Saudi Stroke Standards

In-patient rehabilitation Purpose To ensure that those patients who have complex medical needs and require ongoing medical or nursing support can benefit from rehabilitation in an inpatient setting once their acute medical management has been completed and they are able to leave the acute stroke unit safely. Rationale  There are limited inpatient rehabilitation facilities to meet the rehabilitation needs of the stroke patients in the kingdom of Saudi Arabia.  Some stroke victims may suffer very severe stroke that may lead to multiple impairments with more complex physical and cognitive rehabilitation needs.  Due to the limited number of inpatient rehabilitation beds in Saudi Arabia, stroke patients tend to wait in acute hospitals. Some of the stroke patients also develop many preventable complications by the time they are transferred to rehabilitation.  Stroke patients tend to have the longer hospital stay, require long term care and are frequently discharged to long term-care facilities with added cost implications.  Post stroke depression, fatigue and spasticity could become a problem after discharge from acute stroke units and has a negative impact in the function and quality of life of stroke survivors. Standards 1. The inpatient rehabilitation should be provided in an environment in which rehabilitation care is well coordinated 2. Inpatient rehabilitation should be delivered by skilled multidisciplinary team with expertise in complex physical, cognitive and neurobehavioral impairments. 3. Stroke patient should receive a comprehensive assessment to determine: I. Pre-stroke functional abilities; II. Level of physical impairment; III. Impairment of cognition, swallowing, communication, vision and perception, selfcare and continence status; IV. Symptoms related to depression, pain, spasticity, fatigue etc; V. Activity limitations and participation restrictions; VI. Social and environmental factors. 4. All stroke patients who are medically stable and identified to benefit from in-patient rehabilitation should be referred to an inpatient rehabilitation facility immediately after the assessment by the stroke team or inpatient rehabilitation program. 5. All patients who meet the criteria for a comprehensive inpatient rehabilitation program should be transferred with in 48 hours from acceptance. 6. The inpatient rehabilitation multidisciplinary team should include the following disciplines: I. Consultant in Physical Medicine and Rehabilitation; II. Rehabilitation nurses; III. Physiotherapists; IV. Occupational therapists; V. Speech and language therapists; VI. Clinical psychologists; VII. Case managers; VIII. Social workers; IX. Health educators. 7. The inpatient stroke rehabilitation team should have access to the following services: I. Dietetics; II. Orthotics and functional electric stimulation; III. Respiratory therapist; IV. Continence service; V. Wheelchair services and equipment; VI. Assistive technology; VII. Psychiatry support; VIII. Podiatry. 8. All symptoms that develop after the stroke which impact on the rehabilitation e.g. hemiplegic shoulder and neuropathic pain, muscle spasticity, fatigue and depression should be managed appropriately. In addition, complications e.g. pressure injury, venous thrombo-embolism and joint contractures should be prevented. 9. Inpatient rehabilitation therapy should provide a range of interventions and high- intensity training to promote and improve motor recovery. 10. Patients should be given at least 45-60 minutes of rehabilitation by each discipline, five days per week if they are able to tolerate this level of therapy. 11. Patients who are unable to participate in 45-60 minutes of daily therapy should receive up to 30 minutes of therapy 5 days per week. 12. Multidisciplinary rehabilitation team should be collecting regular outcome measures using valid tools on admission and discharge. 13. Multidisciplinary team should set agreed goals with patients and their families on admission and update them about progress towards those goals. 14. Stroke patients and their families /carers should be provided with information related to their condition and it is management. 15. Appropriate equipment and training should be provided for stroke patients and their families/carer after assessing the suitability of the home environment. 16. Prior to discharge from hospital to home or long-term facilities, a follow up plan should be agreed with stroke patients and their families in relation to their health and social care needs. 17. Arrangements should be made to meet the educational and vocational rehabilitation needs of young stroke patients after their discharge from inpatient rehabilitation program. 18. Criteria for a patient’s admission to a comprehensive inpatient rehabilitation program may include the following: I. Medical stable; II. Significant unresolved neurologic deficit; III. Impairment affecting at least 2 of the following functions:  Mobility  self-care activities  swallowing  Communication  bowel or bladder control IV. Cognitive and communicative abilities to learn and participate in therapy; V. Ability to tolerate the active intensive therapy program; VI. Achievable rehabilitation goals. QM