Occupational Therapy Case Study: Enhancing Daily Living for a Patient with Post-Stroke Hemiparesis

 

Introduction

Occupational therapy (OT) plays a crucial role in helping individuals regain independence and improve their quality of life following debilitating conditions. This case study explores the application of OT in the rehabilitation of a patient with post-stroke hemiparesis, focusing on assessment, intervention strategies, and outcomes.

Patient Background

The patient, John Smith, is a 58-year-old male who experienced an ischemic stroke three months ago, resulting in right-sided hemiparesis. John lives alone and was previously independent in all activities of daily living (ADLs). Post-stroke, he has significant difficulties with mobility, self-care tasks, and returning to his work as a computer technician.

Initial Assessment

1. Clinical Evaluation

The initial assessment involved a detailed clinical evaluation to understand John’s physical, cognitive, and emotional status. Key tools and observations included:

• Modified Ashworth Scale: Assessed muscle spasticity, with John showing moderate spasticity in his right arm and leg.
• Fugl-Meyer Assessment: Evaluated motor function, balance, and joint functioning. John scored 42 out of 66 for upper extremity and 30 out of 34 for lower extremity motor function.
• Barthel Index: Measured performance in ADLs, indicating moderate dependence with a score of 55 out of 100.
• Cognitive Assessment: Mini-Mental State Examination (MMSE) indicated mild cognitive impairment with a score of 24 out of 30.

2. Patient Goals

John’s primary goals were to regain independence in self-care activities, improve mobility, and return to work. Specific objectives included:

• Dressing and grooming independently
• Cooking simple meals
• Walking without a cane for short distances
• Using a computer for work-related tasks

Intervention Strategies

1. Motor Function Rehabilitation

Task-Oriented Training:

• Focused on practicing specific tasks that John found challenging, such as dressing and meal preparation.
• Used repetitive practice and progression of task difficulty to enhance motor learning and muscle strength.

Constraint-Induced Movement Therapy (CIMT):

• Encouraged use of the affected right arm by restraining the unaffected left arm for several hours a day.
• Combined with intensive practice of functional tasks to improve motor control and reduce learned non-use.

Functional Electrical Stimulation (FES):

• Applied to the right arm and leg muscles to enhance muscle contraction and improve strength and coordination during specific tasks.

2. Cognitive and Perceptual Training

Cognitive Rehabilitation:

• Utilized computer-based cognitive exercises to improve attention, memory, and problem-solving skills.
• Incorporated real-life scenarios relevant to John’s work as a computer technician to enhance cognitive engagement and relevance.

Visual-Perceptual Training:

• Addressed visual neglect and spatial awareness issues through exercises involving scanning, matching, and constructional tasks.

3. Activities of Daily Living (ADL) Training

Adaptive Equipment:

• Introduced adaptive tools such as a button hook for dressing, a one-handed cutting board for meal preparation, and a long-handled reacher for picking up objects.
• Educated John on the use of these tools to increase independence in ADLs.

Environmental Modifications:

• Suggested modifications in John’s home to facilitate safer and more efficient performance of daily tasks, such as installing grab bars in the bathroom and rearranging kitchen items for easier access.

4. Psychosocial Support

Counseling and Support Groups:

• Provided individual counseling to address emotional and psychological challenges related to stroke recovery.
• Encouraged participation in stroke survivor support groups to share experiences and gain social support.

Outcome Evaluation

1. Motor and Functional Outcomes

After six months of intensive OT intervention, John demonstrated significant improvements:

• Modified Ashworth Scale: Reduced spasticity in the right arm and leg.
• Fugl-Meyer Assessment: Improved scores to 54 for upper extremity and 32 for lower extremity motor function.
• Barthel Index: Increased independence in ADLs with a score of 80.

2. Cognitive and Perceptual Outcomes

• MMSE: Improved cognitive function with a score of 27.
• Enhanced ability to concentrate and solve problems during computer-based work tasks.

3. Psychosocial Outcomes

• Reported improved mood and reduced feelings of frustration and helplessness.
• Developed a stronger support network through participation in support groups.

Conclusion

This case study illustrates the comprehensive approach of occupational therapy in addressing the multifaceted needs of a patient with post-stroke hemiparesis. Through a combination of motor function rehabilitation, cognitive and perceptual training, ADL training, and psychosocial support, John achieved significant improvements in independence and quality of life. This case highlights the importance of individualized, goal-oriented interventions in occupational therapy to maximize patient outcomes.

References

1. American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.
2. Fugl-Meyer, A. R., Jaasko, L., Leyman, I., Olsson, S., & Steglind, S. (1975). The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine, 7(1), 13-31.
3. Cramer, S. C., & Nudo, R. J. (2010). Recovery after stroke. Stroke, 41(10 Suppl), S108-S110.
4. Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.
5. Pollock, A., Farmer, S. E., Brady, M. C., Langhorne, P., Mead, G. E., Mehrholz, J., & van Wijck, F. (2014). Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews, (11), CD010820.

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