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May/June 2015
Optimizing Stroke Survivors' Quality of Life Statistics continue to indicate that stroke is one of the leading causes of adult disability in the United States, with an estimated 7 million current stroke survivors. Each year, approximately 795,000 people experience either a new or recurrent stroke. Despite the negative consequences of stroke, such as hemiplegia, balance loss, cognitive impairments, and depression, there are therapies available to stroke survivors to ensure that their participation in life is maximized. Occupational therapy (OT) is a vital component of ensuring this goal is met. Occupational therapy's role begins in the intensive care unit and continues through the community reentry phase of recovery. The overarching goal of OT is to help individuals achieve health, well-being, and participation in life through engagement in occupation (ie, everyday life activities). Referral to OT is appropriate for patients who are having difficulty managing and participating in daily activities such as self-care, driving and community mobility, returning to work, parenting tasks, home management, and money management. Occupational therapists work collaboratively with their patients/clients to develop individualized intervention plans with goals that are specific to the needs and desires of the stroke survivor. Recent research has documented that there are several effective interventions occupational therapists can utilize to improve daily living skills for those with motor impairments following a stroke. Goal-directed individualized tasks that promote frequent repetitions of task-related or task-specific movements are common among these evidence-based interventions. Examples of specific interventions available to stroke survivors include repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation. These interventions have been shown to be effective in improving limb function, balance and mobility, keeping active, and participating in life situations. Similarly, research has documented that stroke survivors who are living with cognitive impairments can improve their everyday function with interventions that are performance focused, involve strategy training, and use a compensatory as opposed to a remediation approach. Teaching scanning strategies to those with visual field cuts or unilateral neglect to cross the street safely, using compensatory memory strategies to remember to take medications, and teaching time pressure management strategies to engage effectively in life situations are all examples of such interventions. It is important to remember that stroke is a chronic condition and the needs of stroke survivors will vary based on where they are in the recovery process. Evidence has suggested that stroke survivors can continue to improve their daily functions months and even years after a stroke. While rehabilitation should continue after the acute recovery phase, the focus of occupational therapy services is likely to vary as rehabilitation progresses. For example, OT may be focused on self-care training during the early phase of recovery, progressing to home management and reengagement in leisure activities during the home care phase, and return to work and safe driving or alternative community mobility during the community reentry phase. For more information on OT and the role of OT related to stroke recovery, visit www.AOTA.org. — Glen Gillen, EdD, OTR, FAOTA, and Dawn M. Nilsen, EdD, OTL, are occupational therapists and faculty members in the Programs in Occupational Therapy at Columbia University Medical Center, specializing in stroke rehabilitation. |
