Session Description

Keynote Presentation: The Performance and Participation Issues of Stroke

Carolyn Baum, PhD, OTR/L, FAOTA; Washington University , St. Louis, MO

For years intervention for person with stroke was treated primarily as a medical condition.  As we have learned more about the population of people who have strokes, including children, adults and older adults, we have learned that stroke must be treated as a chronic health condition that seriously impairs the occupations of the person and their families.  Occupational therapy practitioners must build interventions to address the occupational performance and participation issues of those with stroke at the acute, rehabilitation, and community level. The keynote will propose a measurement and treatment model that highlights occupational therapy's unique contribution in the management of stroke.

Joyce S. Sabari, PhD, OTR, FAOTA; State University of New York, Downstate Medical Center, Brooklyn, NY

Practice guidelines are developed by many health professions to promote the use of evidence-based interventions for the goals of improving client care, enhancing consumer satisfaction, and facilitating inter-disciplinary communication. Based upon evidence presented in the AOTA Practice Guidelines for Adults with Stroke and recent updates, I will:

• present a framework for OT intervention with stroke survivors; and
• discuss findings from published research that guide best practice in OT intervention with the stroke population

Upper Limb Post Stroke Sensory Impairments

Susan Doyle, MS, OTR/L, CFE; Cascade Park Care Center, Vancouver, WA

This presentation will outline our current understanding of upper limb post-stroke sensory impairments (ULPSSI) including a description of the impairments, their incidence and how they impact rehabilitation and survivor outcomes. The experience of ULPSSI from the survivors' perspective will also be discussed. A brief review of evidence based interventions will also be undertaken.

Jan Davis, MS, OTR/L; International Clinical Educators, Port Townsend, WA

Clinical excellence in the treatment of stroke survivors is the driving force behind this two-part session. Dynamic treatment approaches are clearly and effectively demonstrated with video examples taken in intensive care, acute care, skilled nursing, in-patient rehab, home health and outpatient therapy settings. Presenter will emphasize the importance of developing exceptional skills in every aspect of practice, including observation, assessment, determining the impact of impairment on function, determining client-centered goals, creating effective intervention programs, and evaluating the results of intervention. Practice labs are included and help participants learn specific therapeutic handling skills.

Creating Dynamic Treatment Programs While Striving for Clinical Excellence in Stroke Rehabilitation - Part II

Jan Davis, MS, OTR/L; International Clinical Educators, Port Townsend, WA

Clinical excellence in the treatment of stroke survivors is the driving force behind this two-part session. Dynamic treatment approaches are clearly and effectively demonstrated with video examples taken in intensive care, acute care, skilled nursing, in-patient rehab, home health and outpatient therapy settings. Presenter will emphasize the importance of developing exceptional skills in every aspect of practice, including observation, assessment, determining the impact of impairment on function, determining client-centered goals, creating effective intervention programs, and evaluating the results of intervention. Practice labs are included and help participants learn specific therapeutic handling skills.

Mary W. Hildebrand, OTD, OTR/L; East Carolina University, Greenville, NC

Psychological or emotional conditions often occur after stroke either as a direct result of damage to the brain or as a result of experiencing a traumatic event. Depression has been estimated to occur in 30 to 50% of persons who have had a stroke. Similarly, anxiety disorders and personality changes have been reported after stroke.  Psychological and emotional conditions after stroke have been shown to negatively impact occupational performance and, thus, quality of life and participation. We will examine the literature to determine if there are evidenced-based interventions to mitigate their effects on occupationalperformance.

Timothy J. Wolf, OTD, MSCI, OTR/L; Washington University; St. Louis, MO

Individuals with mild neurological injury following stroke represent a large percentage of the stroke population in the acute care setting.  Impairments following mild stroke tend to be more subtle (e.g., executive dysfunction) as opposed to the more common overt symptoms associated with stroke (e.g., hemiparesis).  Longitudinal studies with individuals with mild stroke have shown that these subtle impairments are often not identified and this population is having difficulty reintegrating back into complex everyday life activities (e.g., work, driving, leisure activities).  The impairments and participation changes seen in the mild stroke population pose several challenges for the rehabilitation community.  This lecture will define and describe mild stroke.  Specific assessments and intervention approaches for working with individuals with mild stroke will also be discussed.

Robert C. Ferguson, OTRL; University of Michigan Hospital; Ann Arbor, MI;
Douglas Rakoski, MA, OTR/L, ATP; University of Michigan Hospital; Ann Arbor, MI;

Evidence from traditional as well as innovative neuromuscular facilitation and re-education approaches can help improve motor and functional recovery after stroke. Many clinicians, however, struggle to find ways to link these approaches to a person's participation in meaningful occupations. One novel solution is to use an innovative computer therapy lab to incorporate these approaches into an occupation-based treatment. Additionally, low to mid-level technologies are available that can impact daily treatment interventions. This presentation will explore how to incorporate technology using a clinical reasoning process to appropriately select, utilize and modify the technology and software to meet therapeutic goals.

Hemiplegic Shoulder Pain: Evidence-Based Strategies for Assessment, Remediation, and Prevention

Kathryn Levit, PhD, OTR/L; Shenandoah University; Winchester, VA

Stroke is a leading cause of disability in the United States and shoulder pain is a common complication that may affect up to 80% of stroke survivors.  Hemiplegic shoulder pain (HSP)is a significant problem for occupational therapists because of its devastating effects on arm function, occupational performance, participation, and quality of life.  This presentation introduces an evidence-based approach to understanding HSP.  It will begin with a review of the literature on the causes of HSP and introduce a simple schema for assessing pain in acute and chronic hemiplegia.  The second part of the presentation will focus on research evidence on treatment effectiveness, and will tie specific evidence-based interventions to the assessment categories previously described.  Participants will leave the session with a practical, evidence-based framework for assessing and treating this challenging clinical condition.

Occupation Based Cognitive Assessment & Intervention After Stroke

Glen Gillen, EdD, OTR, FAOTA; Columbia University, New York, NY

This session will compare and contrast various methods of assessing cognition after stroke. It will highlight the use of performance based assessments and provide several examples. Various approaches to improving occupational performance for those with cognitive impairment will be reviewed with a focus on strategy training. Specific evidence based interventions will be discussed. The main theme of this presentation is to highlight occupational therapy's unique contribution to this area of practice.