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Hillary Hoffman

on 30 October 2014

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Transcript of STROKE

Terms to know
"Rapidly developing clinical signs of focal or global disturbance of cerebral function, with lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin."
Incidence of Stroke
Risk Factors
How to Identify a Stroke
Types of Strokes
Cerebrovascular accident= CVA- Stroke
Infarct= localization of dead tissue
Occlusion= blockage of a blood vessel (clot)
alcohol use
family history of stroke
high cholesterol
[Untitled cartoon of FAST] Retrieved October 10, 2014, from: http://www.mass.gov/eohhs/images/feature-story/fast-stroke-712x250.jpg
How to Identify a Stroke
Clinica World Technology News. (2009, February 9th). Recognize stroke F.A.S.T. [Video file] Retrieved from http://youtu.be/yXONEHmupy0.
third leading cause of death
795K people/yr suffer new/recurrent stroke
72% older than 65 yo suffer stroke
approximately 50-80% of all strokes occur to 65-85 yo
major strokes often occur in the night

After the Stroke
- stroke is the leading cause of serious, long-term disability in the US
- out of those who survive:
50% hemiparesis
30% can’t walk
26% dependent in ADL
19% aphasic
35% clinically depressed
26% require home nursing care
After the Stroke
10% almost complete recovery
25% recover with minor impairments
40% experience moderate to severe impairments
15% die shortly after the stroke
Functional Limitations
- inability to perform chosen occupations
while standing
while seated
secondary to upper extremity dysfunction
secondary to visual impairment
- inability to communicate secondary to language dysfunction

Occupational Therapy for Stroke Patients - In the Community

Some driving adaptions:
Steering knobs
Left foot accelerators
Adaptive Equipment and
Home Modification
Hemorrhagic stroke/Aneurysm
Lacunar Stroke/Small Vessel Infarct

Sue is a 65 year old who had a stroke. She lost a lot of range of motion on her left side and part of her visual field on the affected side as well. Before her stroke she enjoyed crafts and camping. As her OT, what are some occupations you would suggest she work on to improve her vision and mobility and maintain her cognition and memory?
American Occupational Therapy Association. (2013). Recovering from Stroke. Retrieved
from http://www.aota.org/About-Occupational-Therapy/Patients-Clients/Adults/Stroke/RecoveringFromStroke.aspx

Atchison, B., & Hansen, R. A. (2000). Conditions in occupational therapy: Effect on
occupational performance (2nd ed.). Baltimore: Lippincott, Williams & Wilkins.

Clinical World Technology News. (2009, February 9th). Recognize stroke F.A.S.T. [Video
file] Retrieved from http://youtu.be/yXONEHmupy0.

Crepeau, E. B., Cohn, E. S., & Schell, B. A. B. (2008). Willard and spackman’s
occupational therapy. (11th ed.). Baltimore: Lippincott, Williams & Wilkins.

Farber, L. (2013, February 28). donning a shirt one handed. Retrieved from http://
Gabriel DE ROQUEFEUIL. (2013, August 1) Andy - cook with one hand! Retrieved from https://
www.youtube.com/watch? v=ynWjV5qJXuM.

Kelly, Karen. (2013, September 5th). Interview with aphasic person. [Video file] Retrieved
from http://youtu.be/u09gaosZCVg.

Lewis, S. C. (1989). Elder care in occupational therapy. (1st ed.). Thorofare, NJ: SLACK incorporated.

NIH: National Heart, Lung and Blood Institute. (2014). Types of Stroke. Retrieved from

National Stroke Association. (2014a). Rehabilitation therapy after stroke. Retrieved from

National Stroke Association. (2014b). Stroke 101: Fast facts on stroke. Retrieved from http://
National Stroke Association. (2014c). Stroke prevention. Retrieved from http://

National Stroke Association. (2014d). Types of Stroke. Retrieved from http://

NYU Langone Medical Center. (n.d.) Inpatient occupational therapy services for
stroke. Retrieved from http://rusk.med.nyu.edu/inpatient-occupational-therapy-services-stroke

Pendleton, H. M., & Schultz-Krohn, W. (2012). Pedretti's occupational therapy: Practice
skills for physical dysfunction. (7th ed.). St. Louis: Mosby.

