Display Patient Information Leaflets

Date issued: October 2024

For review: October 2026 

Ref:  C-524/CC/Neurology/My Stroke Therapy Booklet v2

PDF: My Stroke Therapy book.pdf[pdf] 2MB

Information for Relatives, Carers and Friends

Car Parking:  Charges applicable

Protected mealtimes:  

• Midday to 1pm

• 5:30pm to 6:30pm

Visiting Times: Open visiting 

Please sign in at reception desk on arrival.

Due to limited space and ongoing patient care, we request a maximum of two visitors by the bedside at a time. We have a family room that you are welcome to use for larger groups.

We encourage relatives to be involved in patient care where possible. If you would like to assist in the personal care of your relative, or during meal times to assist with eating and drinking; please speak to the named nurse or nurse in charge. If you would like to attend a therapy session with your relative please let the team know and we will arrange this where possible.

Contacting the Ward

The best time to phone to speak to a member of the team on the Stroke Unit is 10am to 5pm and 6pm to 8pm. Please remember, we are not allowed to give confidential information over the phone.

If you have a big family, please try to ensure that one person rings in the morning and then they can let everybody else know the news. This will free up the stroke team to spend time with patients. 

Telephone numbers: 01752 432234 and 01752 432858

It can be beneficial for relatives and carers to be involved in the rehabilitation process so please discuss this with the ward team.

What is a Stroke?

A stroke occurs when the blood supply to a part of the brain is reduced. This can occur in two ways.

Infarct or Ischaemic Stroke

(a clot) reduces the blood supply to an area of the brain.

Haemorrhage

(a bleed) bleeds into an area of the brain.

Transient Ischaemic Attack TIA (Mini Stroke)

• A TIA is a stroke where symptoms last less than 24 hours and a full recovery is made.

• A stroke in the left side of the brain will affect the right side of the body.

• A stroke in the right side of the brain will affect the left side of the body.

• A stroke at the back of the brain can affect balance and coordination.

Risk factors in stroke

• Smoking

• Lack of exercise

• Being overweight

• Diabetes

• Family history of stroke

• Excess alcohol

• Poor diet

• Age

• High blood pressure

• High cholesterol

• Previous stroke or TIA

The Multidisciplinary Team (MDT)

Doctors 

The doctors will diagnose your stroke and give you advice on how to prevent further strokes.

To confirm that you have had a stroke, the type of stroke and the cause of the stroke the medical team need to carry out tests and investigations.

Neurological Investigation

In order to see how your brain has been affected the doctor may begin with:

• Asking you some questions.

• Asking you to move your arms and legs and check your  response to touch.

• Examine your eye movements.

CT scan (Computerised Axial Tomogram): A CT is an x-ray of the brain and is painless. This may allow the doctors to diagnose your stroke and see where it has happened in the brain.

MRI (Magnetic Resonance Imaging): An MRI takes an image of your brain using magnetic waves. It does not hurt, but it is very noisy. 

ECG (Electrocardiogram): This shows the doctors how well your heart is working

Ultrasound imaging: This examines the blood supply to your brain.

Blood tests: Samples of your blood may be taken to provide the doctors with more information.

The doctor may prescribe you with new medications after your stroke.

Nurses

The nursing staff are here 24 hours a day. 

Your nurse should introduce themselves to you at the start of their shift. The nurses have a varied role on the Stroke Unit. They will assess and monitor your condition regularly. The nurses will assist you with personal care, administer prescribed medication, and assist with discharge planning. The nursing staff will also encourage you to move about and sit out of bed where possible. This continues the work done with the therapists and can prevent you from developing a chest infection or other complications.

Nurses are here to help so if you need anything please use your buzzer next to your bed.

The nurses will wear different uniforms. If you would like to get to know the team more and the different uniforms, you can see a list of the different uniforms staff where and staff names on the information board by the ward reception.

The nurses will regularly monitor:

Neurological Observations (Glasgow Coma Core or GCS)

• Blood Pressure
• Pulse rate
• Breathing
• Temperature

These measurements help us to check for early signs of problems and monitor how new treatments are working.

The Ward is involved with various Research Studies. 

All of our clinical Trials are ethically approved, and all of them are being conducted in centres nationally or internationally.

The research team will talk to you if they feel you might be interested in a particular study.

