Healthy Living

after a Stroke
Kinesiology 1113
Presented by: Vanessa Trieu, PT & Kayla Valiharju, OT
 Vanessa and Kayla

Kayla Valiharju, OT
Vanessa Trieu, PT
● Carleton University:
● H. BScKin, McMaster
Neuroscience and Mental
University 2019
Health B.Sc. Honours with a
● Master of Physiotherapy,
minor in Applied Linguistics
Western University 2022
and Discourse Studies (2020).
● Physiotherapist at the Hand ● Western University: Master of
and Upper Limb Clinic
Science in Occupational
Therapy (2023).
● Occupational Therapist at the
Hand and Upper Limb Clinic
 Table of Contents

1 Learning 2 Case Study 3 Stroke and

Objective Risk Factors

4 Stroke Related 5 Outpatient 6 Brainstorming

Impairments Therapy and Conclusion
 Learning Objectives

1. Overview of basic of stroke pathology, stroke-related impairments

and post-stroke rehabilitation
2. Learn about physical activity participation, psychosocial factors
affected after stroke
3. Learn about the roles of physiotherapy and occupational therapy
in stroke rehabilitation
4. Application of social determinants of health to a case study
5. To become familiar with accessible resources for healthy living in
Thunder Bay, ON
Hi I’m Jane!
 Jane’s story
● Jane (she/her) sustained a left sided stroke in September 2023. She
woke up feeling dizzy and unwell with right sided weakness. Her
partner called 911, she arrived at the hospital and was treated with
tissue plasminogen activator (tPA) at the TBRHSC. She was admitted
for 1 week, then transferred to St Joseph’s Hospital for stroke
rehabilitation for 2 months.
● She attended outpatient stroke rehabilitation for 1 month, and was
then discharged with a home exercise program.
● She was referred to OT/PT by her family doctor for continued therapy
with Kayla (OT) and Vanessa (PT)
The Patient
● Social history:
○ Retired primary school teacher in 2020
○ Married for 30 years to her supportive partner (Riva)
○ Two children in who live in town, with 3 grandchildren all living in
Thunder Bay
● Past medical history:
○ Ex-smoker (quit after stroke) x 30 years
○ Diabetes type II
○ HTN (uncontrolled before their stroke, no primary care provider)
○ Anxiety (controlled with stress management, exercise, mindfulness)
○ After her stroke, she was diagnosed with post-stroke depression which
affected her sleeping, and social engagement with family and friends
The Patient
● Current impairments:
○ Left hand dominant
○ Right upper extremity: R shoulder pain and limited movement, R wrist/hand
spasticity
○ Right lower extremity: leg weakness with uses a cane for walking at home,
walker for long distances in the community
○ Activities of Daily Living - assistance required with bathing, toileting and
dressing, independent with eating
● Goals:
○ Play card games with her grandchildren
○ Walk around the block (500m) using her walker without taking any breaks
○ Go to the 55+ Centre and attend fitness classes
○ Cook a meal independently
 What is Stroke?

- Ischemic when there is a blockage or clot in a blood vessel resulting

with death of brain cells affecting different brain regions.
- Transient ischemic attack (TIA) (aka. Mini stroke): caused by a small
clot that briefly blocks an artery.
- Hemorrhagic stroke a rupture of blood vessels within the brain leading
to cell death.
Risk factors

https://concordialm.org/blog/stroke-prevention-understanding-your-risk-factors/
 Common impairments after stroke
❖ Fatigue
❖ Spasticity affecting muscles and joints
❖ Pain
❖ Balance
❖ Depression
❖ Cognition
❖ Vision
❖ Language and communication
 What is Neuroplasticity?
The brain’s ability to rewire its structures, functions, and connects from intrinsic
and extrinsic stimuli. Neuroplasticity is recognized through cellular/synaptic
changes, reorganization of brain regions and networks, and changes in
behaviour.

Neuroplasticity and Stroke:

Post-stroke, neural plastic changes occur days, weeks, months, and years after
the brain has been injured. These changes are learning and experience
dependent.
Outpatient therapy: Assessment
● Right shoulder ROM decreased by 30°, painful with movement
● Right elbow ROM decreased on right, spasticity limiting active movement
● Wrist and hand: rests in a fist with wrist flexed, wrist and fingers are
passively extensible with moderate effort

● Right lower extremity:

○ Weakness in quadriceps and hip extensors, which Jane uses her cane
to help with at home and walker for longer distance in the
community
● 30 second sit to stand test: 5 repetitions (normal for age 60 = 12-17)
● Berg Balance Scale: 48/56 (<49 = increased risk for falls)
Outpatient Therapy
PT treatment plan:
❖ In clinic - hands on therapy with challenging exercises (video)
❖ Home exercise program:
➢ Balance exercises (safe for home)
➢ Shoulder and leg range of motion and strengthening exercises
❖ Prescribe cardiovascular exercise for Jane
➢ Walking with her walker!
Lower extremity strengthening
 Outpatient Therapy

Occupational Therapy Treatment Plan:

❖ Kitchen assessment: to measure an individual’s functional and cognitive

abilities when engaging in cooking tasks
❖ Resting hand splint
❖ Hand over hand activities: towel exercises, card flipping
❖ Assistive devices
2 MINUTES:
How active are
people after
stroke?
Fini et al. (2022) Physical Therapy
Can you identify social determinants of health that could positively or negatively influence
Jane’s stroke recovery

Determinants of health: - Social supports and coping skills

- Income and social status - Healthy behaviours
- Employment and working conditions - Access to health services
- Education and literacy - Gender
- Childhood experiences - Culture
- Physical environments - Race/ racism
- Biology and genetic endowment
● Jane has been going on daily walks around her block (500m) with her
partner, or grandchildren
● Has been attending fitness classes at the 55+ centre designed for
stroke survivors
● Has been cooking light meals (i.e. grilled cheese, oatmeal, salads,
and sandwiches)
● She has a team of professionals working with her including her family
doctor, cardiologist, pharmacist, dietitian, social worker
Questions?