The Hyper-Acute and Acute Stroke Unit

COVID-19 and Stroke Services

Please note that there may be changes to teams and visiting due to COVID.

In this section:

About the Unit
Contact details
Visiting times
The Team
Therapies
Occupational Therapy
Physiotherapy
Speech and Language Therapy
Dietitians
Clinical Neuropsychology
Therapy Assistants
Related Links

About the Unit

The Hyper-Acute and Acute Stroke Unit are based on Cedar Ward within the Duchess of Kent wing at St Peter’s Hospital.

Following your arrival and initial assessment at St Peter’s Hospital, you may be admitted directly to the Stroke Unit if you have had a stroke or who are suspected of having had one.

Ashford and St Peter’s Hospitals NHS Trust is a specialist centre for acute stroke and we provide a 24 hour, 7 days a week telemedicine service which includes thrombolysis (giving 'clot-busting' drugs to break down blood clots) if appropriate.

You may undergo further tests in order to confirm a stroke diagnosis and determine the cause:

CT head scan (computerised tomography)
Carotid artery Doppler
ECG
MRI scan (magnetic resonance imaging)

There are eight hyper acute beds and fifteen acute stroke beds. The Stroke Unit is within a modern specialist unit, it has access to interventional equipment and a wealth of expertise. It also works closely with the hospital's Vascular Surgery Department. In some occasions, liaison between St Peter’s Hospital and St George’s Hospital is required and after assessment a transfer to the Neurosurgery Department at St George’s Hospital can sometimes occur.

Some people come to Ashford and St Peter’ NHS Trust for the specialist stroke care and are from another area. If we are not your local Hospital, you will be transferred to your own Hospital as soon as you are ready for transfer. We will keep you and your family updated and will continue with your care and treatment in the meantime.

If Ashford and St Peter’s Hospital NHS Trust is your local Hospital then we will identify the most appropriate treatment plan for you.

If you have had a stroke without any resulting problems you might be able to be discharged from hospital quickly. You will need new medications.
If you have mild difficulties after a small stroke you might be able to be discharged quickly with support from our Early Supported Discharge Team, who can provide rehabilitation at home.
If you need to stay in hospital for your treatment and ongoing rehabilitation, you may be referred to the Stroke Rehabilitation (Phoenix Team) or Bradley Neurorehabilitation Team at Woking Community Hospital. You will be able to transfer wards when you become medically well enough and when a bed becomes available.

Please see the pathway below for more details and click on the teams underlined for further information.

Stroke Services

If your diagnosis is not a stroke or TIA you may need to be transferred to another more appropriate ward.

Unfortunately some strokes are devastating and we will ensure appropriate palliative end of life care on the ward if this is necessary.

We are part of the Kent, Surrey and Sussex Research network and HASU on Cedar Ward has a dedicated stroke research nurse. There are a number of voluntary clinical trials that are ongoing within the unit. We also participate in the National SSNAP (Sentinel Stroke National Audit Programme).

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.

Contact details

Stroke Unit (Aspen Ward): 01932 723907

Visiting times

Monday to Sunday: 3pm – 4.30pm, 6pm – 8pm.

Only 2 visitors will be permitted per patient.

In exceptional circumstances the nurse in charge can make the decision for visiting to be permitted outside these hours.

Consultants

Dr Giosue Gulli, Dr Kirsten Kamman, Dr Brendan Affley, Dr Mudhar Obaid, Dr Cristina Russo

Stroke Specialist Nurses

The Stroke Specialist Nursing team at St Peters Hospital is comprised of a group of 6 nurses that provide a service 7 days a week from 8am-8pm. The nurses contribute to all aspects of stroke care, particularly early assessment in Accident and Emergency (A&E), Hyper-Acute Stroke Unit, referrals throughout the hospital and GP referrals.

The Stroke Team at St Peters Hospital delivers a thrombolysis service (clot busting treatment) for acute stroke 24 hours a day, seven days a week. The out of hour’s service is supported by a Surrey-wide telemedicine network. We also supply a one stop Transient Ischaemic Attack (TIA) service 5 days a week. The Stroke Specialist Nurse aims to provide support to the newly diagnosed stroke patient and their family throughout their stay in hospital, acting as a link between the multidisciplinary team involved in the patients care.

Therapies

The Stroke unit has a team of specialist therapists to assess, support and provide rehabilitation to patients. The team will work with you and your family to identify goals and work with you throughout your hospital stay to help you progress.

