Here is a collection of the questions we frequently receive. If your question is not among them please go to the contact page and choose the appropriate person to sent your question to.

Admin

General

Research

Stroke

Admin

Please could you tell me the cost of sending a flier to all members?

Charges for mailing a flier or similar to our members to go out with a mailing, e.g. with the newsletter in June / December:

Our region is organising an event. What do we need to do to get it on the NANOT website?

You need to send the details of the event to the website co-ordinator at website@ssnp.co.uk. Please put the details in the following order:

There is no cost to your region to have the event put onto the website.

Please could you put our event/conference on your website?

This website can only be used for Neurological Practice related events/conference. However, you could place your event on the COT website. For more information please contact paula.willock@cot.co.uk.

General

Could you tell me about...?

It is not our role to anwer general questions. You are advised to visit the COT library where you can find several search engines that will help you with finding your answer.

Are there any splinting guidelines for neurology and if so, where can I find / access them?

We have not produced any splinting guidelines for neurology. Many areas of the UK have produced their own e.g. Derby, Sheffield, Oxford and Queens Square, London.

National Clinical Guidelines for Stroke (RCP, London, 2004) state:

"Orthotics are comprised of ankle foot orthoses, knee ankle foot orthoses, resting splints, lycra garments, and serial splints or casts. Evidence is conflicting with regard to the use of orthotics following stroke as they appear to have both biomechanical and tone-reducing effects. Most studies are on the use of ankle foot orthoses. Although the hemiplegic upper limb may develop contractures due to the presence of abnormal tone and paresis splinting in hemiplegia is not well addressed in the literature. A Cochrane Review on orthotics in stroke management is in progress at the time of this publication."

ACPIN produced some neuro splinting guidelines in March 1998 (reference given below) but I do not know if they have updated them since then.

Reference: Association of Chartered Physiotherapists Interested in Neurology (ACPIN). Clinical practice guidelines on splinting adults with neurological dysfunction. March 1998.

The Scottish Intercollegiate Guidelines Network (SIGN, 2002) guidelines for the management of patients with stroke state:

"Ankle foot orthoses (AFOs) can be prescribed to patients with dropped foot following stroke with the aim of maintaining ankle dorsiflexion, reducing spasticity and improving the pattern and safety of gait."

"Only one RCT investigating the efficacy of a polypropylene AFO was found; this included 60 patients and investigated the effects of thermocoagulation of the tibial nerve and an AFO. This study found no evidence that AFOs were useful in the reduction of motor impairments or the improvement of function. Over 67% of patients reported a problem or harm associated with the use of the AFO. Approximately 50% of patients did not fully comply with the use of the AFO."

"Although there is a lack of evidence to support an AFO having a measurable effect on gait parameters, in clinical practice there are distinct benefits in their use, particularly to allow early ambulation in patients with severe hemiplegia."

"A joint assessment by a physiotherapist and an orthotist of patients for whom ankle stability can only be achieved through orthotic means, will allow a decision to be made on whether AFOs are appropriate.

"Guideline: Although ankle foot orthoses may help some patients with foot drop, they should not be used routinely without proper assessment prior to use and follow-up to establish their effectiveness in the individual."

Publications

Where can I get the NANOT Fatigue Management pack?

At present the fatigue pack is being reviewed by COT and is not available for sale. Please contact COT to find out when it will become available again.

Research

Can you send my research questionnaire/survey to members?

We are sorry but we are unable to send out questionnaires or research questions to the membership database.  If you would like assistance from members you can put a request for volunteers to assist you with your research on this website or discussion forum and/or in the newsletter.

Can the Specialist Section help with research projects?

The executive committee are sometimes asked to help students with research projects. We wish to encourage research and have put together the following guidance to help.

What we can't do

What we can do

We hope this will help and look forward to hearing from you.

Stroke

I am trying to develop an OT service for stroke patients in hospital and wondered if anyone had set up a similar service in an acute setting. Please could you give me some advice re: how to prioritise patients, things to consider, any evidence etc.?

There are many such services around the country but they all differ according to what is included in the term "acute". For instance, some hospitals will mean the first 3 days, others may mean first 7 days and some the first few weeks.

The best place for you to find the evidence you require is from the Royal College of Physicians National Clinical Guidelines for Stroke www.rcplondon.ac.uk (type 'national clinical guidelines for stroke' in the search site box). These are the most up to date guidelines based on research evidence. NANOT produced a document, which is a shortened version of these guidelines, which includes the evidence most relevant to OT practice. NANOT also produced OT standards for stroke care, based on the College of Occupational Therapists / Royal College of Physicians standards for stroke care. Both of these latter documents can be found on this website.

