A Stroke is sudden and happens when the blood supply to the brain is reduced and brain cells become damaged or destroyed. Stroke can affect people in many different ways. Your assessment and treatment will depend on the nature of these symptoms. 
It is common to experience the following symptoms:

Physical

• Weakness.
• Changes in sensation.
• Difficulty with co-ordination.
• Increased muscle activity. 

Cognitive

• Reduced memory.
• Poor concentration/attention.
• Poor problem solving.
• Reduced insight into difficulties experienced.
• Difficulties multi-tasking.

Speech and swallow 

• Difficulty swallowing food and/or drinks.
• Word finding difficulties.
• Difficulty understanding what people say.
• Slurred speech.
• Changes in social communication skills.

Our stroke service provides a 24 hour, seven day a week service for thrombolysis (giving 'clot-busting' drugs to open up blocked arteries causing stroke). This is a regional service so we also accept patients from local hospitals who do not provide thrombolysis outside normal working hours.

The stroke service has two wards:

• 14 bed Hyper Acute Stroke Unit (Sky B) which gives immediate care for patients who have a suspected stroke
• 30 bedded Acute Stroke Unit for local patients (Harvest B Ward).

Patients needing further rehabilitation may be transferred to Japonica ward at King George hospital.

The Stroke service has seven consultants and a multi-disciplinary staff including specialist therapists and nurses.

Outpatient services include a follow up clinic for patients who have had a stroke and a one-stop clinic for those who have had a transient ischaemic attack (TIA). This is a 'mini stroke' where the blood supply to the brain is only briefly interrupted and symptoms of stroke are temporary. More information on the different types of stroke is available from the Stroke Association.

Stroke referrals

Patients who have had an acute stroke should be referred directly to the Emergency department via the ambulance service. If further advice is needed on the management of patients with a recent stroke, please contact the stroke consultant on call directly via the hospital switchboard.

What happens next

The London Ambulance service will bring you to Queen's hospital Emergency Department (A&E) where a multi-professional team of stroke skilled staff will be involved in your care.

All people admitted to the Hyperacute Stroke Unit will be assessed by the Occupational Therapist and Physiotherapist for cognitive and physical symptoms. If you have any problems with your communication or swallow you will be referred to the Speech and Language Therapist for assessment. After your assessment process on HASU you may be able to return home or may require further rehabilitation.

Further rehabilitation

This decision will be made with you, your family and the stroke multidisciplinary team. If you need to remain in hospital and live locally you will be moved to Harvest B, our Acute stroke unit

The rehabilitation process

Stroke rehabilitation is the process of working to restore functional ability and quality of life to those people who experience new disabilities as a result of their stroke.

This rehabilitation process usually begins as soon as a person is well enough to work with nurses and therapists. Following your assessment period an individually tailored programme of rehabilitation is started. Therapy goals are often set as part of this process, representing graded steps to help you maximise your recovery.

Your rehabilitation will usually be overseen by a named therapist. The roles of the main therapy disciplines are described below

Occupational Therapy (OT)

Occupational Therapy aims to support you to remain as independent as possible in areas of day to day living. Whether that is, managing self-care activities such as dressing, or helping you return to leisure/work life.

We will find out more about your lifestyle and assess what you are finding difficult after your Stroke. As part of this process we will observe how you carry out day to day tasks.

We will aim to see you up to five sessions a week for up to 45 minutes to work on goals that are important to you. When you are ready to leave hospital the Occupational Therapist may suggest completing a visit to your home to ensure it is safe for you to return, supply any necessary equipment and provide advice to family and carers.

Physiotherapy (PT)

PT will address the more physical symptoms of your stroke that are impacting on your ability to move yourself around (i.e. in bed or getting from A to B) or carry out tasks. It might involve working on compensatory strategies to help you gain more independence.

Physiotherapy will take place either on the ward or in the gym and you will receive up to five sessions of physiotherapy a week, each session lasting up to 45 minutes.

Your physiotherapist may provide you with additional exercises that can be done at your bedside, either on your own or with a friend/relative to support you. If suitable you may also be able to attend the upper limb, balance and snack groups that run weekly, offering the opportunity for rehabilitation in a group environment.

Speech and Language Therapy (SLT)

The SLT team, work with the many people who have problems communicating and/or swallowing following a stroke.

The SLT team will assess, and provide help with the early stages of managing, difficulties with swallow and communication you may have after stroke. If you are having difficulty with your swallowing modifications to your diet and fluids may be required to support safety when eating and drinking. If necessary further investigations, such as an x-ray of your swallow, may be carried out to guide your swallow rehabilitation programme.

We also support families, friends, hospital staff and carers to understand any changes to communication and swallowing that have occurred, and can provide information, advice and strategies so that they can support your recovery process.

Psychology

Clinical Psychologist/Neuropsychologists are specially trained in the assessment and treatment of emotional, cognitive and behavioural difficulties. Changes in emotion and cognition (thinking skills like memory, attention and problem solving) are common following a stroke and can impact on an individual’s recovery..

We know that if someone is depressed or anxious following their stroke it can negatively affect how long they stay in hospital and how well they progress in rehabilitation. It is important we recognise when someone might be low in mood and do what we can to treat it.