Please remember, you are not obliged to take part in any of these studies.

Therapists

Physiotherapists (PT)

Strokes can cause a variety of physical symptoms which affect everyone differently. This can vary from quite subtle problems to complete loss of movement.

Physiotherapists wear blue trousers with blue trim on the collar.

Your physiotherapist will assess you early on during your stay and help you to get moving as soon as possible. 

This can range from careful positioning in bed, to transferring out into a supportive chair, to walking and doing everyday tasks. Transferring between bed and chair may require the use of manual handling equipment such as a hoist. This is all dependent on how much effect the stroke has had. 

This needs to be done with physiotherapists, or by nurses and occupational therapists trained to work with stroke patients. 

When rehabilitation is limited because of other medical problems or the severity of the stroke we will help to ensure comfort and try to prevent problems such as pain or stiff muscles and joints.

Fatigue is a common side effect following a stroke, especially in the early phase and if you are medically not very well. It is widely known that being as active as you feel able to after a stroke can have a positive outcome on your recovery. We therefore advise patients (with support from relatives and staff) to be as active as you can even outside of your therapy sessions. 

Sometimes you may feel unwell with a chest infection or need some help to make your breathing feel more comfortable. A Physiotherapist can help with this in addition to your stroke rehabilitation.

Things you can do outside of therapy sessions to help your recovery:                          

• Getting out of bed and sitting in your chair regularly throughout the day e.g., sitting out for meals.
• If you are medically unable to get out of bed, sitting upright in bed.
• Ask the nurses or therapists to use a cycling machine for your arms or legs.
• Try to use your stroke affected side, weak arm or leg as regularly by moving around in bed.
• Stand or walk with support from the nurses if you can to use the toilet.
• Complete exercises prescribed by therapists in your spare time.

Speech and Language Therapist (SLT)

The speech and language therapists are involved in the assessment and management of communication and swallowing post stroke.

Swallowing difficulties

After a stroke the muscles involved in swallowing can be affected. Sometimes a person may be at risk of food going down the wrong way into the windpipe (trachea), towards the lungs, instead of the oesophagus and into the stomach. This can then cause aspiration pneumonia.

The speech and language therapist can assess a person’s swallow and recommend what is safe for a person to eat. It may be necessary for alternative feeding to prevent aspiration pneumonia. The therapist can also recommend different consistencies of food or drink to ensure safe eating. 

Types of foods and consistencies

Nil by mouth: This may be due to the person being at high risk of food going down the windpipe on all food consistencies or the person is too drowsy to be eating or drinking. 

Puree diet (Level 4) This may be due to weak facial muscles that may make chewing food difficult. The person is sometimes too tired to chew so a mousse diet ensures that they get the nutrition they need. 

Soft and bite sized (Level 6) this may be due to some difficulties chewing but the person will be able to manage foods that are not too hard. 

Easy chew diet (Level 7) everyday foods which are more tender. You should be able to bite off pieces of these foods, chew them and then swallow them without tiring easily. 

Normal diet (Level7) regular diet with no modification.

Fluids: If fluids are difficult the therapist may recommend that it is not safe for the person to be taking fluids orally. In some circumstances the therapist may recommend that the person have water only to reduce the risks of a chest infection (aspiration).

Alternative feeding: If it is considered appropriate a person may be fed via a nasogastric tube (NG). This is when a tube is passed via the nose down the throat and into the stomach as a temporary measure to meet nutritional needs.

Communication Difficulties

There are two types of communication difficulties following a stroke.

Aphasia

(sometimes called dysphasia) is an acquired communication disorder that impairs a person’s ability to process language but does not affect intelligence.

Aphasia often hides people’s thoughts, ideas, personality, intelligence and competency but these things are all still inside. People who have aphasia can think clearly; they know what they think and feel but can’t get the words in or out.

People with aphasia may find it hard to:

• Talk
• Understand others when they speak
• Read
• Spell
• Use numbers and do calculations

In the early stages it can be best to concentrate on what the person with aphasia can do. This involves developing their use of non-verbal communication such as facial expression and gestures.

Dysarthria

occurs where the muscles of articulation are not working properly, making speech sound slurred.

