Occupational therapy plays a vital role in stroke recovery at Catholic Health

 If the word 'recovery' doesn't mean 100% recovery, then this place is a complete failure! Don't allow your stroke medical 'professionals' to use the tyranny of low expectations to NOT GET YOU 100% RECOVERED!

Occupational therapy plays a vital role in stroke recovery at Catholic Health

2025

In the United States, a stroke occurs every 40 seconds, totaling over 795,000 cases each year. Even more startling, according to the Centers for Disease Control and Prevention (CDC), someone dies from a stroke about every three minutes. A stroke cuts off oxygen to the brain, causing brain cells to die, which can lead to death or long-term disability if not treated promptly.

Strokes can result in speech difficulties, paralysis and cognitive challenges, making everyday tasks like bathing, dressing or eating difficult. That’s why occupational therapy plays such a crucial role in the recovery process — helping stroke survivors regain their independence and adapt to life after a stroke.

Occupational therapists (OTs) help individuals relearn basic tasks, improve impaired motor and sensory function and recommend home modifications to enhance safety and accessibility. They may also suggest adaptive equipment and work with families to support the patient’s recovery at home.

“Occupational therapists play a key role in improving a patient’s mental, physical and social well-being,” said Matthew Clifford, an occupational therapist in the Medical Rehabilitation Unit at Kenmore Mercy Hospital. “They also provide essential education to patients and their families to achieve the best outcomes and ensure a safe hospital discharge.”

As part of the stroke rehabilitation team, occupational therapists work alongside physical therapists and other caregivers. While physical therapy focuses on rebuilding strength and balance, occupational therapy emphasizes restoring cognitive function and everyday skills like cooking, grooming or driving. Together, they offer a comprehensive approach to healing.

At Catholic Health, inpatient stroke rehabilitation services — including physical, occupational and speech therapy — are offered at Kenmore Mercy Hospital’s Medical Rehabilitation Unit (MRU). MRUs provide a higher level of rehabilitation care for patients recovering from strokes, hip fractures or complications from neurological conditions such as Parkinson’s Disease or Multiple Sclerosis. For those who require a different level of care based on their functional needs, Catholic Health also offers a wide range of subacute, outpatient and home care rehabilitation services across Erie and Niagara Counties.

Returning to everyday activities can be overwhelming for stroke survivors, especially when speech, vision or mobility are affected. Occupational therapists provide emotional support and teach strategies to navigate these challenges. They also assess home and work settings and recommend modifications to ensure smooth and safe transitions after a stroke.

Occupational therapists are more than care providers — they’re essential partners in the recovery journey. Through evidence-based care and compassionate support, they help stroke survivors rebuild their lives, one step at a time.

For more information on programs and services available at Catholic Health or to find a medical provider, call 716-706-2122. 

Q&A: A task-oriented approach in occupational therapy is critical to recovery after a stroke

But does it get you 100% recovered? The only goal in stroke!

Q&A: A task-oriented approach in occupational therapy is critical to recovery after a stroke

by University of Nevada, Las Vegas

Chih-Huang "Jeffrey" Yu, a professor in the School of Integrated Health Sciences' brain health department, works with occupational therapy doctoral student Julie Canda on how to apply makeup with only her left hand. Yu has been a practicing occupational therapist for 30 years and is one of the field's premier advocates for using the task-oriented approach while working with stroke patients. Credit: Josh Hawkins/UNLV

Recovering from a life-altering stroke can be a long and arduous journey when an irascible demeanor and a litany of frustrations prolong a patient's return to normalcy.

Stroke is the leading cause of death in the United States and a major cause of serious disability for adults, according to the Centers for Disease Control and Prevention.

A task-oriented, client-centered approach is the preferred method of rehab for stroke patients, says Chih-Huang "Jeffrey" Yu, an assistant professor in the Department of Brain Health's occupational therapy doctorate program within the UNLV School of Integrated Health Sciences.

"A typical rehab is more of a one-size-fits-all approach, and a lot of times, our clients can feel frustrated by that approach," he said.

"The occupational therapy task-oriented approach allows us to really learn more about the person, their life, what kind of tasks they were able to do before their stroke that they're not able to do anymore, and determine a strategy to improve their performance effectively. That's why I really need to understand and get to know the person so I can establish their own personal plan going forward. We really have to put ourselves in their shoes."

