OT + Neurological Rehabilitation

Driving After a Stroke

Here's another external article I found recently, regarding important factors to consider when someone wishes to return to the wheel. Written in 2024, it is aimed at the public rather than clinicians, so is fairly easy-reading - but I think it is a good one to signpost to those you support!

Here's an excerpt from the article:

'If you find yourself driving too fast or too slow for road conditions or posted speeds, getting lost in familiar areas, making slow or poor distance decisions, or having close calls, working with an occupational therapist who specialises in driver rehabilitation can be an important first step in getting back on the road safely. Training sessions not only assess if you’re road-ready, but also help you get the skills you need to drive safely... 

Request a comprehensive neuropsychological evaluation, often completed by a neuropsychologist, that assesses cognitive strengths and weaknesses and helps inform your treatment plan. Early cognitive therapy is a crucial component and is typically carried out by an occupational therapist, speech-language pathologist, and occasionally by the neuropsychologist themselves.  

In my case, returning to driving took patience, work and a bit of good fortune, but the brain is an amazing organ. After a lot of language therapy and the time it took for my brain to heal - a natural process called neuroplasticity - I have been driving for the past 12 years.'

Personality changes after stroke

Hi again all. Here's an external article I came across recently about personality changes (cognitive and behavioural) post-stroke. Written in 2024, it is aimed at the public rather than clinicians, so is fairly easy-reading - but it summarises the breadth of changes well:

Some post-stroke behaviour and emotional changes occur due to the brain damage itself; others can be caused by the stress of coping with what the article calls a 'new normal'.

An excerpt from the article:

'"For example, if a stroke caused damage to the frontal lobe, which controls personality, concentration, organisation and problem-solving, a formerly cautious person may become impulsive and disorganised," Dr. Schirmer says. "If damage occurred to the temporal lobe, which controls the ability to understand language, hearing and memory, a formerly outgoing person may have trouble communicating and remembering names, and shy away from socialising."

But besides resulting from the physical effects of brain damage, further personality changes after a stroke may arise from the trauma of the event itself - and from new physical limitations and life changes that result.'

Downloadable PDF: 'Occupational Therapy and Neurology'

To all interested in this specialism, we have produced a related document, in PDF format. In Version 1.0 of Occupational Therapy and Neurology, we first provide a compiled ‘A-to-Z’ of commonly used and standardised assessments and interventions. Brief outlines are followed by web links to read more, download the tool, or watch a video demonstration.

The majority of assessments can be repeated at intervals, providing clinicians with outcome measures that demonstrate progress made by clients/patients/service users. Many of these tools were designed for stroke and brain injury rehabilitation, but can be used with other diagnoses and pathologies. It is worth noting that the evidence base is ever-changing. Therapists should consult with senior practitioners on which tools are most appropriate for their setting and client group.

The final pages of this document focus on key considerations for working with traumatic brain injury (TBI). They outline an easy-read summary of findings from ‘Evidence-Based Practice for Traumatic Brain Injury: A Cognitive Rehabilitation Reference for Occupational Therapists’. These takeaways provide added focus for your treatments and rehab planning.

Number of pages: 11

If you have upgraded to Membership Plus+, this is free to you, via IOT DownloadsI. Otherwise, anyone can purchase the document below, via the IHub StoreI:

This such an interesting thread - thank you for posting.

My experience has been a mixed bag of inpatient and community neuro-rehab and I'd agree that communication and getting the client on board is key. Motivational interviewing is really helpful and I'm now interested in looking at the Empowerment behavioural management approach.

I use MOHO, COPM and GAS goals to guide intervention. We don't use a standardised upper limb assessment Jamie but have a general form to record relevant physical, sensory and medical information, ROM, different grips and then how thos translates into functional issues, then a plan.

I'm really interested in the use of VR in upper limb rehab having recently attended a presentation about this. It was based around pain management but has so many applications.

