Archive for August, 2012

BRINGING THE PATIENT WITH A STROKE BACK HOME

Tuesday, August 14th, 2012 by admin

As an occupational therapist, I often work with clients that have suffered a stroke.  The effects of a stroke, otherwise known as a cerebrovascular accident, can manifest in a number of ways.  It can range from slight weakness of the muscles to total paralysis of one side of the body.  The side of the body that is affected is the one opposite to the area of the brain that was injured.  This blog post will focus on those individuals who have completely lost use of one side of their body. 

In the past, rehabilitation facilities had therapists’ assess the client’s home prior to discharge.  This was done in order to make the discharge as efficient and effective as possible.  However, due to the overwhelming emphasis on work productivity, budget cuts, and cutting back on staff more and more rehab centers have abandoned this practice. Clients suffering from a stroke are being sent home with just the basic skills they have learned while at the rehab centers.

Individuals with a hemiparesis (paralysis of one side of the body) can present with many difficulties.  One of the areas mainly affected is the ability to perform Basic Activities of Daily Living (BADL’s).  This includes: bathing, grooming, feeding, dressing, and toileting.  They can also present with poor coordination, diminished sensation, speech difficulties, problems with swallowing, and cognitive impairments.  As a result, we will explore some ways to help these clients live more comfortable while at home.

To begin, it is important to assess the environment and remove anything that would hinder the performance of a daily routine.  This can be done by adapting the environment to include things that would make the setting more user-friendly.  For instance, two of the main areas that need to be looked at when assessing the environment are the bathroom and bedroom.  Sometimes remodeling is not an option; therefore, it is necessary to adapt the existing space.  Occupational therapists with their vast knowledge of assistive technology can help in selecting the right assistive devices and durable medical equipment to facilitate this task.

Currently, there are a number of items on the market that occupational therapists can recommend to assist in performing activities of daily living.  We often suggest that all self-care items be placed in an easy to access area.  It is also important to make sure that there is good lighting and ventilation in these areas.  In the bathroom, water temperature should be regulated to avoid getting burned.  When it comes to dressing, utilizing one- handed techniques has proven to be just as beneficial as using assistive devices to complete the task.  One- handed techniques allow the client with a stroke to use their unaffected side to aide in performing various tasks.  Consult with an occupational therapist to learn more about one- handed techniques.  In the meantime items such as elastic shoelaces, pants with a velcro fastener, and shirts with snaps or larger buttons can facilitate dressing activities.  As a rule of thumb, it is important that the individual performing the activity be seated on a firm surface with both feet placed on the floor to provide ideal support and optimal posture.

Mealtime is another difficult task to perform after a stroke.  It requires stabilizing the plate; gathering and/or placing food onto a spoon/fork; and stabilizing food while cutting. In order to help the individual successfully perform the task, it may be necessary to use assistive devices.  As a rule of thumb, during mealtime an upright sitting posture is essential.  It not only facilitates the activity, but also decreases the likelihood of aspiration (choking).  Thus, it is necessary to ensure that dining chairs provide proper support to maintain a good posture and that the table be at a comfortable height for the individual.  Currently, there is a vast amount of assistive devices that can help individuals with a stroke become more independent during mealtime.  Some frequently used items are a scoop dish/ plate, ergo plate, and rocker knife.  These items can help turn this experience from a frustrating one into a rewarding one.

Suffering from a stroke can be a life changing experience.  Even more so for those individuals with complete paralysis of one side of the body.  Hospitals and rehab facility programs are designed to make life after a stroke easier.  However, when the client goes home it tends to be a different story.  A combination of one- handed techniques coupled with assistive devices can help the client with a stroke live at home more comfortable and independent.  An occupational therapist can assist in training and selecting appropriate assistive devices. 

 By

Miller Calberto, MS, OTR/L, CAPS
Senior partner
Adapting Spaces, LLC
mcalbertotr@adaptingspaces.com
1888-956-0077

Edited by Ester Gonzalez, MS, OTR/L, Bil TSHH