Introduction

What does occupational therapy do for stroke patients? On the surface, it may not look like a lot. The therapist is helping the client walk, take a shower, or put on clothes. But there is way more that goes on “under the hood” as it appears. Occupational therapists assess for, consider, and provide rehabilitation for many factors after a stroke. Here is a list of the many things that occupational therapists consider when working with a client who has suffered a stroke.

The Client

  • Cognition – Occupational therapists can do a lot for cognition
    • Often with stroke, clients may experience difficulty with insight (creating a barrier to recovery), attention, problem-solving, memory, safety awareness, sequencing of steps, and more.
    • Imagine how difficult it may be to have cognitive deficits, and now physical and/or mental health conditions on top of that. Everything is now exponentially more difficult. Occupational therapists can help.
  • Communication and language – difficulty with speech (aphasia)
    • Collaboration with speech-language pathology
  • Disruption in sleep cycles, having to take frequent naps, easily fatigued
  • Swallowing – dysphagia resulting in training in different types of foods
  • Psychosocial – adjustment to disability, depression, anxiety, suicide ideation, and more
    • Collaboration with mental health professionals and spiritual care
  • Physical rehabilitation – mobility and function in daily activities
    • Collaboration with physical therapy
  • Roles – return to those roles, modified role, change in role
    • Examples: Father, brother, employee, co-worker, neighbor, teacher.
    • Collaboration with family, friends, employers, etc.
How would you take your medications with 1 hand?

Activities of Daily Living

  • Bed mobility – getting in and out of bed (often with only half your body working)
  • Sitting balance – such as sitting and “dangling” on the edge of the bed.
    • Disruption in midline orientation – resulting in clients miscalibrating how to sit up straight; some may push away from what is correct.
  • Transfers – moving from surface to surface, e.g. bed to wheelchair, wheelchair to toilet
  • Functional mobility (walking)
  • Feeding and eating
  • Brushing teeth
  • Washing face
  • Shaving
  • Combing hair
  • Putting on make-up
  • Getting dressed and undressed, including new items such as ankle braces or arm slings
  • Toileting
    • Getting on and off the toilet or commode
  • Bathing
    • Getting in and out of showers and bathtubs
  • Taking medications

How would you change a diaper with one hand? How would you breastfeed/bottlefeed with one hand?

Instrumental Activities of Daily Living

  • Fine motor skills such as using a cell phone, TV remote
  • Community mobility (walking and crossing the street)
  • Public transportation
  • Driving
  • Household chores
    • Cleaning
    • Cooking
    • Gardening
    • Maintenance
    • Household safety (e.g. changing smoke alarm batteries)
    • and more
  • Washing a car
  • Shopping
  • Finances (bill pay, ATMs)
  • Child care and child-rearing
  • Petcare
  • Scheduling and appointments
  • Religious and cultural activities
How would you wash a car with only 1 hand?

Sleep

  • Fatigue
  • Needing to sleep more
  • Broken sleep
  • Sleep deprivation

Work, Education, Volunteering

  • Loss of work, modified work, or work rehabilitation
  • Resuming school
  • Volunteering

Leisure

  • Hobbies
  • Relaxation

Social

  • Being “slower”, “useless”, “I can’t…”
  • Increased isolation, mental health needs
  • Difficulty with communication, word-finding (leading to more isolation)
  • Connecting with support groups

Conditions, Symptoms, Deficits

  • Cognition (as mentioned earlier)
  • Inattention and neglect – ignoring a significant portion of their body and/or the environment leading to fall hazards, not noticing your hand is stuck in a wheelchair, not looking both ways when crossing the street, etc.
  • Visual field cut
  • Tone (high or low) – arm(s)/trunk/leg(s) may no longer “work” as before
  • Pusher syndrome
  • Sitting and standing balance
  • Bowel and/or bladder incontinence (neurogenic)
  • Pain
  • Loss of sensation and proprioception
  • Residual face droop (psychosocial and appearance)

Occupational Therapy Education

  • 1:1 training with the client
  • Collaboration with PT, SLP, MD, RN, Mental health, and more.
  • Caregiver training with family, friends, neighbors
  • In-service education to staff on cognitive techniques, transfers, ADLs, splints, homework, exercise programs, inattention/neglect, low vision, and more

Some Interventions

  • Direct engagement in the activity
  • Trunk and arm rehabilitation
  • Fine motor skills
  • Using adaptive equipment
  • Exercise and strengthening
  • Relearning how to balance
  • and much more!

This is not an exhaustive list of what occupational therapists can do for clients with stroke. So as you can see, there are many interventions that occupational therapists work on for stroke, but not in isolation. For example, in acute rehabilitation, there is a team of physical therapists, speech therapists, doctors (including specialists), nurses, mental health professionals, even someone who makes an ankle brace.

Clients are more likely to be successful in their recovery when the family is involved. Now imagine clients who may live alone or who have no social support – how much harder would it be?

Why Occupational Therapy is Special

Occupational therapists work 1:1 with clients directly on regaining these skills or compensating for them. It’s not just a discussion, phone consultation, or handing out educational packets, occupational therapists use their expertise and their “hands” in the recovery and rehabilitative process working directly with clients. They may see them at their lowest, most vulnerable, and hopeless states. Occupational therapy and stroke is really is a special and rewarding job!

If this is something that appeals to you as a career? Check out my online course to learn more for pre-OT students.

Screenshot from the Course