CVA Team and OT Interventions

OT Dude Academy’s Free NBCOT® Exam Prep Course Stroke (CVA) CVA Team and OT Interventions
Contents Hide
1 General Concepts
2 Evaluation (Acute Care and ARU)
3 Splinting and Slings
4 Positioning and Transfers
5 Weight bearing for Function
6 Hemiparesis
7 Discharge Planning

General Concepts

  • Client-centered and family-centered care
  • Quality of life
  • Participation, performance, and engagement in meaningful occupations
  • Barriers and supports
  • Psychosocial – adjustment, depression, anxiety
  • Location and resources
  • Assistive technology1 

Evaluation (Acute Care and ARU)

Source2 

  • Occupational profile/Baseline occupations
  • Prior roles
  • Prior DME
  • Environmental set-up: stairs, handrails, entry/exit, 1-story vs 2-story, flooring, lighting
  • Type and extent of CVA
  • ROM
  • MMT
  • Grip strength
  • Dexterity
  • Balance
  • Pain
  • Spasticity
  • Sensation
  • Proprioception
  • Coordination: dysdiadochokinesia
  • Pain
  • Visual-perceptual: hemi-inattention, neglect, visual field deficits (field cuts)
  • Cognition: attention, memory, insight, problem-solving, sequencing, safety awareness
  • Communication: aphasia, dysarthria
  • ADLs, e.g., CARE Tool; commode and shower chair/bench
  • IADLs – meal preparation, shopping, finances, community mobility
  • Sleep participation and performance
  • Work and Productivity
  • Leisure and Play
  • Social supports
  • Community Reintegration
  • Fitness to drive: OT-Driver Off Road Assessment (OT-DORA) Battery3 
  • Wheelchair for mobility: size, height, type of cushion, arm trough, anti-tippers
  • Psychosocial: prior and current barriers

Splinting and Slings

  • Correct malalignment
  • Prevent contractures
  • Maintain skin integrity
  • Optimize function
  • Splinting schedule
  • Sling as needed during transfers and/or
  • Kinesio taping for shoulder
  • Standard shoulder sling, Hemi-sling, Giv-Mohr

Positioning and Transfers

Source4 5 6 

  • Treatment plan with team and family members
  • Communication (verbal, non-verbal, aphasia)
  • Regain and improve function (BADLs)
  • Turning schedule, e.g., Q2 hours
  • Early mobility; mobilizing out of bed and minimizing inactivity
  • Positioned on affected, nonaffected, and supine
  • Pillow support and padding
  • Edema management and reduction of limbs
  • Reducing pain and discomfort
  • Side-lying: should be supported and the patient should not lie directly on the affected shoulder (should be protracted)
  • Bridging
  • Sitting
  • Rolling between positions
  • Pre-transfers and Transfers
    • Precautions and contraindications (e.g., ALOC, unstable, O2 saturation)
    • Cognition (attention, memory, sequencing, insight) and safety awareness
    • Signs and symptoms (blood pressure, pain, tone)
    • Amount of participation
    • Balance
    • Use of limbs
    • Strength and ROM
    • Type of transfer
    • Staff assistance vs/and use of mechanical lifts and aids e.g., transfer board
    • Environmental preparation (e.g., clutter)
    • Directions
  • Dysphagia (e.g., not drinking or eating in supine)
  • Surfaces for balance, weight-bearing, and transfers: bed, edge of bed, chair, wheelchair, commode, grab bars, transfer poles, edge of sinks, bed rails
  • Variations: raised and lowered bed, firmness levels, narrow vs. wider stance, levels of assistance by OTP
  • Fall prevention and using lower surfaces
  • Addressing neglect and inattention
  • Maintaining skin integrity with supports (pillows, floating heels)
  • Documenting tone
  • Family training

Weight bearing for Function

  • Feeding and eating, e.g., with bedside tray
  • Grooming tasks
  • Dressing
  • Toileting
  • Bathing
  • Sitting and standing balance and progressing to unsupported sitting and standing

