Stroke and the Role of Occupational Therapy
What is a Stroke
A stroke is a "brain attack" also known as a cardiovascular accident or CVA. It can happen to anyone at any time. It occurs when blood flow to an area of the brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.
How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.
Types of Stroke
Ischemic Stroke – occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. Ischemic strokes account for about 87% of all strokes. An ischemic stroke can occur in two ways: embolic (blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain and then to a blood vessel small enough to block its passage) and thrombotic (blood clot that forms inside one of the arteries supplying blood to the brain).
Hemorrhagic Stroke – occurs when blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain, leading to a brain aneurysm or weakened blood vessel leak. Hemorrhagic is the least common type of stroke but most often results in death. There are two types of hemorrhagic stroke called intracerebal (blood vessel leak) and subarachnoid (aneurysm, head injury, bleeding disorder, blood thinners).
An Occupational Therapist's Role in Post Stroke Recovery
An Occupational Therapist takes into account individual, social and environmental factors when assessing clients after stroke. An OT may recommend modifications or accommodations to activities and the environment that help people surviving with stroke participate in activities at home, at school and in the community.
- Constraint-Induced Therapy – involves constraining the use of your stronger arm to encourage use of your weaker arm
- Task-oriented Therapy – involves practicing an everyday task with the goal of regaining a skill or gaining a new skill to replace it
- Strength Training – involves exercises to increase muscle strength
- Cognitive screening and assessment – involves screening to determine level of cognition, and recommending appropriate activities to improve cognition and/or assigning appropriate tasks for level of cognition
- Compensatory Therapy – involves changing the environment, finding another way to do a task, or using an assistive device to complete a task (Examples: use of a tub transfer bench to safely and independently transfer in and out of the shower, clothing with elastic waists and zippers or Velcro closures instead of buttons, a card holder can allow you to play cards with one hand; use of an audio book, nail clippers on suction cups to enable cutting nails with one hand)
- Assistive devices – an Occupational Therapist can guide you in choosing appropriate assistive devices to increase safety and independence with activities of daily living
- Caregiver training – involves teaching a client's family and caregivers to help minimize the risk of injury and maximize your independence
Most stroke survivors will receive treatment in a stroke rehab program. Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Occupational therapists help stroke survivors through all aspects of rehabilitation, including prevention, assessment and interventions. Occupational therapy focused on improving personal activities of daily living after stroke can improve performance and reduce the risk of deterioration in these abilities.
Through rehab, you:
- Re-learn basic skills such as talking, eating, dressing and walking
- Increase your strength, flexibility and endurance
- Regain as much independence as possible
An Occupational Therapist can also help to address barriers to participation in active and healthy occupations by advocating for stroke related resources for all Canadians.
Occupational therapists also evaluate driving, develop programs to improve safe driving, or help find alternative transportation.