Stroke: Physiotherapy and occupational therapy treatment

Occupational therapy and physiotherapy in early rehabilitation

An interprofessional rehabilitative approach ensures optimal assessment and rehabilitation of the patient. A patient’s progress is reassessed at regular intervals and goals and measures are adapted to the current situation. The task of physiotherapy is in particular to assess movement control and the ability to move in everyday life. The overriding goal is to regain independence with the best possible recovery of lost bodily functions and to prevent complications such as pneumonia, pain due to incorrect strain or injury. Possible sub-goals:

• Deeper and easier breathing compared to breathing in the passive supine position
• Increased alertness through targeted activation and early sitting up
• Increase in body awareness. It is important to integrate the affected side into the body schema so that the brain does not “forget” this side
• Increased orientation in space and understanding of the situation as a prerequisite for targeted movement
• Ability to assume certain postures such as sitting or standing and to move without losing balance
• Increased movement control and strength on the affected side of the body
• Knowing suitable movement strategies to optimize independence in the activities of daily living
• Achieving walking ability and general mobility through the targeted use of aids such as shoes, splints, walking aids, wheelchairs, etc.
• Increase general endurance performance by training the heart and lungs

In occupational therapy, patients’ everyday activities are assessed. The overriding goal is to regain the greatest possible independence, e.g. in personal hygiene, dressing and eating. From the very first day, targeted support is offered for the implementation of these activities. Possible sub-goals:

• Increasing independence in self-care (washing/dressing/eating)
• Optimization of posture, body movement and coordination in collaboration with physiotherapy
• Increasing the awareness of neglect of one side of the body, the training is adapted to the phases of the attention deficit disorder and leads to the goal that the patient recognizes dangers due to the limitations independently and acts accordingly
• Promoting cognitive skills such as attention, memory and planning as a prerequisite for independent action
• Optimization of the functions of the affected hand through functional training and the provision of aids. Assistive devices are also used to protect unstable joints or to make everyday activities easier
• Positive influence on reduced or altered body awareness through targeted sensitivity training with various everyday materials. This is a prerequisite for coordinated and efficient movement sequences such as button fastening

Physiotherapy is based on the principles of motor learning

For optimal recovery after a stroke, an early start to therapy and the highest possible training intensity are recommended. The exercises should be meaningful and significant and must be practiced repeatedly. The patient should be able to participate in the training as actively and motivated as possible and experience fun and success. Only what is practiced has a chance of improvement. This means that if walking is to be improved, the patient must also practise walking. The requirements must be continuously increased with improved performance.

Basics of occupational therapy

An early start to therapy and the highest possible training intensity are recommended in the literature. Patient orientation plays a key role here. Occupational therapy is based on the assumption that being active is a human need and therefore selects meaningful activities for the patient for therapy.