Body & Mind
Occupational therapy for stroke patients
A stroke might cause many forms of disability. According to the latest study by WHO published in April 2011, the rate of deaths from stroke in Bangladesh has reached to 82,039 or 8.57 per cent of total deaths. Post-stroke complications are common, occurs in 40-95 per cent of patients. These complications lead to death. So, early treatment is needed to handle the complications of stroke.
There are many complications arise as a direct result of injury to the brain due to stroke. Some occurs due to physical problem. For example, bedsore can occur, if the patient cannot move his body. Depression and anxiety can also occur after stroke. Other common complications are:
v Brain edema: Swelling of the brain after a stroke.
v Pneumonia: Causes breathing problems, a complication of many major illnesses. Common swallowing problems after stroke can sometimes result in things 'going down the wrong pipe', leading to aspiration pneumonia.
v Urinary tract infection and/or bladder control.
v Seizures: Abnormal electrical activity in the brain causing convulsions.
v Clinical depression: A treatable illness that often occurs with stroke and causes unwanted emotional and physical reactions to changes and losses.
v Bedsores: Pressure ulcers that result from decreased ability to move and pressure on areas of the body because of immobility.
v Falls and accidents: Stroke deficits such as weakness, sensory impairment, in coordination, imbalance and visual problems predispose the patient to accidents and falls.
The physical or occupational therapist will advise on home modifications to assist the patient in moving around the house to reduce accidents. Gait training and assisted walking devices may be prescribed to lessen the risk of falls.
v Limb contractures: Shortened muscles in an arm or leg from reduced range of motion or lack of exercise.
v Shoulder pain: Stems from lack of support of an arm due to weakness or paralysis. This usually is caused when the affected arm hangs resulting in pulling of the arm on the shoulder.
v Deep venous thrombosis: Blood clots form in veins of the legs because of immobility from stroke
v Social impact: Stroke complications not only affect the stroke patient but also the family. Stroke affects the dynamics of a family. Stroke patients may no longer be able to work or perform their previous roles in the family. A family member may need to provide care for the stroke patient. Stroke has an economic burden due to the cost of medical care as well as the loss of income. Hence the quality of life of the stroke patient's family may be affected.
Occupational therapist have vital role to rehabilitate the stroke patients. Occupational therapy is a profession which work for make the stroke patients independent in their self care activities. Occupational therapist works in basis of four steps to increase their performance in self care. These are adjunctive method, enabling activity, purposeful activity and occupational role.
Stage One (Adjunctive method): This stage is called the readiness stage for doing activity. In this stage therapist use different treatment techniques for retaining the patient's previous performance as much as possible. It includes: pain management, education about positioning, advice splint for maintain correct position of hand, functional joint range of motion exercise, weight bearing etc.
Stage Two (Enabling activity): In this stage therapist involve the patient in different activities which are similar in daily activities. Therapy include fine motor activities, bilateral hand activities, ADL practice by using modified equipment, cognitive and social skills training, memory training, money management etc.
Stage Three (Purposeful activity): In this stage therapist directly involve the patient in different daily activities like: dressing, combing hair, writing etc.
Stage Four (Occupational Role and Performance): In this stage, patient become independent in his/her daily life in his family, society and job sector.
In this way, Occupational therapy practitioners address the physical, cognitive, and emotional challenges brought on by a stroke, and they can help stroke survivors engage in the things they want and need to do.
The writer is an occupational therapist, department of Physical Medicine & Rehabilitation, National Institute of Neurosciences & Hospital (NINS & H)