#WorldStrokeDay: Occupational therapists' key role in rehabilitation of stroke survivors

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This is according to a group of researchers from Stellenbosch University (SU) and the University of the Western Cape (UWC). They searched two leading healthcare databases for relevant systematic reviews published between 2018 and 2023 on the role of occupational therapy in stroke care and recovery. The aim was to gather evidence on how occupational therapists work with stroke patients of all ages and at all stages of care.

Their findings were published recently in the South African Journal of Occupational Therapy.

Stroke recovery

Speaking ahead of World Stroke Day on 29 October, lead researcher Dr Madri Engelbrecht from the Division of Disability and Rehabilitation Studies at SU said, “Stroke is the second leading cause of death in the world, with most deaths occurring in low-income countries. As strokes become more common in sub-Saharan Africa, it’s important to explore how occupational therapy can help in stroke recovery.” She conducted the study with Janke van der Walt and Hester van Biljon from SU and Shaheed Soeker from UWC.

According to the researchers, evidence from the past five years reflects diverse occupational therapy interventions with people who had a stroke and the profession’s commitment to addressing impairments and individual needs.

Out of all the articles they reviewed, nine showed evidence of occupational therapy helping with upper limb problems after a stroke. Six articles discussed how occupational therapy improves stroke survivors’ overall function, three focussed on cognitive interventions, two reported on interventions that address mobility, balance, social participation, work, and leisure activities. One article reported on how occupational therapy helps with daily living activities, while another focussed on support interventions for caregivers.

"Clients who received upper limb rehabilitation after a stroke included adults up to the age of 73 with arm impairments. Their recovery ranged from the early stage (8.5 days after stroke) to the long-term stage (6.2 years after stroke). Only one article clearly mentioned where the intervention took place ie. at a clinic, at the client’s home, or in a research laboratory," said the researchers.

Tele-rehabilitation and OT intervention

“One article reported on an updated systematic review of evidence for tele-rehabilitation, while the rest of the articles reported on face-to-face or in-person intervention. Therapists offered motor rehabilitation for paralysis of one side of body and upper limb limitations, interventions for ankle disability, cognitive rehabilitation and therapy for depression through tele-media such as telephones and videoconferencing. The review concluded that tele-rehabilitation is effective in treating motor and cognitive deficits, as well as post-stroke depression.

“Two articles focused on non-drug interventions aimed at relieving spasticity (when muscles become tight or stiff after contracting for long periods) and immobility-related complications, as well as improving physical function after a severe stroke.”

The researchers add that caregivers of stroke survivors also benefit from occupational therapy intervention.

“Providing them with cognitive behavioural therapy techniques (identifying and changing negative thought patterns and behaviours), education, training, and support – preferably before a person with a stroke has been discharged – can help them cope with the challenges of caregiving and in maintaining their own well-being.”

According to the researchers, the different intervention approaches reported to treat stroke survivors illustrate occupational therapy’s potential to use innovative practices, methods and technologies, and also demonstrate the profession’s alignment with global trends of integrating technology with healthcare services to overcome geographical and accessibility barriers.

Recommendations

Based on their findings, the researchers made the following recommendations for occupational therapy practice:

“Occupational therapists should use a holistic approach in stroke rehabilitation, customising their treatments to meet the unique needs and goals of each stroke survivor. They should also stay informed about emerging technologies and evidence-based practices to enhance their effectiveness.

“Given the prevalence of upper limb impairments after a stroke, therapists should be well-versed in diverse intervention approaches for upper limb rehabilitation, including technologies like brain computer interface, mental practice, mirror therapy, and action observation therapy.

“Since occupational therapy is vital in addressing cognitive impairments in stroke survivors, practitioners should explore interventions such as virtual reality and computer-assisted cognitive rehabilitation that have shown promise in improving cognition and the ability to perform basic daily tasks.”

Because South Africa’s public health system is under-resourced, the availability, access to, and use of technology by the country’s occupational therapists in stroke rehabilitation must be carefully considered to optimise rehabilitative interventions for local clients, added the researchers.

They emphasise the urgent need for studies that are relevant to South Africa.

“Future studies should aim to clarify the optimal intensity and duration of interventions, determine long-term outcomes, and explore the cost-effectiveness of these approaches. Of interest would be the level of training, skills, and experience of therapists offering sophisticated stroke rehabilitation in the country.”

Source: Engelbrecht M, Van der Walt J, Van Biljon, HM, Soeker, SM. Occupational therapy for cerebrovascular accidents: a rapid review of evidence: South African Journal of Occupational Therapy, Vol. 54 No. 2 (2024).