CEREBROVASCULAR

ACCIDENT
(STROKE)

Ghadeer Alomari
 WHAT IS A
CEREBROVASCULAR
ACCIDENT?
Cerebrovascular accident (CVA) is
the medical term for a stroke. A
stroke is when blood flow to a part is a thrombotic stroke, which
of your brain is stopped either by a occurs when the clot forms in
blockage or the rupture of a blood a blood vessel within the
brain. This is the most common
vessels ,characterized by sudden.
type; about 80% of strokes are
onset and lasting longer than 24
ischemic.
hours
Hemorrhagic stroke
TYPES OF

CEREBROVASCULAR A hemorrhagic stroke occurs

ACCIDENT
There are two main types of
cerebrovascular accident, or stroke:
an ischemic stroke is caused by a
blockage; a hemorrhagic stroke is
caused by the rupture of a blood
vessel. Both types of stroke deprive
part of the brain of blood and
oxygen, causing brain cells to die.
ATTACK (TIA):
Ischemic stroke
when a blood vessel ruptures, or
hemorrhages, and then prevents
blood from getting to part of the
brain. The hemorrhage may occur
in any blood vessel in the brain,
or it may occur in the membrane
.surrounding the brain
TRANSIENT ISCHEMIC

It's sometimes called a "mini-stroke".

An ischemic stroke is the most
common and occurs when a blood
clot blocks a blood vessel and
prevents blood and oxygen from
getting to a part of the brain.
There are two ways that this can
happen. One way is an embolic
stroke, which occurs when a clot
forms somewhere else in your
body and gets lodged in a blood
vessel in the brain. On other way…
TIAs happen when the blood supply to
the brain is blocked for a short
time(Symptoms go away within 24
hours). The damage to the brain cells
isn't permanent, but if you have had a
TIA, you are at a much higher risk of
having a large stroke.

Who is at risk for a stroke?
Certain factors can raise your risk of a
stroke. The major risk factors include:
1. High blood pressure. This is the
primary risk factor for a stroke.
2. Diabetes.
3. Heart diseases. Atrial fibrillation
and other heart diseases can
cause blood clots that lead to
stroke.
4. Smoking. When you smoke, you
damage your blood vessels and
raise your blood pressure.
5. A personal or family history of
stroke or TIA.
6. Age .Your risk of stroke
increases as you get older.
7. Race and ethnicity. African
Americans have a higher risk of
stroke.
There are also other factors
that are linked to a higher risk
of stroke, such as:
Alcohol and illegal drug use.
Not getting enough physical
activity.
High cholesterol.
Unhealthy diet.
Having obesity.
The loss of blood flow to the
brain damages tissues within
the brain. Symptoms of a
stroke show up in the body
parts controlled by the
damaged areas of the brain.
Symptoms of a
cerebrovascular
accident
The quicker you can get a
diagnosis and treatment for a
stroke, the better your prognosis
will be. For this reason, it’s
important to understand and
recognize the symptoms of a
stroke.
Stroke symptoms include:
1. Difficulty walking.
2. Dizziness.
3. loss of balance and coordination.
4. Difficulty speaking or
understanding others who are
speaking.
5. confusion, disorientation, or lack
of responsiveness.
 6. Sudden behavioral changes,
especially increased agitation.
7. seizures.
8. Numbness or paralysis in the
face, leg, or arm, most likely on
just one side of the body
9. Blurred or darkened vision.
10. A sudden headache, especially
when accompanied by vomiting,
nausea.

Remembering the acronym

“FAST” helps people recognize
the most common symptoms of
The symptoms of a stroke can stroke:
vary depending on the
individual and where in the
brain it has happened.
F A S T
Symptoms usually appear
suddenly, even if they’re not
Face: Arm: If a Speech: Time: It’s
very severe, and they may
Does one person Is their time to call
become worse over time. side of the holds both speech 911 and get
face arms out, abnormal to the
droop? does one or hospital if

any of
drift slurred?
these
downward
?
symptoms
are present.


