Pre-Conference

TRENDS AND CONTROVERSIES IN OCCUPATIONAL THERAPY FOR PERSONS WITH STROKE

            This pre-conference institute will intertwine findings from my studies, from that of others, and from current international practices and focus on neurological recovery for the arm; hand; leg; face; and adaptive recovery following stroke and resulting hemiplegia. 

            While it is recognized that rehabilitation is the only effective way to maximize recovery for persons with stroke, there are many concerns expressed about its efficacy.  Therapists' strategies must counter these concerns by developing the evidence-base, by profiling persons with hemiplegia who could benefit most from rehabilitation, by understanding current concepts and controversies in stroke recovery, and by demonstrating efficacy in maximising quality of life.  Vital ingredients include correct interpretation of CNS squeal to insult, and moving away from monolithic approaches to modular intervention strategies to keep pace with new neuroscience knowledge.

            Recent re-analysis of endarterectomies and transient ischemia demand therapists shift focus from just post-stroke rehabilitation to encompassing active participation pre-stroke to promote healthy life styles for persons with transient symptoms and pre-arranged stroke admissions.  The hypothesis is that improved quality of life could be achieved by evaluation of pre-morbid status and developing strategies to increase willingness to alter life style to coerce bad habits down for better health. 

            Such intertwined modular treatment approaches for maximising neurological recovery could include: (i) self-modelling, imagery, and mental rehearsals to prepare the CNS to respond (ii) positioning to minimise oedema and preventing contractures (iii) mobilizing proteins and absorbing excessive intracellular fluids via pressure garments (iv) manipulating precisely to facilitate sustained stretch (v) unmasking the neural pathways for functional reorganization with EMG biofeedback (vi) maintaining muscle viability via functional electrical stimulation (vii) stimulating micro electrically for repetitive movement set network (viii) percolating and exciting non-specific nervous system via high intensity exteroceptors (ix) provoking proprieoceptors during volitional effort (x) maintaining obtained gains by orthotics application that allow to splint beyond the point of stretch reflex (xi) stimulating ipsilateral motor cortex by hierarchy of occupation based tasks as evidenced by fMRI (xii) minimizing and reversing learned neglect via CIMT with repetitive tasks (xiii) establishing wrist stability using natural viscoelastic property (xiv) utilising hand and wrist exercises based on motor learning, neuromuscular facilitation, and perceptual motor integration (xv) empowering the individual with immersive virtual reality (xvi) using perceptual ingram via unaffected hand image (xvii) establishing use of rectus femoris, ilio-psoas and hamstrings via decreased orthogonal distance during pre-gait training (xviii) avoiding circulatory stasis in lower limbs from dependency wheelchairs (xix) integrating appropriate muscle tension for phasic and dynamic tasks such as transferring from one surface to another (xx) minimising pain and intractable spastic influences by Botulinum Toxin A to block acetylcholine.

            For adaptive recovery it is important to determine which functional dependency measure to use.  Evidence supports the superiority and the use of the Modified Barthel Index for example as a measure of activities of daily living function, dependency needs, type of housing people would need, increased ability to interact with their own environment and thus improving quality of life.  For adaptive recovery, it will show outcomes of the MBI sensitisation, its predictive ability for independent functioning, and its ability to measure efficacy and effectiveness of comprehensive rehabilitation. 

Objectives

·        Participants will understand the distinction between neurological recovery and adaptive recovery after stroke induced hemiplegia.

·        Participants will be able to correctly interpret CNS squeal to insult, and learn to move away from monolithic treatment models to modular intervention strategies to incorporate free standing components to keep pace with neuroscience knowledge.

·        Participants will learn how voluntary movement and tone changes occur in persons with stroke induced hemiplegia and why though stereotyped, why the clinical presentation is different.

·        Participants will learn the neuroscience basis of evidence-based and current occupational therapy intervention approaches to maximize neurological recovery in the (i) face (ii) upper limb (iii) hand, (iv) leg and, (v) primary prevention contribution by occupational therapists.

·        Participants will be able to determine why the Modified Barthel Index is one of the most favored activities of daily living measures and is the measure of choice in stroke and neurological rehabilitation outcomes.

·        Participants will be able to calculate the expected discharge functional outcome score as a prediction of outcome at the commencement of stroke rehabilitation.