Saudi Stroke Standards

Post-Acute Stroke Rehabilitation) 3. All patients who are medically stable should receive rehabilitation therapy within 48 hours of admission 4. Stroke patients who were identified by the stroke multidisciplinary team to have complex rehabilitation needs should be immediately referred to inpatient rehabilitation and transfer for inpatient rehab when they are medically stable 5. Each patient diagnosed with acute stroke and admitted to acute stroke unit should be screened for speech and language, physical, functional and cognitive functions by a multidisciplinary rehabilitation team within 24 to 48 hours, to identify the cases eligible for the rehabilitation services. 6. Stroke patients should receive the acute rehabilitation management carried by the specialist multi-disciplinary team when the patient meets the inclusion criteria (please see the suggested inclusion criteria in appendix 2).20 19 https://www.who.int/classifications/drafticfpracticalmanual2.pdf?ua=1 20 https://www.clinicalguidelines.gov.au/portal/2585/clinical-guidelines-stroke-management-2017 7. A valid and reliable tool must be used to assess the disability level of the stroke patient by the multidisciplinary rehabilitation team in the acute stage (i.e. within 24 to 48 hours post onset). 8. The multidisciplinary rehabilitation team should set specific recovery goals to meet the expected outcomes for each patient as early as possible, and update it on a regular basis, based on the prognosis of the stroke patient. 9. Stroke patients suffering from muscle spasticity need to have access to specialised treatment for management of symptoms including Botulinum Toxin for treatment of spasticity. 10. When the stroke patient is medically stable, the multidisciplinary rehabilitation team should create an evidence-based comprehensive management plan. 11. The multidisciplinary rehabilitation team should regularly reassess the stroke patient to identify the effectiveness of the rehabilitation plan. 12. Each stroke patient should be reassessed before discharge to identify his or her disability level and the need for follow-up support services. 13. The multidisciplinary rehabilitation team should prepare a transfer plan prior to discharge of the stroke patient from the stroke unit (e.g. home with outpatient rehabilitation, admission to a rehabilitation center/hospital, long term or palliative care) based on certain eligibility criteria for each facility. 14. The multidisciplinary rehabilitation team should report the continuity of care recommended for the stroke patient, this should be communicated to the stroke patient, patient’s family members and receiving clinicians. 15. The multidisciplinary rehabilitation team should have an agreed-upon method to maintain communication between its team members. 16. The multidisciplinary rehabilitation team should involve the stroke patient and/or their family in setting goals, expected outcomes, medication management and discharge plan. 17. All patients should be assessed for Physiotherapy within 24 hours of admission, unless contraindicated, for example, due to being medically unstable. Rehabilitation management should begin within 24/48 hours. This should include: I. early mobilization II. prescribing the right amount of exercise III. prescribing the right assistive device IV. educating the staff, patients and caregiver to regular turning, provide special mattresses and cushions to prevent skin breakdown V. educating the staff, patients and caregiver to transfer the patient safely to prevent shoulder dislocation. VI. determining whether the orthosis was appropriate to the patient VII. stroke patient should receive therapy for one hour, 5 days per week as tolerated VIII. following up on patient’s functional level within 30 days post discharge. 1) All patients must receive swallowing screening from a qua