Those with dysarthria may also have problems controlling the pitch, loudness, rhythm and voice qualities of their speech. The best exercise for these muscles is to talk. Sometimes it may be appropriate to give exercises for specific muscle movements by your Speech and Language Therapist.

Communication Tips

• Have a pen and paper to hand, writing key words and drawing can be a useful strategy
• Use conversation props, for example photographs, maps, books and diaries
• Show/ask people what helps you
• Try drawing
• Stay calm and talk in a relaxed manner
• Don’t be afraid of silences
• Keep conversation as natural as possible, keeping language levels simple.

Occupational Therapist (OT)

Occupational Therapists wear green trousers with green trim on the collar.

When you are on the Stroke Unit you may need to be seen by an Occupational Therapist who will help you to:

• Develop your independence in activities of daily living.
• Consider your home environment and any support you may need to complete activities of daily living.
• Look at your cognitive and psychological skills and how they impact on your everyday activities.              

Following a stroke people may experience any of the following:

• Loss of movement
• Poor balance
• Altered sensation in upper limbs.
• Communication problems
• Difficulties with planning and organising oneself

It may be difficult to manage some activities, for example.

• Washing and dressing
• Toileting
• Preparing drinks and meals 
• Going shopping
• Housework
• Managing finances

It may also affect your ability to return to work, do leisure activities, sport and other social activities.

You may need to learn how to do new things and the OT may recommend different pieces of equipment to aid independence at home or refer to community teams to follow up for equipment and rails after discharge. The OT will work with you and your family and other members of the team to make sure you feel happy and confident with what you are doing.

Personal Care Assessments

The OT may ask family or friends to bring familiar items onto the ward so that patients can practise washing and dressing.

These may include bringing in your wash bag of toiletries, shoes, clothing and shaving equipment, (it is a good idea to put name labels on personal items.)

It is important that you try and be involved with your own washing and dressing.

The OT may be able to suggest on techniques/equipment to help with this if necessary.

Leisure Activities on the Ward

It can be important to keep yourself stimulated whilst in hospital to help with your recovery.

You can practice activities that can stimulate the brain. This may include card games, solitaire, reading the newspaper and talking.

Friends and relatives can bring in photos, books or magazines, word searches/puzzles, cards, board games or other things that you like doing. 

If you have an IPad or tablet, therapists can direct you to some free Apps that could be beneficial.

How your friends and family can help?

Therapists can help advise families/carers how they can help you on the ward, including exercises and advice.

If your arm has been affected, therapists may advise family/carers on how they can help you position your arm correctly. They may provide massage or simple activities/a functional exercise programme that can encourage activity to return and increase sensory awareness.

Leaving Hospital

The therapy team will help co-ordinate discharge from the acute ward to appropriate settings considering ongoing therapy needs, support and equipment.

Dietitian

A stroke can cause chewing and swallowing difficulties which can affect the amount of food and fluid a patient can manage.

The Dietitians work closely with the Speech and Language Therapists to ensure the correct texture of diet is obtainable and supported, or in the event of alternative feeding being required that the correct feed type is prescribed to meet individual needs.

Good nutrition has many benefits: 

• Prevent malnutrition / weight loss
• Decrease the risk of infections
• Aid the healing of pressure sores/wounds
• Reduce the length of hospital stays. 
• Maintain muscle mass
• Provide energy for participation in rehabilitation

The dietitian can calculate exactly how much energy, protein and fluid a person is likely to need. If someone is unable to meet their full nutritional requirements and weight loss occurs, the dietitian can advise a high energy and high protein diet.

Hospital meals and puddings, extra snacks, milky drinks and oral nutritional supplements are all good ways to increase energy and protein intake.                                       

The dietitian can prescribe different types of supplements suitable for individual requirements and preferences.

For persons who cannot safely swallow any food or fluid after a stroke, they will need to be fed by a tube through the nose into the stomach (called a nasogastric or NG tube). 

If someone needs to be artificially fed for a longer period of time they may need a tube to feed straight into the stomach (known as a Percutaneous Endoscopic Gastrostomy, PEG). The team will normally discuss this with you and your relatives if this is a suitable option that needs to be considered.

The dietitian will regularly assess a patient to ensure they are receiving the best possible nutrition whilst in hospital, with the aim to maximise their rehabilitation. 

