Community Stroke Rehabilitation Team. An information guide

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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Community Stroke Rehabilitation Team An information guide

2 Community Stroke Rehabilitation Team Who are we? The community stroke rehabilitation team provides rehabilitation for adults who have had a stroke and have ongoing rehabilitation needs. Rehabilitation may take place in the patient s own home, clinic or an appropriate community location. Who is the service for? adults who have had a stroke adults who registered with a North Manchester general practitioner adults who are medically stable and are able to participte in and benefit from therapy are able to participate in goal setting with support. The team consists of: stroke lead physiotherapists occupational therapists speech and language therapists stroke specialist nurse therapy assistants 2

3 How to access the service The Community Stroke Team visit Fairfield Hospital on a weekly basis to attend MDT meetings and discuss rehabilitation needs of patients on discharge from hospital. On discharge from the ward a Healthcare Professional will complete a referral to our team. You can self refer if you are already living in the community. However the team will ask for further medical information from your GP or specialist. If you have been seen by the community stroke team before, you can contact us directly for a review of your rehabilitation needs at any point in the furture. Any health care professional can contact the team to discuss potential referrals. 3

4 What will happen during the first visit? You will be contacted by a member of the team to arrange a visit to your home to assess your rehabilitation needs shortly after discharge. As part of your initial assessment we will: record personal details, including your relevant medical history and medication that you take discuss details about the problems that you are experiencing complete an assessment of the difficulties you are experiencing discuss goals with you and make a treatment plan In some cases this may involve a referral to other agencies. We are happy for you to have a relative or carer present at this assessment. Follow-up Depending on the problems identified, follow-up treatment sessions will be carried out by the relevant team member. Patients will usually be given a treatment programme that they are encouraged to complete themselves in between visits. This programme should help to speed up your recovery. The team will, if you wish, involve family or carers in the rehabilitation process to support you in reaching your goals. 4

5 Discharge Patients are discharged from the service when they have achieved their goals, or if there are no significant improvements following treatment. Please be aware that if patients fail to attend appointments or are not carrying out the recommended self practice they may be discharged and will require a new referral to access the service again. This leaflet only provides a brief outline of the community stroke rehabilitation service. For further information, or if you have any questions please contact: Community Stroke Rehabilitation Team Newton Heath Health Centre 2 Old Church Street Newton Heath Manchester M40 2JF Tel: Fax:

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8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: November 2014 Date of review: November 2017 Ref: PI_MC_894 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests

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