Occupational therapists help people achieve the things they want to do, not just what they need to do, after experiencing a health affliction. They approach a person holistically to improve their physical, spiritual, and emotional health in an effort to maximize their overall well-being.

Yu has been a practicing occupational therapist since the mid-1990s. Born and raised in Taiwan, he honed his skills using the occupational therapy task-oriented approach while studying at the University of Minnesota in 2010.

According to Yu, the task-oriented approach is a novel concept in occupational therapy, with Yu having published one of just two articles on the subject. We spoke with him about how occupational therapists, especially those utilizing a task-oriented approach, can impact the lives of stroke patients while making their long road to recovery a little less stressful.

For those unfamiliar with occupational therapy, can you explain how occupational therapists work with stroke patients?

Occupational therapists work on how we can best help our clients (we refer to them as "clients" in outpatient settings and "patients" during acute care and inpatient settings) to do the things that they most value. These are tasks that people do on a daily basis that take up their time and are also meaningful to them.

As an example, I am a father, a son, and a husband, and I work at a university. I also need to do things that give me life, like eating, shopping, and other tasks that give me the fulfillment I need. As a father and husband, I need to spend quality time with my daughter and my wife. Those tasks take up my time and are meaningful for me. After a stroke, I may be able to do some of those tasks, but not all of them.

Occupational therapists are experts in working with our clients to address the areas with the most need, and we customize our plans for each client. You might eat your breakfast at home or at work, where it's quiet, and I might eat my breakfast while watching videos on my couch. Even though we are both having breakfast, we are eating it differently. They are different experiences that affect us in our own way.

As occupational therapists, we also educate our clients to ensure they are rehabbing in the healthiest way. We believe everything is parallel to each other. The task, the environment, and someone's personal ability are parallel, and we regard them as separate systems. When using the occupational therapy task-oriented approach, you need to spend a lot of time working with a client.

Why is there a dearth of published information about the task-oriented approach in occupational therapy, specifically working with stroke patients?

The occupational therapy task-oriented approach was first proposed by my mentor, Virgil Mathiowetz, in Minnesota in 1994. He and one of his colleagues proposed this at a time when occupational therapy was focused on a medical model, so the rehab world did not accept this type of thinking.

This also makes funding more difficult because it is not a mainstream approach, and research opportunities are limited. I wanted to learn his approach even though I knew it was risky [in terms of research funding opportunities]. After I did some more research on it, I moved from Taiwan to study under him while being sponsored by the occupational therapy program at the University of Minnesota.

Over the past 20 years, especially in motor learning theory, we have seen an increase in awareness about how the environment is very important to a client's recovery. There have been a few case studies done about occupational therapists using the task-oriented approach, but not much. It is a different approach than most health care professionals use, but the new model is moving toward a whole-body approach.

How have you seen the difference in a patient's recovery process between a more generalized approach and a multi-task approach?

I really saw the difference when working on my dissertation. After three or four weeks of intervention with a stroke patient, his motor skill issue had become a psychological issue. My assumption was that his ability to move was holding him back, but it turned out to be psychosocial. Once we established that it wasn't his mobility that necessarily contributed to his motor skill issue, the recovery process was easier because we knew what to focus on.

That is why we treat each system as its own. Systems can trigger change. By the end of the study, the man was able to regain his driver's license just a few years after suffering a stroke.

Sometimes, you have to change your entire intervention strategy based on the needs of the patient. It was a perfect example of why it is so important to pay attention to the little things. You have to put yourself in their shoes and not come in with your own perception in order to find out what's wrong. I witnessed the power of that personalized, task-oriented approach, and I want to produce more research to share with our society.

What do you hope the future holds for more occupational therapists using the task-oriented approach?

As capstone coordinator for UNLV's occupational therapy program, I coordinate scholarly projects for our students. Right now, I'm trying to recruit students to do stroke rehab while guiding them toward the occupational therapy task-oriented approach. In terms of research evidence, our studies have only been done with patients who have had a stroke, and our students are eager to learn more.

I spent 20 years in the clinic, and my goal is to develop a clinical protocol for the occupational therapy task-oriented approach. Task-oriented approaches aren't currently covered by insurance companies. I want to create a protocol for therapists to use so it becomes more acceptable. I hope that more people recognize its effectiveness so they can use it to benefit their patients.

Provided by University of Nevada, Las Vegas

---

Explore further

Goal-oriented rehab improves recovery in older adults

Turning the spotlight on assessment of severe cognitive impairment: Reducing disparity and inequality in stroke care

You can immediately tell this is going to be useless from one word in the title: 'care'!

