STROKE REHABILITATION IN

OCCUPATIONAL THERAPY

“How We Help Patients Heal”

Pn. Nordiyana Binti Othman

Occupational Therapist
Hospital Pakar Sultanah Fatimah,
Muar.
 Stroke
Data Statistic KKM 30%-35% people death from 1000 patient admission
because of stroke

The largest During the 1st few

Medical day after stroke
emergency and single cause of people might very
prompt treatment severe physical tired and need to
is crucial. disability recover
from initial event.

Multidisplinary team People will lost of - People also weakness one

identify
the type of stroke, where
it occurs, the type and
amount of damage and
affect
skills specifically side body
physical (inability to - Social disablity
walk), decline in - Inability to care for
cognitive and themselves
emotional function. - Decrease in community
participation

Source : https://www.stroke.org.stroke
 Stroke Rehabilitation
vs
Occupational Therapy (OT)
Stroke Rehabilitation has been revolutionized in the last decade
through a combination of new imaging techniques looking at brain
recovery and what is working in stroke rehabilitation. Combination with

Vs
other profesion.
Source : https://www,ninds.nih.gov

OT is a qualified healthcare and client centered profession that

uses meaningful
activities across the spectrum of physical and mental domainn
to reduce limitation after stroke. We also implement compensantory
strategies to promote independently. we often work with other
members of the stroke team to make sure they can help with the
full range of problem that stroke can cause
Source : https;//www.regenyspecialist.com
 - The number of stroke patient increase day by day
- Based on research article STROKEAHA, 2014 by David H Saunders, there are a wide
range of post stroke problem. The longer term problem are 1 to 5 years after stroke
attack
Mobility
58%
OT’s are Fatigue
Falls 44%
Important 52%
45%
Concentration

- The stroke people able to participate with exercise after stroke attack as soon as possible
after screening by healthcare team and also on patient condition. (Jun 2017)

Source : (https://w.ahajournal.org/doi/10.1161/strokeaha.114.004311)
Let’s learn how Occupational
Therapy (OT) can help stroke
people
 Occupational Therapy :
- Important part of people recovery and rehabilitation.

- Involvels re-learning everyday activities to enable patient to independent

- To help people to regain the skills day by day based on activities.
- Help people to Return To Work
- To teach people Independent in own home.
- To support and teach people to doing leisure activities and hobbies.
- To advise the suitable equipment people can use and changes needed to
people accommodation.
- To improve and restore Quality Of Life
Source : https;//www.webmd.com

Neuromusculoskeletal
- Range Of Motion for Upper
Limb
- Pinch strength
- Grip strength
- Balance : sitting/standing
- Fine motor
- Hand Function
- Eye hand ccordination
Cognitve
- Cognitive impairment :
memory, attention, concentration
- Difficult to use telephone, take
medication, handling money
Sensory
Occupational Assessment for :
Therapy - Light and deep touch
Assessment / - Stereognosis
- Sharp and dull
Intervention
- Oedema
- Pain
Treatment : sensory stimulation,
massage, pets therapy, deep breathing,
relaxation tech etc
Psychological
Driving Asessment
- Emotional impairment : people
has depression, anxiety, mental
- Will identify and prescribe the specific
health
modifications that an individual requires
- Treatment : exercise, music
to drive safely
therapy, behavioral therapy,
- Complete with physical examination
education, family support group,
include upper and lower limb : ROM,
meditation,
strength, coordination, sensation
- Monitoring the people medical
- condition, physical deficit during off road
assessment.
Source: The American Journal of Occupational
Therapy,2015,vol.69(1)
 Occupational Therapy Return To Work
Assessment and
Intervention - To return back patient to work
- Work assessment, work visit
- To suggest the suitable job for
Wheelchair stroke people depends on the
Thermoplastic condition.
Assessment
Splint
- Measure and suggest Home Assessment
- Antispastic splint
the suitable wheelchair
- Night splint - Done with home visit after patient discharge or pre
for stroke people.
- Ankle Foot Orthosis discharge.
- Quotation for
(AFO) - To assess the home suitable for people or not.
wheelchair - To suggest the best position for stroke people
- To suggest home modification and precribe assistive
tools to improve physical, mental, social and perception
Aids And Adaptation skills

