The Role of Occupational Therapy in Stroke Management/Rehabilitation[1]

The role of OT in a stroke client starts from the Intensive Care Unit (ICU)[2] and continues until the client is fully independent in every aspect of well being. Occupational Therapist helps stroke clients through various stroke stages (disease process), which also depends on care settings where the clients receive service. Regardless of the care settings and the stroke stages, the occupational therapist’s goal is to improve the client’s FUNCTIONAL WELL BEING.

  • Table 1. OT approaches and interventions to achieve outcomes
GoalSub GoalsOutcomesApproach/ Intervention
              FUNCTIONAL WELLBEINGPhysical
Well Being    
1. Normalize muscle tone (UE)

2. Improve muscle strength (UE)

3. Improve ROM (UE)

4. Improve FMC/EHC

5. Improve functional balance
(sitting/standing)
NDT

PNF

Brunstrom

Rood

CIMT

Electrical-stimulation

Activity-based therapy[3] *
FUNCTIONAL WELLBEING  Sensory Well Being1. Improve visual field

2. Normalize tactile pathways

3. Improve proprioceptive skills

4. Improve stereognosis skills

5. Improve vestibular skills
Rood
 
Ayer’s sensory integration
 
Virtual reality
  FUNCTIONAL WELLBEINGCognitive & perceptual Well Being1. Improve cognitive skills
2. Improve perceptual skills
CCT

VE
FUNCTIONAL WELLBEINGPsychological and emotional Well Being1. Alleviate depression
2. Reduce Anxiety
3. improve self-awareness
4. improve confidence
Behavioral therapy

Recreational therapy

Group therapy

Family & patient education
UE – Upper Extremity, FMC – Fine Motor Coordination, EHC – Eye-Hand Coordination, NDT – Neuro-development Treatment, PNF –  Proprioceptive Neuro Facilitation, CIMT – Constraint-Induced Movement Therapy, CCT – Computerized Cognitive Training, VE – Virtual Environment

* Activity-based therapy is the most widely used intervention strategy amongst OT. The focus of attention is on completing the task rather than mastering one skill or performing a specific movement. For this purpose, the activity has to be therapeutic, carefully, and thoughtfully chosen with a goal in mind after adequately analyzing the activity and giving proper consideration to the client’s capability. Task-related training, task-specific training, repetitive task practice,  task-oriented therapy, purposeful activity therapy, and therapeutic occupation are the various terms for activity-based therapy .

OT expertise in specific training/teaching in stroke clients

  • Positioning: The extremity’s proper position depends on the stroke’s stage’s muscle tone (flaccid or spastic). OT may recommend specific positioning equipment or brace. Proper positioning plays an essential role in preventing shoulder subluxation, normalizing muscle tone, and preventing joint contracture and bed sores.
  • Environment modification: It is crucial to adjust, move around, or modify the placement of the bed, furniture, TV in a way that the hemiplegic side gets more exposure to tactile, auditory, and visual stimuli. With OT’s help, such changes in the environment assure auto therapy 24/7 as clients slowly become aware of the weak side that otherwise is neglected.
  • Functional adaptation or modification: To gain functional independence, OT helps clients learn new techniques of doing ADL tasks or recommend and provide training to use adaptive and assistive devices to facilitate functional independence.
  • Shoulder, wrist, and hand pain: OT expertise helps prevent the onset of such pain and/or alleviate the pain through various modalities.
  • Pusher’s syndrome: OT’s expertise helps prevent the start of this syndrome and/or resolve the pusher’s syndrome using specific therapeutic activities and techniques.
  • Unilateral neglect: OT has the know-how of resolving one side neglect common in right hemisphere stroke resulting in “left neglect.”
  • Fine motor coordination and eye-hand coordination: This is specifically important in the hemiparetic hand. OT uses several specific graded activities to improve FMC and EHC.

References


[1] Aota.org. Web. 25 Nov. 2020.

[2] Occupational Therapy in the Intensive … – Shannen Marie OT. https://shannenmarieot.com/2018/12/01/inpatient-settings-occupational-therapy-in-the-intensive-care-unit/comment-page-1/. Accessed November 25, 2020.

[3] Joyce S. Sabari, Activity-Based Intervention in Stroke Rehabilitation  in Stroke Rehabilitation (Fourth Edition), 2016

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