Occupational therapy
The role of the occupational therapist varies from country to country. In some countries, there are no occupational therapists in stroke units and their role is taken on by nursing staff or physiotherapists. In the UK (and Australia) the role of the occupational therapist includes the assessment of basic and more advanced functional activities. In medical terminology, the basic activities required to exist in a reasonable state are called activities of daily living (ADLs), and more advanced activities are referred to as extended activities of daily living (EADLs).
/ Activities of daily living and extended (instrumental) activities of daily living
ADLs
- ? Bathing, and use of shower or bath
- ? Mobility (walking on the flat and stairs)
- ? Continence (bladder and bowel)
- ? Toileting
- ? Grooming (e.g. combing hair, shaving)
- ? Dressing
- ? Feeding
- ? The ability to accomplish these basic ADLs is usually a requirement for return home.
Extended ADLs
- ? Cooking
- ? Shopping
- ? Leisure activities
- ? Driving a car
- ? Riding a bicycle
- ? Using public transport
- ? Getting out in the community
- ? The ability to accomplish extended ADLs usually adds enormously to quality of life.
Impairments that impact on ADLs and EADLs
Dementia and cognitive impairment can have a huge effect on the person’s ability to complete these activities. Many people with such problems may manage these tasks only with supervision.
Aphasia
Problems with language may not affect ADLs but have a huge effect on EADLs (e.g. the ability to ask for shopping items).
Postscript
A recent study identified that being able to shop is currently the most
sought-after EADL for stroke survivors!
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The occupational therapist will work on specific tasks in collaboration with nursing staff and physiotherapists. This will involve a period of assessment, including the ability to understand instructions (often disrupted by aphasia and dementia), followed by specific training in basic ADLs. For example, when patients have enough motor recovery to maintain sitting balance, it is possible to start working on basic washing (e.g. washing the face, cleaning the teeth). As recovery proceeds, more complex tasks can be assessed and practised (e.g. getting on and off the toilet, getting dressed, and feeding).
The occupational therapist has a very important role in predicting how people will manage at home, and when there is doubt, or after a particularly severe stroke, they will often (together with other members of the stroke team) perform a home visit, with or without the patient, to determine how feasible discharge home will be.
