As an occupational therapist, your role in helping patients restore or adapt to loss of function after a stroke is critically important. Yet, a recent study, published in Disability and Rehabilitation, found that although therapists know evidence based practice is important in achieving quality stroke rehabilitation outcomes, very few of them actually use and apply research-based evidence.
This article is designed to help you get up to date on some of the latest occupational therapy stroke rehabilitation research, and provide helpful resources for further exploration.
Occupational Therapy Stroke Rehabilitation Research
A study published in the Journal of Physical Therapy Science, compared bilateral to unilateral training on upper limb outcomes in stroke patients. Two groups were assigned to either bilateral training (movement of both the impaired and unimpaired limbs simultaneously) or unilateral training (exercising just the impaired arm). The study found that the bilateral training group had significantly improved shoulder movement compared to the unilateral group so the researchers recommend using bilateral training for upper limb problems.
Another study in the Journal of Physical Therapy Science has shown that neurofeedback and computer-assisted rehabilitation provided in 30-minute sessions, 5 times a week, for 6 weeks, helps improve activities of daily living.
A study published in Frontiers of Psychology evaluated if stress levels influenced neuroplastic changes in stroke patients. They determined that patients with lower levels of stress achieve higher performance in all tasks compared to those who have higher stress. What this indicates is that it’s important to consider the patient in all aspects of treatment and use a person centered approach.
Although it may not be possible due to fiscal restraints of both organizations and families, according to research in the Journal of Physiotherapy, increasing rehabilitation by up to 200% improves activity in patients after stroke. Perhaps this is additional incentive to get patients family involved in the rehabilitation process where possible.
In the Journal of Neuroengineering and Rehabilitation, an interesting study was conducted in Mexico to evaluate if there could be a more cost effective solution to providing one-on-one therapy. The study looked at a technology assisted gym (robot gym). Two groups were randomized to either the robot gym or usual care for 24 sessions over 6-8 weeks. In most instances the outcomes were similar if not better with the robot gym. And the benefit for therapists was that they could train 1.5 to 6 times more patients for the same cost over the long term.
The Journal of Motor Behavior speaks of a modality called “transcranial direct current stimulation (tDCS), a form a noninvasive brain stimulation that can be overlaid onto task practice and delivers a constant, low intensity current into the brain. tDCS is safe, portable, and efficacious in remediating a variety of deficits, yet is not consistently incorporated into clinical practice.”
tDCS helps improve the learning-related synapse connections in the brain to speed up outcomes. Because it is a safe treatment that directly influences neuronal communication, researchers believe it is an emerging technology to keep a sharp eye on.
A review published in the Cochrane Library, found that to improve walking capacity and speed in stroke patients, cardiorespiratory and mixed training is beneficial. Cardiorespiratory includes water training, cycle ergometer, circuit training, and treadmill gait training (most popular) of average 20+ minute sessions. Mixed training combined cardiorespiratory with resistance training using weights, body weight or elastic devices.
As you can see, a lot of great information can be gathered from research studies which can then be put into practice. The above studies are just some of the most recent studies. There is ample evidence on occupational therapy stroke rehabilitation, so search PubMed, search the Cochrane Library, do your own mini literature review and stay up to date by implementing evidence into practice.
I like that you pointed out how a study showed that patients with low-stress levels will have better performance over time. I guess I will keep my mom happy these days until she recovers from a stroke. We will be looking for a rehabilitation program to help her out since she suffered from this months ago when we got home from a tropical country vacation.