USDOTNHTSA. (2013, June 20) Driving after stroke. Retrieved from https://

Jack was a former teacher who had a stroke at the age of 70. Before his stroke he loved to box and play basketball. He continues to enjoy telling jokes, stories, and painting as he is currently in a wheelchair with limited mobility. As his OT, what are some occupations you would suggest he work on to improve his mobility and maintain his cognition and memory?
Case study 2

Lucy is a fun-loving, 70 year old grandmother of several grandchildren. Lucy also enjoyed having her friends over for tea in the afternoons. However, after her stroke, one of the issues she has is anomic aphasia. Lucy speaks fluently with correct grammar, but she often times has difficulty retrieving words. This leads her to speak in a slow, hesitant manner. Lucy is embarrassed at her speech disorder and has lately withdrawn from her friends and grandchildren. The lack of social interaction has also made her feel depressed. As her OT, what are some occupations you would suggest to help Lucy regain interaction with her community?
Case Study 1
Case Study 3
Kelly, Karen. (2013, September 5th). Interview with aphasic person. [Video file] Retrieved from http://youtu.be/u09gaosZCVg.

To think about: What is the purpose of these stretches and exercises? How would they be useful to a stroke victim?
Occupational Therapy for Stroke Patients
Help client regain functional independence with meaningful occupations:
Physical skills - strength, coordination, balance
Cognitive skills - memory, problem solving, sequencing, focus
Visual skills - scanning & depth perception
Psychological skills - coping & manage frustration
Sensory skills - identify varying textures/temperatures & develop a sense of space
WHO Definition of Stroke
(Pedretti, 2014, p. 845; Lewis, 1989, p. 166)
(National Stroke Association, 2014c)
(National Stroke Association, 2014a)
(Pedretti, 2013, p.846)
Learn how to use hemiplegic arm/hand
Occupational Therapy For Stroke Patients - In Home
i.e. Transfers; assistance in ADLs or IADLs
Teach caregivers how to help client
Evaluate and modify home
Provide adaptive equipment
Safe transfers
Home Safety
One-handed techniques to complete tasks
Training in using mobility aids
Paratransit Services
If able, refer to a driving OT specialist
USDOTNHTSA. (2013, June 20) Driving after stroke. Retrieved from
https:// www.youtube.com/watch?v=P7NM5I-eLqs.
Gabriel DE ROQUEFEUIL. (2013, August 1) Andy - cook with one hand!
Retrieved from http://youtu.be/ ynWjV5qJXuM.
(NYU Langone Medical Center, n.d.)
Make activities more manageable
other Common Impairments in Stroke Patients
Visual Impairments
(Lewis, 1989, pp. 169-170)
(American Occupational Therapy Association, 2013)
(American Occupational Therapy Association, 2013)
Donning a Shirt One-Handed
Tips for dressing with one-sided weakness: Put the weak side on with your strong arm and hand first.
Goal - to independently put on a shirt one handed
Prep the Shirt (Steps 1-3):
Step 1: Place shirt on lap with front of shirt facing down and collar at the knees.
Step 2: Roll the bottom edge of the shirt. It will look similar to a donut or tube. This allows us to expose the sleeve opening and put the shirt on easier.
Step 3: Move the sleeve opening for weak arm between the legs. Make sure you can see through the sleeve opening. This will allow you to put your arm through the sleeve easier.
Don the Shirt (Steps 4-8):
Step 4: Use strong arm; grab weak arm and place through sleeve opening. Lean forward to help arm through hole.
Step 5: Use strong arm to pull sleeve up over your weak arm, past the elbow. Align shoulder seam with shoulder.
Step 6: Put strong arm through the other arm hole.
Step 7: Grab back of shirt with strong hand, tuck chin in, lean forward, and pull shirt over head.
Step 8: Adjust shirt as needed.
(Farber, 2013)
(Farber, 2013)
Donning a Shirt One-Handed Cont.
Activity: Get into pairs. Choose which arm is the affected (weak arm).
Motor Impairments
Bilateral Problems
Language Impairments
Right Hemisphere Language Dysfunction
Unilateral Visual/Perceptual Neglect
Homonymous Hemianopsia (Visual Field Neglect)
Left Hemisphere - analytical processing,
Lesion Location and Type of Impairment
Right Hemisphere - integrative processing,
Frontal Lobe - Motor performance, judgement
Prefrontal Cortex - social attitudes,
Occipital Lobe - visual input
Temporal Lobe - language, hearing, memory,
emotion, personality
perception of the whole
(Lewis, 1989, p. 168)
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