Back to Contents page What’s new in the 2023 edition Guideline development 1.0 Introduction 1.1 Scope 1.2 Context and use of this guideline 1.3 Models underpinning guideline development 1.4 Methodology of guideline development 1.5 Funding and conflicts of interest 1.6 Treatments not mentioned in this guideline 1.7 Participation in clinical research 1.8 Licensing and approval of medication 1.9 Contributors 1.10 Notes on the text Organisation of stroke services 2.0 Introduction 2.1 Public awareness of stroke 2.2 Definitions of specialist stroke services 2.3 Transfer to acute stroke services 2.4 Organisation of inpatient stroke services 2.5 Resources – inpatient stroke services 2.6 Location of service delivery 2.7 Transfers of care – general principles 2.8 Transfers of care from hospital to home – community stroke rehabilitation 2.9 Remotely delivered therapy and telerehabilitation 2.10 Measuring rehabilitation outcomes 2.11 Psychological care – organisation and delivery 2.12 Vocational rehabilitation 2.13 Follow-up review and longer term support 2.14 Stroke services for younger adults 2.15 End-of-life (palliative) care 2.16 Carers 2.17 People with stroke in care homes 2.18 Service governance and quality improvement Acute care 3.0 Introduction 3.1 Pre-hospital care 3.2 Management of TIA and minor stroke – assessment and diagnosis 3.3 Management of TIA and minor stroke – treatment and vascular prevention 3.4 Diagnosis and treatment of acute stroke – imaging 3.5 Management of ischaemic stroke 3.6 Management of intracerebral haemorrhage 3.7 Management of subarachnoid haemorrhage 3.8 Cervical artery dissection 3.9 Cerebral venous thrombosis 3.10 Acute stroke care 3.11 Positioning 3.12 Early mobilisation 3.13 Deep vein thrombosis and pulmonary embolism Rehabilitation and recovery – principles of rehabilitation 4.0 Introduction 4.1 Rehabilitation potential 4.2 Rehabilitation approach – intensity of therapy (motor recovery and function) 4.3 Rehabilitation approach – goal setting 4.4 Self-management 4.5 Remotely delivered therapy and telerehabilitation 4.6 Self-directed therapy Rehabilitation and recovery – activity and participation 4.7 Introduction 4.8 Independence in daily living 4.9 Hydration and nutrition 4.10 Mouth care 4.11 Continence 4.12 Extended activities of daily living 4.13 Sex 4.14 Driving 4.15 Return to work Rehabilitation and recovery – motor recovery and physical effects of stroke 4.16 Introduction 4.17 Motor impairment 4.18 Arm function 4.19 Ataxia 4.20 Balance 4.21 Falls and fear of falling 4.22 Walking 4.23 Pain 4.23.1 Neuropathic pain (central post-stroke pain) 4.23.2 Musculoskeletal pain 4.23.3 Shoulder subluxation and pain 4.24 Spasticity and contractures 4.25 Fatigue 4.26 Swallowing Rehabilitation and recovery – psychological effects of stroke 4.27 Introduction 4.28 Psychological effects of stroke – general 4.29 Cognitive screening 4.30 Cognitive assessment 4.31 Apraxia 4.32 Attention and concentration 4.33 Memory 4.34 Executive function 4.35 Mental capacity 4.36 Perception 4.37 Neglect 4.38 Mood and well-being 4.39 Anxiety, depression and psychological distress 4.40 Apathy 4.41 Emotionalism Rehabilitation and recovery – communication and language 4.42 Introduction 4.43 Aphasia 4.44 Dysarthria 4.45 Apraxia of speech Rehabilitation and recovery – sensory effects of stroke 4.46 Introduction 4.47 Sensation 4.48 Vision Long-term management and secondary prevention 5.0 Introduction 5.1 A comprehensive and personalised approach 5.2 Identifying risk factors 5.3 Carotid artery stenosis 5.4 Blood pressure 5.5 Lipid modification 5.6 Antiplatelet treatment 5.7 Anticoagulation 5.8 Other risk factors 5.9 Paroxysmal atrial fibrillation 5.10 Patent foramen ovale 5.11 Other cardioembolism 5.12 Vertebral artery disease 5.13 Intracranial artery stenosis 5.14 Oral contraception and hormone replacement therapy 5.14.1 Oral contraception 5.14.2 Hormone replacement therapy 5.15 Obstructive sleep apnoea 5.16 Antiphospholipid syndrome 5.17 Insulin resistance 5.18 Fabry disease 5.19 Cerebral Amyloid Angiopathy 5.20 CADASIL 5.21 Cerebral microbleeds 5.22 Lifestyle measures 5.23 Physical activity 5.24 Smoking cessation 5.25 Nutrition (secondary prevention) 5.26 Life after stroke 5.27 Further rehabilitation 5.28 Social integration and participation Implementation of this guideline 6.0 Introduction 6.1 Overall structure of stroke services 6.2 Acute stroke services 6.3 Secondary prevention services 6.4 Stroke rehabilitation services 6.5 Long-term support services Acronyms and