This document discusses stroke, its causes, signs and symptoms, diagnosis, risk factors, and complications. It also summarizes the roles of occupational therapists and prosthetists/orthotists in treating stroke patients. Occupational therapists focus on intervention for upper extremities, while prosthetists/orthotists design and fit lower extremity orthoses like ankle-foot orthoses to improve walking. Both work closely with physical therapists to facilitate rehabilitation.

1. Nurul Nadhiroh Mohamad Naser KED120014
Nurul Nadia Ashikin Zakaria KED120015
Nurul Naemah Md Salleh KED120016
Siti Nur Nabilah Lutfi KED120020
Siti Zubaidah Hassan KED120022

2. stroke
ischemic
disruption of blood flow to
a portion of the brain. This
usually stems from a blood
clot in a blood vessel in the
neck or brain causing cell
damage in that area
hemorrhagic
result of
bleeding into
the brain,
causing injury
to brain tissue.

5. Signs and symptoms
• Hemiparesis, monoparesis, or (rarely) quadriparesis
• Hemisensory deficits
• Monocular or binocular visual loss
• Visual field deficits
• Diplopia
• Dysarthria
• Facial droop
• Ataxia
• Vertigo (rarely in isolation)
• Aphasia
• Sudden decrease in the level of consciousness

6. Diagnosis
• CT angiography and CT perfusion
scanning
• Magnetic resonance imaging (MRI)
• Carotid duplex scanning
• Digital subtraction angiography

7. Diagnosis
Laboratory test
• Complete blood count (CBC): A baseline study
that may reveal a cause for the stroke or provide
evidence of concurrent illness (eg, anemia)
• Coagulation studies: May reveal a coagulopathy
and are useful when fibrinolytics or
anticoagulants are to be used
• Toxicology screening: May assist in identifying
intoxicated patients with symptoms/behavior
mimicking stroke syndromes

8. Differential Diagnosis
Stroke mimics commonly confound the clinical diagnosis of stroke.
One study reported that 19% of patients diagnosed with acute
ischemic stroke by neurologists before cranial CT scanning actually
had non-cerebrovascular causes for their symptoms.
The most frequent stroke mimics include the following:
• Seizure (17%)
• Systemic infection (17%)
• Brain tumor (15%)
• Toxic-metabolic disorders, such as hyponatremia and
hypoglycemia (13%)
• Positional vertigo (6%)
• Conversion disorder

9. Nonmodifiable:
• Age
• Race
• Sex
• Ethnicity
• History of migraine
headaches
• Fibromuscular dysplasia
• Heredity: Family history of
stroke or transient
ischemic attacks (TIAs)
Modifiable:
• Hypertension
• Diabetes mellitus
• Cardiac disease
• Hypercholesterolemia
• TIAs
• Lifestyle issues
• Obesity
• Oral contraceptive
use/postmenopausal
hormone use
• Sickle cell disease

10. • Paralysis or loss of muscle movement
– usually on one side of body(HEMIPLGIA)
– loss of sensation on one side of body
– lose control of certain muscles
• Difficulty talking or swallowing
– difficulty with language (aphasia), including speaking or
understanding speech, reading, or writing
– less control over the way the muscles in mouth and throat
move
• Memory and concentration difficulties
– experience some memory loss
– Others may have difficulty thinking, making judgments,
reasoning and understanding concepts.

11. • Emotional problems
– more difficulty controlling their emotions
– psychological problems such as anxiety or depression
• Extreme tiredness and sleep problems
• Problems with vision, such as double vision or
partial blindness
• Difficulty controlling bladder and bowel
movements (incontinence or constipation)
• Changes in personality, behaviour and self care
ability
– more withdrawn
– less social or more impulsive
– need help with grooming and daily chores.

12. • Pain
– pain, numbness or other strange sensations in parts of the bodies
affected by stroke
– For example: if a stroke causes lose feeling in left arm, itcan
develop an uncomfortable tingling sensation in that arm.
– sensitive to temperature changes, especially extreme cold
(central stroke pain or central pain syndrome)
• Dynamic balance and gait symmetry
– The former has been linked to fall risk, whereas the later has
been associated with both fall risk and poor balance.
– drop foot which is a lack of dorsiflexion during the swing phase of
gait and equinovarus deformity.
– lack of knee and hip stability (an incorrect ankle position during
their gait cycle).
– toe contact at the initial stance phase of gait.
– unaffected side is always turned forward
– equinovarus deformity of the foot and ankle often accompanied
by a hyperextension or recurvatum at the knee joint

13. • Bed sores (pressure ulcers)
• Deep vein thrombosis (DVT)
• Pneumonia
• Contractures (altered position of your
hands, feet, arms or legs because of muscle
tightness)

15. • Prevent secondary impairments
• Restore performance skills
• Modify activity demands and the contexts
in which activities are performed
• Promote a healthy and satisfying lifestyle
• Maintain performance and health