NOT RESULTS OR RECOVERY! 

The second tell is 'assessment', assessments do absolutely nothing to get survivors recovered!

Turning the spotlight on assessment of severe cognitive impairment: Reducing disparity and inequality in stroke care

Jennifer Stadden https://orcid.org/0009-0004-4463-3261 j.stadden@nhs.net and Ann-Marie MorrisseyView all authors and affiliations

OnlineFirst

https://doi.org/10.1177/03080226231178109

• 
  

• Implications for Occupational Therapy practice
• Conclusion
• Acknowledgments
• Declaration of conflicting interests
• Funding
• ORCID iD
• Footnotes
• References

PDF / ePub

• Cite article
• Share options
• Information, rights and permissions
• Metrics and citations
• 
  

More than 100,000 strokes occur in the United Kingdom (UK) each year (Stroke Association, 2023). Decreasing stroke mortality rates have resulted in more people living with long-term disabilities, with approximately 50% of survivors demonstrating neurocognitive difficulties (Barbay et al., 2018). Cognitive impairment in the acute phase post stroke has been shown to impact participation in rehabilitation and increase the risk of poorer functional outcomes (D’Souza et al., 2021). Initial cognitive assessments play an important role in informing clinical reasoning for a person’s onward rehabilitation and care decisions; if an upward trajectory of improvement is demonstrated at an impairment and/or functional level, this further supports the need for referrals to inpatient specialist rehabilitation. Therefore, measuring their cognitive baseline following a stroke is pertinent to inform clinical decisions for professionals as well as advocate for patients where onward specialist rehabilitation is required to optimise their recovery.

Completing cognitive assessment in the acute phase post stroke is recommended within national stroke guidelines (Intercollegiate Stroke Working Party, 2023) and these are routinely completed by occupational therapists (OTs) (Manee et al., 2020). For individuals with severe cognitive impairment following a stroke, they are highly unlikely to be able to engage in standardised assessments (Elliott et al., 2019), and functional cognitive assessments are recommended (Intercollegiate Stroke Working Party, 2023).

OTs hold unique expertise in understanding occupation and the environmental impact on function. Through the utilisation of these specialist skills, we provide a vital contribution to cognitive assessments. Not only this, but we are skilled in implementing cognitive assessment results to support participation, choice and engagement in meaningful occupations. It is now time that our profession stands confident in our ability to be leaders in the field of assessment of individuals with severe cognitive impairments and drive change to improve consistency and quality of care.

We completed a systematic review of OTs’ cognitive assessment practices in the acute stroke setting for individuals with severe cognitive impairment. Five academic databases (MEDLINE, CINAHL, PsychINFO, AMED and Embase) were searched and no study was found that explicitly looked at assessment practices for severe cognitive impairment post stroke.

Four related studies (Geraghty et al., 2019; Koh et al., 2009; Korner-Bitensky et al., 2011; Pilegaard et al., 2014) focused on the assessment of individuals with mild cognitive impairment post stroke and participants were predominantly experienced OTs, with 5–10 years of stroke experience. These studies found that while OTs preferred using functional cognitive assessments, because they are client centred and meaningful to the patient (Koh et al., 2009), there was a wide variability in their content (Pilegaard et al., 2014). The content of functional assessments was mainly developed from their past experiences and colleague recommendations, rather than informed from research (Holmqvist et al., 2009; Koh et al., 2009).

Implications for Occupational Therapy practice

Research to date, has focused predominantly on detecting the presence of mild to moderate cognitive impairment using standardised measures. This has placed individuals with severe cognitive impairment at a disadvantage. These individuals are being assessed and clinical decisions are being made, without OTs having access to a strong evidence base to guide their practice.

Due to the heterogeneity of available functional assessments and the individual nature in which some may be conducted, this poses a risk to the establishment of a true cognitive baseline and thus the measurement of change over time. Without an evidence base guiding practice the content of functional cognitive assessments are likely to be reliant on the OT’s clinical experience and clinical reasoning. The application of outcomes of these functional assessments may also be reliant on the OT’s ability to interpret and articulate findings to individuals, families and the wider multidisciplinary team. Not capturing an extensive baseline of their impairments and abilities, could hold implications for subtle changes in these cognitive areas being missed, which could impact their opportunity for rehabilitation.

