Stroke is the third leading cause of death worldwide. It is defined as acute neurologic dysfunction of vascular origin affecting focal areas of the brain. Common effects of stroke include motor paralysis, sensory disturbances, cognitive impairments, and speech or language disorders. Occupational therapists play an important role in evaluating clients after a stroke and providing intervention to improve functional limitations in areas like mobility, self-care, and upper extremity function. Treatment focuses on retraining skills and compensating for deficits through task-oriented and occupation-based approaches.

1. Stroke

2. 10/4/2013 Mohsen Eslampanah OT18 , USWR 2

3. 10/4/2013 Mohsen Eslampanah OT18 , USWR 3

4. • Introduction
• Definition of stroke
• Causes of stroke
• Effects of stroke
• Medical management
• Evaluation and intervention procedures for clients who
sustained a stroke
• Adopting a framework for intervention
• Functional limitations commonly observed after stroke
10/4/2013 Mohsen Eslampanah OT18 , USWR 4

5. •
‫میر‬ ‫و‬ ‫مرگ‬ ‫علت‬ ‫سومین‬
•
‫هر‬
40
‫هر‬ ‫و‬ ‫شود‬ ‫می‬ ‫استروک‬ ‫به‬ ‫مبتال‬ ‫نفر‬ ‫یک‬ ‫ثانیه‬
4
‫نفر‬ ‫یک‬ ‫دقیقه‬
...
•
28
%
‫زیر‬ ‫مبتالیان‬
65
‫دارند‬ ‫سن‬ ‫سال‬
!
•
5
‫مرد‬
/
4
‫زن‬
•
‫مبتالیان‬ ‫بین‬ ‫در‬
:
50% hemiparesis
30% cannot walk
26% dependent in ADL
19% aphasic
35% clinically depressed
26% require home nursing care.
OT => from ICU to Community based programs
10/4/2013 Mohsen Eslampanah OT18 , USWR 5

6. WHO:
I. Acute neurologic dysfunction
II. vascular origin
III. Focal areas of the brain
limbs
CVA=> UMN dysfunction => Hemiplegia => trunk
face,oral structure
Left CVA = Right hemiplegia
10/4/2013 Mohsen Eslampanah OT18 , USWR 6

7. • Motor paralysis
• Sensory disturbances
• Cognitive and perceptual dysfunction
• Visual disturbances
• Personality and intellectual changes
• Speech and language disorder
Longer than 24 hours to be labeled a CVA
10/4/2013 Mohsen Eslampanah OT18 , USWR 7

8. • Ischemia
• Hemorrhage
• Related syndromes
• Transient ischemic attacks
10/4/2013 Mohsen Eslampanah OT18 , USWR 8

9. 10/4/2013 Mohsen Eslampanah OT18 , USWR 9

10. • ICA:
hemiplegia,hemianesthesia,homonymous
hemianopia
DH=> Aphasia,agraphia,acalculia,right-left
confusion,finger agnosia
NDH=>Visual perceptual dys,unilateral
neglect,anosognosia,dressing apraxia,attention
deficits,loss of topographic memory.
10/4/2013 Mohsen Eslampanah OT18 , USWR 10

11. • Most common cause
• Contralateral hemiplegia
• Sensory deficit
• Contralateral homonymous
hemianopia
DH=> aphasia
NDH=> perceptual deficit
10/4/2013 Mohsen Eslampanah OT18 , USWR 11

12. • Lower extremity
• Apraxia
• Mental changes
• Primative reflexes
• Bowel and bladder incontinence
10/4/2013 Mohsen Eslampanah OT18 , USWR 12

13. • Upper brainstem region
• Temporal and occipital lobes
Dysfunction:
1. Sensory and motor deficits
2. Involuntary movement disorder
3. Memory loss
4. Alexia
5. Astereognosis
6. Dysesthesia
7. Akinesthesia
8. Contraleteral homonymous hemianopia
9. Anomia
10. Topographic disorientation
11. Visual agnosia
10/4/2013 Mohsen Eslampanah OT18 , USWR 13

14. • Ipsilateral ataxia
• Contralateral loss of pain and temprature
sensitivity
• Ipsilateral analgesia
• Dysphagia
• Dysarthria
• Nystagmus
• Contralateral hemiparesis
10/4/2013 Mohsen Eslampanah OT18 , USWR 14

15. • Cerebellar dysfunction
• Loss of proprioception
• Hemiplegia
• Quadriplegia
• Sensory disturbances
• Unilateral or bilateral involvement of cranial
nerves III to XII
10/4/2013 Mohsen Eslampanah OT18 , USWR 15

16. • First step: which client factors are impaired
and affecting performance in area of
occupation
• Medically stabilized
• First 3 to 6 months after stroke
10/4/2013 Mohsen Eslampanah OT18 , USWR 16

17. • COPM
1. Identify areas of difficulty
2. Rate the importance of each area
3. Rate his or her satisfaction with current
performance
COPM
10/4/2013 Mohsen Eslampanah OT18 , USWR 17

18. • focused on the Roles that are important to the client
• Top-down approach to evaluation is in contrast to a
bottom-up approach
10/4/2013 Mohsen Eslampanah OT18 , USWR 18

19. • Activity analysis identify errors during
• Keen observation task performance
10/4/2013 Mohsen Eslampanah OT18 , USWR 19

