Occupational Theory: Stroke Patients

Defining the Groups

Stroke impairs normal routine activities and can change a person’s regular activities dramatically, a stroke can occur at any age, however, many of the individuals that have a stroke, fit into the category of men over the age of sixty-five years, (ref), this age group and gender are what the paper will be focused on. This is an active time of life for a man at this age and a stroke can impact the many roles he may have. One of these important roles may include employment, this is an important time of life for this age group as many men are still the main income earners for the family and may plan to work on it for many years. Having a stroke may alter these plans temporarily, or permanently, by limiting the abilities of the worker, or symptoms may make continuing employment not possible. Many men of this age group are still very active within the community and a decrease in community involvement can lead to isolation and depression. A license is a valuable thing to these patients as this allows for independence, possibly employment, leisure activities and used in everyday life, to be unable to drive post a stroke will prove to have a significant impact on the patients’ life and generate negative life changes. Occupational needs such as self-care tasks are important to people of all ages, however, to a man of this age dignity and physical privacy may play a considerable role on how they see themselves, requiring assistance with this area of everyday occupation may have a great impact on feelings of self worth and pride. Often, the husband is the one to complete handyman type jobs around the house and this is an occupational need to many men as this is part of their role and what they are expected to continue to do.

A man of this age may be part of a sports team or enjoy some sort of leisure activity that may now be in jeopardy due to the symptoms of the stroke.The patient may be a grandfather and this in turn can lead to the loss of the usual role and task a grandfather may complete.

Having a stroke can affect person’s sex life, not only the sexual act itself, this can also encompass the expression of intimacy and how attractive a person may feel. This in turn may affect the patients self esteem and feeling of self worth or closeness to their partner, this area of difficulty may also lead to feelings of letting their partner down (guideline saved for ref)

Some of the symptoms (yet to complete) that can be experienced post stroke are… (guideline saved)

The individuals that have experienced a stroke, post acute care would be in strong need to undergo a rehabilitation program, this program would include intervention strategies aimed at enabling individuals to meet the peak stage of function and independents in all facets of life. Stroke patients have a real need for a continuation of productive activities that ameliorate daily living performance and aid recovery (Legg, Drummond & Langhorne, 2006).

Programs focusing on improving functional ability following stroke have good implications. A training method on Repetitive task performance has led to significant outcome in lower limb function (French et al., 2007). This method known as a task-specific motor activity was considered as an important approach in stroke rehabilitation program (French et al., 2007). Stroke patients discharged from acute care settings require basic mobility skills as revealed from a study (Paquet, et al., 2009).

Demands of Setting

Programs focusing on improving functional ability following stroke has good implications for motivation. A training method on Repetitive task performance has led to significant outcome in lower limb function (French et al., 2007). This method known as a task-specific motor activity was considered as an important approach in stroke rehabilitation program (French et al., 2007). Patients performed significantly well in the Walking distance and speed, sit-to stand and moderately in functional ambulation and global motor function tasks (French et al., 2007).

Here, the intervention was an active motor sequence and was done in a continuous manner in a one training class (French et al., 2007). This was targeted for a lucid objective and where there could be more productivity (French et al., 2007). With these strategies, patients could earn and live independently in the community. Stroke patients discharged from acute care settings require basic mobility skills as revealed from a study (Paquet, et al., 2009). Hence, motor skills would contribute to the development of motivational skills in the old stroke patients. It was described that a strategy of timed up-and-go (TUG) when measured at various stages of discharge has indicated that walking care is required for performing daily life activities and recovery of motor skills is more likely to improve foot oriented abilities from the program of rehabilitation(Paquet, et al., 2009).

Similarly, depression and problems in oral communication were considered as the reliable predictors of the strategy TUG for those patients in acute care settings (Paquet, et al., 2009). In contrast, the certain components like schooling and memory defects, utility of walking devices, recovery of foot associated with motor skills were considered as the reliable predictors for patients in rehabilitation program (Paquet, et al., 2009). This could indicate that patients in acute care settings are strongly in need of devices that could enable them to earn and live independently.

Next, working in an acute care setting would enable to manage the stroke patients. Stroke patients are in great need of care takers in order to perform daily tasks. Hence, it is reasonable to mention that acute care setting work experience would enable to overcome the barriers of participation in daily activities and social interactions (Desrosiers et al., 2008). This could be accomplished by making a follow up of the stroke patients discharged from the acute care and identifying the predictors that could reflect psychological, cognitive, perceptual, and physical abilities (Desrosiers et al., 2008). The awareness of intervention programs applied at acute care settings could impact the participation of stroke patients and as such more patients could be encouraged to get involved in the program.

After acute stroke patients may face difficulties related to costs and health insurance that impact economic conditions of households (Heeley, et al., 2009). This could prevent the better clinical management of stroke patients. Staff of acute care settings could understand the patient financial status and take measurable steps to cover the policies (Heeley, et al., 2009). It was described that insurance policies prevent families from the disastrous payments and that there is a requirement of enhancing the method of providing a framework in variety of settings (Heeley, et al., 2009).

Theoretical Framework for Guiding Clinical Reasoning

It is vital by a person suffering from stroke needs some incentives and other supporting factors for overcoming the hardships of the disease. Therefore, there is the necessity to work out particular strategies and philosophy contributing to the effective coping with stroke patients. In additional to this the devised methodologies should also conform to the usual mode of living. The following theoretical framework will consider different aspect that a treatment model should include, such as motivation, independence, the presence of choice, and enablement.