Therefore, more needs to be explored around the content and structure of functional cognitive assessments for this stroke population to improve consistency within these assessments. Also, more research needs to be completed to help understand OTs’ confidence when assessing those with severe cognitive impairment, as it is likely that the more complex and widespread the impairments, the more challenging functional cognitive assessments will be to complete, particularly for less experienced therapists.

Conclusion

The spotlight should now be turned to focus on understanding the content of functional cognitive assessments for those with severe cognitive impairment following a stroke. As more is understood, this will lead the way in supporting OTs in delivering evidence-based functional cognitive assessments for this population as well as promoting greater equity for this patient population in accessing specialist rehabilitation to optimise their quality of life.

Key messages

•

There is no research to date that has explored the cognitive assessment practices of OTs for individuals with severe cognitive impairment following a stroke.

•

This is a key area for future research to improve consistency in OT practice as well as to support OTs delivering evidence-based functional cognitive assessments. This can ultimately improve standards of care and patient outcomes.

•

OTs are equipped with the specialist skills to be clinical and academic leaders in the field of cognitive assessment and drive much needed change for this stroke population.

Acknowledgments

Dr Catherine Hurt, City University London. CH was an academic supervisor for JS and supported protocol development for the systematic review.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) declared no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jennifer Stadden https://orcid.org/0009-0004-4463-3261

Interventions to improve social participation, work, and leisure among adults poststroke: A systematic review

You're solving the wrong problems, these are all secondary problems that don't need to be solved if you worked on the primary problem of 100% recovery

 Interventions to improve social participation, work, and leisure among adults poststroke: A systematic review

American Journal of Occupational Therapy (AJOT) , Volume 76(5) , Pgs. 7605205120.

NARIC Accession Number: J90080.  What's this?
ISSN: 0272-9490.
Author(s): Proffitt, Rachel; Boone, Anna; Hunter, Elizabeth G.; Schaffer, Olivia; Strickland, Madison; Wood, Lea; Wolf, Timothy J. .
Publication Year: 2022.
Number of Pages: 11.
Abstract: Study examined the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults post stroke. MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases were searched for relevant peer-reviewed journal articles published between January 1, 2009, and December 31, 2019. Forty-seven articles met the inclusion criteria. Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. Occupational therapy interventions may improve work, leisure, and social participation outcomes post stroke, with the strongest evidence existing for client education, upper-extremity training, and cognitive training for improving social participation. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.
Descriptor Terms: EMPLOYMENT, LEISURE, OCCUPATIONAL THERAPY, SOCIAL SKILLS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Proffitt, Rachel, Boone, Anna, Hunter, Elizabeth G., Schaffer, Olivia, Strickland, Madison, Wood, Lea, Wolf, Timothy J. . (2022). Interventions to improve social participation, work, and leisure among adults poststroke: A systematic review.  American Journal of Occupational Therapy (AJOT) , 76(5), Pgs. 7605205120. Retrieved 12/21/2022, from REHABDATA database.

Evaluating Implementation Strategies and Outcomes in Postacute Stroke Rehabilitation: A Scoping Review

My god, no one understands what survivors want. 100% recovery.  Are you that fucking stupid?

Evaluating Implementation Strategies and Outcomes in Postacute Stroke Rehabilitation: A Scoping Review

James Edward Murrell, MOTR/L;

Janell Pisegna, MOT, OTR/L;

Lisa Juckett, PhD, OTR/L, CHT

Author & Article Information

The American Journal of Occupational Therapy, 2022, Vol. 76(Supplement_1), 7610510236p1.

https://doi.org/10.5014/ajot.2022.76S1-PO236

• Standard View
• PDF
• Share Icon Share
• Tools Icon Tools

Abstract

Listen

Date Presented 04/02/2022

This research describes implementation strategies and outcomes commonly leveraged to support evidence implementation in adult stroke rehabilitation. Presenters will share findings from their scoping review that examined the effectiveness of implementation strategies with practitioners in stroke rehabilitation settings. This study addresses the research priority concerning the need to progress beyond implementation barriers to examining implementation strategies to overcome them.

