Cerebral Vascular Accident (Stroke) and Occupational Therapy Report

This report provides an overview of Cerebral Vascular Accident (CVA), commonly known as stroke, and the significant role of Occupational Therapy (OT) in the rehabilitation process. The report highlights the challenges faced by stroke survivors, including paralysis, cognitive impairments, and difficulties with activities of daily living (ADLs). It examines three key articles that explore various OT interventions. The first article focuses on the Multiple Errands Test–Revised (MET–R) as a performance-based measure of executive function, crucial for assessing cognitive abilities post-stroke. The second article discusses the benefits of combining intensive OT with low-frequency repetitive transcranial magnetic stimulation (rTMS) for patients with upper limb hemiparesis, emphasizing improved motor function. The third article delves into the combined therapeutic application of botulinum toxin type A, low-frequency rTMS, and intensive OT for post-stroke spastic upper limb hemiparesis, demonstrating increased effectiveness. The report emphasizes the importance of OT in addressing deficits, promoting health and well-being, and facilitating community reintegration for stroke survivors, often in conjunction with other medical interventions. The references provided support the evidence-based approach to OT in stroke rehabilitation.

Running head: CEREBRAL VASCULAR ACCIDENT
Cerebral Vascular Accident
Name of the Student
Name of the University
Author Note

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Cerebral Vascular Accidentis a medical term used to define stroke. A stroke is a
medical condition, which occurs when the flow of blood to certain parts of the brain is
hampered due to rupture or blockage in the blood vessels (Singh et al., 2014). According The
American Occupational Therapy Association, one of the leading causes of adult disability in
United States (U.S) is stroke. US have 7-million estimated stroke survivors. Stroke survivors
experience numerous challenges like paralysis at one side of the body, inability to walk,
decline in emotional functioning and cognitive thinking along with decrease in community
participation. The role of occupational therapy is ornamental in stroke as it helps in
addressing these challenges resulting out of strokes and thereby promoting health and well-
being among the strokes survivors.
Article 1
Title: Multiple Errands Test–Revised (MET–R): A Performance-Based Measure of Executive
Function in People With Mild Cerebrovascular Accident
Summary: Executive function (EF) is a cluster of critical thinking abilities that
defines cognitive ability of a person and differs from attentional and memory capacities.
People who have sustained stroke suffer from poor EF and thereby affecting ADLs. However
moderate deficits in EF are difficult to identify via traditional occupational therapy or
neurophysiological therapy. Performance-based tests (PBTs) in association with Multiple
Errands Test (MET) employ functional tasks and help in proper assessment of EF.Such
assessment helps in discrimination between healthy individual and person who has sustained
cardiovascular accident (CVA) and thereby framing occupational therapy accordingly.
Interpretation: At present, fewer people are dying out of stroke, as CVA is less
severe butCVA is affectingyounger population at large. Mild to severe brain injury resulting
out of stroke hamper the quality of life along with ADLs. In order to help this younger

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population to resume the normal community life, it important for the occupational therapists
to access the EF level and then design the occupational therapeutic intervention accordingly.
The MET-PBTs help in the proper detection of the EF level among the patients of CVA via
performing a comparative study among the healthy individual and thereby framing the
occupational therapy accordingly.
Article 2
Title: A multi-center study on low-frequency rTMS combined with intensive occupational
therapy for upper limb hemiparesis in post-stroke patients.
Summary: Intensive occupational therapy (OT) (for about 120 minutes per day) along
with low-frequency repetitive transcranial magnetic stimulation (rTMS) (20 minutes) is
clinically beneficial for the patients who have suffered cardio vascular accident with upper
limb hemiparesis. It leads to the increase in the Fugl-Meyer Assessment (FMA) score along
with decrease in the Wolf Motor Function Test (WMFT). All these attribute to positive
neurorehabilitive intervention among post stroke patients. 120 minutes intensive OT is
composed of 60 minutes individual training then another 60 minutes of exercise after rTMS.
Moreover, the efficacy of the treatment is not affected with the age or time of CVA onset.
Interpretation:Post stroke condition with upper limb hemiparesis hampers the self-
care skils and basic mode of adaption with the external environment post rehab. OT along
with rTMS helps to maximize the ability to perform the ADLs in safe manner like dressing,
bathing and other functional mobility. It also helps in addressing sensory, cognitive
impairments like lifting groceries bag, maintain balance while walking, setting direction
while walking etc. Such combinational therapy also promotes community reintegration via
modifying tasks or surrounding environment.
Article 3

