The strengths of occupational therapy in rehabilitating stroke victims

Every five minutes someone in the UK has a stroke. It is the equivalent of a heart attack for the brain. A stroke is sudden and its effects immediate. As well as affecting body functions it can damage how someone may think, learn, feel and communicate. Caused by a clot or bleed, stroke is the single most common cause of severe disability (currently over 250,000 people live with stroke-induced disability) and the third most common cause of death.

A stroke can happen without any obvious reason at any time and to anyone. However, you are more likely to have a stroke if you are over 55, and the risk continues to rise as you get older. People with conditions such as high blood pressure and diabetes are at increased risk as are people from Asian, African and African-Caribbean communities.

National charity the Stroke Association provides information and community services, as well as funding research into prevention, treatment and rehabilitation each year. One such piece of research, carried out by professor Catherine Sackley and her team at Birmingham University and published August 2006, looked at the effects of occupational therapy for residents with stroke living in care homes.

Occupational therapy is about living. It enables people – usually those with difficulties resulting from physical or psychological problems – to carry out activities which make their lives meaningful: from getting up and dressed, to going out for work, shopping and socialising.

The research was commissioned because figures suggest that between 20% to 40% of older residents in care homes are stroke survivors. And despite the potential for recovery they receive little effective rehabilitation largely because care staff lack understanding or knowledge about what to do.

“A quarter of stroke survivors move directly from acute care into care homes and it is vital that all stroke survivors have access to the best possible rehabilitation,” says the Stroke Association’s head of professional training, Sue Wayne. “It is appalling that their needs are currently not being met and this in turn puts increased pressure on the health service as patients are often readmitted to hospital.”

Sackley’s research centred on 118 residents in 12 care homes for older people in Oxfordshire. Using an evaluation tool known as the Barthel Index (which tests continence and abilities such as walking, eating, dressing, using stairs, getting in and out of chairs and bed, and so on) it highlighted that even a small amount of occupational therapy had “a significant, quite large effect on the residents of a care home”: they were detectably less likely to deteriorate in performing daily activities.

To fill this gap in the market, the Stroke Association has designed and developed a training package called Caring for People Affected By Stroke. The six modules (all about stroke, physical needs – written in collaboration with the Association of Chartered Physiotherapists Interested in Neurology, hard to swallow, it’s good to talk, thoughts and feelings, and family and friends) can be covered in one day’s intensive training or broken down into more in-depth half-days.

The registered manager of Abercorn nursing care home in Hampshire, Olivia ten Kate, says the training made her staff more aware of the consequences of stroke, such as depression, residual brain damage, discomfort and frustrations.

“The residents feel that staff now have more empathy and understanding,” she adds. “They have noticed staff respond more quickly to their needs in respect of change in position, swallowing difficulty and they have a greater understanding of their mood swings.”

For Wayne, the research on the benefits of even small amounts of occupational therapy are “actually very significant”. She says: “It can be applied to all care home residents, not just to stroke survivors and it also focuses on an understudied and extremely vulnerable group. We hope that care homes will take note of this research and look to improve standards of care for all residents.”

Further information
Stroke Association
Stroke Services Training and Development Unit can be contacted on 020 8994 2847 or e-mail SST&DD@stroke.org.uk

THE LEARNING CURVE

 Stroke is the primary cause of severe disability in residential and nursing care homes in the UK, but remains an area where care staff have little understanding or knowledge let alone expertise.

 Research indicated that 63 residents affected by stroke in six homes who experienced occupational therapy interventions scored higher ratings on the Barthel Activity of Daily Living Index than the 55 residents affected by stroke in six other homes who continued to receive standard care.

 The occupational therapy techniques included specific tasks such as dressing practice, transfer practice and mobility training reducing complexity by providing and using aids and adaptations and specific therapeutic interventions, such as stretching to relieve tissue shortening in a hand and providing a splint.

 The best results are more likely to be achieved by a problem-solving approach, rather than one specific intervention.

 The benefits of occupational therapy can be applied equally to residents who have not experienced a stroke.

Contact the author
Graham Hopkins

This article appeared in the 17 May issue, under the headline “Return to strength”