Primary Author and Speaker: James Edward Murrell

Additional Authors and Speakers: Janell Pisegna, Lisa Juckett

Keywords:

stroke rehabilitation

BACKGROUND: Every year, millions of people worldwide experience a stroke. Stroke survivors expect occupational therapy practitioners to utilize evidence-based practice to provide the highest quality, cost-efficient services. The benefits of OT in stroke rehabilitation have been well-established for decades. However, practitioners can experience complex barriers when implementing EBP. Moreover, while identifying these barriers is a necessary precursor to optimizing implementation, it remains unclear what strategies have been used to promote effective implementation in the real-world context. This scoping review aimed to answer the following two research questions: What implementation strategies have occupational therapy researchers used to support the uptake of evidence-based interventions and assessments in stroke rehabilitation? And what outcomes have been measured to determine the effectiveness of implementation strategies in stroke rehabilitation? Addressing these questions will point OT practitioners and researchers towards strategies that may support evidence implementation in stroke rehabilitation.

DESIGN: The scoping review methodology was guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review reporting recommendation. Studies were eligible for inclusion in the review if they were published between Jan 2000–Jan 2020, examined the implementation of interventions or assessments, had a target population of adult (19 years and older) stroke survivors, included occupational therapy practitioners, and were relevant to physical rehabilitation.

METHOD: Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Recommendations for Implementing Change project and the Implementation Outcomes Framework guided synthesis of review findings.

RESULTS: The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes.

CONCLUSIONS: With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care.(Wrong, wrong, wrong! Survivors want recovery, NOT 'CARE' you blithering idiots!)Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

IMPACT STATEMENT: This review highlights implementation strategies and outcomes that have been examined in the stroke rehabilitation literature. Moreover, it facilitates the need to explore effective implementation strategies to enhance the adoption, implementation, and sustainability of evidence-based practices and improving outcomes. This research is pertinent as it remains unclear which implementation strategies are most effective and implementation theories or frameworks guide limited research.

Measuring value: Cost-effectiveness analysis for occupational therapy

Value to survivors is recovery.  IF YOU'RE NOT MEASURING THAT, YOU'RE NOT HELPING YOUR SURVIVORS. My god, does no one in stroke have two functioning neurons to rub together?

Measuring value: Cost-effectiveness analysis for occupational therapy

American Journal of Occupational Therapy (AJOT) , Volume 76(1) , Pgs. 7601347010.

NARIC Accession Number: J88795.  What's this?
ISSN: 0272-9490.
Author(s): Morrow, Corey; Simpson, Kit.
Publication Year: 2022.
Number of Pages: 5.
Abstract: 

Article illustrates the contribution of cost-effectiveness analysis (CEA) to stroke rehabilitation using a hypothetical new occupational therapy intervention as an example. It also explains how CEA improves consistency with reporting standards for cost-effectiveness studies. Stroke rehabilitation is expensive, and recent changes to Medicare reimbursement demand more efficient interventions. The use of CEA can help occupational therapy practitioners, rehabilitation directors, and payers better understand the value of occupational therapy and decide whether to implement new treatments.
Descriptor Terms: COST BENEFIT ANALYSIS, INTERVENTION, OCCUPATIONAL THERAPY, REHABILITATION, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Morrow, Corey, Simpson, Kit. (2022). Measuring value: Cost-effectiveness analysis for occupational therapy.  American Journal of Occupational Therapy (AJOT) , 76(1), Pgs. 7601347010. Retrieved 6/23/2022, from REHABDATA database.
 

Occupational therapy interventions to address depressive and anxiety symptoms in the physical disability inpatient rehabilitation setting: A systematic review

Do you not understand that the solution to depression is 100% recovery protocols? Your patients will be too busy counting reps and looking forward to recovery to get depressed.  If you can't see that and aren't working towards that. GET THE HELL OUT OF STROKE!

 

Occupational therapy interventions to address depressive and anxiety symptoms in the physical disability inpatient rehabilitation setting: A systematic review

American Journal of Occupational Therapy (AJOT) , Volume 76(1) , Pgs. 7601180110.

NARIC Accession Number: J88790.  What's this?
ISSN: 0272-9490.
Author(s): Pisegna, Janell; Anderson, Sarah; Krok-Schoen, Jessica L..
Publication Year: 2022.
Number of Pages: 10.