Medical Management of
CVA
Management of complications:
Respiratory problems.
Cardiac disease.
Deep-vein thrombosism(DVT).
Incontinence.
Aspiration risk.
Skin care.
Contractures & soft
tissue stretching.
Occupationa therapy
intervention:
1.Compensations with task specific
devices/techniques
2. Remediation of body
structure/function
3. Skills that impact occupation
Interventions to increase
functional ability in seated
posture:
1. Establish a neutral yet active
starting alignment.
2. Attempt reaching activities from
posture (1) and do the same
activities with a posterior pelvic
tilt and flexed spine.
3. Maintain trunk in midline using
external cues.
4. Maintain trunk ROM by wheelchair
and armchair positioning.
5. Dynamic weight-shifting
activities
6. Strengthening the trunk.
7. Using compensatory strategies
and environmental adaptation.
(e.g. wheelchair seating systems,
reachers..etc.).
Postural Adaptation
intervention:
IN SITTING:
1. Establish “position of
readiness”.
2. Use external cues when
necessary to facilitate trunk
alignment—(verbal or visual
feedback, environmental/tactile
cues).
3. Maintain trunk ROM—(exercise
and activity,…)
4. Use dynamic activities to
promote weight shift through
pelvis .
5. Strengthen trunk muscles.
6. Use compensatory strategies &
adaptations when necessary
(lumbar rolls, lateral supports,
chest straps, reachers).
IN STANDING:
1. Establish symmetrical base of
support & proper alignment—
(feet hip width apart, equal
weight bearing through feet,
neutral pelvis, both knees
slightly flexed, aligned &
symmetrical trunk).
2. Establish the ability to bear
weight and shift weight
through more affected LE.
3. Encourage dynamic reaching
activities in multiple
environments that require
different wt-shifting abilities.
Activities that survivors want to focus
on during occupational therapy usually
fall into three categories, including:
Self-care: personal daily activities,
including eating, bathing, and
getting dressed, in addition to
household management tasks such
as cooking and cleaning.
Productivity: tasks can consist of
returning to work, school, or other
prior responsibilities and finding
new ways to adjust.
Leisure: activities usually include
fun things a person enjoyed doing
prior to the injury such as golfing,
painting, dancing, and other social
skills.
⬛️Self-care, productivity, and leisure
activities are an important part of
everyday life. The more these skills are
practiced, the higher the chances of
regaining function and seeing
promising results.
Recommendations:
1. Home Modifications:
After discharge, it can be challenging to
transition smoothly back home.
make the appropriate adjustments to
ensure an individual’s safety. This can
include making home modifications
such as adding doorknob extenders
and/or using non-slip bathmats.
Removing rugs and excess clutter
from the floor to lower the risk of
falling.
A smoother transition can help
survivors feel more at ease and
redirect their energy towards healing.
2. Rehabilitation Exercise Programs:
provide various targeted exercises
for individuals to practice safely at
home.
Establishing a proper rehabilitation
program at home and practicing
therapeutic exercises consistently is
important to stimulate
neuroplasticity, the brain’s ability to
rewire itself.
(It works by strengthening neural
connections in the brain and
creating new ones, which is an
essential part of stroke recovery).
 3. Visual Scanning:
(Spatial neglect is a condition that can
make it difficult to orient, identify, or
respond to stimuli in the environment
on the affected side. For instance, when
an individual sustains a stroke in the
right hemisphere of the brain, they can
experience spatial neglect on their left
side).
Fortunately, visual scanning can help
treat spatial neglect by:
encouraging individuals to
intentionally draw their attention to
their affected side. For example, one
visual scanning activity suggest is
using a highlighter to draw a bright
line down the left side of a book. The
individual must then practice
moving their eyes all the way to the
left until they find the highlighter
mark.
4. Activities of Daily Living Training:
Occupational therapists are
specialists in the area of performing
BATHING:
1. Teach how to be more safe and
independent with this task.
2. Promote better safety is to install grab
bars and seats in the shower.
3. Placing a rubber mat in the shower
helps make the floor less slippery.
DRESSING:
learn how to put your pants on while
lying in bed or how to use adaptive
tools like button hooks and zipper pulls.
GROOMING:
may have you use an adaptive tool called
a universal cuff to help you grip onto
items or recommend using an electric
toothbrush to clean the teeth more
effectively.
TOILETING:
schedule and performing the same tasks
at around the same time every day,
individuals can better predict when they
should empty their bowels and prevent
accidents.

activities of daily living (personal care

tasks) after stroke. Since activities of

daily living require physical and
cognitive skills, both of which may be
affected by a stroke, many survivors
find that they have difficulties with
these seemingly simple tasks.