Love OT . Worked as a an OTA State Hospital Mental Health Provider, (1993.-2002) . as well as many other areas such as Easter Seals, In patient hospital , group homes My education was provided by the best OT Instructors - they taught us more/ above what was required/ educational experiences fieldwork! Best tumes un my kife as an older 30 yr old qst time college / as a single parent!! And my favorite courses were rehan/neurology. Then ironicly, I sustained a SCI at age 53...c5-c7 incimplete SCI / freak Accident! I was beginning another OTA position in nursing home Physical ADL'S therapy, and made it only 4 days before i collapsed on the job! Apparently when i initially stubbed/ broke my left little toe, and rather than just fall down, i struggled to remain upright and 'whipplashed my neck/head. Not discovered for 3 months when i needed emergency surgery March of 2011!!! So I try to look at now having real lufe neuro training/experiences bc had i not been OTA Trained/ Educated, I wouldnt have known what i was up against in needing to keep moving every body part i could. The information told to me, " dont expect youll ever walk again!" Thats all i kept hearing, and i tokd the drs and nurses, No not me! Im an OT provider, i have to finish my lifes work! And I did@ thos time itcwas/still is, for me!!!

Such a cool and visual pictorial! Summarizes up what we assess and the complexity of cognition!

I'm currently struggling a bit with being able to measure "initiation" - can only do it functionally and based on observation at the current time and exploring with my patient into what motivates and will cue her to get "up and going" especially when she goes home!

Otherwise today I've used the COGNISTAT and the Rivermead Behavioural Memory test. All used alongside functional tasks to see how my patients would be affected with their goals for rehab :)

Executive Function

A branch of cognition I assess daily, here's a handy graphic I recently came across, summarising elements of executive function:

Full image credit to Pepper Kids Therapy. If you have insights or tools related to executive function, I'd love to hear about them. If so, comment below! Jamie

'How to Manage Spasticity After a Stroke'

Summary:

• Post-stroke spasticity can make it difficult to stretch, move and accomplish daily tasks.

• Modifying your home, working with an occupational therapist, practicing daily exercises, and using mobility aids can help you manage spasticity.

• Treatments, such as injections and medications, can help reduce long-term damage from spasticity.

Interested? Read full Healthline article here

Hi Jamie,

I am an independent OT who works with adults in the community who have had suffered a TBI. Before this I worked in both acute and inpatient neurorehab in London.

I mostly work in cognitive-behavioural rehabilitation and from my perspective, it is important to know about the impairment stuff and pathology of injuries however, in my experience, the medical model is not so useful for guiding OT in long term neuro rehab. If you see people who are 1 -2 years post injury, understanding the biopsychosocial model will guide your rehab much better and help you formulate treatment plans.

I would advise you go back to the routes of OT as discipline. I would recommend reading some of Karen Hammells work on the limitations of using the ICF and OT client centred practice. Neuro-rehab in the community is as much about mental health and coping with changes to identify, as it is to do with 'cognitive rehab'. Compensation strategies rarely work unless the individual is ready in themselves to start using them. The complexity as of rehab is supporting them to get to that point.

The MOHO provides some good grounding for thinking about the individual as an occupational being. Also useful is theories such as Occupational identity, occupational justice and deprivation.

You should also consider about your communication skills and how you interact with the client. Motivational interviewing has good elements to it. Be aware of its limitations though. Mark Holloway wrote a good article discussing this (2016 I think.

A recent model that is being used in the community is the Empowerment behavioural management approach. There is chapter about this is Neuropsychological rehabilitation (2017). This considers the system around the client and is about empowering them rather than others making choices for them. This is particularly relevant for OT when considering goal development and how you communicate to clients. Its also a framework to guide support workers and families.

Fatigue management is another area if real importance that OTs are involved in. Donna Malley has done some really good articles about this. Her research paper 'Fatigue after ABI: A model for clinical management' is great.

I hope this is helpful. Let me know if you have any questions about the above!

BW

Alex

I work in the only secure NHS acquired brain injury unit in the north west....we use MOHO assessments & outcomes ....our main focus is risk ...we’re looking to add to our range of assessments

@Shawn Phipps could you share a few ideas, links or resources here? We loved your TED talk!

Case Study: Stroke Rehabilitation - Assessment and Upper Limb Intervention

I first met 'Mr. M' on a stroke ward, when I assisted another occupational therapist with the patient’s self care (wet shaving). On discharge to the stroke discharge team, I led and co-facilitated Mr. M’s upper limb assessments, with regular visits to his home. I was then able to lead a home exercise programme (HEP) and shaving intervention, both of which were meaningful to him and focused on key skill deficits following his stroke.