17. Intervention to Prevent Secondary
Impairments
• Abnormal changes in postural alignment (postural deformities)
– using available motor control in the affected and nonaffected limbs to begin a
self-exercise program designed to stretch muscles gently throughout the body
• Pain associated with immobility or abnormal joint alignment
• Learned nonuse
– Therapists use every opportunity to teach the stroke survivor to be aware of
and to use the paretic limbs to the limits of current available motor function.
• Injury due to falls
– develop strategies for adjusting to shifts in their body's center of mass to
enhance their balance skill and efficacy
• Aspiration during feeding, eating, and swallowing
– use techniques to improve sensation, strength, and muscle tone of oral
structures to maximize the potential for safe of independent eating.
• Depression following stroke
– by promoting independence, autonomy, participation

19. Intervention to Restore
Performance Skills
• To generalize their new skills to enhanced performance of
activities in their daily lives
• Cognitive skills include the abilities to attend to
environmental stimuli; remember relevant information;
plan, organize, and sequence activity performance; and
assess actions.
• Perceptual skills include the abilities to interpret sensory
information and navigate the spatial environment.
• Emotional coping skills include a core of effective strategies
that stroke survivors must develop to negotiate their
interactions with others and return to full participation in
their communities

21. Intervention to Modify Activity Demands
and the Contexts in Which Activities Are
Performed
• Environmental Modifications
– Depend on each client's ambulation status and
capacity to use the paretic arm
• Adaptive Equipment
– Equipment selection is highly individualized and is
based on the constellation of factors assessed in
the occupational therapy evaluation

23. Intervention to Promote a Healthy
and Satisfying Lifestyle
• Help stroke survivors establish performance
patterns in:
– Medication routine
– Appropriate diet
– Appropriate levels of physical activity
– Satisfying levels of engagement in social
relationships and activities

25. Intervention to Maintain Performance
and Health
• Education of clients, family, and caregivers to
maintain performance and health after
services have ended
• Establish active, healthy daily routines:
– Maintaining the performance capacities
– Preventing an avoidable decline toward inactivity,
loss of social roles, and emotional depression.

26. CPO INTERVENTION
FOR STROKE PATIENT
UPPER
EXTREMITY
LOWER
EXTREMITY

27. PROSTHETIST & ORTHOTIST
• The role are
– To assess patient condition.
– To produce (prescribe and design) suitable
devices for patient.
– To fit and help patient learn to wear the
devices.
– To educate regarding the use and care of an
appropriate orthosis/prosthesis that serves
an individual’s requirements.

28. LOWER EXTREMITY
• In general ankle foot orthosis(AFO) is given to
improves stroke patient’s stability, safety, and
efficiency of walking.
• Types of orthosis given based on
– patient condition.
– muscle strength in ankle, calf, and lower leg.
• In order to improve biomechanical correction of
deformity, the footplate will be put on the base
of polypropylene AFO.

29. AFO candidates
Patient with drop
foot or unable to
lift their leg to
swing
To prevent foot
dragging on the
ground when walk
Patient with knee
recurvatum
Aid in managing
and controlling
recurvatum of the
knee.

30. Types of
AFO
Solid AFO
Hinged
AFO

31. • Knee ankle foot orthosis (KAFO) not a suitable
choice for stroke patient.
• Reason:
– Heavy
– No strength to lift it to walk properly.
– Can control the problem at the knee by correctly
addressing the problem at the foot and ankle.

32. UPPER EXTREMITY
• The majority of orthotic prescriptions for upper
extremity stroke patients are for the wrist, hand or
both.
Preserve functional
position of hand
and wrist , keeping
it in a neutral
position
No
moveable
parts
Static
splinting

33. Splint
• Sling
Resting splint
Patient with low
muscle tone.
Anti-spastic
splint
Patient with high
muscle tone.
- Support the arm when sublaxation occur.
- Used to hold joint and assist in long term
stability

34. Intervention
of CPO and
OT in stroke
patient Lower
extremity
Upper
extremity

35. • Historically, OT has primarily been involved in
the provision of upper extremity orthotic.
• In upper extremity orthotic practice for stroke
patient, OT typically design, fabricate, fit and
supervise functional training.
• OT manage every stage of the upper extremity
orthotic delivery process therefore able to
adapt each step to individual need in stroke
patient

36. • In contrast, OT are not direct providers of
lower extremity orthotic care.
• Orthotist design, fabricate and fit lower
extremity and PT provide functional gait
training with the orthotics.
• OT collaborates in the delivery of the lower
extremity orthotic services to ensure that the
orthosis is designed to facilitate occupational
performance at each stage of development.

37. • The orthosis may address a biomechanical goal
such as providing a stable base of support and a
functional gait training goal such as increasing the
ankle dorsiflexion during toe-off.
• However, if the orthosis does not address the
occupational performance goal (such as donning
and doffing the device independently) the person
may discard the orthosis.
• Thus, OT plays important role to anticipate such
patient’s performance issues and initiate effective
interventions before design and fabrication
decisions have been completed by the orthotist.

38. Designing the orthosis
• The OT and orthotist works closely during the design phase.
• Considerations must be made based on:
Patient’s strength
• the weight and force required to use the device
Fine motor strength and coordination
• Design and material strapping system
Skin integrity and sensation
• Material selection
Status of activities of daily living and functional capabilities
• Donning and doffing

39. • Although the orthotics devices is made by the
orthotist, the occupational therapist is
typically the one who teaches the user how to
perform daily activities while wearing it.