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

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

3. 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

4. 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

5. 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

6. Role of OccupationaL Therapy after Stroke

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

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

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. Occupational Therapy after a Stroke

16. 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

17. References
Acute and Preventative Treatments (2007). American Stroke Association. Retrieved from
Diagnosis. (2007). American Stroke Association. Retrieved from
Diagnosis. (2007). Society of Interventional Radiology. Retreived from
Impact of Stroke. (2007). American Stroke Association. Retrieved from
Neurological Diagnostic Tests and Procedures. (2006). National Institute of Neurological Disorders and Stroke. Retrieved from
Stroke. (2006). Mayo Clinic. Retreived from
Stroke. (2005). Medline Plus. Retrieved from

18. References
Stroke Prevention & Treatments. (2007). Society of Interventional Radiology. Retrieved from
Transient Ischemic Attack Information Page. (2006). National Institute of Neurological Disorders and Stroke. Retrieved from
What are the Types of Stroke? (2007). American Stroke Association. Retrieved from