From the Research
Approximately 30-40% of patients with minor stroke require occupational therapy follow-up in the chronic phase of stroke. This need persists despite the initial classification of their stroke as "minor," as many patients develop subtle but significant functional impairments that become apparent weeks to months after the acute event. These impairments often include difficulties with fine motor skills, executive functioning, and instrumental activities of daily living that weren't immediately evident during hospital discharge.
Key Considerations
- The need for occupational therapy in the chronic phase is particularly important for patients who experience fatigue, mild cognitive impairment, or those who attempt to return to complex work environments or independent living situations.
- Early identification of these patients through standardized assessments like the Montreal Cognitive Assessment (MoCA) or the Assessment of Motor and Process Skills (AMPS) can help determine who might benefit from continued therapy, as suggested by 1.
- Regular follow-up evaluations at 3,6, and 12 months post-stroke are recommended to identify emerging functional challenges that weren't apparent during the acute recovery phase.
Evidence-Based Recommendations
- The most recent and highest quality study, 2, provides strong evidence for the effectiveness of occupational therapy interventions in improving performance and participation in daily activities and occupations for stroke survivors.
- Another study, 3, highlights the benefits of virtual reality therapy in upper limb motor function and manual dexterity for stroke patients, particularly when combined with traditional therapy.
- However, the study with the most direct relevance to the question of the percentage of patients requiring occupational therapy follow-up, 1, suggests that occupational therapy may result in little to no clinical difference in basic activities of daily living immediately after intervention and at three and six months' follow-up, but may slightly improve global cognitive performance of a clinically important difference immediately after intervention.
Clinical Implications
- Occupational therapy practitioners should prioritize early identification and intervention for patients with minor stroke who are at risk of developing subtle but significant functional impairments.
- A multidisciplinary approach, incorporating occupational therapy, physical therapy, and speech-language pathology, may be necessary to address the complex needs of these patients.
- Further research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke, as noted by 1.