Jen DeFeo, OTR/L provides therapy and encouragement to patients after stroke.
How do you help patients who experience weakness in their dominant upper extremity?
Occupational therapists work on improving functional use of the hemiparetic limb following a stroke. One way this is done is by attempting to facilitate movement in the arm, starting from having the patient initiate normal movement in all joints and in all directions as they are able. Then building on what movement they are able to perform to increase the range of motion of the arm. This is accomplished by traditional hands-on facilitation for neuromuscular reeducation as well as additional use of robotics when appropriate. Once movement in present, therapists work on increasing the coordination or the quality and accuracy of the movements, including speed, force, smoothness etc. with a goal of improving the functional use of the arm and hand.
Which is harder, helping with anger and sense of loss or helping them to do the therapy to gain function?
Having a stroke is a life changing event. The person can go from being completely independent one minute to becoming totally dependent on others to live their lives. Depression is common after a stroke. Patients need to be able to understand and see the value of therapy in order to buy into the process. Patients who are actively engaged in their therapy services will produce better outcomes. Giving patients hope is essential. They need to be able to see the progress they are making, however small, from moving more normally to transferring and performing their activities of daily living with less assistance. Providing therapy is the easy part. Rehabilitation after a stroke is a process. We as therapists provide services based off of where the patient currently is in their recovery. As an inpatient therapist, we sometimes are laying the groundwork for other therapists to then build upon further down the continuum of care through home, outpatient or private therapy services.
Is the rehab process focused on workarounds (reachers, sockaides, etc.) or trying to regain or recreate function?
Rehabilitation following a stroke is focused on both remediation and compensation to allow for patients to function as independently as possible. Remediation focuses on facilitating normal movement that is often lost or affected by hemiparesis after a stroke. The goal is to use the hemiparetic side as functionally as the patient is able to regardless of what level they are at. Medicine has changed so much over the years; patients are coming to inpatient rehab earlier from the acute care hospital and the length of stay is significantly shorter. Compensatory techniques need to be learned in order to allow patients to go home and function while continuing with the therapy process. Even though we may be working on compensation such as one-handed dressing or sit pivot transfers, we should still be focusing on using the hemiparetic upper and lower limbs in some functional capacity, even if its just being used to support the patients body weight initially or as a gross stabilizer during those activities. Patients want to be able to do as much for themselves as they are able to, through compensatory techniques, and not have to depend on others, but they also want a future where they are able to move and perform tasks more normally as well.