Secondary Prevention

The dietitian can also offer practical advice on how to change the balance of your diet, for example, to reduce your cholesterol or lose weight, which may reduce the risk of further strokes. Please inform the team if you would like information with regards to this prior to your discharge from hospital.

Integrated Hospital Discharge Team (IHDT)

The IHDT may be involved during your hospital stay depending on your discharge destination or pathway identified by the whole multi-disciplinary team (MDT).

They will help co-ordinate and streamline discharge planning and will liaise regularly with yourself, family and the wider MDT on the ward.

Your Discharge: Where to next?         

When?

When you and your hospital team feel that you are ready to move on.

Where?

If you still have symptoms after your stroke, you will either return home with ongoing rehabilitation from the Early Supported Discharge Team (ESD). If this is not possible, you may be referred to the Stroke Rehabilitation Unit (SRU) closest to where you live for further in-patient rehabilitation.

If your care needs after your stroke cannot be met at home, going to a residential or nursing home placement may be discussed with you. This may be temporary (interim) or more long-term depending on your progress and recovery.

How?

The multi-disciplinary team will meet to discuss your expectations and liaise with you and your family about where to go next.

Various support services can be offered to support a safe discharge home if this has been identified as a suitable location or alternative locations will be discussed. These services are coordinated through the IHDT team as mentioned.

The Rehabilitation Process

The length of time it takes to recover from a stroke is different for everybody. Some people may recover completely, and some people learn to develop new ways to manage the difficulties caused by a stroke.

Our aim is to help you:

• Identify any problems you are having
• Find ways of coping with the effects of your stroke
• Help you recover as far as possible
• Give you the support and assistance you need

To do this it may help to set goals. This can be difficult to do on your own so you may want to communicate to the staff or your family about this.

Your goals can be big or small, for example:

• Washing yourself
• Walking to the bathroom
• Sitting out in a chair for meals
• Going home

Your goals will be broken down into small steps.

Goal Setting

• Recovery from stroke is often lifelong.

• Goal setting helps recovery.

• Setting goals can break things down into chunks.

• Therapists talk about short term and long-term goals. 

• A long-term goal may be “I want to get better at walking”

• A short-term goal may be “I want to walk to the toilet and back in one week”

Here are some goals you may want to work on:

• Dressing

• Walking

• Problem solving

• Eating and Drinking

• Speaking

• Cooking

My Exercises

Your therapists will prescribe you some personalised exercises tailored to your abilities. 

Exercises may include everyday tasks such as reaching or picking up objects or functional activities such as writing or using a hairbrush which is proven to be the best way to strengthen weak muscles after a stroke. Other exercises could be stretching to reduce pain and stiffness in a weak muscle or joint. 

These exercises may be for you to complete on your own or could be exercises your family / nurses need to support you with. 

You could also use the space to consider planning your daily activities whilst in hospital:

Morning:

• Sit up in a chair / bed for breakfast.
• Have a wash or a shower.
• Complete daily exercises
• Sit out for lunch / dinner.
• Walk to the bathroom.

Afternoon / Evening

• Complete therapy session with therapy team
• Visit with my relatives / friends.
• Have a rest on the bed.
• Cycling challenge.
• Sit out for dinner

My Exercises

Ask a member of the nursing or therapy team if you would like to use the exercise bike. Your family member can set you up with the machine with our easy-to-follow instructions.

Why not try participating in our Southwest Cycling Challenge.

My Therapy Adjuncts

Therapists may use other specialist equipment alongside exercise to enhance your recovery after your stroke. These types of exercises can be completed with therapist or family support.

Please ask the team if these are suitable adjuncts for you.

Electrical stimulation

Pads are placed over the nerves within the muscle belly, the machine can help recreate movement. This can help provide sensory information to the affected side of the brain and can stimulate muscle activity. A tingling sensation is normally felt but does not cause any pain.

Mirror Therapy

The affected arm is placed in the mirror box. The other arm is taken through a series of exercises. The brain can visualise the affected arm through the mirror feedback. This provides stimulation to the side of the brain affected by the stroke.

Mental Rehearsal

An audio collection of guided mental practice and imagery exercises used as a treatment tool for motor recovery. Suitable for all patients following stroke regardless of the severity of the stroke. Ask your therapist for a copy of the exercises you could listen to on your own audio device.