abbreviations Glossary Bibliography Contributors Appendices Evidence tables & additional evidence assessed Previous editions of the guideline Select Subject Back to Contents page What’s new in the 2023 edition 1.0 Introduction 1.1 Scope 1.2 Context and use of this guideline 1.3 Models underpinning guideline development 1.4 Methodology of guideline development 1.5 Funding and conflicts of interest 1.6 Treatments not mentioned in this guideline 1.7 Participation in clinical research 1.8 Licensing and approval of medication 1.9 Contributors 1.10 Notes on the text 2.0 Introduction 2.1 Public awareness of stroke 2.2 Definitions of specialist stroke services 2.3 Transfer to acute stroke services 2.4 Organisation of inpatient stroke services 2.5 Resources – inpatient stroke services 2.6 Location of service delivery 2.7 Transfers of care – general principles 2.8 Transfers of care from hospital to home – community stroke rehabilitation 2.9 Remotely delivered therapy and telerehabilitation 2.10 Measuring rehabilitation outcomes 2.11 Psychological care – organisation and delivery 2.12 Vocational rehabilitation 2.13 Follow-up review and longer term support 2.14 Stroke services for younger adults 2.15 End-of-life (palliative) care 2.16 Carers 2.17 People with stroke in care homes 2.18 Service governance and quality improvement 3.0 Introduction 3.1 Pre-hospital care 3.2 Management of TIA and minor stroke – assessment and diagnosis 3.3 Management of TIA and minor stroke – treatment and vascular prevention 3.4 Diagnosis and treatment of acute stroke – imaging 3.5 Management of ischaemic stroke 3.6 Management of intracerebral haemorrhage 3.7 Management of subarachnoid haemorrhage 3.8 Cervical artery dissection 3.9 Cerebral venous thrombosis 3.10 Acute stroke care 3.11 Positioning 3.12 Early mobilisation 3.13 Deep vein thrombosis and pulmonary embolism 4.0 Introduction 4.1 Rehabilitation potential 4.2 Rehabilitation approach – intensity of therapy (motor recovery and function) 4.3 Rehabilitation approach – goal setting 4.4 Self-management 4.5 Remotely delivered therapy and telerehabilitation 4.6 Self-directed therapy 4.7 Introduction 4.8 Independence in daily living 4.9 Hydration and nutrition 4.10 Mouth care 4.11 Continence 4.12 Extended activities of daily living 4.13 Sex 4.14 Driving 4.15 Return to work 4.16 Introduction 4.17 Motor impairment 4.18 Arm function 4.19 Ataxia 4.20 Balance 4.21 Falls and fear of falling 4.22 Walking 4.23 Pain 4.23.1 Neuropathic pain (central post-stroke pain) 4.23.2 Musculoskeletal pain 4.23.3 Shoulder subluxation and pain 4.24 Spasticity and contractures 4.25 Fatigue 4.26 Swallowing 4.27 Introduction 4.28 Psychological effects of stroke – general 4.29 Cognitive screening 4.30 Cognitive assessment 4.31 Apraxia 4.32 Attention and concentration 4.33 Memory 4.34 Executive function 4.35 Mental capacity 4.36 Perception 4.37 Neglect 4.38 Mood and well-being 4.39 Anxiety, depression and psychological distress 4.40 Apathy 4.41 Emotionalism 4.42 Introduction 4.43 Aphasia 4.44 Dysarthria 4.45 Apraxia of speech 4.46 Introduction 4.47 Sensation 4.48 Vision 5.0 Introduction 5.1 A comprehensive and personalised approach 5.2 Identifying risk factors 5.3 Carotid artery stenosis 5.4 Blood pressure 5.5 Lipid modification 5.6 Antiplatelet treatment 5.7 Anticoagulation 5.8 Other risk factors 5.9 Paroxysmal atrial fibrillation 5.10 Patent foramen ovale 5.11 Other cardioembolism 5.12 Vertebral artery disease 5.13 Intracranial artery stenosis 5.14 Oral contraception and hormone replacement therapy 5.14.1 Oral contraception 5.14.2 Hormone replacement therapy 5.15 Obstructive sleep apnoea 5.16 Antiphospholipid syndrome 5.17 Insulin resistance 5.18 Fabry disease 5.19 Cerebral Amyloid Angiopathy 5.20 CADASIL 5.21 Cerebral microbleeds 5.22 Lifestyle measures 5.23 Physical activity 5.24 Smoking cessation 5.25 Nutrition (secondary prevention) 5.26 Life after stroke 5.27 Further rehabilitation 5.28 Social integration and participation 6.0 Introduction 6.1 Overall structure of stroke services 6.2 Acute stroke services 6.3 Secondary prevention services 6.4 Stroke rehabilitation services 6.5 Long-term support services Acronyms and abbreviations Glossary Bibliography Contributors Evidence tables & additional evidence assessed Previous editions of the guideline Glossary A B C D E F G H I L M N O P Q R S T V W X Orthosis An appliance used to support or align an area of the body to facilitate movement, or prevent or correct damage. 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