Understanding the Journey of Stroke Recovery Timeline

17 December 2021

Article by: Nur Yee Jie Min, Corporate Communications

Stroke can strike anyone, anytime – recovery is possible and the timeline is different for everyone. Our multidisciplinary team of medical professionals are ready to help each patient on their journey to recovery. On this journey map, we help you to understand what happens from a stroke onset to treatment and recovery.

	Accident & Emergency A triage officer screens the patient, gets a quick history and checks vital signs. A CT scan is done immediately to assess the severity and determine if it is an intracranial bleed or ischemic stroke. Our emergency physicians will refer the patient to the relevant consultants: neurosurgeon for intracranial bleed and neurologist for ischemic stroke. If within the golden hours (up to 4.5 hours), thrombolysis treatment can be given. If there is a large vessel occlusion, the patient is referred to our Interventional Radiologist for thrombectomy in the Cath Lab.
	Operation Theatre A haemorrhagic (bleeding) stroke is managed by neurosurgeons. Surgery to remove the blood clot is aimed at preserving life, reducing mass effect and possibly improving neurological state. Bleeds could track into the water spaces of the brain and block the normal water passages leading to a condition called “hydrocephalus” which can be managed with surgery (insertion of tubes to drain the brain water, or cerebrospinal fluid (CSF), and blood). Other types of “stroke” caused by a multitude of other problems such as aneurysms, arteriovenous malformations, cavernomas, and Moya-moya disease are not very common and are treated with various types of surgery.
	Intensive Care Unit (ICU) and High Dependency Unit (HDU) Patients are transferred here to receive critical care and intensive monitoring. When in stable condition, the patient is transferred to a normal ward where the nursing team will assist in Activities of Daily Living (ADL) which refers to daily self-care activities. This includes hygiene, toileting, getting in and out of bed, eating and frequent repositioning to prevent bedsores or pressure ulcers. Our nurses also coordinate with the rehabilitation team for rehabilitation care as well as educate and motivate the patient and their family on treatment, home care and prevention.
	Neuroscience Centre Our team of experienced neurologists, neurosurgeons, neuroradiologists, neuro interventional radiologists, and neuro rehabilitation specialists work together to design the best treatment programme for the patient’s brain recovery.
	Rehabilitation Medicine Centre A comprehensive range of rehabilitative treatments are provided to help stroke patients get back to normal life through regaining and relearning daily living skills. Most patients get better with rehabilitation, enhancing their quality of life. Our Rehabilitation Physicians manage medication if needed and if required perform necessary procedures. Rehabilitation Therapists work closely with them to deliver the patient’s exercise routine more effectively. Physiotherapists focus on gross motor skills to help patient regain functional abilities such as walking and climbing up the stairs while Occupational Therapists focus on fine motor skills, allowing the patient to perform ADL and Return to Work (RTW).
	Speech and Hearing Centre Some patients have trouble speaking normally after a stroke, as it may have damaged any level of auditory (listening) and vocal (speaking) pathways in the brain. Therapy helps improve patients’ ability to communicate by giving personalised support and teaching them the right coping strategies. Our Speech-Language Therapists provide individualised assessment and management, allowing patients time to express themselves and clarify what they are trying to say when unsure. They also encourage patients to use different means of communication such as gestures or drawing if they are unable to verbally express themselves. It is crucial during the acute stage (the first 3 days since a stroke onset) to assess the patient on their swallowing capability. This allows the nursing team to facilitate the patient’s food intake.
	Behavioural Health Centre Our Clinical Psychologists provide psychological assessment to personalise recommendations for rehabilitation. This includes: Cognitive and adaptive functioning assessment to identify areas of cognitive and adaptive functioning impairment. Emotional functioning assessment to identify possibility of mental health issues. Counselling and psychotherapy are also provided to address emotional issues related to life after stroke, as well as other possible reasons for distress.
	Dietetics & Nutrition Services Dietitians and nutritionists help patients manage their nutritional condition when they suffer from weight loss due to swallowing difficulties and decrease in appetite. Stroke patients are advised to: Eat a variety of nutritious foods from different food groups and drink plenty of water every day. Limit intake of foods containing trans fat, saturated fat, and added salt and sugars. Modify food texture if they experience swallowing and chewing difficulty by eating foods that are either soft, chopped, minced or blended, and consuming thickened drinks.

