Stroke Training and Awareness Resources (STARs)


Dave is discharged

Dave has been discharged from the acute stroke unit after 8 weeks and from the general ward at 12 weeks.

Please enable JavaScript in your browser to see this interactive content.

Dave’s discharge summary
Acute Stroke Unit, 8 weeks later General ward, 12 weeks later
Details
Mr Walker was admitted to hospital on 13th April following a right infarction while travelling on a flight from America. He presented with left sided weakness, impaired sensation and dysarthria. Mr Walker was admitted to hospital on 13th April following a right infarction while travelling on a flight from America. He presented with left sided weakness, impaired sensation and dysarthria.
Medical issues
  1. Right middle cerebral artery (MCA) infarction.
  2. Chest infection x1, treated with IV antibiotics.
  3. Post-stroke seizures x1. No medical treatment required. No driving restrictions.
  4. Transient post-stroke pain – settled with simple analgesics and MDT care.
  5. Transient constipation, responded well to treatment.
  6. Transiently deranged LFT’s. Normal liver scan. Settled after withholding statin and have stayed normal on a lower dose.
  7. Some high tone initially which quickly settled and hasn’t needed any specific treatment.
  1. Right middle cerebral artery (MCA) infarction.
  2. Chest infection x1, treated with IV antibiotics.
  3. Post-stroke seizures x3, treated with anti-epileptic drugs. Can’t drive for 1 year.
  4. Post-stroke pain – remains on analgesia including atypical analgesic.
  5. Constipation. Please monitor.
  6. Deranged LFT’s – last LFT’s still slightly elevated, please repeat after one month.
  7. Post-stroke spasticity – treated with baclofen. Please monitor.
Function
He is walking with a stick and an ankle foot orthosis (AFO). This fits well and should continue to be worn for now. He needs supervision on stairs still. He has a wrist hand orthosis (WHO) which he wears overnight but not during the day, as hand function is improving and should be encouraged as much as possible. He and his wife have been taught to apply the orthoses and the techniques to stretch muscles in his arm and leg. He still has increased tone and some limitation of his thumb function for grip and release. This will be kept under review by the community stroke team. The following equipment has been fitted:

  • Rails have been fitted in bathroom, stairs and at front door.
  • A bath seat has also been supplied
Rehabilitation has been slow and difficult, not helped by spasticity and post-stroke fatigue. He is walking short distances with assistance of two when wearing an ankle foot orthosis (AFO). This isn’t fitting well so he often won’t wear it. He will be sent an appointment to have this reviewed. He was fitted for a wrist-hand orthosis (WHO) but has not been wearing this regularly. He needs assistance with activities of daily living. The following equipment has been supplied:

  • Grab rail at front door and in bathroom.
  • Bath seat.
  • Raised toilet seat.
  • Urine bottle.
  • Bed rail.
Follow-up
He has been referred to the community stroke team (CST) for further physiotherapy and occupational therapy. Mr Walker has been setting goals during his recovery and he has identified long term goals of driving and eventual return to work. CST may decide to refer him to the spasticity clinic for assessment of muscle tone, review of orthotics and botulinum injections to improve thumb function. He is being referred to an exercise after stroke programme. He is taking part in an upper limb stroke rehabilitation trial as an outpatient. Referral done to community rehab team for further physiotherapy and occupational therapy. Care package for assistance with dressing and bathing. Already has an appointment with orthotics in a few weeks. Discharge letter copied to stroke clinic for review.

Page last reviewed: 06 May 2020