WSO - June 2023 - 516

516
International Journal of Stroke 18(5)
Table 3. (Continued)
Recommendation
Minimize skin friction and skin pressure, provide appropriate support surfaces, avoid
excessive moisture, maintain adequate nutrition and hydration to prevent skin breakdown
Regular turning, good skin hygiene, and use of specialized mattresses, wheelchair cushions,
and seating are recommended until mobility returns
Management of dysphagia and provision of food and fluids
Health care professionals should regularly monitor and reassess patients with dysphagia
who need modified food and liquid
Ensure good oral and dental (including dentures) hygiene, particularly for those with
dysphagia, through assistance and/or education
For stroke survivors with swallowing difficulties, behavioral approaches such as swallowing
exercises (e.g. shaker exercises, or chin tuck against resistance), environmental modifications,
safe swallowing advice, and appropriate dietary modifications should be used early
Offer swallowing therapy, e.g. compensatory strategies, exercises and postural advice, at
least 3 times a week to people with dysphagia after stroke who are able to participate, for
as long as they make functional gains.
For patients whose nutrition status is poor or deteriorating, nutrition supplementation
should be offered. Enteral diet should be started if required within 7 days of admission
(preferably within 24-48 h)
Patients who require tube feeding should receive percutaneous endoscopic gastrostomy
rather than nasogastric tube in the post-acute phase
Aerobic training
Individually tailored aerobic training involving large muscle groups (with monitoring of
heart rate and blood pressure) should be incorporated into a comprehensive stroke
rehabilitation program to enhance cardiovascular endurance and cognitive function
Exercise is needed at least 3 times weekly for a minimum of 8 weeks, progressing as
tolerated to 20 min or more per session, exclusive of warm-up and cool-down
Use strategies to address specific barriers to physical activity related to patients, health
care providers, family, and/or the environment
Group circuit class therapy should be used to increase scheduled therapy time
Offer early supported discharge services for those with mild to moderate disability
Provide advice on prescribed medications for people after stroke
Support and educate people after stroke and their families and carers, in relation to
emotional adjustment to stroke, recognizing that psychological needs may change over
time and in different settings
Specific impairments: upper and lower limb
Stroke survivors with difficulty walking should undertake tailored repetitive practice of
walking (or components of walking) using circuit class therapy (with a focus on overground
walking practice and/or Treadmill training with or without body weight support)
Rhythmic auditory stimulation (RAS) could be considered for improving gait parameters,
including gait velocity, cadence, stride length, and gait symmetry
For reduced strength in arms or legs, provide progressive resistance training which is
meaningful, engaging, repetitive, progressively adapted, task-specific, and goal-oriented
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International Journal of Stroke, 18(5)
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Minimal
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Essential
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Advanced
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WSO - June 2023

Table of Contents for the Digital Edition of WSO - June 2023
