Stroke

Occupational therapy interventions after Stroke

Spasticity

 stretching 
 static or dynamic splinting
 tone management

prevent contracture or dependant edema

 Bandaging
 compression garments
 retrograde massage
 education for the patient and family in ways to support and position the stroke-affected upper limb
 electrical stimulation

reduce the hand edema that may occur after a stroke

 Active therapy and graded task selection is used to encourage sensorimotor return; the therapy may include
muscle facilitation and strengthening, in conjunction with everyday activities to develop reach, grasp, and
object manipulation skills. Specific techniques include functional electrical stimulation
 progressive resistive exercise sensory-related training

reduce the risk of shoulder subluxation or prevent further subluxation

 prescribe a firm support device

 Upper limb positioning


dressing

 different-sized buttons, zippers, Velcro, clips, and laces

Visual and perceptual impairments

 teaching compensation techniques

 substitution of unimpaired skills
 adapting the task or environment
 visual scanning training
 practical strategies for daily task (dressing, meal preparation, money management and, eventually, crossing
the road and shopping)
 Depth perception problems
o may be encouraged to hold the handrail for additional proprioceptive cues to safely negotiate stairs
Praxis or motor planning problems affecting one upper limb 

 feedback,cueing,
 functional repetitive practice to overcome the impairment
 compensatory strategies

Cognitive therapy

memory difficulties
  external cues may help prompt their memory (using a diary, visual prompts, or an alarm)

environment modification

 prescribe assistive equipment

 home modifications.
 train carers to use assistive equipment or modifications safely with the patient

Occupational Therapy Post-discharge Intervention after Stroke

Outpatient services

 aim is to enable independence in the activities of daily living

Residential care when stroke patient is unlikely to benefit from active rehabilitation

 proper positioning for eating tasks

 visual scanning strategies for reading
 suggest equipment to enable participation in leisure activities
 educate on pressure-relieving mattresses and cushions for patients managed in bed and seated in
wheelchairs
  education regarding positioning for comfort and prevention of deformity