Abstract: 

This review identified what occupational therapy interventions have been used to address depressive and anxiety symptoms within the physical disability inpatient rehabilitation (IPR) and determined determine the efficacy of these interventions for mental health, quality of life, and functional outcomes. Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Five of 8,082 articles met inclusion criteria. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Diagnoses included stroke, traumatic brain injury, spinal cord injury, and musculoskeletal conditions. Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. The findings indicate that limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning.
Descriptor Terms: ANXIETY DISORDERS, DAILY LIVING, DEPRESSION, FUNCTIONAL STATUS, INTERVENTION, LITERATURE REVIEWS, MENTAL HEALTH, OCCUPATIONAL THERAPY, PHYSICAL DISABILITIES, QUALITY OF LIFE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Pisegna, Janell, Anderson, Sarah, Krok-Schoen, Jessica L.. (2022). Occupational therapy interventions to address depressive and anxiety symptoms in the physical disability inpatient rehabilitation setting: A systematic review.  American Journal of Occupational Therapy (AJOT) , 76(1), Pgs. 7601180110. Retrieved 6/23/2022, from REHABDATA database.

Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke

This only talks about providing occupational therapy not delivering recovery that OT should be doing. So useless.

Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke

 

Author links open overlay panelWenxiLi^aDongshengXu^ab

https://doi.org/10.1016/j.medntd.2021.100097Get rights and content

Under a Creative Commons license

open access

Highlights

•

Discussing the different combining forms and purpose of intelligent rehabilitation equipment and occupational therapy in different settings and different phases.

•

Exploring the importance and possible difficulties of introducing intelligent rehabilitation equipment in stroke rehabilitation from the perspective of occupational therapy.

•

Offering ideas about the future application of intelligent rehabilitation equipment in occupational therapy to improve limb function.

Abstract

Stroke was one of the leading causes of death in the Chinese population in 2017. Most stroke survivors may suffer from different levels of disabilities, which prevents them from returning to their daily activities. The decreased upper limb function is considered as the principal factor that makes the patients have less access to their activities of daily livings. Occupational therapy (OT), aiming to enhance patients’ functional performances and improve the participation in daily activities is usually applied from the onset of stroke. However, conventional OT intervention still has several problems that need to be solved, such as the inefficient use of human resources, inadequate upper limb functional training and non-continuous OT services. To address these difficulties and improve the patients’ functional outcomes, intelligent rehabilitation equipment is combined with OT through evaluation and intervention. Based on this combination, OT can be provided in health care facilities, home, and community for patients with all phases of stroke. This combination promotes the transition of OT to digitization, intelligence and homogenization.

Keywords

Stroke

Occupational therapy

Rehabilitation devices

Robotic technology

Virtual reality

Home rehabilitation

1. Introduction

Stroke is a general term for a class of brain injury diseases caused by blockage or rupture of blood vessels[1]. It is one of the leading causes of death in the Chinese population in 2017[2]. 80% of stroke survivors may be disabled for a period of time[3]. The difficulties of stroke include physical, cognitive, communication, sensory and perceptual problems, etc[4]. All of these conditions affect patients’ return to their original lives and works, bringing huge burdens to their families[5]. Among these problems, the most significant one is physical dysfunction, particularly the upper limb dysfunction[6]. Almost half of the stroke survivors experienced different degrees of chronic impairment of upper limb function[7], which seriously decrease patients’ participation in self-care activities, reduce their working output, affect social reintegration, and finally lead to economic and social burdens[8]. The other important aspect is that the sudden onset of illness may cause an increased risk of psychological problems[9]. In the early weeks following the stroke, about 30% of the patients reported depression, and 20% reported anxiety[10]. These emotional conditions decline patients’ motivation to participate in rehabilitation training and eventually affect the recovery of their physical function. This vicious circle formed by physical dysfunction and psychological problems weakens patients’ function, reduces the independence of daily activities, slows down their pace of returning to the original life, and aggravates the human and financial costs on the family and society. To help patients with stroke regain the ability in activities of daily livings(ADLs), occupational therapy(OT) is being applied through various interventions to promote the physical function and mental state of patients.

As a health care profession, OT focuses on helping patients achieve their goals in their daily lives[11]. The methods we use in OT are not only the extension of functional training but also a process to help patients acquire new abilities to achieve their lives. As a result, OT can be regarded as a bridge connecting the patient with his or her family and society.

When treating stroke patients, occupational therapists are concerned with the patients’ acquisition and maintenance of skills necessary to perform daily tasks, such as dressing, feeding, mobility, grooming, and communication[12]. It is a particular challenge for occupational therapists to integrate various problems faced by stroke patients and draw up treatment plans. Because of the irreplaceable role of upper limb function in the implementation of activities of daily living (ADLs)，the dysfunction of the upper limb makes the patients have less access to their ADLs[13]. Thus, the primary issue that needs to be concerned when the OT is treating the patient with stroke is that how to remedy or compensate the function of the affected limb to the most extent, to improve the independence of patients' activities of daily living. OT intervention can run through the whole process of stroke patients from onset to return to their families[14].

