Introduction

Stroke is a disease that usually leads to limitations in the daily lives of survivors. Since stroke survivors can sometimes suffer from their inability to live independently, occupational therapy is provided as part of their rehabilitation program. This article provides an overview of stroke and an explanation of occupational therapy, its importance, and its role. If you are a stroke survivor, a family member of a survivor, or a caregiver of a stroke survivor, this article will be useful.

Stroke and its burden 

Stroke is when blood stops flowing (ischaemic) or when bleeding occurs due to the rupture of blood vessels (haemorrhagic) in part of the brain. Stroke is not only the second leading cause of death but also the leading contributor to acquired disability globally, defined as a disability that develops during a lifetime. While its common symptoms include sudden weakness in limbs, face drooping, paralysis or slurred speech, other less typical symptoms are present, such as dizziness, vision problems, or cognitive impairment.^1,2

Millions of people worldwide experience stroke. In middle- and high-income countries, the overall number of new stroke cases every year has become around 85 to 94 cases for every 100,000 individuals. These numbers are much higher in the older population (older than 75 years of age), around 1151 to 1216 for every 100,000 individuals.³

Stroke further burdens the economy. In the UK, stroke treatment and productivity loss due to stroke lead to societal costs of £8.9 billion every year, with care costs accounting for approximately 5% of the NHS's total costs.³

People who are at increased risk for stroke include those who are 65 and older or practice unhealthy behaviours, such as smoking, poor diet, and physical inactivity. Other risks include high blood pressure, high blood sugar, low kidney function, obesity, and high cholesterol. With the rapid growth of the older population, the number of stroke survivors is expected to increase in the coming years, leading to a higher global disease burden.⁴

The need for rehabilitation therapy, including occupational therapy

Stroke survivors often face many challenges that result in them depending on others instead of taking care of themselves. Their movement can also become restricted, and they can suffer from unemployment and cognitive limitations. As a result, they are usually referred to stroke rehabilitation therapy, in which occupational therapists (OTTs) work as part of a rehabilitation team to address the physical, cognitive, and psychosocial challenges that appear after surviving a stroke.⁴

What is occupational therapy?

Occupational therapy (OT) is part of the rehabilitation therapy provided to patients who need to optimise their ability to function and reduce their disability, like stroke survivors. Other aspects of rehabilitation therapy include physiatry, physiotherapy, and speech-language pathology.⁵

Intending to help patients live their lives as independently as possible, OT helps people of all ages overcome challenges related to completing everyday tasks or activities, what is called occupations. These are any activities that are needed, wanted, or liked, as well as physical and mental health and emotional and spiritual well-being.⁵ 

OT covers wide areas of practice, from physical to mental health. For example, occupational therapists (OTTs) can help people who have limited use of their hands or arms due to a physical illness, and provide support if psychological problems make it difficult to manage in daily life.⁵

Role of occupational therapy for stroke patients

Stroke patients need a team of specialists to work together to establish the impact of stroke and prepare goal-focused programs that would help stroke survivors develop the skills required to handle daily life. This team includes OTTs specifically concerned with helping stroke survivors complete their occupations.⁵

OTTs work to improve motor control and function in body areas affected by stroke. They also help stroke patients to overtake self-care and domestic tasks and manage the cognitive and behavioural changes associated with stroke. Finally, they prepare the patient's home and work environment when they return.⁶

Assessment

OTTs first conduct an assessment to check the effects of stroke, including the changes in several aspects.

Activities of daily living

OTTs interview stroke survivor patients and their responsible carers to learn about their previous daily tasks and roles. This is usually done through observing the patients and checking their ability to complete self-care tasks, including showering, dressing, toileting, eating, and others. Tasks such as shopping, cleaning, and managing finances are also assessed. Accordingly, the level of assistance needed by the stroke survivor is determined, and the optimal rehabilitation intervention is chosen. The intervention must be tailored to the specificities of stroke (the stroke’s impact) and measure the progress towards the intervention goals.⁶

Visual and visual perception

OTTs need to check the vision of stroke survivors and their brains’ ability to interpret and make sense of the visual information received in the process of sight, also called visual perception. After recovering from a stroke, routine checking of vision and visual perception is integral to the assessment process to optimise independence.⁶

Memory and cognition 

OTTs conduct assessments to check the memory and cognitive functions of stroke survivors to see if stroke has impacted the patients’ ability to resume daily tasks. Memory and cognitive impairments are specifically important to identify as they can greatly impact the patient's ability to participate in rehabilitation programs and perform daily tasks.⁶

Sensory, motor, and upper limb function

A detailed assessment of motor changes and sensory changes following a stroke, especially on the upper limbs and the hands, is performed. The rate of improvement in these functions is followed throughout the rehabilitation program, with treatment tailored accordingly.⁶

Home assessment

Before hospital discharge, OTTs will examine the survivors’ capacity to perform their home tasks and safely manage them. The home itself could be assessed, depending on the status of the stroke survivor, for any barriers or risks. Accommodations could then be adapted. For example, the OTT will examine if the patient can safely go to bed.⁶

Occupational therapy intervention

OTT intervention starts as soon as the stroke survivor becomes stable, as it increases the chances of becoming more independent.⁶

Interventions could include graded tasks and activities:⁶

• Involving the re-training of motor, sensory, visual, and cognitive skills
• Minimising complications that may further appear
• Providing education and support to survivors and their caregivers

Other interventions can include the following:⁶

• Reducing plasticity, like stretching and static or dynamic splinting
• Preventing dependent water buildup (oedema) by educating them on how to position the affected part of the upper limb to prevent oedema 
• Treating developed muscle tightness or stiffness (contractures) by electrical stimulation 
• Reducing the risk of shoulder subluxation or further deterioration by prescribing a firm support device
• Reducing visual impairments by visual scanning training, in which survivors are trained to locate more items in their environment
• Training their memory by using a diary, visual prompts or alarms

These interventions are continued after the patients are discharged from the hospital when needed. Finally, OTT will help stroke patients adapt their daily tasks to their environment to become as independent as possible, perhaps by including assistive equipment, like wheelchairs, or other home modifications.

The supportive care that should be provided to stroke survivors is also determined by OTTs. They will establish the frequency and intensity of care to be provided by caregivers.⁶

Other diverse roles of occupational therapists

In specific situations, active rehabilitation is not possible for stroke patients and residential care is required. OTTs have a role in training the carers in these care facilities. Assessing the driving capability of stroke patients afterwards and their ability to return to work is also a responsibility for OTTs.⁶

FAQs

What is the most important goal of stroke rehabilitation or recovery?

The primary goal of stroke rehabilitation is to regain independence and improve quality of life. This is achieved by minimising the challenges faced when performing activities of daily living.⁷ 

What is the difference between occupational therapy and physical therapy?

Physical therapy focuses on improving a patient’s movement and mobility, while occupational therapy helps them carry out everyday activities more independently.

Summary

In conclusion, stroke is a deadly and limiting disease that could lead to disability and limit the ability of its survivors to function normally. Occupational therapy has become one of the rehabilitation pillars that aim to help stroke survivors gain their independence, as much as possible, and perform their daily tasks. The responsibility of occupational therapists is broad, as they are involved in assessing the impact of stroke on its survivors and determining the correct interventions accordingly. They also accommodate these interventions based on the progress of the stroke. The role of occupational therapists can extend further in certain situations.