DR. PAUL L. PENOLIAR, OTD, OTR/L, C/NDT City of Carson stroke symposium 2016 Health care & self-care: a medical perspective

Lifestyle Risk Factors Being overweight or obese Heavy or binge drinking Use of illicit drugs such as cocaine or methamphetamines Physical inactivity

PREVENTION Control high Blood Pressure Lower cholesterol Quit smoking Control diabetes Maintain healthy weight Exercise Manage stress Eat a health diet Healthly people – aim for 30 min/day or 2 hr and 30 min per week of moderate physical activity, like brisk walking To lower BP – aim for 40 min of vigorous activity 3 or 4 times per week Include flexibility, stretching Strengthening 2 times per week Diet –low in sodium but rich in fruits, vegetables, high fiber foods, fat free or low fat dairy, beans, skinless chicken, lean meats and fish

PROGNOSIS The results of a stroke vary depending on the size and location, the presence of any associated medical problems, and the likelihood of recurring strokes Dysfunctions correspond to the area in the brain that had been damaged

Interdisciplinary Team Approach Patient Patient’s family Primary physician Neurologist Rehabilitation nurse Clinical psychologist Occupational Therapist Physical Therapist Speech-Language Pathologist Dietitian Social Worker Neurologists – physicians trained in the treatment and diagnosis of brain and central nervous system disorders and diseases Rehab nurse – nurses with a specialty in rehabilitation Clinical psychology – branch of psychology concerned with treatment of mental illness and psychiatric problems Dietician – will design special diet plans and counsel patients on specific modifications Social worker – case manages the clients needs and advocates to obtain resources required

Role of OccupationaL Therapy after Stroke

What is Occupational Therapy? Occupational therapy is skilled treatment that helps people become successful in their everyday occupations.

Visual Deficits Loss of acuity, double vision Visual form constancy Visual figure ground Visual spatial neglect Hemianopsia (blindness in ½ of visual field)

Sensorimotor Hemiplegia (paralysis) and or hemiparesis (partial paralysis or weakness) on the side of the body opposite of the stroke Hypertonicity or hypotonicity of muscle on the involved side Contractures Decreased tactile sensation Perceptual motor impairments: Unilateral neglect, apraxia, agnosia

Speech and Language Aphasia – loss of the ability to produce and/or understand language Fluent Aphasia Produces speech but auditory and comprehension is limited Wernicke’s aphasia (Receptive aphasia) Nonfluent Aphasia Speech output that is difficulty to produce Slow awkward articulation with limited vocabulary and grammar Well preserved auditory and comprehension Broca’s aphasia (Expressive aphasia)

Cognition May have problems with: Attention Orientation Concentration Reasoning Judgment Problem solving Sequencing and organization OT’s role is to focus on adaptive abilities of planning judgment, problem solving, and initiation

Psychosocial Aspect Patient may be: Depressed Labile or apathetic Angry or easily irritated Impulsive Anxious All of these factors could cause difficulty with social activities

Impairment: Implications for OT Activities of daily living Interests, leisure skills Work productivity Roles and role functions Social and family support Language and communication Cognitive functions Motor skills Muscle strength and tone Range of motion Fine motor coordination Praxis and motor planning

Role of Occupational Therapy Occupational function is the focus for an OT Primary goal = improve independence in daily living tasks and the patient’s quality of life Reduce disability and impairments by engaging patient’s in meaningful activities Teach compensatory methods for performing important tasks and activities Use affected limb whenever possible Teach remedial treatment strategies

Occupational Therapy after a Stroke

F.A.S.T. F – FACE: Has their face fallen on one side? Can they smile? A – ARMS: Can they raise both arms and keep them there? S – SPEECH: Is their speech slurred? T – TIME: Time to call 911 if you spot any single one of these signs

References Acute and Preventative Treatments (2007). American Stroke Association. Retrieved from http://ww.strokeassociation.org/presenter.jhtml?identifier=2532 Diagnosis. (2007). American Stroke Association. Retrieved from http://www.strokeassociation.org/presenter/.jhtmlidentifier=2552 Diagnosis. (2007). Society of Interventional Radiology. Retreived from http://www.sirweb.org/patpub/strokediagnosis.shtml Impact of Stroke. (2007). American Stroke Association. Retrieved from http://strokeassociation.org/presenter/jhtml?identifier=1033 Neurological Diagnostic Tests and Procedures. (2006). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.html Stroke. (2006). Mayo Clinic. Retreived from http://mayoclinic.com/health/stroke/DS00150 Stroke. (2005). Medline Plus. Retrieved from http://www.nim.nih.gov/medlineplus/ency/article/00726.htm

References Stroke Prevention & Treatments. (2007). Society of Interventional Radiology. Retrieved from http://www.sirweb.org/patpub/stroketreatments.shtml Transient Ischemic Attack Information Page. (2006). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/tia/tia.html What are the Types of Stroke? (2007). American Stroke Association. Retrieved from http://www.strokeassociation.org/presenter.jhtml?identifier=1014