Stroke – SAFE Score 0 Rehabilitation — SCE Neurology MCQ

Correct answer: A — Continue goal-directed positioning, range maintenance, pain prevention and compensatory training, after checking contraindications, within specialist-led care

The best answer is “Continue goal-directed positioning, range maintenance, pain prevention and compensatory training, after checking contraindications, within specialist-led care”. Severe paresis makes constraint-induced therapy unsuitable, but rehabilitation remains important for comfort, contracture prevention, participation and reassessment. “Use high-intensity constraint-induced movement therapy despite absent active movement” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Stop all arm therapy because a low SAFE score proves that no benefit is possible” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Immobilise the shoulder to prevent every episode of post-stroke pain” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Use functional electrical stimulation as a guaranteed substitute for voluntary recovery” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: NICE NG236 stroke rehabilitation recommendations: https://www.nice.org.uk/guidance/ng236/chapter/Recommendations