We set some early goals for therapy which are usually related to feeding, sitting balance and mobility. This will involve broad assessment of your movement, memory, mood, communication, swallow and your ability to carry out your normal daily activities.

The therapists you see will depend on the difficulties that you are experiencing after your stroke.

Occupational Therapy

A stroke can cause a range of difficulties such as physical problems, problems with memory and thinking, vision changes and emotional problems or changes in your mood. These difficulties can make it challenging to complete everyday activities.

The Occupational Therapists will complete a thorough assessment looking at all of these aspects. Depending on your difficulties, they will work with you to improve your skills and confidence. This may include:

Practice of a new task
Advice on new ways of doing things to increase your independence and safety
Provision of equipment such as handrails, commodes and other options
Looking at how you will manage in your own home and what help you will need if you are ready to be discharged
Advice on returning to work, driving or leisure activities

The Occupational Therapist may discuss visiting your home so they can suggest adaptations or equipment that may help you to remain safe at home.

Physiotherapy

A stroke can affect the part of your brain that controls movement. It can cause weakness or paralysis on one side of the body. Some people experience muscle spasms, balance problems and joint pain. All these things may make it difficult to move and complete everyday activities.

The aim of Physiotherapy is to help regain mobility and relearn the movements required to be able perform activities such as standing up, walking or reaching for objects following a stroke.

The Physiotherapists will complete a thorough assessment looking at all aspects of your mobility, transfers, sensation, co-ordination and power to identify impairments and plan your therapy accordingly. You may also require Chest Physiotherapy which involves techniques to improve your oxygen levels and clear sputum (mucus) from your airways.

During Physiotherapy sessions we work with you to improve:

Moving around in bed
Moving from bed to chair
Standing up and sitting down
Balance
Muscle strength
How to improve arm movement
Walking

The Physiotherapists and Occupational Therapists also assess positioning to ensure that you are comfortable when you are in bed or in a chair and that your affected arm is well supported.

Speech and Language Therapy

A stroke may cause difficulties with communication or swallowing. If you are experiencing these difficulties you will be referred to the Speech and Language Therapists (also referred to as Speech Therapists).

The Speech Therapists will assess your swallowing and provide recommendations to try and make eating and drinking as safe as possible. Some people have severe difficulties with swallowing after a stroke and may require feeding via a tube either short or long term; the team will discuss this with you in more detail if it is required.

Communication problems are common after a stroke. The Speech Therapists will assess your speech and language to identify any difficulties. They will provide exercises and strategies to support you to communicate. They may provide you with picture, word or alphabet charts to help you to communicate your needs whilst you struggle to talk.

The Speech Therapists also work with your relatives to make them aware of strategies that will help you to communicate.

Dietitians

If you have difficulties in eating you may be referred to a Dietitian. The Dietitian will assess your dietary requirements and guide your nutritional health by monitoring your weight and food/fluid intake. The Dietitian’s role includes:

Providing nutritional support if you have a poor appetite or weight loss. A high protein high energy diet may be recommended to improve your nutritional status and additional nutritional supplements may also be required. If you are unable to take food or drink orally an alternative feeding method may be advised e.g. nasogastric feeding, gastrostomy feeding (PEG)
Advising on appropriate modified texture diets if you have swallow difficulties identified by the Speech and Language Therapists. The Dietitian will guide you on suitable foods and drinks to ensure your nutritional requirements are met
Reducing your dietary risk factors by providing advice on a healthy diet if you have diabetes, hypertension, high cholesterol or are overweight

The Dietitian will also liaise with your family/carers and the community services including your GP to ensure that specific nutritional intervention is continued following your discharge from hospital.

Clinical Neuropsychology

Clinical neuropsychology is concerned with the assessment and management of changes in people’s emotions, mood, cognition (thinking processes like memory and concentration) and behaviour following illnesses such as a stroke. These issues are common: they can happen as a result of direct changes to how the brain is working, and/or as people react and adapt to these changes.

They help people understand these changes, and offer advice and support for managing them. Clinical Neuropsychologists may work with you individually and with your family, other carers and staff as appropriate.

Therapy Assistants

Therapy Assistants are core members of the stroke team. They work alongside the therapists to deliver your therapy. They may practice exercises and activities with you to help you to progress. They provide feedback to the therapists who are leading on your care so that your exercises can be adjusted.