Hemiparesis

Source7 8 

  • Remedial vs compensatory
  • SROM, AAROM, PROM9 
  • Splinting (above)
  • Weightbearing
  • Team management of hypo-/hypertonicity
  • Functioning with ADLs
  • Use of physical agent modalities, e.g., E-stim, FES10 
  • Awareness of (neglect and inattention)
  • Edema control: isotoner gloves, retrograde massage, compression stockings
  • Neuromuscular re-education11 
  • Constraint-induced Movement Therapy (CIMT) 12 
  • Mirror Therapy (MT)

Discharge Planning

  • Conferring with MD, RN, PT, SLP, SW, case management, and other OTs
  • Home exercise program
  • Setting and home evaluation
  • Environmental modifications
  • Family Caregivers: education, training, hiring, level of supervision (24/7?)
  • Caregiver burnout13 
  • Durable medical equipment and assistive devices
  • Continued OT Services: Home Health vs Outpatient vs Skilled-nursing Facility
  • Referrals: driver rehabilitation, ophthalmologist
  • Preventing re-admission14 
  1. AOTA. (n.d.). The Role of Occupational Therapy in Stroke Rehabilitation. Retrieved from https://www.aota.org/about-occupational-therapy/professionals/rdp/stroke.aspx[↩]
  2. Rowland, T. J., Cooke, D. M., & Gustafsson, L. A. (2008). Role of occupational therapy after stroke. Annals of Indian Academy of Neurology, 11(5), 99.[↩]
  3. Unsworth, C. A., Baker, A., Taitz, C., Chan, S. P., Pallant, J. F., Russell, K., Odell, M., & Coulson, M. (2012). Development of a standardised Occupational Therapy Driver Off Road Assessment (OT-DORA) battery to assess older and/or functionally impaired drivers. Australian Occupational Therapy Journal, 59(1), 23–36. http://dx.doi.org/10.1111/j.1440-1630.2011.00979.x[↩]
  4. Galarneau, L. (1993). An interdisciplinary approach to mobility and safety education for caregivers and stroke patients. Rehabilitation Nursing, 18(6), 395-399.[↩]
  5. Kaur, G., English, C., & Hillier, S. (2012). How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke research and treatment, 2012.[↩]
  6. Peters, J. (n.d.). Best Practice Updates Mobility. [PowerPoint slides]. Brockville General Hospital https://www.strokenetworkseo.ca/sites/strokenetworkseo.ca/files/mobility_best_practice_updates-_2017_updated_-_copy_2.pdf[↩]
  7. Eng, J. J., & Chu, K. S. (2002). Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Archives of physical medicine and rehabilitation, 83(8), 1138-1144.[↩]
  8. Lee, S., Cho, S., & Kim, K. (2013). The Effects of Weight-Bearing Exercise on Upper Extremity Activities Performance in the Female Stroke Patients. International Journal of Contents, 9(1), 65-70.[↩]
  9. Hosseini, Z. S., Peyrovi, H., & Gohari, M. (2019). The effect of early passive range of motion exercise on motor function of people with stroke: a randomized controlled trial. Journal of caring sciences, 8(1), 39.[↩]
  10. Ring, H., & Rosenthal, N. (2005). Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation. Journal of rehabilitation medicine, 37(1), 32-36.[↩]
  11. Lord, J. P., & Hall, K. (1986). Neuromuscular reeducation versus traditional programs for stroke rehabilitation. Archives of physical medicine and rehabilitation, 67(2), 88-91.[↩]
  12. Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., & Wolf, S. L. (2015). Constraint-induced movement therapy after stroke. The Lancet Neurology, 14(2), 224-234.[↩]
  13. Oliva-Moreno, J., Peña-Longobardo, L. M., Mar, J., Masjuan, J., Soulard, S., Gonzalez-Rojas, N., … & Alvarez-Sabín, J. (2018). Determinants of informal care, burden, and risk of burnout in caregivers of stroke survivors: the CONOCES study. Stroke, 49(1), 140-146.[↩]
  14. Andersen, H. E., Schultz-Larsen, K., Kreiner, S., Forchhammer, B. H., Eriksen, K., & Brown, A. (2000). Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors. Stroke, 31(5), 1038-1045.[↩]
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