The Impact of Strokes
The Impact of Strokes
Undergoing a stroke can be one of the most shocking and confusing things a loved one can go through. With everything all happy and dandy one minute and then a person unexpectedly has a stroke, it can change the way a person feels and functions to complete daily life tasks. An independent loved one now needs assistance to shower, to put a shirt on or even prepare a basic meal for themselves. For a family or caregiver, the question turns to what now?
Impairments that can arise from strokes include:
· Muscular: Difficulty walking, paralysis with weak muscles, problems with coordination, or stiff muscles
· Visual: Blurred vision, sudden visual loss, or visual neglect
· Sensory: Loss of sensation or pins and needles
· Speech related: Slurred speech, difficulty swallowing, muscle weakness and balance disorders.
(CDC, 2020)
Rehab to the Rescue!
Each stroke is different and unique and can impact a person in many ways! As a family or patient, you now must turn to rehabilitative services to assist in your recovery.
Stroke patients will begin comprehensive Physical and Occupational Therapies and dependent on the symptoms sometimes Speech Therapy.
Physical Therapy vs. Occupational Therapy
Occupational Therapists (OT) and Physical Therapists (PT) are part of a patients stroke care team. OT and PT will create a specific rehabilitation program that is tailored to helping you regain your function and becoming as independent as possible. Both disciplines work together to achieve this common goal however they are different in some ways also.
Physical Therapy (PT)
A stroke can cause difficulty and problems with movement. Loss of muscle function and muscle coordination is a common problem after a stroke, especially in one side of the body. PTs are trained with an emphasis on movement and coordination.
Some examples of what PT will address:
· Strength and endurance
· Range of motion
· Ability to walk and gait abnormalities
· Coordination and ability to sense one’s body · Motor planning and motor sequencing
Occupational Therapy (OT)
OTs provide a holistic approach in helping patient’s reach the highest level of function and independence during stroke recovery. The process focus’s incorporating the mind, body, spirit and emotion of the patient.
Some examples of what OT will address:
· Basic Activities of Daily Living such as feeding, bathing, toileting, grooming and more
· Instrumental Activities of Daily Living such as cooking, driving, medication management and more
· Rang of motion including improving muscle strength, tone and control and coordination for functional tasks
· Cognition skills such as thinking, processing, and interpreting visual and spatial information
· Movement and mobility when performing daily tasks
The media clip below shares an example of the Occupational Therapist’s role in completing a functional task such as cleaning or grooming. This media clip is a reliable source because the source is posted by AOTA which is the organization in charge of the practice of Occupational Therapy.
(AOTA, Youtube)
Help me with dressing? Show me how that works!
The media clip attached shows an Occupational Therapist teaching dressing after a stroke.
Some of the key takeaways include:
The media clip accurately shares what treatment can involve in OT stroke rehab. You are being informed by an Occupational Therapist so you can rest assured this a professional and valuable clip of information. This video directly correlates what the literature below discusses making this an informative source.
(Youtube, 2018)
Sounds Great!! Does Occupational Therapy work?
The short answer is…yes!!!
Occupational Therapy has been shown and proven through evidence that it is an effective treatment with patients who have undergone a stroke!
With so many different possible things to address you may wonder what an OT would typically address first. A study done in 2009, Classification of Occupational Therapy Intervention for Inpatient Stroke Rehabilitation, by Stacy Smallfield investigated the specific type of OT intervention used by OTs during inpatient stroke rehabilitation to determine the frequency of prefunctional versus functional activity usage. The study analyzed patient services between 2003 – 2004 at an inpatient hospital located in the Midwest. Each session data collected included type of intervention, intervention strategies, and adaptive equipment usage. The study collected data for nearly two years.
The results of the study shared many noteworthy points. For example, musculoskeletal intervention strategies were used in more than half of the sessions (52.25%). Most sessions, about 66%, consisted of activities that were pre-functional in nature compared with about 49% that focused on activities of daily living. Activities of daily living include bathing, dressing, oral hygiene, functional mobility, and other basic self-care tasks. The authors concluded while the research was useful and important to highlighting the different interventions done in Occupational Therapy.
(Smallfield, 2009)
More Evidence-Based Research
A study completed by Hoffman T, Bennett S, Kohn CL, McKenna KT explored the effectiveness of Occupational Therapy services to treat the cognitive impairment with stroke patients. Cognitive impairment was a broad term utilized but the term covers visual and spatial deficits, memory, attention, and orientation.
The study had two groups with one group focusing on compensatory approach’s while the other had a remedial approach training with paper and pencil tasks and even board games. All participants had a stroke with some sort of cognitive impairment and received OT services for 34 minutes 3x a week. The group was led by an Occupational Therapist.
Outcomes were measured by participation in functional tasks. The Modified Barthel Index was used to determine the patient’s ability to function within their community. Other outcomes included life roles, attention to task, and orientation during tasks. In the total of the 33 patients’ judgement skills and ADLs were improved were observed to improve through utilizing the Barthel Standardized Assessment. I would recommend this source to you or your loved one!
(Hoffman & McKenna)
Another study, Occupational Therapy for Stroke Patients, by Esther Steultjens discovers the effectiveness from the available literature to determine whether OT interventions improve outcomes for stroke patients.
