Occupational Therapy and Stroke
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Occupational Therapy and Stroke Second Edition Edited by Judi Edmans On behalf of the Stroke Clinical Forum of the College of Occupational Therapists Specialist Section Neurological Practice A John Wiley & Sons, Ltd., Publication Occupational Therapy and Stroke Occupational Therapy and Stroke Second Edition Edited by Judi Edmans On behalf of the Stroke Clinical Forum of the College of Occupational Therapists Specialist Section Neurological Practice A John Wiley & Sons, Ltd., Publication This edition first published 2010 C ! 2010 Blackwell Publishing Ltd Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell. Registered office John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom Editorial offices 9600 Garsington Road, Oxford, OX4 2DQ, United Kingdom 350 Main Street, Malden, MA 02148-5020, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Occupational therapy and stroke / edited by Judi Edmans on behalf of the Stroke Clinical Forum of the College of Occupational Therapists Specialist Section Neurological Practice. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-9266-8 (pbk. : alk. paper) 1. Cerebrovascular disease–Patients–Rehabilitation. 2. Occupational therapy. I. Edmans, Judi. II. College of Occupational Therapists. Specialist Section Neurological Practice. Stroke Clinical Forum. [DNLM: 1. Stroke–therapy. 2. Disabled Persons–rehabilitation. 3. Occupational Therapy–methods. WL 355 O15 2010] RC388.5.O33 2010 616.8"1062–dc22 2010003297 A catalogue record for this book is available from the British Library. R Set in 10/12.5 pt Times by Aptara! Inc., New Delhi, India Printed in Malaysia 12010 Contents List of Contributors ix Foreword xi Preface xiii Acknowledgements xv 1Introduction 1 Judi Edmans, Fiona Coupar and Adam Gordon Definition of stroke 1 Impact of stroke 1 Symptoms of stroke 2 Causes of stroke 3 Classification of stroke 4 International Classification of Functioning, Disability and Health 4 Medical investigations following stroke and TIA 6 The prevention of recurrence of stroke (secondary prevention) 7 Neuroanatomy 9 Damage that can occur in different areas of the brain 13 Policy documents relating to stroke 13 Self-evaluation questions 23 2TheoreticalBasis 24 Janet Ivey and Melissa Mew Introduction 24 Theoretical constructs 24 Conceptual models of practice 25 Frames of reference 27 Neuroplasticity 29 Intervention approaches 36 Self-evaluation questions 47 vi Contents 3TheOccupationalTherapyProcess 49 Melissa Mew and Janet Ivey Introduction 49 The occupational therapy process 49 Procedural reasoning in different stroke care settings 53 Professional duties 60 Self-evaluation questions 63 4EarlyManagement 64 Sue Winnall and Janet Ivey Introduction 64 Prior to assessment 64 Initial interview 66 Initial assessment 67 Intervention 75 Equipment 75 Other impairments impacting on functional ability 77 Swallowing 80 Mood 81 Fatigue 83 Self-evaluation questions 84 5ManagementofMotorImpairments 86 Stephanie Wolff, Ther´ ese` Jackson and Louisa Reid Introduction 86 Assessment 86 Management principles and intervention 90 Therapeutic aims of intervention 91 Positioning the early stroke patient 91 Clinical challenges 109 Upper limb re-education 111 Avoiding secondary complications 112 Self-evaluation questions 116 6ManagementofVisualandSensoryImpairments 117 Melissa Mew and Sue Winnall Introduction 117 Visual processing 119 Somatosensory processing 127 Auditory processing 137 Vestibular processing 139 Olfactory and gustatory processing 141 Self-evaluation questions 142 Contents vii 7ManagementofCognitiveImpairments 144 Ther´ ese` Jackson and Stephanie Wolff Definition of cognition 144 Cognitive functions 144 Assessment of cognitive functions 144 Cognitive rehabilitation 146 Attention 147 Memory 149 Language 151 Motor planning and apraxia 151 Executive dysfunction 155 Self-evaluation questions 157 8ManagementofPerceptualImpairments 158 Louisa Reid and Judi Edmans Introduction 158 Definition of perception 158 Normal perception 158 Perceptual impairments 160 Perceptual assessment 162 Intervention 165 Self-evaluation questions 172 9Resettlement 173 Pip Logan and Fiona Skelly Home visits 173 Community rehabilitation 174 Support available after a stroke and self-management 177 Carers 178 Younger people 180 Lifestyle and long-term management 180 Leisure rehabilitation 181 Getting out of the house and transport 183 Driving after stroke 185 Vocational rehabilitation 186 Resuming sexual activity 188 Stroke education 189 Self-evaluation questions 190 10 Evaluation 191 Fiona Coupar and Judi Edmans Record keeping 191 Standardised assessments 195 Evidence-based practice (EBP) 199 viii Contents Outcome measures 203 Standards 206 Self-evaluation questions 207 Appendix: One-Handed Techniques 208 References 212 Definitions 229 Useful Books 231 Useful Organisations 233 Index 241 List of Contributors Fiona Coupar, University of Glasgow, Glasgow Dr Judi Edmans, University of Nottingham, Nottingham Dr Adam Gordon, University of Nottingham, Nottingham Janet Ivey, Llwynypia Hospital, RCT, Mid-Glamorgan, South Wales Ther´ ese` Jackson, NHS Grampian, Scotland Dr Pip Logan, University of Nottingham, Nottingham Melissa Mew, Bournemouth University, Bournemouth Louisa Reid, National Hospital for Neurology and Neurosurgery, London Fiona Skelly, Community Rehabilitation Team, Rotherham Sue Winnall, Mile End Hospital, London Stephanie Wolff, Manchester Royal Infirmary, Manchester Foreword Occupational therapists working with people who have had a stroke will be delighted to learn that there is a new edition of this popular textbook. The book has again been produced on behalf of the College of Occupational Therapists Specialist Section Neurological Practice, under the enthusiastic editorship of Dr Judi Edmans. Since the last edition, the text has been substantially and comprehensively updated in terms of the research evidence presented. It has also been placed in the context of national developments and initiatives in stroke care to span the entire stroke spectrum – from aetiology through to resettlement and evaluation. However, it still remains a practical guide, written in user-friendly terms, which provides an excellent reference manual for both those starting out in the stroke field and established practitioners. The overall format and structure of the book is clear and logical. The addition of good-quality illustrations brings the text to life, and many will find the self-evaluation questions with each chapter useful. Special mention must go to Chapter 1 which provides acomprehensivebackgroundtostrokeandtoChapter4onearlymanagement. Above all, the book underlines the important and unique role of occupational therapy in the treatment and care of people with a stroke. Dr Avril Drummond Associate Professor in Rehabilitation University of Nottingham Preface This book is a timely update of the first edition of Occupational Therapy and Stroke (Edmans et al.,2001).AlthoughtargetedforpracticeintheUK,thefirsteditionsoldover 5000 printed copies with countless hits from e-book access worldwide and has proven to be a well-thumbed and well-known book for occupational therapists working in stroke all over the world. Since the last edition of the book, evidence-based quality stroke services have come to the forefront of the government agenda throughout the UK with the release of national stroke guidelines, stroke service strategies and initiatives such as the Stroke Research Networks, the Stroke Association’s annual multidisciplinary UK Stroke Forum conference and an imminent Stroke-Specific Educational Framework. It is an exciting time to work in stroke services, and this book is intended to compliment these works to provide a more in-depth, practical, evidence-based guide for occupational therapy students, newly qualified occupational therapists, those new to stroke management