Evidence can also be found from the Scottish Intercollegiate Guidelines Network www.sign.ac.uk (under Management of Patients with Stroke, a national clinical guideline).

The College of Occupational Therapists Professional Standards for OT practice will also give you advice on how to conduct your service. These can be found on the College of Occupational Therapists' website (www.cot.org.uk).

Could you please tell me what outcome measures to use with stroke patients?

There are many outcome measures suitable for stroke rehabilitation and the choice depends on what you want to measure i.e. ADL, upper limb function, cognition etc. Many are listed in the appendix of the College of Occupational Therapists / Royal College of Physicians. Occupational Therapy Standards for Stroke Care, published in September 2002. This document is available on the RCP website at www.rcplondon.ac.uk (under multidisciplinary stroke audit) and on the NANOT website.

Many others can also be found in the following book:

Measurement in neurological rehabilitation by Derick T. Wade.
Publisher: Oxford Medical Publications. ISBN 0 19 261954 3.

Please could you tell me what intensity of Occupational Therapy is recommended for stroke patients?

National Clinical Guidelines for Stroke (RCP, London, 2004) state:

"Contact with therapists

There is much debate about the amount of therapy that is needed. One important but unanswered question asks whether there is a minimum threshold, below which there is no benefit at all. Studies on well-organised services show that it is rare for patients to receive more than 2 hours therapy each day.

Recommendations

  1. Patients should undergo as much therapy appropriate to their needs as they are willing and able to tolerate (A)
  2. The team should promote the practice of skills gained in therapy into the patient's daily routine in a consistent manner (A)

Local Guidelines

Local teams should agree standards of practice including frequency and duration of therapy."

The Scottish Intercollegiate Guidelines Network (SIGN, 2002) guidelines for the management of patients with stroke state:

"Within the stroke unit trials, patients received an average of 45 (range 30-60) minutes of physiotherapy and 40 (30-60) minutes of occupational therapy per weekday. Other trials have investigated the intensity of therapy. Some of these trials included small numbers of subjects, reported heterogeneous interventions and possessed possible selection bias. Most of these studies reported a small positive result. A select proportion (perhaps the fittest 10%) of the stroke population may derive moderate benefit from greater intensity of therapy. There is insufficient evidence however, to make a judgement on the cost effectiveness of this increased intensity of therapy or to make an overall recommendation."

The Occupational Therapy Practice Guidelines for Adults with Stroke (AOTA, 1996) state:

Acute Care Hospitals - "Treatment in acute care is usually provided daily for 30 minutes to an hour or more, 5 to 6 times a week, depending on the patient's endurance and goals"

Subacute Centers - "30 minutes to 1½ hours, 5 or 6 days a week. The duration of treatment depends on whether the patient continues to improve, but frequently it is 10 to 35 days."

Rehabilitation Centers - "1½ to 2 hours or more a day, 5 to 7 days a week. The duration of treatment depends on the patient's progress but often is 3 to 6 weeks."

Nursing facilities - "Occupational therapy services are usually offered 3 to 5 days a week for 30 minutes to 90 minutes a day. The duration of services is usually 3 weeks to 3 months if seen 5 days a week and up to 6 months if receiving services less frequently."

Out-patient departments, comprehensive outpatient rehabilitation facilities and private practice clinics - "Patients are seen 1 to 1½ hours, 1 to 3 times per week for 1 to 6 months, based on patients' continued measurable improvement in functional performance areas."

Home health agencies - "Occupational therapy services in the setting ease the transition to home and usually provide treatment from 1 to 3 visits per week. The duration of treatment may be 1 to 6 months."

Please could you tell me the recommended level of staff on stroke units?

There is no definitive answer.

National Clinical Guidelines for Stroke (RCP, London, 2004) state:

"The precise composition and numbers for such a team will vary according to the size of the unit and its objectives. The range of staffing levels has been described in the British Association of Stroke Physicians benchmarking survey (Rodgers et al 2003). Each profession is responsible for defining the levels of expertise required."

Rodgers H, Dennis M, Cohen D, Rudd A. British Association of Stroke Physicians: Benchmarking survey of stroke services. Age and Ageing 2003; 32(2): 211-7.

The Scottish Intercollegiate Guidelines Network (SIGN, 2002) guidelines for the management of patients with stroke state:

"The core multidisciplinary team should consist of appropriate levels of nursing, medical, physiotherapy, occupational therapy, speech and language therapy, and social work staff. Other disciplines are also regularly involved in the management of stroke patients including clinical psychologists, psychiatrists, dietitians, and others."

"The typical staffing structure within stroke unit trials was as follows (approximated to a 10-bed stroke unit).

"Guideline: The core multidisciplinary team should consist of appropriate levels of nursing, medical, physiotherapy, occupational therapy, speech and language therapy, and social work staff."