Nevertheless, in the clinical practice of OT for patients with stroke, there are many problems need be solved in the conventional OT intervention(1) (Fig. 1). First of all, it is the inefficient use of human resources. Occupational therapists in hospitals and rehabilitation institutions usually provide OT service to patients in the form of one-to-one, and the treatment time ranges from 20 minutes to 1 hour[15]. This form reduces the efficiency of the OT interventions. In the meanwhile, it increases the medical cost of the hospital and society. Secondly, the intensity of the patient's training did not reach the expectation[16]. The time for a stroke patient to participate in the upper limb exercise is not enough in a treatment session, and the patient does not have continuous services to achieve the purpose of promoting motor learning[17]. Also, the conventional OT can not take the multiple sensory inputs into account during the treatment, which may promote the connection between the sensory cortex and motor cortex, so as to improve the motor function of the patient. From the perspective of mechanism, the effect of conventional OT is generalized, which may not catalyze the reorganization of cortical function specifically. So, the therapeutic effect can not be expected[18]. Last but not least, the continuing service of OT resources is incomplete. In the inpatient settings, most of the patients have access to health services from the rehabilitation team, such as occupational therapy, physical therapy and speech therapy. However, as the patients’ discharge from the hospital, only about a third of the patients received rehabilitation care in the first 30 days following discharge home[19]. There is still a significant gap in continuous rehabilitation services support.

1. Download : Download high-res image (218KB)
2. Download : Download full-size image

Fig. 1. Problems that need to be solved in the conventional occupational therapy

Currently, the application of intelligent technologies has become the mainstream trend in all walks of life. (2)Intelligent rehabilitation device combines assistive technology and artificial intelligence to promote the development of physical, cognitive and psychological rehabilitation in terms of informatization, standardization, and intelligence[20]. It is a kind of high-tech equipment with the ability of perception, which can capture and record the strength, accuracy, and speed of the patient’s movement in real time[21]. After analyzing the recorded data, the intelligent rehabilitation device can give the corresponding feedback to adjust the training program and difficulties[22] [23]. The executive function of intelligent rehabilitation equipment is to provide appropriate guidance and correction when patients make wrong decisions[24]. When patients are in danger, intelligent rehabilitation equipment also can respond in time to protect the patients. It can be combined with occupational therapy to provide services for patients no matter the period (acute phase, sub-acute phase, recovery phase), different settings (hospital, nursing center, home), or for multiple purposes (evaluation, training, application in daily life). The purpose of using the equipment is to make up for the deficiency of conventional occupational therapy, as well as to enhance the effect of occupational therapy for patients with stroke. For example, transcranial magnetic stimulation (TMS) can activate the motor cortex according to the patient's condition combining with upper limb function training to improve the motor function of the upper limb for better participation in ADLs[25,26]. The upper limb robot assist patients with upper limb function training, improve the frequency of patients using the affected limb, and promote the desired movement[27]. Virtual Reality (VR) technology provides virtual interaction and feedback through visual, auditory, and other aspects of sensory input while increasing the interest of patients to complete controllable body movement[28]. It can stimulate and maintain the patients’ motivation to practice repeatedly, regulate their emotions, and improve their depression and anxiety[29]. Brain-Computer Interfaces (BCI) use the neural activity of the stroke patients to directly control external hand devices with real-time feedback[30].

Therefore, the application of intelligent rehabilitation equipment in occupational therapy has many advantages. It supports therapists in their abilities through providing high-intensive, repetitive, and task-oriented treatment to enhance the recovery process and obtain better occupational performance. The combination of occupational therapy and intelligent rehabilitation equipment may strengthen the therapeutic effects of each other to achieve desired outcome and participation in daily activities. Intelligent rehabilitation devices are changing the mode of occupational therapy in the whole phases of stroke (Fig. 2).

1. Download : Download high-res image (1MB)
2. Download : Download full-size image

Fig. 2. The process of OT evaluation and intervention for patients with stroke through the whole phase of the disease.

Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

Absolutely nothing here tells me your rehabilitation outcomes. Useless. Did you get any of the patients even minutely close to 100% recovery?

 Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

J. Edward Murrell (  ed21@uab.edu )
UAB: University of Alabama at Birmingham https://orcid.org/0000-0002-4204-8075
Janell L. Pisegna
The Ohio State University School of Health and Rehabilitation Sciences
Lisa A. Juckett
The Ohio State University School of Health and Rehabilitation Sciences

J. Edward Murrell, Janell L. Pisegna, Lisa A. Juckett
DOI:
10.21203/rs.3.rs-229354/v1
Download PDF
LICENSE:
This work is licensed under a CC BY 4.0 License. Read Full License

Abstract

Background

Every year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes.

Methods

A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework.  

Results

The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes.  

Conclusions

This scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. (So you don't even care whether or not your therapies are effective?) Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

Characterizing 'Standard Care' Occupational Therapy for Adult Stroke Survivors Using the Rehabilitation Treatment Specification System (RTSS)

You can tell immediately that this is totally fucking worthless.

'Standard Care' NOT 'Standard results'

Characterizing 'Standard Care' Occupational Therapy for Adult Stroke Survivors Using the Rehabilitation Treatment Specification System (RTSS)

No abstract.

Evidence-Based Practice Implementation in Stroke Rehabilitation: A Scoping Review of Barriers and Facilitators

 If we had stroke protocols then your doctor and therapists would know exactly what to do based upon your objective damage diagnosis. But since all we have is the crapola of guidelines you will barely recover.

Current rehab only gets you 100% recovered 10% of the time. So you can see how fucking bad the status quo is in stroke rehab. And I can with 100% assurance state that your doctor and stroke hospital are doing nothing to change that 90% failure rate.  That should get me flamed by every stroke hospital in the world. But no one will tell me I'm wrong.

Evidence-Based Practice Implementation in Stroke Rehabilitation: A Scoping Review of Barriers and Facilitators

 

Lisa A. Juckett; Lauren R. Wengerd; Julie Faieta; Christine E. Griffin

Author Affiliations

American Journal of Occupational Therapy, October 2019, Vol. 74, 7401205050. https://doi.org/10.5014/ajot.2020.035485

• View
  • Article
  • Figures
  • Tables
• PDF
• Supplemental
  • Data Supplements
  • Multimedia
• Share
  • Email
  • Twitter
  • Facebook
  • Google Plus
  • Pinterest
• Tools
  • Get Citation
  • Alerts
  • Get Permissions

Abstract

Importance: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services.

Objective: To synthesize research related to occupational therapy practitioners’ implementation of EBPs in adult stroke rehabilitation.

Data Sources: We searched four electronic databases—CINAHL, MEDLINE, PubMed, and Academic Search Complete—and the peer-reviewed journal Implementation Science to identify relevant research studies.

Study Selection and Data Collection: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O’Malley (2005) . Thematic analysis identified themes that emerged from the included studies.

Findings: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs.

Conclusion and Relevance: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed.

What This Article Adds: This article summarizes the contextual factors and effective strategies that may influence practitioners’ implementation of stroke research findings in real-world practice.

Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation

I see nothing in stroke healthcare that suggests a rapid and successful rehabilitation process. All I see is complete failure.  What parallel universe are you living in? 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS 

The wishful thinking here:

 

Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation

Permanent Link

https://hdl.handle.net/2144/38178

Abstract

A major dilemma that is being addressed in the current project is the discrepancies between healthcare system's expectations for a rapid and successful rehabilitation process and patients after having a stroke ability to meet these expectations while striving to adapt to the calamitous event in their life. Emphasizing a more biomedical approach and under implementation of psychosocial approaches, poor acknowledging of patients' basic psychological needs lead to poor motivation, therapeutic disengagement and may lead to a rehabilitation failure. To cope with this gap in the process of stroke rehabilitation, an educational program aiming for occupational therapists working with patients after having a stroke in their acute and post-acute rehabilitation phases was constructed. The program guides practitioners for effective communication with their patients, building a needs-supportive environment and addressing their patients' basic psychological needs in light of the selfdetermination theory, theories of adaptation from occupational therapy perspectives and considering occupational justice and the ICF model. A clinical reasoning, step-by-step problem solving is introduced using adaptation of known models and innovated models for interventions that were created for this purpose. Program delivery through a series of 4-webinar modules is illustrated with their learning objectives, assignments and discussions. The program evaluation and implementation are expected to be the initiator of a change in the health and rehabilitation climate and in Israel.

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

Collections

• Boston University Theses & Dissertations [5826]