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Transcript of Brain
Vera (58) was taken to A&E 4 weeks ago after an emergency call from her son, Elijah.
She is currently in the stroke rehabilitation unit receiving care from a multidisciplinary healthcare team.
She suffered from Breast Cancer 8 months previous of this, which she was successfully treated for.
Who has been involved?
Addressing Vera's concerns
Outlining a care plan
Vera admitted to A&E
Rehabilitation and return to normality
Background image courtesy of Alpha Coders: http://wall.alphacoders.com/big.php?i=263254
 (NICE, 2009) (http://www.nice.org.uk/nicemedia/live/12132/43315/43315.pdf)
 (Cancer Research UK, 2012) (http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/types/dcis-ductal-carcinoma-in-situ)
 (Map of Medicine, 2013) (http://healthguides.mapofmedicine.com/choices/map/breast_cancer1.html)
http://www.csp.org.uk/your-health/conditions/cancer#how-can-physiotherapy-help-cancer – 06/11/2013
Breast cancer treatment
Concerns about treatment
Concerns about abilities
Thank you for listening
Vera's case to date involves two areas of focus:
• Breast Cancer treatment
• Stroke treatment
Introduction to Breast cancer  
Breast assessment clinic (radiographer,
breast physician, nurse, surgeon, pathologist)
Clinical nurse specialist in breast care
Counselling and psychological support team
Oncologist surgeon and specialist nursing team (lumpectomy)
Physiotherapist (post-operative care)
GP, pharmacist and oncology team (long-term treatment) 
First contact - Son (Elijah)
Admission to ITU by staff in A&E 
Diagnostic Radiographers 
Admission to acute stroke ward (3 days later) 
Consultant stroke physician, stroke medicine services expert, neurologist, clinical nurse specialist, stroke SpR 
Admission to rehab unit (3 days ago) 
Specialist medical and nursing team 
MDT assessment   
Counselling, psychological and physiotherapy support team 
Home visit support as required
Vera has several concerns relating to the treatment she has received, her physical abilities and what the future holds for her.
• Vera can't understand why this has happened to her
- to be addressed by: doctor, oncologist or any health professional with whom she has a good rapport
-Genetic disposition to Cancer and possible link to Stroke  
- Environmental factors
- Ethnicity 
• She is angry that she has not had the best treatment
- to be addressed by: doctor, oncologist, specialist nurse
-Explain that the emergency clot busting drugs for Stroke have a four hour window to be administered in
Vera should be informed about the complaints procedure or given a chance to talk to Patient Advice and Liaison Service in the Hospital 
Why address Vera's Concerns
The importance of addressing these issues is:
• To reassure Vera
• To ensure she does not lose trust with healthcare professionals
• To ensure she complies with future medical treatment
supporting and assisting her regain the ability to perform day-to-day tasks
Vera is worried about returning to work and how she will pay the bills.
-Social service - financial benefits
Abnormal speech (dysphasia)
Speech therapist 
Right sided weakness (hemiparesis)
The need for further medication
Doctor and pharmacist
Once discharged from the rehabilitation unit, Vera will have a care plan including:
Psychological assessment in first month
Teaching of cognitive functions and communication skills
Physiotherapy will play a crucial role in Vera's recovery.
Initially, the physio will:
• improve posture and balance   
• form an exercise plan  
• daily tasks 
• attempt/ensure involvement of family and friends  - especially the Church group
If progress is good, and Vera feels strong enough, the physio will then:
long term goal
set a new home exercise plan
home visits 
Vera can benefit from support from other organisations, such as the Stroke Association, who offer services such as:
• Information, advice and support service
• Communication support
• Stroke prevention
• Getting back to life
• Carer support  
Aiding her recovery, regaining independence, getting back to work
To help improve her quality of life by
 Torbey MT, Selim MH.
The Stroke Book
. 2nd edn. Cambridge: Cambridge University Press;2013
 Ansari Y.
. [Online]. Available from: http://www.prospects.ac.uk/physiotherapist_job_description.htm [Accessed 31st October 2013]
 AGCAS editors.
. [Online]. Available from: http://www.prospects.ac.uk/occupational_therapist_job_description.htm [Accessed 31st October 2013]
 AGCAS editors.
Speech and language therapist
. [Online]. Available from: http://www.prospects.ac.uk/speech_and_language_therapist_job_description.htm [Accessed 31st October 2013]
 The NHS Choice website [Acessed 06/11/2013] http://www.nhs.uk/Conditions/Stroke/Pages/recovery.aspx
 NICE website [Acessed on 07/11/2013] http://pathways.nice.org.uk/pathways/stroke/acute-stroke
] The NHS website [Accessed on ] http://www.nhs.uk/Service-Search/Patientadviceandliaisonservices
Physiotherapy after stroke,
Stroke Association booklet, Factsheet 16, version 01, published April 2012