Strokes And Ot Therapy: Weekly Sessions For Recovery

Stroke patients often require occupational therapy to help them regain their ability to perform daily tasks such as maintaining balance, concentrating, and retaining information and completing self-care tasks. The frequency of occupational therapy sessions for stroke patients can vary depending on their specific needs and the severity of the stroke. On average, stroke patients receive occupational therapy for at least 45 minutes per day, five days a week. This intensive therapy is an essential part of the rehabilitation process and helps patients improve their sensory and motor abilities, as well as adapt to their new range of motion. The ultimate goal is to help stroke survivors regain their independence and resume their regular lives.

Upper extremity management

Upper limb impairments are common after a stroke, affecting the ability to perform daily tasks. Upper limb rehabilitation is a complex intervention that integrates different modalities to address deficits that are often multi-factorial.

Upper limb impairments

Upper limb impairments are common after a stroke, affecting the ability to perform daily tasks. Upper limb rehabilitation is a complex intervention that integrates different modalities to address deficits that are often multi-factorial.

Upper limb rehabilitation

Upper limb rehabilitation after a stroke often involves several different interventions and generally requires the cooperation of the patient, carers, and rehabilitation team.

Types of interventions

A wide range of interventions can be delivered to improve the function of the upper limbs after a stroke. Such interventions may be aimed at particular impairments or functional movements. Upper limb rehabilitation may be delivered at different doses, with "dose" referring to the intensity, frequency, and duration of an intervention.

Upper limb rehabilitation interventions

• Bilateral arm training
• Biofeedback
• Bobath approach
• Transcranial direct current stimulation (tDCS)
• Transcranial magnetic stimulation (TMS)
• Constraint-induced movement therapy (CIMT)
• Electrical stimulation
• "Hands-on" therapy (manual therapy techniques)
• Exercise-based and functional movement-based interventions
• Mirror therapy
• Music therapy
• Pharmacological interventions
• Repetitive task training
• Sensory interventions
• Strength training
• Stretching and positioning
• Surgical interventions
• Task-specific training
• Virtual reality
• Telerehabilitation services

Improving upper limb function is a core element of stroke rehabilitation needed to maximize patient outcomes and reduce disability. However, evidence about the effects of individual treatment techniques and modalities is often synthesized within many reviews, making it challenging to compare the relative effectiveness of different interventions.

Mobilization of the upper extremity

• Task-specific training: This approach focuses on improving a specific skill by practicing it directly. For example, patients may practice reaching into a cupboard, turning doorknobs, or flipping light switches.
• Constraint-induced movement therapy: This involves restraining the non-affected limb to promote the use of the affected limb.
• Electrical stimulation: This technique uses non-invasive electrodes placed on the skin to send gentle electrical impulses to the affected muscles, helping to stimulate the connection between the brain and muscles.
• Mirror therapy: This approach is particularly useful for patients with hand paralysis or severe hand impairments. It involves placing a mirror in the middle of the body to reflect the non-affected side and hide the affected side. Patients then complete simple exercises with the non-affected side while focusing on the reflected image, stimulating the brain's motor areas.
• Sensory re-education: This technique is used to retrain the brain to process and respond to different sensations, such as textures, temperatures, and pain.
• Adaptive equipment: Occupational therapists may recommend or provide adaptive equipment, such as a sock aid, reacher, or long-handled sponge, to help patients safely complete daily living tasks.

Visual success

Occupational therapy is a vital aspect of stroke recovery, helping patients regain their independence and quality of life. A key challenge for stroke survivors is their ability to perceive their environment visually, which can be affected by the stroke. Therapists play a crucial role in helping patients overcome these visual deficits and adapt to their new way of moving.

Visual Challenges After a Stroke

Visual issues are common after a stroke, and they can significantly impact a person's ability to perform daily tasks and interact with their environment. These issues may include:

• Agnosia: Difficulty recognizing objects or people.
• Visuospatial problems: Difficulty judging distances or understanding spatial relationships.
• Unilateral neglect: Lack of awareness or response to stimuli on one side of the body or environment.
• Impairments in constructional skills: Difficulty copying or drawing shapes or objects.

Assessing Visual Challenges

An occupational therapist will often perform a brief vision screen to identify any visual challenges a stroke patient may be facing. This may include assessing:

• Visual fields: The patient's ability to see objects in their peripheral vision.
• Convergence: The ability of the eyes to focus on an object as it moves closer.
• Oculomotor abilities: The eyes' ability to fixate, track, and move smoothly.

Strategies for Visual Success

Occupational therapists employ various strategies to help stroke patients overcome visual challenges and improve their visual success:

• Positioning: Encouraging patients to position themselves to face their side of inattention. This may involve sitting at the edge of a room to force them to attend to their affected side.
• Visual scanning activities: These activities help patients intentionally draw their attention to their affected side. For example, using a highlighter to mark the left side of a book and then practicing moving their eyes to find the mark.
• Environmental modifications: Making changes to the patient's environment to encourage visual scanning. This may include placing stickers on doors, mirrors, or workspaces to encourage scanning and exploration.
• Highlighting: Highlighting one side of reading materials to help patients scan and find the boundary between pages.
• Family and team involvement: Educating family members and the interdisciplinary team about the patient's visual challenges and encouraging them to stand on the patient's affected side during interactions.