- Feeding tools : spoon, fork, plate, cup

- Cooking tools : knife, cutting board
- Bathing : long handed brush etc Source : National On Elderly and ersons with Disablities, 2017
: Occupational Therapy and Return To Work Liteiture Review
; https;//www.aota.org
 Occupational Therapy
Treatment ....what’s today??
CIMT

Constrain Induced Mirror Therapy

Movement
Therapy
Who, how, when... Who, how, when
- Require some hand function - Place affected side bhind a mirror so that when looking
- High Motivation reflection of the unaffected arm appears in place of hidden 1
- Minimal Cognitive Dysfunction - Series of basic movement exercises with both hand
- Good in balance - To create a illusion that the arm or leg affected by the stroke is
- Edequat walking ability moving
- 10’ wrist extension, thumb abduction, finger extension - MR will improve movement in affected upper limb and lower limb
- At least 6-7 hours per day and 10- 15 min per task and ADL
- Trial every 10-30 sec - Can relief pain after numerous session by helping the brain
- Practice sling for six hour per day for 2 or 3 week. recognize and feel the arm
- Duration ; 3-5 session per week (20 to 90 min)
 Constraint Induced Movement Therapy
(CIMT)
• Approach to stroke rehabilitation that involves the forced use of the affected arm by
restraining the less affected arm combined to several hours of exercise.

• This therapy involves CIMT movements of the less affected arm, usually with a sling
or mitt for 90% of waking hours, while intensively inducing the use of the more
affected arm. concentrated, repetitive training of the more affected limb is usually
performed for six hours a day for a two to three week period.

• The effect of CIMT is to improve movement that not only remain stable for months
after the completions of therapy but translate well to improvements of everyday
functional task.

• Benefits : Acquisition of new motor, increase the affected arm in functional activities
such as dressing, eating etc. improve quality of movement, enhanced independence
with everyday task, improve sense and improve quality of life.

Source : https://www.ahajournals.org.
: Metaanalysis.ncbi.nig.gov
: Taub et al,1993. 1Jul 2011
 Mirror
Therapy Mirror Therapy
• Can be used even in completely plegic stroke survivors, as it uses visual stimuli for
producing a desired responses in the affected limb.

• Not for motor impairment but also on sensations, visuospatial neglect and pain after
stroke.

• Intervention in chronic and acute phases post stroke with therapy duration lasting
between 1 and 8 weeks.

• MT show improvement althought the extent of improvement in sensory impairment and

hemineglect is limited.

• MT prove to be effective abd feasible approach to rehabilitate post stroke survivors in

the acute, sub acute and choronic phase of stroke.

Source :Research Article Dorcas BC Gandhi, Albert Sterba 2020

Occupational Therapist can help you with
lost cognitive abilities, such as memory,
processing, problem solving, judgement
and safety awareness.

But how .....

Component to be assess for stroke people
in cognitive
MEMORY
ORIENTATION

PERCEPTION

ATTENTION AND
CONCENTRATION Cognitive

PRAXIS
THINKING VISUOMOTOR
OPERATION
 Card matching sequencing

Visual/ Spatial processing games

Count money
words search,
Alphabetize sentences
teka silang kata

Brain teasers puzzle, cooking, drawing

cognitive online games
How to improve Simon Memory Games
memory, attention, visual
cognition after stroke

Cognitive Therapy apps thoughtfullchat: mental health, betterhelp

calm ; meditate, sleep, relax app

Meditation apps meditation reminder

Strategy Games chess, dam haji, dam ular

Board games carrom, congkak

 Quantity vs
Quality in OT’s
Social support in the promotion of community participation for stroke
people
Quality : 35%
Quantity : 65 %

Occupational Therapist treat stroke people

Quality : 70 %
Quantity : 30%
( prevent recurrent)

Exercise after stroke

Quality : 55 %
Quantity : 45%

Source : https://onlinelbrary.wiley.com
Thanks!
Any questions?