A stroke is ‘a clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24hours or leading to death’ (WHO,1978) Occurs when the blood supply to part of your brain is obstructed Two types of stroke; Ischaemic - when parts of the brain are starved of O 2 and nutrients due to a blockage in a blood vessel Haemorrhagic - when a weakened blood vessel supplying the brain, bursts and causes blood to flow into the brain which will then clot quickly and stop parts of the brain from functioning properly (NHS Choices, 2013) LEFT MCA INFARCT WITH FRONTAL CONTUSIONS IMPACT OF STROKE ON JANE’S OCCUPATIONAL PERFORMANCE PERSONAL REHAB GOALS GUIDELINES ON STROKE REHAB REFERENCES APPLIED SCIENCES 1: OCTH2001 BY ANABEL CEJUDO RUBIO STUDENT ID: HOW HAS JANE DOE* BEEN AFFECTED BY HER STROKE? OVERVIEW OF CANDIAN MODEL OF OCCUPATIONAL PERFORMANCE AND ENGAGEMENT WHAT IS A STROKE? PHYSICAL & COGNITIVE IMPAIRMENT AFFECTS ABILITY TO PARTICIPATE IN OCCUPATION AFFECTS ABILITY TO INTERACT WITH ENVIRONMENT AFFECTS MOTIVATION AND MENTAL WELLBEING Duncan E. (2012) Blockage in the Middle Cerebral Artery Has led to ischaemic stroke in left hemisphere of her brain Possibly affected her Premotor Cortex as this part of the brain is supplied by the MCA Can cause issues with: Movement and sensation Attention, memory and judgment Perception Speech Vision (The Ohio State University Medical Centre, 2008) ↓ Sensory processing, coordination & mobility in right UL – Has impacted ability to participate in domestic and leisure activities ↑ Fatigue Ideomotor and articulatory Apraxia Expressive Aphasia ↓ reading and writing ability ↓ mobility NOTE: The colours in this flow chart relate to the CMOP-E diagram above To use right hand during kitchen tasks 50% of the time – completed in 2 weeks To be able to write a shopping list of 5 items independently – completed in 3 weeks To be mobile outside over short distances with 3- wheeler – completed in 3 weeks To improve her ability to use and talk on the telephone To improve her speech fluency and word finding CANADIAN MODEL OF OCCUPATIONAL PERFORMANCE AND ENGAGEMENT IN RELATION TO JANE A minimum of 45 minutes for each visit of each appropriate therapy should be offered. Minimum of 5 days a week for therapy. Promotion practice of skills gained in therapy in daily routine needs to be advised by all staff. Therapy assistants and nurses should facilitate rehab under the guidance of a qualified therapist. (Royal College of Physicians, 2012) Duncan, E. (2012) Foundations for Practice in Occupational Therapy. United Kingdom: Elsevier Science Health Science div. Intercollegiate Stroke Working Party. National clinical guideline for stroke, 4th edition. London: Royal College of Physicians, Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H. and Pollock, N. (2004) Canadian Occupational Performance Measure. Available at: (Accessed: 25 March 2015). National Health Service, Stroke - NHS Choices (2014). Department of Health. [online] Available at: (Accessed: 25 March 2015). The Ohio State University Medical Centre (2008) Effects of Left Middle Cerebral Artery Stroke. Available at: education.osumc.edu/documents/LeftMidCerebralArteryStroke.pdf (Accessed: 25 March 2015). World Health Organisation (WHO), 1978 Cerebrovascular Disorder: A Clinical and Research Clasification. Geneva: World Health Organisation. Offset Publication. * This name has been changed to maintain patient confidentiality CANADIAN OCCUPATIONAL PERFORMANCE MEASURE Is an outcome measure that is used to detect change in a client’s perception of occupational performance over time which is very client based Gives patients the opportunity to identify the problem areas they feel are the most important to work on. (Law et al., 2004) I and my Practice Educator carried out the COPM with Jane. She identified 3 main issues: Using the telephone (performance: 3→ 7 & satisfaction: 5→ 7) Problem with word finding; (performance: 4→ 6 & satisfaction: 4→ 6) Use of right upper limb (performance: 4→ 5 & satisfaction: 5→ 2) Has improved remarkably and has reacted well to rehab considering her age of 81