social and health
care project
April 2012
Royal Borough of Kensington & Chelsea
(RBKC)
Central London Community Healthcare NHS
Trust (CLCH)
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Why create this service?
Patients report stress
at diagnosis
discharge from hospital
discharge from support at home
Transition to ‘life as normal’
Psychological element of physical health –
mind/body health
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Original service
• Brief individual therapy – self referrals!
• Over 18 survivors of stroke with symptoms of
mild to moderate anxiety or depression
• Very positive response from professionals
• Very low numbers of patients coming for
therapy – 10 in the first 6 months!
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“Talking about it won’t
take away my stroke!”
Life After Stroke group
• To improve patient experience by providing
an alternative intervention to 1:1 counselling.
• To prevent harm – education; reducing
isolation
• Smart, effective care – maximise use of
resources
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Activity of service
Target
(yearly)
April – June
2013
July-Sept
2013
Oct-Dec
2013
Jan-March
2014
Referrals
25
5
8
1
2
First Appts
25
4
8
1
2
Follow ups
320
28 counselling
20 group
sessions
17 counselling
20 group
sessions
10
10
People in
groups
10
3
5
1
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Plans for the future
• Self help groups
• Early Supported Discharge team
- group in their service?
• New group in tandem with Hammersmith &
Fulham service
• Using non-NHS premises
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Contact us
Lucy Mabbott – Lead Therapist
Tel: 020 7349 2400
Mark McDonagh – Service Manager
Tel: 020 8962 4748 M: 07766 205431
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