20. • A-ONE
occupation based neurobehavioral evaluation(ADL)
• AMPS
performance skills and process skills(IADL)
• Barthel index
BADL 10 item
• TEMPA= UE performance,9 tasks , bilateral and
unilateral
• Jebson = hand function
10/4/2013 Mohsen Eslampanah OT18 , USWR 20

21. • In the past,sensorimotor approaches
• Rood,Bobath,Knott and Voss and brunnstrom
• Task-oreinted approaches
focus on the use of functional activities
10/4/2013 Mohsen Eslampanah OT18 , USWR 21

22. 1. Inability to perform chosen occupations while seated
2. Inability to engage in chosen occupations while
standing
3. Inability to communicate secondary to language
dysfunction
4. Inability to perform chosen occupations secondary to
neurobehavioral/cognitive-perceptual impairment
5. Inability to perform chosen tasks secondary to upper
extremity dysfunction
6. Inability to perform chosen tasks secondary to visual
impairment
10/4/2013 Mohsen Eslampanah OT18 , USWR 22

23. Loss of trunk and postural control
10/4/2013 Mohsen Eslampanah OT18 , USWR 23

24. 10/4/2013 Mohsen Eslampanah OT18 , USWR 24

25. client’s perceived limits
Limits of stabilty
actual limits
10/4/2013 Mohsen Eslampanah OT18 , USWR 25

26. Treatment interventions
10/4/2013 Mohsen Eslampanah OT18 , USWR 26
Establishing a neutral yet active starting alignment
attempt reaching activities
Maintain the trunk in the midline by using external cues
Maintain trunk ROM by positioning
Prescribing dynamic weight-shifting activities
Strengthening the trunk
Compensatory strategies and environmental adaptation

27. • Loss of Postural reaction
• Inability to bear and shift weight
• Treatment strategies
10/4/2013 Mohsen Eslampanah OT18 , USWR 27
Establishing a symmetric base of support and proper alignement
Bear and shift weight throgh the more affected LE
Dynamic reaching in activities
Grade task difficulty and provide external support
Training upright control

28. • Most frequently => left hemisphere of the brain
• Communication techniques
10/4/2013 Mohsen Eslampanah OT18 , USWR 28

29. 10/4/2013 Mohsen Eslampanah OT18 , USWR 29

30. • Global aphasia
• Broca’s aphasia
• Wernicke’s aphasia
• Anomic aphasia
10/4/2013 Mohsen Eslampanah OT18 , USWR 30

31. 10/4/2013 Mohsen Eslampanah OT18 , USWR 31

32. • Affect
• Body scheme
• Cognition
• Emotion
• Gnosis
• Language
• Memory
• Motor movement
• Perception
• Personality
• Sensory awarness
• Spatial relations
• Visuospatial skills
10/4/2013 Mohsen Eslampanah OT18 , USWR 32

33. • Near transfer => 1 or 2
• Intermediate => 3 to 6
• Far => conceptually similar
10/4/2013 Mohsen Eslampanah OT18 , USWR 33

34. • Pain
• Contracture and deformity
• Loss of selective motor control
• Weakness
• Orthopedic limitations
• Loss of postural controls to support UE control
• Learned nonuse
• Loss of biomechanical alignment
• Ineffecient and ineffective movement patterns
10/4/2013 Mohsen Eslampanah OT18 , USWR 34

35. • Integration into function
• UE complications after stroke
• The nonfunctional UE
10/4/2013 Mohsen Eslampanah OT18 , USWR 35

36. Category tasks
Nonfunctional use of the arm ?
Postural support/weight bearing ?
Support reach ?
reach ?
10/4/2013 Mohsen Eslampanah OT18 , USWR 36

37. Treatment activities
10/4/2013 Mohsen Eslampanah OT18 , USWR 37
Using objects of different sizes and shapes
Activities that are appropriate to the level of available
motor control
CIMT
WB,reach,manipulation within the context of ADLs and
mobility
Graded tasks

38. • Subluxation
• Abnormal skeletal muscle activity
• Prevention of pain syndromes and contracture
10/4/2013 Mohsen Eslampanah OT18 , USWR 38

39. • Protection of unstable joints
• Maintaining soft tissue length
• Positioning programs
• Soft tissue elongation
• Splinting
• Client management
10/4/2013 Mohsen Eslampanah OT18 , USWR 39

40. Right hemisphere Left hemisphere
Visual field inattention or neglect Visual object agnosia
Lack of controlled eye movement Lack of controlled eye movement
Spatial relation dysfunction Spatial relation dysfunction
Visual loss Visual loss
Anomia and grammatical language
problems
10/4/2013 Mohsen Eslampanah OT18 , USWR 40

41. 10/4/2013 Mohsen Eslampanah OT18 , USWR 41

42. • Depression => 35%
• Anxiety
• Agoraphobia
• Substance abuse
• Sleep disorder
• Mania
• Aprosody
• Behavioral problems
• Lability
• Personality changes
10/4/2013 Mohsen Eslampanah OT18 , USWR 42

43. Pedretti’s , Occupational Therapy: practice skills for physical
dysfunction,
7th edition, chapter 33
10/4/2013 Mohsen Eslampanah OT18 , USWR 43

44. 10/4/2013 Mohsen Eslampanah OT18 , USWR 44

45. 10/4/2013 Mohsen Eslampanah OT18 , USWR 45