The Nurse and Stroke Rehabilitation By: Bernadette Lee SRN National Rehabilitation Hospital
	Back to leaflet index

For Rehabilitation to be successful it must be a co-ordinated team effort involving patients and their families. The programme must be consistent with short term achievable goals. Morale is all important. Co-operation between nurses and, above all, family carers ensures that the patient can look to the future with confidence. It is this confidence that gives stroke people the will to strive for ever higher levels of recovery.

The aim is to maximise recovery and help the patient return to maximum independence. This can best be achieved when the patients and their families are involved with the team - Doctor, Nurses, Physiotherapists, Occupational Therapists, Speech and Language Therapists, Psychologists and Social Workers.

Back to top

Problems associated with each stroke are identified. These may include:

Short term realistic goals are set with the patient and his/her family and the Health Care team. The role of the family carers is crucial.

Back to top

Good positioning of the stroke patient is most important.

Positioning in bed.

(a) Lying on the stroke side

This should always be encouraged with the stroke shoulder well forward so that the body weight is supported on the flat of the shoulder blade and not on the point of the shoulder. Place the stroke leg with the thigh so that it is in line with the trunk, and bend the knee slightly. The unaffected leg should be brought forward and placed with the knee bent on a pillow in front of the affected leg for comfort. This prevents the patient rolling onto his back. Lastly, bend the head forward a little.

(b) Lying on the unaffected side.

Again the stroke arm should be well forward, keeping the elbow straight and supported on a pillow. The stroke leg should be brought far enough in front of the body to prevent the patient rolling on to the back, the knee bent and leg supported on a pillow. A small pillow can then be placed under the patient's waist to maintain the the line of the spine. When lying on the side position, the patient should have two pillows only under the head.

(c) Lying on the back

This is the position most likely to encourage spasticity, but some patients do like to lie on their back for a while and it will be required for some treatments. Place two pillows under the patient's head and help him bend his head slightly towards his unaffected shoulder and gently turn his head towards his stroke side but do not uses force. A small pillow is placed under the buttock of the stroke side and should extend just to the knee, this will relax the leg and prevent it turning out at the hip. A pillow is placed under the stroke arm which is kept straight at the elbow and if possible, the palms of the hand facing upwards. The bed must be the correct height to promote independence and safety for the patient, family and health care workers.

Sitting position in a chair

The patient should sit upright - well back in the chair - and should not slump to one side. A table should be used to support the stroke arm which then rests on a pillow. The arm should be positioned with palm facing downwards, fingers and thumb straight and elbow straight. The stroke leg may need to be supported by a pillow beneath the buttock on the stroke side to prevent the knee rolling outwards and so keep the foot flat. The Occupational Therapist will advise on the appropriate type of chair for safety and independence.

Back to top

Nursing care will involve setting up a programme of regular toileting to promote continence. A chart or a diary may be useful. Sometimes drug treatment may be necessary. Restoration of continence can provide a tremendous psychological boost for patients and give them the confidence to participate in therapy and social events. Adequate fluid intake and the use of natural bran products and fibre-rich foods are important. A raised toilet seat and grab rails are essential for safety and independence.

Back to top

The nutritional problems that may arise following a stroke include:

Back to top

Great progress can be made here, especially in the early stages. Goals for working with the patient might be:

• Creating an atmosphere that encourages communication
• Encouraging patients to express themselves - e.g. through writing or gestures
• Use of picture or alphabet boards

Back to top

The patient may experience:

• Emotional lability which may result in him laughing or crying on the slightest pretext and often inappropriately
• Reduced tolerance to stress
• Fear, hostility, anger, frustration
• Withdrawal and isolation
• Depression

The nurse must be supportive by listening and providing a safe comfortable environment. It is important to work closely with the family to ensure they fully understand the nature of the problem.

Back to top

The nurse works closely with the Social Workers in getting the patient ready to leave the hospital. The process includes:

• Early contact with the patients family so they can observe therapy, learn about stroke and the support services available such as the Volunteer Stroke Scheme, Home Help, Meals on Wheels. The new video on stroke will be a great help here.
• Assessing what are the patient's and the family goals for discharge.
• Evaluating what type of help and supervision will be required at home.
• Teaching the patient and his family about the use of assistive devices.
• Encouraging weekend leave or overnight stay at home to determine the patient's ability to function at home.
• Early ordering of equipment or adaptive devices to ensure their arrival before discharge.
• Making referral to the Community Care Services including the Public health Nurse and the GP.

Back to top