My care plan 

Depending on how your stroke has affected you, the nursing staff may be provided with specific care plans if you require more specialised equipment or tailored advice to aid your recovery. 

This could include using specific splints (Orthoses) on your arm or leg or specific positioning plans of your body in your bed or a specialist chair. 

A copy of these can be provided to you here and will also be provided to the nursing staff to allow them to support you using them regularly as prescribed by the therapists.

Communication

Download and print the leaflet PDF to fill out this section.

This is an opportunity for family or friends to leave messages for therapy or nursing team or vice versa. Please feel free to write down any information you feel we will find useful to aid the rehabilitation of your loved one or simply ask any questions you may have, and we will come speak with you at the earliest opportunity. 

­­­­­­­­­­­­­­­­­­­­Useful Therapy Apps

Thinking/Cognition.

• Peak: The brain training app that helps you track and challenge your cognitive skills (free, available on apple and android).

• Memory Matches 2: An app to test your memory. Flip the cards to reveal a matching pair (free, available on apple).

• Flow Free: An app to test your problem solving skills by matching all the colours on the board with pipes (free, available on apple and android). 

• Luminosity: brain training, an app to challenge your memory, attention, problem solving etc. (free, available on apple and android). 

Vision

• Visual Attention Therapy: Exercises to help improve visual problems (£7.99, available on apple and android).

• Attention test: An app with exercises to improve visual attention (free, available on android). 

• Differences: A spot the differences between two images to promote scanning side to side. 

• Readright: A therapy site to help with reading and visual attention. Go to read right at UCL.

• Eyesearch: A therapy site to help people with visual search problems. Go to Eye Search at UCL. 

Mindfulness/ Wellbeing

• Headspace: An app designed to guide you through everyday mindfulness to help manage, stress, anxiety and sleep (free, available on apple and android).

• Calm: An app designed to promote relaxation and aid sleep (free, available on apple and android).

Upper limb function/ dexterity

• REPS Recovery Exercise: An app containing two exercise programmes aimed at improving function in the upper limb (free, available on apple and android).

• Dexteria: An app to help improve dexterity in your affected upper limb (£5.99, available on apple and android).

• Hit It!: An app to improve dexterity and upper limb coordination (free, available on android). 

Healthy lifestyle 

• SitFit: An app containing a seated exercise programme with three different levels (free, available on apple). 

• NHS Active 10 Walking tracker: Whether you want to lose weight, get more active or improve your mood, Better Health and Active 10 will be here to support you reach your health goals.

• Smokefree: An app to help you stop smoking, contains a four week programme to help you gradually give up (free, available on apple and android).

• NHS Quit Smoking app: is a 28 day programme that puts practical support, encouragement, and tailored clinical advice in the palm of your hand.

• Change4Life Food Scanner: An app to help you make smarter food choices. Scan the barcode and see how healthy your food is (free, available on apple and android). 

• Change4Life Smart Recipes: This app is a great way of eating healthier. It contains hundreds of easy, calorie counted recipes (free, available on apple and android). 

Communication

• Language Therapy Lite: Is made by Tactus. Tactus have a range of communication apps designed for people with aphasia. This is a free version that allows the user to choose between comprehension, reading, talking and spelling. Trial the free version before buying the full version (available on apple and android).  

• University College London: UCL provide a free online training course that allows the conversation partner to develop skills in supporting conversations. Go to the course Better Conversations with Aphasia.

• Aphasia Software Finder: It allows you to search through available communication apps and read summaries and reviews to find the best ones. Search the Aphasia Software Finder site. 

Other websites

Headway:

A charity providing information and support for people affected by brain injuries, including stroke. Find more brain injury information at Headway.

Useful Contacts / Links: 

Go to the Stroke Association: 

• Telephone Helpline
• Support groups
• Preventative stroke advice
• Support the charity
• Financial advice
• Carers support
• Research

Improving Lives  

As a long-established organisation, working within the city of Plymouth and the surrounding area. We run information, advice and support services for people with disabilities and long-term health conditions.

Visit Improving Lives Plymouth

Tel: 01752 201766 or 201900

Adult Social Services

Tel: 01752 668000

Social care information for children and families

Tel: 0345 155 1007

Devon Adult Social Care 

Tel: 0300 1234 131

Cornwall Adult Social Care