Stroke occupational therapy is a key component in the rehabilitation journey from the initial stages in hospital to discharge – and in the months and sometimes years following a stroke. The number of Canadians who are living with stroke has increased to 878,000, making the need for specialized care directed towards the long-term needs of this population ever more vital.
At Propel, occupational therapists work side by side with the physiotherapists assessing and treating stroke patients to improve their motor, sensory and cognitive capacities that may be affected by the stroke and interfering in their functional abilities. In this article, we discuss stroke recovery timelines, the role of occupational therapists in stroke rehabilitation, as well as our approach to stroke occupational therapy.
Table of Contents:
- Stroke recovery timelines
- Role of the occupational therapist in stroke rehabilitation
- Our stroke occupational therapy approach
- Conclusion
Stroke Recovery Timelines
The length of time for recovery from a stroke is unpredictable. Depending on the client’s prior health condition, type of stroke, initial treatment offered, intensity of the rehabilitation received and dedication, it can vary from client to client.
Stroke is a leading cause of adult disability. Half of all people in Canada living with stroke needing some help with daily activities such as eating, bathing, dressing, going to the washroom and getting around.[i]
After a stroke, you might receive support from an occupational therapist (OT) in the acute and inpatient hospital setting. After discharge from the hospital, you might also attend an outpatient service which provides OT services or even receive support at home. However, after the intense treatment received in the initial period following a stroke, you might still not function as independently as you could and desire further OT support to achieve your goals.
The most rapid recovery from stroke occurs during the first three to fours months. However, studies show that recovery from stroke is still possible beyond six months.[ii] Improvements in the survivors’ motor function continues to improve after one year. While physical and cognitive recovery is possible during chronic (long-term) stages after stroke due to the neuroplasticity which is the mechanism that allows our brain to heal and create new pathways for cognitive and motor skills.[iii],[iv] Therefore, accessing private rehabilitation services after the in-patient/out-patient care has ended is a critical component in maximizing your recovery potential.
Role of the Occupational Therapist in Stroke Rehabilitation
The role of the occupational therapist in the treatment of the stroke population is to assess the client’s motor function, their ability to use their arms/hands, the perceptual and sensory deficits (lack of sensation, visual neglect, etc) and the cognitive challenges (memory, orientation, attention deficits and executive functioning) that may occur. The OT intervention will target the clients’ goals to regain ability, become as independent as possible and return to their activities prior to the stroke.
The treatment will include:
- Motor Skills: exercises and activities to improve upper extremity motor function including coordination, dexterity necessary to perform daily tasks.
- Activities of Daily Living (ADL) and Instrumental Activities (IADL): to address any challenges that is impacting the client’s independence during dressing, eating, managing personal care, household chores and social/leisure activities.
- Splinting and Adaptations: fabrication of a custom-made splint necessary to position the arm/hand, foster function and prevent deformities Assess and orient the client regarding home adaptations including but not limited to grab bars and adapted utensils, etc., to promote safety and facilitate function.
- Cognitive and Sensory/Perceptual Training: sensory re-education to address any challenges due to lack of sensation or hypersensitivity as well as perceptual deficits (visual filed neglect, visual discrimination difficulties, proprioception). Cognitive retraining is incorporated to address challenges with cognitive skills that interfering in daily activities (memory issues, attention deficits, problem solving skills, etc.).
- Psychosocial Support: to help clients manage their emotional and behavioral challenges, changes in mood that impact their social integration.
- Health Education: to reinforce the importance of health habits after stroke, good sleep hygiene and energy conservation strategies to help with fatigue after stroke.
Our Stroke Occupational Therapy Approach
Stroke occupational therapy is part of a collaborative approach to stroke rehabilitation at Propel Physiotherapy. Our OTs will collaborate with the physiotherapist or any other clinician involved in the clients’ care to offer an integrative approach to best address the needs of the clients.
The OT will specifically focus on the following areas:
Upper Extremity Function (motor and sensory):
- management of spasticity with exercises and splinting
- edema and pain management
- deformity prevention by fostering proper positioning of the limb
- Sensory stimulation and activities to restore sensory perception of the arm and hand
- Mirror box therapy
- Range of motion and strengthening exercises
- Fine motor and dexterity exercises
- Use of SaeboStretch splint, SaeboFlex and SaeboGlove when appropriate
- Functional electrical stimulation (FES)
- Adaptation to facilitate the use of the hand during cooking, dressing, writing, etc.
Cognitive and Perceptual Skills Training:
- In clinic activities to train specific perceptual and cognitive skills necessary for the daily function.
- Incorporate an in-home cognitive training using Happy Neuron program, if appropriate to increase consistency in practice.
Psychosocial Support and Healthy Habits:
- OTs will provide psychosocial support and help address any changes in behaviour due to the stroke in collaboration of a psychologist or social worker by implementing strategies to manage signs of anxiety, depression, fatigue, sleep difficulties and routine management.
Conclusion
In a recent study completed by Heart and Stroke Foundation of Canada in 2022, an estimated 108,707 strokes occur in Canada every year, or one every 5 minutes. Seeking medical help immediately following a stroke is critical for recovery potential.
Occupational therapy treatment during early and later stages of the recovery journey has been shown to be essential to promote function and independence after stroke. Attending regular follow ups with your occupational therapist will also help to prevent any secondary complications and maintain the level of the independence achieved during the rehabilitation.
Pursuing further rehabilitation allow you to continue your recovery journey and maximize your full potential. If you or a loved one has experienced a stroke and is looking for stroke occupational therapy or physiotherapy to maximize your potential, contact us at Propel for more information.
References
[ii] Horgan, NF; O’Regan M; Cunningham, CJ; Finn,AM. Recovery after stroke: a 1 -year profile. Disability Rehabilitation. 2009;31(10):831-9.
[iii] Ballester, B; Maier M; et all. A critical time window for recovery extends beyond one-year post stroke. Journal of Neurophysiology. 2019.
[iv] Ingwersen, T; Wolf,Silke, et all. Long-term recovery of upper limb motor function and self-reported health: results from a multicenter observational study 1 year after discharge from rehabilitation. Neurol Res Pract. 2021 Dec 27;3(1):66.
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