As an occupational therapist (OT), I’ve had the opportunity to discuss with families and patients the role of OT in stroke rehabilitation, the impairments associated with stroke, and explain what a stroke is. Sometimes it can be difficult to understand what a stroke is with all the medical terminology, which is why I’ve made a list of common impairments experienced by patients after a stroke- made simple.
First, what is a stroke?
A stroke occurs when the blood supply to the brain is disrupted, either due to a blockage (ischemic stroke) or bleeding (hemorrhagic stroke).
Ischemic stroke happens when a blood vessel that supplies blood to the brain becomes blocked causing decreased oxygen to the brain.
Hemorrhagic stroke occurs when a blood vessel that supplies blood to the brain ruptures and blood begins leaking into the brain.
Disruption of blood flow to the brain may cause brain cell death or damage. Depending on which area of the brain was affected, various impairments may occur.
Common impairments after stroke
Hemiparesis/hemipleiga
Hemiparesis means weakness on one side of the body, and hemiplegia means paralysis on one side of the body. When experiencing symptoms of hemiparesis or hemiplegia after a stroke, one will lose strength or ability to control parts of the body on one side, typically affecting the arm, leg, and face on the same side. Example: Hemiplegia of the left side of the body will result in the inability to use or control the left arm, left leg, and left side of the face.
Aphasia
Aphasia means difficulty with language and communication, which can manifest in difficulty speaking, understanding speech, reading, or writing. There are 3 types of aphasia that can occur depending on the area of the brain that was affected.
With expressive aphasia, one might lose the ability to speak because they have difficulty forming speech patterns, they might speak in choppy bits, or they may not be able to say the right word associated with what they’re thinking making it difficult for others to understand.
Receptive aphasia: The Wernicke’s area of the brain is affected resulting in difficulty with language comprehension.
With receptive aphasia, one might be able to produce speech normally, but will not be able to understand spoken words.
Expressive Aphasia: Broca’s area of the brain is affected resulting in difficulty with speaking or communicating wants/needs.
With expressive aphasia, one might lose the ability to speak because they have difficulty forming speech patterns, they might speak in choppy bits, or they may not be able to say the right word associated with what they’re thinking making it difficult for others to understand.
Receptive aphasia: The Wernicke’s area of the brain is affected resulting in difficulty with language comprehension.
With receptive aphasia, one might be able to produce speech normally, but will not be able to understand spoken words.
Global aphasia: Both the Broca and Wernicke areas of the brain are affected and one may not be able to express verbally what they want and need, and they also will have difficulty understanding spoken language.
Dysarthria
Dysarthia results in difficulty controlling the muscles of the mouth involved in speech production. This may result in slurred or unclear speech. Dysarthria differs from aphasia, as someone with dysarthria is unable to control their speech muscles, but someone with aphasia has full control of their speech muscles. Sometimes both dysarthria and aphasia can occur resulting in overall impairment in speech.
Apraxia
Apraxia results in difficulty with planning and performing purposeful movements. Someone with apraxia has difficulty sequencing or motor planning which may look like someone who is clumsy or does not know how to coordinate their body to use certain objects even though they don’t have any muscle weakness or paralysis.
A few examples of apraxia may be a person who does not know how to coordinate their arm to brush their own hair or someone who has difficulty performing a sequenced task such as cooking which involves multiple steps.
Hemispatial neglect
Hemispatial neglect is a lack of awareness or attention to one side of the body or the environment. This typically affects one side of the body depending on which side of the brain is affected. If a person has damage to the right side of the brain, then they will experience left-side hemispatial neglect. If a person has damage to the left side of the brain, they will experience hemispatial neglect on the right side of their body.
This may present itself as a person who ignores one side of their body as if it does not exist. For example, if you position a plate of food in front of them to eat, they will only eat the food on one side of the plate, or when bathing, they will only wash one side of their body.
Visual impairments
These can range from partial vision loss to complete blindness, affecting one or both eyes. Common visual impairments after stroke include loss or partial loss of visual fields, hemianopia, visual neglect, diplopia, or blurred vision. The severity of visual impairment varies depending on the extent or damage of the stroke.
Cognitive impairments
Stroke can lead to various cognitive deficits, including problems with memory, attention, problem-solving, and executive functions.
Sensory disturbances
After stroke, senses may become altered or diminished resulting in numbness, tingling, or hypersensitivity of affected parts of the body. Complex regional pain syndrome is common after stroke as a result of hypersensitivity.
It’s important to note that the specific impairments and their severity can vary from person to person, depending on the location and extent of the stroke. Additionally, with appropriate rehabilitation, some of these impairments may improve over time. Rehabilitation programs are often designed to address these impairments and help individuals regain as much function as possible.
How can occupational therapy help?
Occupational therapy (OT) plays a crucial role in stroke rehabilitation. OT focuses on helping individuals regain their independence and functional abilities to perform activities of daily living (ADLs) and participate in meaningful activities. A few ways OT can help are listed below.
Through a holistic approach, occupational therapy helps stroke survivors regain confidence, adapt to any ongoing challenges, and regain independence in their daily lives.
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