EATING:
1. To encourage you to use your
affected arm to eat after a stroke.
2. An occupational therapist may
teach you how to use adaptive
utensils.They can help supplement
for limited grip or control over the
wrist.
5. Work Accommodations
Lastly, occupational therapy can help
survivors relearn the skills they need to
return to their occupation. Therapists
may provide individuals with unique tasks
to practice depending on the type of
workload and environment.
To transition smoothly back to work
after a stroke, OTs may also recommend:
Working shorter hours.
Taking breaks to help prevent
overstimulation.
Installing grab bars in the office
restrooms to help with balance.
Having ergonomic equipment and
flexible scheduling to help with
increased fatigue after a stroke.
Working “smarter, not harder”
through task simplification (if
possible).
Practicing proper body mechanics
(how one moves) to reduce muscle
strain.
Using Work Accommodations.
Lastly, occupational therapy can help
survivors relearn the skills they need
to return to their occupation.
Therapists may provide individuals
with unique tasks to practice
depending on the type of workload
and environment.
wall calendars and alternative lighting
to help with concentration and spatial
neglect.
Therapists may also encourage
their clients to talk to their
employer about what they can do
to help facilitate their return to
work. It’s important to note that
the Americans with Disabilities
Act requires employers to make
reasonable accommodations for
their employees to help them get
back to work.
neurobehavioral
impairment:
neurobehavioral impairment
—”functional impairment of
an individual manifested as
defective skill performance
resulting from a neurologic
processing dysfunction”
Examples: Affect, body,
scheme, cognition, emotion,
language, memory, motor
planning, perception,
personality, spatial relations,
visuospatial skills
Intervention: Choice of treatment driven by tasks
relevant to client needs; tasks
1. Compensatory/adaptive:
presented so that the underlying
Repetitive practice of tasks. deficits are challenged via the task.
Emphasizes intact skill training .
Emphasizes modification .
Uses environmental or task. Examples of Assistive
modifications to support optimal
Devices Used after Stroke to
performance.
Improve Task Performance:
Choice of activity driven by
performance challenges, not by Rocker knife.
component deficits Treats symptoms, Elastic laces and lace
not the cause . locks Adapted.
Client-driven compensatory strategies cutting board.
Dycem.
.
Plate guards.
Caregiver-therapist environmental
Pot stabilizer.
adaptations.
Playing card holder.
Task specific and not generalizable.
Suction devices to
2. Restorative/remedial:
stabilize mixing bowls,
Restoration of component skills.
cleaning brushes.
Deficit specific.
Targets cause of symptoms and
emphasizes components.
Assumes that transfer of training will
occur.
Assumes that improved component
performance will result in increased
skill
Choice of activity driven by
component deficits.
Research demonstrates short-term
results with skills generalizable to very
similar tasks.
3. Combination Approach:
Rejects dichotomy between
compensatory and restorative
approaches.
Uses optimally relevant occupations
and environments as the treatment
modality to challenge components.
Rejects use of contrived activities.
 ⬛️A critical role of the occupational
therapist is to help the client adjust to
hospitalization and, more important,
to disability. Much patience and a
supportive approach by the therapist
are essential.
The therapist must be sensitive to
the fact that the client has
experienced a devastating and
lifethreatening illness that has
Psychosocial caused sudden and dramatic
changes in the client’s life roles
Adjustment and performance.
The therapist must be cognizant of
The psychologic consequences of a
the normal adjustment process
stroke are substantial. The incidence and must gear the approach and
of depression in this population is expectations of performance to the
35% according to statistics collected client’s level of adjustment.
by the American Heart Association. Frequently, the client is not ready
The highest reported incidence is to engage in rehabilitation
found in clients in acute and measures with wholehearted effort
rehabilitation hospitals, and the until several months after onset of
lowest is in samples of those living the disability.
Family education is extremely
in the community following stroke.
important throughout the
Other psychologic manifestations
treatment program.
that have been documented in Family members are better
survivors of stroke include : equipped to assist their loved one
Anxiety. in adjusting to disability when they
Agoraphobia. are knowledgeable about the
Substance abuse. disability and its implications.
Sleep disorders. Many clients dwell on the
Mania. possibility of full recovery of
Aprosody (difficulty expressing function; they should gradually be
made aware that some residual
or recognizing emotion).
dysfunction is likely.
Behavioral problems (e.g., sexual
inappropriateness, verbal
outbursts, aggressiveness).
Lability (alteration between
pathologic laughing and crying).
Personality changes (e.g.,
apathy, irritability, social
withdrawal).

interventions for the
psychologic
manifestations of stroke:
1. Fostering an internal locus of control
related to recovery.
2. Using therapeutic activities to
improve self-efficacy or confidence in
the performance of specific activities.
3. Promoting the use of adaptive coping
strategies, such as seeking social
support, information seeking, positive
reframing, and acceptance.
4. Promoting success in chosen
occupations to improve self-esteem.
5. Encouraging social support networks,
such as families, friends, or support
group.
6. Using occupations to promote social
participation
In addition to the
aforementioned
interventions, it is
important to remember
that pharmacologic
interventions.
⬛️The OT program should focus on the
skills and abilities of the patient. The
patient’s attention should be focused,
through the performance of activity, on
his or her remaining and newly learned
skills.
⬛️The OT program can also include
therapeutic group activities for
socialization and sharing of
common problems and their
solutions. The discovery that there
are residual abilities and perhaps
new abilities and success at
performing many daily living skills
and activities that were initially
thought to be impossible can
improve the patient’s mental
health and outlook.
Summary
Stroke is a complex disability that
challenges the skills of professional
health care workers. Although the
number and effectiveness of
approaches for the remediation of
affected motor, sensory, perceptual,
cognitive, and performance
dysfunctions have increased
considerably, many limitations in
treatment remain. The occupational
therapist must bear in mind that the
degree to which the patient achieves
treatment goals depends on the CNS
damage and recovery,
psychoneurologic residuals,
psychosocial adjustment, and the
skilled application of appropriate
treatment by all concerned health
professionals.
REFERENCES:
1. PEDRETTI’S OCCUPATIONAL THERAPY:
PRACTICE SKILLS FOR PHYSICAL
DYSFUNCTION
2. https://www.healthline.com/health/cere
brovascular-accident
3. http://www.emro.who.int/health-
topics/stroke-cerebrovascular-
accident/index.html
4. https://medlineplus.gov/stroke.html
5. https://www.flintrehab.com/activities-of-
daily-living-after-
stroke/#:~:text=They%20include%20nine
%20activities%3A%20eating,functional%2
0mobility%2C%20and%20sexual%20activi
ty

Thank you for

reading

Made by:
Ghadeer Hazim Alomari