The Road to Recovery Through Stroke Rehab
Occupational Therapy & Stroke Rehabilitation
Contributed by Mallory Klonk, OTR/L
Following a stroke, early management and rehabilitation through a multidisciplinary team of healthcare professionals is essential for optimal recovery. Occupational therapy plays an important role in this coordinated effort. When working with stroke survivors, an occupational therapist’s main goals include helping patients maximize functional independence to complete everyday activities (bathing, dressing, eating, performing household tasks, etc.) and to resume meaningful life roles (parent, spouse, caregiver, employee, etc.).
In order for patients to experience success during their rehabilitation experience, an occupational therapist (OT) must take two approaches. First, an OT assists patients in recovering any function that was lost as a result of stroke. Second, an OT helps patients cope with any residual physical deficits by providing education and exploring compensatory strategies and adaptations.
For example, an occupational therapist may provide a patient with range of motion and strengthening exercises to help regain upper extremity function. Patients will learn and practice one-handed techniques for completing bathing and dressing tasks and for opening containers. Endurance and balance activities are implemented to help patients increase activity tolerance for better stamina when completing self-care and household tasks.
An OT may also introduce adaptive equipment, such as a rocker knife to an individual to use to complete one handed cutting during meal times or a long-handled sponge to assist with bathing. In addition, an occupational
therapist may recommend environmental modifications to a patient’s home. These modifications, such as a shower chair or grab bars, will increase independence and safety with bathing and ambulation. Lastly, an occupational therapist will educate a stroke survivor’s family and/or caregivers on ways to safely assist patients at home and provide information to help promote additional recovery of function in the discharge setting.
Through a patient-centered team approach, occupational therapy has an important place in the stroke rehab process. With the use of skilled interventions, occupational therapy ensures that stroke survivors reach their maximum potential to return to a meaningful and productive life.
Dysphagia Therapy & Stroke Rehab
Contributed by Amber Klein, M.A., CCC-SLP
Individuals recovering from stroke may notice changes in their swallow function. These changes might include frequent coughing or choking, increased time needed to chew and swallow small bites, or new difficulties swallowing pills. In these instances, it is not always apparent where these problems might be occurring in the mouth and/or throat. The physician or speech-language pathologist (SLP) may recommend a modified barium swallow study for further assessment of an individual’s swallow function.
A modified barium swallow study (MBSS) is a video x-ray of a person’s swallow completed under fluoroscopy by a speech-language pathologist. Modified barium swallow studies are often recommended for patients who complain of food and/or liquid “going down the wrong pipe,” difficulty eating and/or drinking, or when food becomes stuck or caught in the throat.
Most people think that the purpose of the MBSS is to determine whether or not a patient is “aspirating” (a term indicating that food/liquid is going into the airway/lungs), and that the test is either pass or fail. However, just because a patient is aspirating with one texture of food or drink doesn’t mean that they are not safe with another. Also, an MBSS not only assesses whether or not a person’s food/liquid is going into the airway instead of the esophagus, but it can give a lot of good information regarding the transit and efficiency of the swallow. The SLP can watch the MBSS and determine which muscle groups are not working to their full potential, what positioning changes and/or swallow maneuvers may help to increase the effectiveness and safety of the swallow, and what food and liquid textures will be most appropriate for the patient.
The speech-language pathologist may recommend a change in diet consistency, altering the presentation of the patient’s solid and liquid meal items. However, this diet change is typically meant to be temporary and, as the patient’s swallow function improves with speech therapy, the diet can be advanced. After the patient has the MBSS, the speech-language pathologist writes a report that goes to the ordering physician as well as to the treating SLP so that the treating clinician can determine a more individualized treatment plan.
Physical Therapy & Stroke Rehabilitation
Contributed by Kay Fox-Ruffing, PT
Patients admitted to Firelands Regional Medical Center Inpatient Rehabilitation Center will receive therapy based on an individualized plan of care. For individuals recovering from stroke, therapeutic interventions may be based on the presentation of symptoms and not necessarily on the location of the stroke in the brain. Physical therapy (PT) aims to help stroke survivors reclaim physical function and maintain independence in their daily lives. PT incorporates a variety of activities to promote neuroplasticity. Neuroplasticity, which refers to the brain’s ability to learn, reorganize, and make adaptations by forming new neural connections, is essential to stroke recovery.
Physical therapists will encourage standing activities (such as parallel bars, use of the standing frame, free standing, step-lunge, and other box steps) to promote weight bearing, to address balance deficits, and to improve trunk stabilization. Other weight bearing tasks may include high kneeling, plank positioning, and quadruped positioning. Re-establishing trunk stabilization is a key factor in a patient’s ability to regain dynamic functional abilities. Patients will complete activities in supine position (lying flat on one’s back), sitting at the edge of a mat table, and/or sitting on a physio-ball to promote endurance and strengthening of core muscles.
PTs are committed to using a variety of resources and techniques to maximize a patient’s potential for returning to functional independence through stroke rehab. Electrical stimulation is utilized to promote the return of the neuromuscular connection. Carr-Shepherd supine exercises are frequently used in order to isolate the muscle group movements required during the gait cycle. Reciprocal activities and crossing-the-midline activities are also beneficial in stimulating neuroplasticity.
It is very important to provide stroke rehab patients with encouragement and support throughout their rehabilitation process. The use of visual and verbal feedback has a significant impact, as it can be difficult for individuals to notice small changes that occur during the course of treatment.