Benefits of Visual Success Strategies

The strategies employed by occupational therapists offer several benefits for stroke patients:

• Improved safety: By addressing visual challenges, patients are less likely to miss important environmental cues, reducing the risk of falls or accidents.
• Increased independence: Visual success strategies enable patients to navigate their environment more effectively, improving their ability to perform daily tasks and increasing their independence.
• Enhanced quality of life: Overcoming visual challenges helps patients resume their regular activities, hobbies, and social interactions, leading to an improved quality of life.

In conclusion, visual success is a critical aspect of stroke recovery, and occupational therapists play a vital role in helping patients regain their visual abilities and adapt to their new way of seeing. By employing various strategies, therapists can help patients improve their safety, independence, and overall quality of life.

Addressing deficits in functional cognition

Occupational therapy plays a critical role in helping stroke patients address functional cognition deficits and improve their overall quality of life. Functional cognition refers to the cognitive abilities required to perform daily life tasks and includes metacognition, executive function, and other domains of cognitive functioning. By targeting functional cognition, occupational therapists can help stroke patients regain their independence and resume their regular activities. Here are some strategies that can be employed to address deficits in functional cognition:

Home Modifications:

Occupational therapists can recommend home modifications to ensure the patient's safety and facilitate a smooth transition back home. This may include adding door knob extenders, using non-slip bath mats, and removing clutter to reduce the risk of falling.

Rehabilitation Exercise Programs:

Therapists can provide targeted rehabilitation exercise programs to be practiced at home. These exercises aim to stimulate neuroplasticity, helping the brain rewire itself and form new neural connections. Consistent practice is key to maximising the benefits of these programs.

Task-Specific Training:

Task-specific training involves improving skills by directly practicing them. This approach aims to improve function in affected muscles through repeated activity. For example, patients may practice reaching into a cupboard, turning door knobs, or flipping light switches. Such exercises spark neuroplasticity and enhance functional independence.

Cognitive Training and Adaptation:

Occupational therapy may involve cognitive training exercises and adaptive techniques when cognitive effects of a stroke impact a patient's ability to perform daily tasks. This can include rote exercises or engaging activities like card games to improve attention, sequencing, and problem-solving skills. Additionally, patients can learn strategies such as writing down reminders, using checklists, or minimising distractions to adapt to their cognitive challenges.

Sensory Re-education:

Sensory re-education is a common intervention for stroke survivors who experience sensation deficits like numbness. Therapists use various activities to retrain the brain to process and respond to different sensations, such as textures and temperatures. This may also include discussing safety strategies, such as reducing the maximum temperature of hot water heaters.

Interactive Neurorehab Devices:

Occupational therapists may recommend interactive at-home therapy programs or devices to keep patients engaged and improve their chances of regaining function. These devices can be used in conjunction with in-clinic therapy sessions for better outcomes.

By implementing these strategies and interventions, occupational therapists can effectively address deficits in functional cognition among stroke patients. This not only improves their ability to perform daily tasks but also enhances their overall quality of life.

Home modifications

Bathroom Adjustments:

• Install grab bars near the shower, bathtub, and toilet to provide support and prevent falls.
• Remove shower screens that may hinder safe access and replace them with shower curtains.
• Provide a shower stool or chair for individuals with balance issues, allowing them to bathe safely while seated.
• Ensure non-slip bathmats are in place to prevent slipping.

Kitchen and Dining Area Adjustments:

• Adjust the height of chairs or provide raised seats to make sitting and standing easier, reducing the risk of falls.
• Recommend the use of a wheeled mobility tray for transporting meals and drinks, reducing the need to carry heavy items.
• Suggest the use of adaptive equipment, such as a sock aid, reacher, or long-handled sponge, to facilitate daily tasks.

Bedroom and Living Area Adjustments:

• Remove rugs and excess clutter from the floor to minimise tripping hazards and create a clear path for mobility.
• Install doorknob extenders to make it easier for individuals with limited hand function to open doors.
• Adjust bed height or provide bed rails to assist with getting in and out of bed.
• Recommend the use of an electric hoist or wheelchair for individuals who need assistance with transfers.

General Home Adjustments:

• Suggest the use of a walker or cane to improve mobility and balance.
• Install ramps at entryways and thresholds to ease transitions and eliminate the need for stepping.
• Ensure adequate lighting throughout the home, especially in hallways and staircases, to improve visibility and safety.
• Recommend the installation of a stairlift or the addition of handrails on both sides of the staircase for support.

These modifications aim to create a safer and more accessible living environment for stroke patients, promoting their independence and sense of well-being as they navigate their daily routines. It is important to work closely with the patient, their family, and caregivers to identify specific needs and implement the most effective home modifications.

Frequently asked questions