Accident & Emergency A triage officer screens the patient, gets a quick history and checks vital signs. A CT scan is done immediately to assess the severity and determine if it is an intracranial bleed or ischemic stroke. Our emergency physicians will refer the patient to the relevant consultants: neurosurgeon for intracranial bleed and neurologist for ischemic stroke. If within the golden hours (up to 4.5 hours), thrombolysis treatment can be given. If there is a large vessel occlusion, the patient is referred to our Interventional Radiologist for thrombectomy in the Cath Lab.

Operation Theatre A haemorrhagic (bleeding) stroke is managed by neurosurgeons. Surgery to remove the blood clot is aimed at preserving life, reducing mass effect and possibly improving neurological state. Bleeds could track into the water spaces of the brain and block the normal water passages leading to a condition called “hydrocephalus” which can be managed with surgery (insertion of tubes to drain the brain water, or cerebrospinal fluid (CSF), and blood). Other types of “stroke” caused by a multitude of other problems such as aneurysms, arteriovenous malformations, cavernomas, and Moya-moya disease are not very common and are treated with various types of surgery.

Intensive Care Unit (ICU) and High Dependency Unit (HDU) Patients are transferred here to receive critical care and intensive monitoring. When in stable condition, the patient is transferred to a normal ward where the nursing team will assist in Activities of Daily Living (ADL) which refers to daily self-care activities. This includes hygiene, toileting, getting in and out of bed, eating and frequent repositioning to prevent bedsores or pressure ulcers. Our nurses also coordinate with the rehabilitation team for rehabilitation care as well as educate and motivate the patient and their family on treatment, home care and prevention.

Neuroscience Centre Our team of experienced neurologists, neurosurgeons, neuroradiologists, neuro interventional radiologists, and neuro rehabilitation specialists work together to design the best treatment programme for the patient’s brain recovery.

Rehabilitation Medicine Centre A comprehensive range of rehabilitative treatments are provided to help stroke patients get back to normal life through regaining and relearning daily living skills. Most patients get better with rehabilitation, enhancing their quality of life. Our Rehabilitation Physicians manage medication if needed and if required perform necessary procedures. Rehabilitation Therapists work closely with them to deliver the patient’s exercise routine more effectively. Physiotherapists focus on gross motor skills to help patient regain functional abilities such as walking and climbing up the stairs while Occupational Therapists focus on fine motor skills, allowing the patient to perform ADL and Return to Work (RTW).

Speech and Hearing Centre Some patients have trouble speaking normally after a stroke, as it may have damaged any level of auditory (listening) and vocal (speaking) pathways in the brain. Therapy helps improve patients’ ability to communicate by giving personalised support and teaching them the right coping strategies. Our Speech-Language Therapists provide individualised assessment and management, allowing patients time to express themselves and clarify what they are trying to say when unsure. They also encourage patients to use different means of communication such as gestures or drawing if they are unable to verbally express themselves. It is crucial during the acute stage (the first 3 days since a stroke onset) to assess the patient on their swallowing capability. This allows the nursing team to facilitate the patient’s food intake.

Behavioural Health Centre Our Clinical Psychologists provide psychological assessment to personalise recommendations for rehabilitation. This includes: Cognitive and adaptive functioning assessment to identify areas of cognitive and adaptive functioning impairment. Emotional functioning assessment to identify possibility of mental health issues. Counselling and psychotherapy are also provided to address emotional issues related to life after stroke, as well as other possible reasons for distress.

Dietetics & Nutrition Services Dietitians and nutritionists help patients manage their nutritional condition when they suffer from weight loss due to swallowing difficulties and decrease in appetite. Stroke patients are advised to: Eat a variety of nutritious foods from different food groups and drink plenty of water every day. Limit intake of foods containing trans fat, saturated fat, and added salt and sugars. Modify food texture if they experience swallowing and chewing difficulty by eating foods that are either soft, chopped, minced or blended, and consuming thickened drinks.

If you suspect a person is experiencing a stroke, call our Stroke Hotline at 019 378 0119. Our team will assess, guide and arrange for an ambulance if needed, or you can immediately send the patient to our Accident & Emergency department.