Hospital locums: expensive and problematic.

Abstract

Stroke is the third highest cause of death and the leading cause of chronic disability in adults in Australia. Studies show clear advantages of treatment of patients in the acute phase of stroke in a dedicated stroke unit. Rehabilitation after stroke is a continuum, starting within days of stroke onset and ending only when it no longer produces any positive effect. More than half the 75% of patients who survive the first month after a stroke will require specialised rehabilitation. Effective rehabilitation relies on a coordinated, multidisciplinary team approach. Regular team meetings, as well as meetings with the patient, his or her family and carers, are essential. Improvements in function after stroke are the result of recovery within the ischaemic penumbra, resolution of cerebral oedema, neuroplasticity, and compensatory strategies learnt by the patient. Evidence supporting rehabilitation programs is based on evaluation of the multidisciplinary approach, or on the effect of a particular discipline (eg, speech therapy), rather than on individual components of treatment. When the patient is discharged from a formal rehabilitation program, the general practitioner's role becomes paramount. GPs can help patients deal with the consequences of stroke, such as depression, and any comorbidities. GPs may also provide counselling on issues ranging from interpersonal and sexual relationships, through ability to drive again, and vocational and recreational activities.