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Title: Combined therapeutic application of botulinum toxin type A, low-frequency rTMS,
and intensive occupational therapy for post-stroke spastic upper limb hemiparesis.
Summary Intensive OT is extremely helpful for the post stroke patients with spastic upper
limb hemiparesis. The effectiveness of the treatment increases when provided in unison with
triple-element protocol of botulinum toxin type A (BoNTA) injection and low frequency
repetitive transcranial magnetic stimulation (LF-rTMS). The said treatment is found to
increase spasticity and motor function for the patients with stroke and CVA.
Interpretation: BoNta when injected intramuscularly prevents the release of the
neuro-transmitter, acetylcholine from the pre-synpatic axons of the endplate motor neurons
and thereby blocking the signal transduction t the neuromuscular junction. This treatment
when given in conjunction with the rehabilitation therapy, it helps to increase the
effectiveness of the limbs along with significant reduction in spasticity. The rehabilitation
therapy ensured that the client would function well even after discharge from the hospital.
Modification in the external environment like accessible room design, wheelchairs, lifts or
elevators further promoter health and well-being. Rehabilitation therapy is not solely directed
towards the patients but also involve proper education towards the caregivers along with
training.
To summarize, it can be stated that occupational therapy during stroke rehabilitation
mainly focuses on developing strategies to overcome barriers experienced while performing
activities of daily living (ADLs). Occupational therapists also address ongoing deficits
associated with AVC like sensory loss, weakness and cognitive impairment that hinderADLs.
However, the effectiveness of the OT increases when provided in unison with other medical
interventions.

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References
Kakuda, W., Abo, M., Momosaki, R., Yokoi, A., Fukuda, A., Ito, H., ... & Kameda, Y.
(2012). Combined therapeutic application of botulinum toxin type A, low-frequency
rTMS, and intensive occupational therapy for post-stroke spastic upper limb
hemiparesis. Eur J Phys Rehabil Med, 48(1), 47-55. (Retrieved from:
https://www.researchgate.net/profile/Ryo_Momosaki/publication/51788412_Combine
d_therapeutic_application_of_botulinum_toxin_type_A_low-
frequency_rTMSandIntensive_occupational_therapy_for_post-
stroke_spastic_upper_limb_hemiparesis/links/56510db608ae1ef929722c9f.pdf)
Kakuda, W., Abo, M., Shimizu, M., Sasanuma, J., Okamoto, T., Yokoi, A., ... & Urashima,
M. (2012). A multi-center study on low-frequency rTMS combined with intensive
occupational therapy for upper limb hemiparesis in post-stroke patients. Journal of
neuroengineering and rehabilitation, 9(1), 4. (Retrieved from:
https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-9-4)
Morrison, M. T., Giles, G. M., Ryan, J. D., Baum, C. M., Dromerick, A. W., Polatajko, H. J.,
& Edwards, D. F. (2013). Multiple Errands Test–Revised (MET–R): A performance-
based measure of executive function in people with mild cerebrovascular
accident. American Journal of Occupational Therapy, 67(4), 460-468. (Retrieved
from: https://ajot.aota.org/article.aspx?articleid=1851702)
Recovering From Stroke. (2017). Aota.org. Retrieved 22 January 2018, from
https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/stroke.aspx

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Singh, S., Singh, H., Loftus, E. V., & Pardi, D. S. (2014). Risk of cerebrovascular accidents
and ischemic heart disease in patients with inflammatory bowel disease: a systematic
review and meta-analysis. Clinical Gastroenterology and Hepatology, 12(3), 382-393.