Synopsis
Plan needs-based multidisciplinary rehabilitation after stroke, protect nutrition and lungs through structured dysphagia care, and treat spasticity only when a goal-directed intervention is likely to improve comfort, care or function.
- Rehabilitation starts in the specialist stroke unit and is organised around the person’s own goals, impairments, activities, participation, home setting and support network rather than around a fixed package of therapies.
- NICE recommends needs-based multidisciplinary therapy for at least three hours a day on at least five days each week when the person can participate; those unable to tolerate that intensity should still receive needed therapy on five days.
- No food, drink or oral medicine should be given after acute stroke until swallowing has been screened by a trained professional using the local validated process.
Key red flags
Coughing, choking, a wet or gurgly voice, drooling, prolonged meals, pocketing food, recurrent chest infection or unexplained weight loss suggests dysphagia, while silent aspiration may present without an obvious cough.
Investigation priorities
Identify who can safely begin oral food, fluid and medication immediately after stroke.
Management branches
A person is admitted with acute stroke once hyperacute treatment and physiological stability are being addressed.
- 1. Admit to a specialist stroke service, screen swallowing before any oral intake and identify immediate mobility, pressure, communication and cognition risks.
- 2. Establish premorbid function, meaningful activities, home layout, work and caring roles, and involve family or advocates with consent.
Key medicines
Baclofen for generalised spasticityA specialist or experienced prescriber may start 5 mg orally three times daily and increase gradually according to response and tolerability; use a lower and slower regimen in frailty or renal impairment.
Botulinum toxin A for focal upper-limb spasticityNICE describes Dysport up to 1,000 units or Xeomin up to 400 units per treatment, distributed across selected muscles by a trained injector; product units are not interchangeable.