From the Guidelines
The majority of patients with minor stroke, approximately 90%, require some form of postacute rehabilitation services, including occupational therapy, as indicated by assessments of their rehabilitation needs. The need for occupational therapy follow-up in the acute phase of minor stroke is determined through comprehensive assessments of body structures and function, activity limitations, and participation restrictions, as recommended by the American Heart Association/American Stroke Association guidelines 1. These assessments can be performed concurrently with diagnostic testing as soon as 24 hours after admission, as the patient’s medical stability allows. Patients with mild functional impairments, subtle cognitive deficits, or difficulties with activities of daily living are typically referred for occupational therapy assessment. The use of standardized assessments like the Barthel Index or the Functional Independence Measure (FIM) can help determine the need for occupational therapy and track stroke rehabilitation outcomes 1.
According to the most recent guidelines, patients with stroke should receive rehabilitation at an intensity commensurate with anticipated benefits and tolerance, and active participation in exercise should be encouraged early after stroke to minimize the detrimental effects of bed rest and inactivity 1. The determination of postacute rehabilitation needs should be based on assessments of residual neurological deficits, cognitive, communication, and psychological status, swallowing ability, and previous functional ability, among other factors 1.
Key elements of successful transition of care include a coordinated and holistic assessment and specific plan for the patient with stroke and their family, as well as strong interprofessional communication and collaboration among nurses, therapists, and family members 1. Early occupational therapy intervention, even for minor strokes, can significantly improve functional outcomes by addressing upper extremity weakness, fine motor control issues, visual-perceptual deficits, and cognitive impairments before they become entrenched. The therapy typically begins within 24-72 hours post-stroke and focuses on personalized rehabilitation goals to maximize independence and prevent functional decline.
Some of the key factors that predict the need for inpatient rehabilitation care include older age, impaired cognition, lower functional level after stroke, and urinary incontinence, as well as the presence of neglect syndrome, which can predict a longer rehabilitation stay and lower functional status at discharge 1. The use of standardized measures such as the Berg Balance Scale or the Postural Assessment Scale for Stroke can help determine the risk of fall and need for inpatient rehabilitation rather than discharge home with outpatient services 1.
In summary, the need for occupational therapy follow-up in the acute phase of minor stroke is determined through comprehensive assessments, and the majority of patients require some form of postacute rehabilitation services. Early intervention can significantly improve functional outcomes, and a coordinated and holistic approach to care is essential for successful transition and rehabilitation.
From the Research
Occupational Therapy Follow-up for Minor Stroke Patients
- The provided studies do not directly address the percentage of patients with minor stroke who require occupational therapy follow-up in the acute phase of the stroke 2, 3, 4, 5, 6.
- However, study 4 discusses the functional and activity limitations in patients after a stroke, which may imply the need for occupational therapy.
- Study 2 mentions that physical, occupational, and speech therapy should be offered as long as benefit is experienced, but does not provide specific information on the percentage of patients who require occupational therapy follow-up.
- Study 5 explores factors associated with level of physical activity after minor stroke, but does not directly address occupational therapy follow-up.
Limitations of Current Evidence
- The current evidence does not provide a clear answer to the question of what percentage of patients with minor stroke require occupational therapy follow-up in the acute phase of the stroke.
- Further research is needed to address this specific question and provide guidance for healthcare professionals 2, 3, 4, 5, 6.