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| Division of Occupational Therapy - OT Connect Cerebrovascular Accident (CVA)
Common Symptoms/Course of disease
Usual Age of Presentation: After age 55 the risk doubles with each decade (Longe, 2002). Sex Biases: About equal for men and women but 19% higher in men (Longe, 2002 & Pedretti, 2001) Cultural Biases: Greater chance of stroke when there is a family history and is more prevalent in African-Americans, Hispanics, and Asians (Longe, 2002). Current Medical Treatment: Emergency treatment is to dissolve the clot (usually done with tissue plasminogen activator, or t-PA). If t-PA is not appropriate, they use heparin or another blood thinner or an anti-clotting agent such as aspirin (Longe, 2002). Referred to Occupational Therapy to prevent deformity, remediate psychosocial dysfunction, promote symmetrical motor function, improve functional use of affected side, integrate sensory and perceptual function and restore to maximum level of independence (Pedretti, 1996). Common evaluations test independence level with activities of daily living, ROM, MMT, Sensation, Visual-perception, Subluxations, and Cognition. Many additional specialized tests are used based on the needs and limitations of the individual and their family. Goals of Occupational Therapy are to prevent abnormal tone and proper positioning to decrease deformities, prevent abnormal postures and movements, increase strength and ROM, increase voluntary movement in extremities for functional movements, remediate cognitive and perceptual deficits, reach maximum level of independence with ADL's, help the adjustment process transition easier, improve functional communication and social interaction, help patient return to their previous roles, and achieve balance with work, rest, and play (Pedretti, 1996) Adaptive equipment - Splints, lap tray, reacher, long handled sponge, weighted or long handled silverware, rocker knife, buttonhook, tub bench, hand held shower, long handled shoe horn, grab bars, and elastic shoe laces. Treatment:
Other: Prognosis - Recovery depends on location of lesion, size of lesion, and client's age and health history (Neistadt,1998). While some clients remain disabled despite efforts, most benefit from occupational therapy and will achieve improvement in skills (Pedretti, 2001). References
How OT Makes a Difference: Evidence-Based Practice A study conducted by Catherine Trombly and Hui-ing Ma looked at the “the effects of occupational therapy on the restoration of role, task, and activity performance for the persons who had a stroke, with the purpose of guiding practice and research (Trombly, 2002).” They looked at fifteen studies that had been previously conducted to try and document the benefits of occupational therapy. Eleven of the studies found that participation, ADL’s (activities of daily living), and IADL’s (instrumental activities of daily living)) improved significantly more with training more than with control conditions. The measured indicators of success were activity - extended activities of daily living and the BADL (Barthel Index). In the first indicator, it was found that task-specific practice in a familiar environment (such as the home) improved more than the control group. It was also shown that leisure skills and mobility improved significantly over no training. These results show that task-specific therapy is beneficial. The second indicator was the BADL. This showed that client-centered activities in the home showed significant improvement in performance in dressing and other self-care activities compared to no treatment. Five of the nine studies using the BADL showed significant improvement of occupational therapy with stroke patients. Due to the small sample number, the magnitude of success could not be determined. In conclusion, this study showed that “task-specific practice on activities clients identify as important to them may be accepted cautiously as best practice.” This study reports that occupational therapy improves performance of BADL and IADL and role participation of some persons who have had a stroke. Trombly, Catherine A. & Hui-ing Ma. (2002). A Synthesis of the Effects of Occupational Therapy for Persons with Stroke, Part I: Restoration of Roles, Tasks, and Activities for Persons with Stroke. The American Journal of Occupational Therapy Vol. 56, 250-259. This interview was conducted with Mrs. M, whom is the caregiver of her husband who suffered multiple strokes. He received Occupational Therapy for six months after the first stroke. The others occurred within this time period. He received Occupational Therapy twice a week in his home through the local home health agency. He began receiving services in the Fall of 1999. The primary provider was an OTR. Mrs. M stated, “We were so fortunate to have her come to our house because my husband could not stay home alone in case he got hungry and couldn’t get himself something. I just wanted him to be able to make a small meal.” She felt that her main concern was the focus of therapy. The therapist worked on teaching Mr. M how to prepare a peanut butter and jelly sandwich for himself. They also worked on toileting to assure he could stay home alone. Mrs. M said that the therapist adapted the environment so the items were set up next to each other and a small work space was set up to prevent fatigue and help him from losing his balance. The workspace consisted of a chair next to the refrigerator with a lowered table and the utensils were always sitting out. She felt she understood therapy because she was always involved. The therapist listened to her concerns and thought of ways to help him accordingly. Therapy was not graded to become more challenging because they used many adaptive strategies to help him stick to the basic self-care skills. The major benefits of therapy were that Mrs. M could go out of the home to run errands and prevention of caregiver burnout by spending quality time with her friends. In addition, Mr. M was allowed to stay home alone so he could feel like he was “his old self”. Mrs. M recommended that more people should receive services in their own house because there is no better environment to practice in than the one they will be living in. She was very pleased with her services and encourages more people to learn what Occupational Therapy can do for them.
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