Assessment of neurologic deficits in stroke. Acute-care and rehabilitation implications.

It has been estimated that half of all stroke patients who survive are left with some level of disability and that for some patients this disability is severe. Methods that maximize recovery and decrease complications are essential for all stroke patients, regardless of the level of disability. Rehabilitation philosophy and practices are applicable in all types of care settings. The Joint Committee for Stroke Facilities set the guidelines for stroke rehabilitation to provide the following: . Prevention of secondary complications . Compensation for sensory, perceptual, and motor loss . Environmental stimulation . Socialization . Development of motivation . Enablement of independent living and home living . Achievement of vocational rehabilitation when feasible In the acute-hospital setting, these guidelines can be incorporated into planning care for the stroke patient. Assessment of the patient on an ongoing basis provides a clear description of neurologic, cognitive, and functional status. With this information, the nurse can shape the patient's environment to provide for safety and stimulation, while encouraging maximum mobility and self-care. Within the stressful and busy environment of an acute-care unit, taking time to allow a patient to struggle with performing even simple tasks may be frustrating for the nurse. This frustration may be lessened through the recognition that every patient movement and activity can be viewed as therapeutic and that every improvement brings the patient closer to the reality of independence.