Briefing 226

February 2018

Understanding Stroke and Maximising Involvement in Care and Support Processes

Introduction

Under the Care Act 2014 adult social care practitioners working with a person who has had a stroke must:

  1. Possess the skills, knowledge and competence to work with that person; and
  2. Maximise the involvement of the person in care and support processes and decision making.

This briefing will support practitioners to understand:

  1. The causes of stroke;
  2. The possible impact of stroke; and
  3. The steps that they should consider taking to maximise the involvement of a person who has had a stroke.

The Cause of Stroke

Stroke is a complex health condition, occurring when blood supply is cut off to part of the brain. This causes damage to the brain, and can result in permanent cognitive and/or physical disability.

There are two main causes of stroke:

  1. A blood clot in the brain (an ischaemic stroke); and
  2. A burst blood vessel (a haemorrhagic stroke).

Ischaemic strokes are by far the most common, accounting for around 85% of cases.

The Possible Impact of a Stroke

The precise nature and intensity of difficulties experienced will depend on:

  1. The area of the brain that has been damaged; and
  2. The extent of the damage.

Problems tend to be worse in the weeks following the stroke and then gradually improve over time. Some people will fully recover, but many will never return to how they were before they had the stroke.

The following table sets out some of the difficulties that may be experienced by a person who has had a stroke:

Difficulty with…  Example 
Behaviour Reduced inhibition
Anger, stress and aggression
Emotional Wellbeing Depression (e.g. crying, hopelessness, withdrawal)
Anxiety (e.g. panic attacks)
Difficulty controlling moods or emotions
Hallucinations
Communication No longer being able to understand or use spoken or written language (Aphasia)
Difficulty speaking, due to loss of control of facial muscles (Dysarthria)
Difficulty speaking, due to frozen facial muscles (Apraxia)
Cognitive function Poor memory
Difficulty concentrating
Reduced ability to plan and problem solve
Difficulty remembering how to carry out daily living tasks (e.g. personal care tasks and meal preparation)
Physical movement Poor special awareness
Weakness or paralysis of a limb, or down one side of the body
Poor balance and co-ordination
Tiredness, especially in the first few months after a stroke
Pain associated with muscle spasm or weakness
Bodily function Poor swallowing reflex (Dysphagia)
Loss of or reduced bladder and bowel control
Vision, Smell and Taste Double vision
Limited field of vision
Reduced or lost sense of taste or smell
Hypersensitivity to certain taste or smells

Rehabilitation is key to a person’s recovery and long term outlook following a stroke.

Rehabilitation is a multi-disciplinary health approach that will begin in hospital, and continue post discharge for as long as it is needed.

The aim of rehabilitation is to support the person to:

  1. Build muscle strength; and
  2. Relearn how to do things; so that
  3. The optimum level of independence can be achieved.

Maximising Involvement in Care and Support Processes

There is no reason why a person who has had a stroke cannot be fully involved in all care and support processes.

If the person has experienced significant cognitive impairment as a result of their stroke a mental capacity assessment must be carried out to establish their ability to be involved, and if they lack capacity delaying the care and support process to allow recovery should always be considered.

The following table demonstrates some of the steps that practitioners can take to facilitate involvement:

Step  Further Information 
Try to avoid meeting after rehabilitation visits. Rehabilitation visits can be tiring for the person, and this may affect their concentration, communication and ability to process information.Rehabilitation visits can be tiring for the person, and this may affect their concentration, communication and ability to process information.
Consider using alternative methods of assessment.

Self assessment or communication by email can work well, especially if the person finds verbal communication difficult.

The person may also receive lots of visits from professionals as part of their rehabilitation, and may appreciate the opportunity to communicate without a further invasion of their privacy.
Avoid lengthy meetings. The person may become tired quickly, especially if the assessment is taking place in the weeks or months immediately following the stroke or they need to use a lot of energy to carry out everyday functions, such as walking.
Communicate effectively. Sit where you can hear the person and consider whether they want to write information down instead of speaking it (although take into account their fine motor skills and ability to write at this time).
Consider any support the person may need.

The person may benefit from the support of an advocate, friend or a member of their rehabilitation team as well as any carer.

This support may be needed before the meeting, during and also afterwards to support them to talk through the meeting outcome and next steps.
Limit distractions. The person may find it difficult to concentrate if there are other things happening around them.

Allow time for the person to consider things and respond.

Do not make a judgement about their capacity based on a slowed process time.
A person can experience delays in processing information and providing a response.
Allow time for the person to talk about their worries and wellbeing, and show that you are listening. The person is likely to have worries and concerns for the future. Recognising these concerns will build rapport and also support the person to move on to talk about their current needs and outcomes in a positive way.

Further Information

Adult Social Care Procedures customers can access further information in the Stroke Practice Guidance, which can be found in the tri.x Resources area of the procedures site.

Further information can also be found on the Stroke Association website using the following link https://www.stroke.org.uk/.

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