Likewise, if thinking skills are affected following stroke it's important, we understand the extent and nature of these changes so we can adapt your rehabilitation accordingly and think about what support you will need to return to your previous roles, responsibilities and interests.  
Because we know it is very common following stroke national guidelines recommend we complete mood and cognition screens with all our stroke patients.

A screen is a quick and easy tool to help us work out who would benefit from more detailed assessments.     

The mood screen involves a few questions about how you are feeling.  You may be able to complete it without any help, but we are happy to provide assistance if needed.  We also have a measure that we can complete for patients with communication difficulties.  
The cognitive screen is administered by an appropriately trained member of staff and involves completing a few different tasks and puzzles.  

If the screens identifying any potential difficulties, you will be offered a referral to the clinical psychologist/neuropsychologist for a more detailed assessment.

If you would like to know more about the emotional, behavioural and cognitive impact of stroke the Stroke Association has some useful information leaflets which are available on their website.

Nutrition and dietetics

Our nutrition team includes a specialist dietitian and also clinical nutrition nurse specialist. Good nutrition is an important part of your recovery after a stroke. Our stroke dietitian can help to assess if you are able to eat and drink enough to help with your recovery. If you are finding it difficult to meet your nutritional needs or are losing lots of weight, then we can work with you and your friends/relatives to look at ways to address this.

Following a stroke you may have difficulty with swallowing. This may mean you need a feeding tube to help you meet your nutrition and hydration needs. This feeding tube could be either short term or long term. Our nutrition team can help to support you and your family with making decisions about having a feeding tube. Our dietitian will calculate your nutrition and hydration needs and work with you and the nurses to make a tube feed and fluid plan. 

Once you are feeling better you may want to look at your longer term health and lifestyle. A healthy diet can help to reduce the risks of health complications in the future, including strokes, heart disease and diabetes. If you would like advice on a healthy diet then our dietitian can help you with this.  

Discharge.

After a period of rehabilitation on the stroke unit you/your relative will be discharged from the hospital. The location you/your relative are discharged to will depend on your progress after your stroke.

You/your relative may require further rehabilitation in your/their home from community therapy teams or you may require a further in-patient rehabilitation stay at another hospital site.

If you are not able to return home and further rehabilitation is not required the therapy team (as part of the wider MDT) will support you/your family in the discharge decision making process.  This will aim to ensure your/your relatives on-going care needs have been considered in order to establish your/your relatives discharge destination.

More Information

The multi-disciplinary team will endeavor to organise a family meeting for all Stroke patients. The time frame for this may vary slightly depending on the patient’s needs. This is an opportunity to discuss the patient’s progress and on-going plans such as where the patient may go to next.

SSNAP

The Sentinel Stroke National Audit Programme (SSNAP) is a programme of work which aims to improve the quality of stroke care by auditing stroke services against evidence based standards nationally. All Stroke patients admitted to the Queens hospital  Stroke Service will have data relating to key performance targets entered into the SSNAP data set by the SSNAP coordinator

The Hyperacute Stroke (HASU) therapy team specialises in the assessment and treatment of stroke patients where ever their place of residence. The Acute Stroke therapy team specialises in the treatment of stroke patients local to Queen’s hospital.

If you are assessed on the Hyperacute stroke Unit and do not live locally to Queen's hospital you will be transferred to an Acute Stroke Unit (ASU) closer to your home to continue your rehabilitation. This transfer to the ASU typically happens within 72 hours of admission.

Contact: 01708 503 658.

Opening hours: Monday to Friday, 8am to 4pm.

Mechanical thrombectomy is a treatment for stroke that removes clots that block large blood vessels. Some patients may be candidates for this procedure using an angiogram or a catheterization and a device that grabs clots and removes them, to re-establish blood flow to the brain. Unfortunately, not everyone is a candidate for mechanical thrombectomy, because it requires that a patient has a large vessel that’s blocked.

NHS England announced in April 2017 that it will commission mechanical thrombectomy so it can become more widely available for patients who have certain types of acute ischaemic stroke.

At queens we currently provide this service Monday to Friday, out of hours we refer patients identified as requiring this intervention to the The Royal London Hospital or University College Hospital.

After treatment, patients are often admitted to the hyper acute stroke unit to recover before going back to their usual place of residence

Hyper acute stroke unit

Our HASU is located on the 4th floor (Sky B). You will be looked after by a team of nurses, therapist and doctors who are highly experienced in caring for patients who have suffered a stroke.

Children are allowed to visit the wards but please contact the ward manager before visiting with young children.

Contact: 01708 435 000 Ext 2729.
Location. Queen's Hospital, Level 4. 

Acute stroke unit

Harvest B is a 30-bed acute stroke unit that provides ongoing stroke and rehabilitation for patients local to Queen's Hospital.

Contact: 01708 435000 Ext  3094.
Location. Queen's Hospital, level 4.

Stroke rehabilitation unit

Japonica ward is our local rehabilitation unit that cares for patients from Barking and Dagenham. It is a 15-bed unit that provides ongoing rehabilitation.

Contact: 01708 435 000 Ext  8215.
Location. King George Hospital, 1st floor.