There was a total of seven intervention categories created and analyzed. A total of 32 studies were included in the review with 18 being randomized control trials. For the retraining of skills intervention, some evidence for growth in primary ADLs was discovered. Inconsistent evidence was found that splints decrease muscle tone however, the review identified small but significant effect sizes for the effectiveness and efficacy of comprehensive OT on primary ADL, additional ADLs, and social participation. This source is reliable because it is from the American Heart Association Journal which is a well-recognized resource and organization for all current evidence-based information about various healthcare topics. I would recommend this source to you!
(Steultjens, 2003)
Lastly, in the article by, Almhdawi KA, Mathiowetz VG, White M, & delMas RC the article explores the use of occupation based or task-oriented treatment approach. The purpose of the study is to determine if occupational therapy is an effective treatment approach for those recovering from a stroke by assessing progress through standardized tests.
This study uses a randomized control trial with 20 participants split into two groups that were all post-stroke. Group one participated in skilled interventions for six weeks for three hours a week. On the other hand, the other group had no skilled intervention. The use of standardized tests such as the Functional Measures, Motor Activity Log, AROM and the Wolf Motor Function Tests were to determine outcomes. All of these assessments look at things such as level of assistance needed, motor skills, motor planning and range of motion, strength and other client factors. Occupational therapy using occupation-based intervention showed a functional change in scores and the occupation-based approach was discovered to be an effective treatment method in those treatment from a stroke (Almhdaw, 2016).
The above video shares accurate information about OT interventions with strokes. In the video, the therapist and patient are working on range of motion in attempt to regain loss function in daily tasks. In comparison to the literature this media is an accurate representation and good visual resource for patients to see what is done in therapy. The media clip directly and visually shares what is describe in the evidence-based article. This media clip is reliable to it being posted by a hospital, Helen Hayes Hospital. (Youtube, 2016) This a great education resource to provide a glimpse into treatment.
How Do I Know What To Believe On The Internet?
Google, Yahoo, Wikapedia are available with the click of a button. Twitter, Facebook and Instagram share what a friend of a friend knows and recommends for something yet in reality they are just reposting something they read! The internet and social media are a great thing, and it puts the world at our fingertips and puts ease to our lives. Unfortunately, anyone can post things on the internet or social media which have no professional backing or support.
Some helpful tips and tricks to ask yourself include:
· Does it seem accurate or biased allegations?
· Where is the information located?
· Is it a credible website or social media?
· Is the author credentialed?
· Is the information professionally or peer reviewed?
In healthcare and medicine, we have more knowledge of strokes that ever before which is wonderful but also leaves the door open for many interventions to be trialed. The key is “to be trialed”… to be trialed with or by a professional such as an Occupational Therapist.
In conclusion, when getting medical and health information online be sure to do research but not just any research, proper and correct research. It is recommended to use professional, reliable sources that are peer reviewed articles and journals that are experienced in the field working with the population and the factors that are associated with the diagnoses. Media clips are like a window, you can see a general idea, but the window can become foggy and this is where they can have misleading or biased information. It is important to be aware of these factors when doing research on a health topic such as Stroke Rehabilitation through Occupational Therapy as they can cause barriers and misleading information if not aware of these factors. Topics such as this are important to well-being and health and should be researched, discussed, and treated professionally and correctly with help from a professional.
Sources:
Almhdawi KA, Mathiowetz VG, White M, & delMas RC. (2016). Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-Stroke Rehabilitation. Occupational Therapy Internation, 23940,444-456. https://doi.org/10.1002/oti.1447
Hoffmann, T., Bennett, S., Koh, C.-L., McKenna, K. T., & Hoffmann, T. (n.d.). Occupational therapy for cognitive impairment in stroke patients. Cochrane Database of systematic reviews,9.
“Occupational Therapy How-to: Upper Body Dressing – Youtube.” Youtube, 18 Apr. 2018, https://www.youtube.com/watch?v=6B8mPwQjyZU.
“Occupational Therapy Restores Arm Function.” YouTube, YouTube, 16 Mar. 2016, https://www.youtube.com/?app=desktop.
Stacy Smallfield, Joy Karges; Classification of Occupational Therapy Intervention for Inpatient Stroke Rehabilitation. Am J Occup Ther July/August 2009, Vol. 63(4), 408–413. doi: https://doi.org/10.5014/ajot.63.4.408
Steultjens, Esther M.J., et al. “Occupational Therapy for Stroke Patients.” Stroke, vol. 34, no. 3, 7 Feb. 2003, pp. 676–687., https://doi.org/10.1161/01.str.0000057576.77308.30.
“Stroke Signs and Symptoms.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Aug. 2020, https://www.cdc.gov/stroke/signs_symptoms.htm.
“What OT Can Do for You: Recovering after a Stroke – Youtube.” Youtube, 11 Oct. 2017, https://www.youtube.com/watch?v=mfpVMZDRg9A.
Great job highlighting the impacts of strokes on patients and how the various services differ, particularly PT, OT, and speech. This was informative and easy to read, and your presentation of the information was easy to follow. Overall, this shows people how to separate fact from fiction and where the truth lies in this topic.
Thank you!