Four Things to Remember with CVA/Stroke
Aimee Wagner, OT sees every diagnosis that comes through her therapy department and works across inpatient, outpatient and home health settings. Aimee sees a lot of CVA/stroke patients, but even as the sole OT it’s a rare opportunity to treat a patient recovering from stroke through the whole gamut of therapy.
When a patient is admitted to our hospital after a fairly significant stroke, they may leave after the initial few weeks of acute therapy and go directly into a specialized rehab center where they receive more intensive therapy. Occasionally we will see a patient who has suffered a stroke from beginning to end.
Working with someone all the way through their therapy is a very satisfying professional experience. If you provide therapy services across both inpatient and outpatient at your facility, it’s helpful to remember these four things during the time you have with a patient before their final discharge from therapy.
In the acute phase we just want motion. I tell my patients, “Whatever you can do to use that arm, whatever motion you can do, is good.” I find often that a patient may not lift their arm but they can bring it down. Or they can’t flex, but they can extend. Go through all the motions and see what they do have, and use it as motivation and build on that discovery. Show them they still have life in that arm. When patients see they have movements, they will be more motivated continuing into the next stages of therapy.
Change and Collaborate
When it comes to strictly following evidence-based practice or following personal technique, we all have life experiences. I use those to build on therapy strategies, but it’s definitely based in research. When you find good research you can use it, and if it doesn’t work, try something else. Every patient I see, no matter the diagnosis, I’m constantly changing things and reassessing to individualize my treatment plan.
I’m lucky here because each of my fellow therapists has their own specialty and we’re always learning from each other. There will be situations where you’ve tried everything you know and just have to say, “I’m stuck.” I ask for help from my department (6 PTs, 5 PTAs and a COTA). I guarantee I come away with at least five different pieces of advice to try. It’s helpful to collaborate across disciplines.
Think Outside the Box
Activities that surprise my patients the most are two of my favorite for fine motor restoration. The first involves playing cards and working with the patient to re-learn how to shuffle or build card houses. Cards make them slow down and focus. Building card houses takes precision and a soft touch. With activities after a CVA injury, gross movement can be abrupt, and these activities help with the finesse of movement.
Another strategy I use to get fingers moving is to have patients do the American Sign Language alphabet. It makes therapy fun, and they are usually learning something new. It isolates fingers and makes them move in different directions. It’s a fun way to get a lot of mobility and coordination back in the hands.
A lot of times you’ll work with a patient and just hit a wall. Every person recovering from a stroke is different, so treatment strategies when sessions feel unsuccessful can and should vary dependent on the individual’s situation and what is observed and heard from the patient. Sometimes patients will plateau because they aren’t following through at home. It’s important to have a conversation and educate them and reiterate the importance of following through with a home-exercise program to ensure carryover from therapy to real life.
Other times you can fight a plateau by remembering we’re not just working the physical aspects. A stroke can hit people hard and may cause depression. It’s important to be aware of the mental status of your patients on a day-to-day basis, so you know if you need to push them or work on something else.
Hopefully you can keep identifying something that motivates your patient so they continue to meet goals and prove they can still benefit from therapy. Unfortunately, there are times when patients will hit that final plateau. It’s hard for therapists because we can’t just work on someone forever if they aren’t making progress, and eventually you have to discharge them.
Until that time, keep stocked with a combination of evidence-based-practice treatment ideas, some out-of-the-box ideas to keep things fresh and challenging for CVA patients, and remember that sometimes what you are up against is an internal mental battle—be aware of the mind while treating the body.
A graduate of Creighton University, Aimee Wagner, OT has been with RehabVisions since 2009.