In order to follow the human needs and the previous lifestyles of elderly patients with strokes, I plan to use the biomedical framework as the basic of my model of treatment in combination with the International Classification of Functioning, Disability and Health. Pertaining to the first theoretical framework, the biomedical model allows to detect and to understand the biological process that caused the appearance of stroke. In particular, this framework will be focused on the physical and psychological problems causing “deficits in the cognitive function, and increases in emotional distress” (Sutton et al., 2004, p. 202). By addressing these problems, it is possible to diminish to shortcomings of the emotional distress and problems with blood arterial pressure. The consideration of the components of the ICF theoretical framework will also contribute to the treatment of the disease and its further improvement (Stevens, A., 2004, p. 156). The ICF model discusses the changes in medical terminology. Specifically, the model changes the terms “impairment, disability, and handicap…by new terms (functions, activities, and participation)” (Stevens, 2004, p. 156). Such replacement serves to extend the meaning of the definitions and impart them with meaning. The environmental characteristics are also included into the term. In addition to this, it can also improve the patients’ attitude to the disease thus helping them to adjust to the new conditions. Particularly, as the target patients are males over 65, the behavioral approach will be more appropriate to foster the post-stroke rehabilitation.

Based on the above theoretical frameworks, it is possible to devise a philosophical paradigm for clinical reasoning of the disease and decide which model will suit best to this philosophy. Hence, there are four concepts chosen for this strategy. The first one is motivation consisting in encouraging people to cope with the movement impairments. With regard to this age bracket, the ICF provisions will be more appropriate since, the presented classification provide a positive experience. However, the implication of biomedical model of treatment can equally effective, since the behavioral analysis can stimulate the acute stroke elderly patient to avoid the risk factors, and to follow the instructions. For instance, the model may determine that such faction as hypertension and smoking is peculiar for the old people. In this respect, the indication of these factors can raise the patients’ awareness and desire to overcome the disease.

Independence is another factors that should be included into the rehabilitation model, since patients should feel that they are capable of surpassing the hardships and return to their previous mode of life. In the respect, the treatment foreseen by the biochemical model allows taking medications independently at home in the habitual environment. However, the previous that in order to prevent the development of strokes, there is still the necessity to change the lifestyle and take it as a matter of fact. However, the point is that our age category provides less chances for an absolute change of lifestyle since old people are impervious to them. In this respect, an emphasis should be made on psychological acceptance of the disease.

The main advantage of ICF model is that it is more concerned with restoring the functions rather than compensating them. Such a strategy can enable patients to perform all important physical and mental activities. Unlike compensatory strategies, the restoration approach provides the “behavioral improvement on motor tasks attributable to the treatment” and “…greater neural activity in an area damaged by the stroke…” (Halligan and Wade, 2005, p. 83). This is why ICF model provides more enablement activities for the old patient suffering from stroke. However, the full restoration of functions is impossible, since some problems will still exist. In this regard, there biomedical model can help the patient to adjust to the new conditions, which are admissible for acute stroke elderly patients.

In conclusion, it should be stressed that the implementation of biomedical model together with ICF model would be the best variant for treatment, since this combination only can fully embrace all the needs of stroke patients. However, biomedical model should still prevail, specifically for this age category, which experiences this disease in more complicated and even chronic forms. In whole, the chosen strategy coincides with the philosophic paradigm of treatment aimed at motivating, training the independent performance, and providing the choice for the patients.

References

Desrosiers, J., Demers, L., Robichaud, L., Vincent, C., Belleville, S., Ska, B., BRAD Group.(2008). Short-term changes in and predictors of participation of older adults after stroke following acute care or rehabilitation. Neurorehabil Neural Repair, 22,288-97.

French, B., Thomas, L,H., Leathley, M,J., Sutton, C,J., McAdam, J., Forster, A., Langhorne, P., Price, C,I., Walker, A., Watkins, C,L. (2007). Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 17, CD006073.

Halligan, P. W., and Wade, D. T. (2005). The effectiveness of rehabilitation for cognitive deficits. UK: Oxford University Press.

Heeley, E., Anderson, C,S., Huang, Y., Jan, S., Li, Y., Liu, M., Sun, J., Xu, E., Wu, Y., Yang, Q., Zhang, J., Zhang, S., Wang, J., China QUEST Investigators. (2009). Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke, 40, 2149-56.

Legg, L. A., Drummond, A. E., and Langhorne, P. (2006). Occupational Therapy for patients with problems in activities of daily living after stroke. US: Cochrane Database of Systematic Reviews.

Paquet, N., Desrosiers, J., Demers, L., Robichaud, L., BRAD Group. (2009). Predictors of daily mobility skills 6 months post-discharge from acute care or rehabilitation in older adults with stroke living at home. Disabil Rehabil, 15, 1267-74.

Stevens, A. (2004). Health Care Needs Assessment: the epidemiologically based needs assessment, vol 1. UK: Redcliff Publishing.

Sutton, S., Baum, A., and Johnston, M. (2004). The SAGE handbook of health psychology. US: SAGE.

Vincent, C., Deaudelin, I., Robichaud, L., Rousseau, J., Viscogliosi C., Talbot L. R., Desrosiers J., and other members of the BRAD group. (2007).Rehabilitation needs for older adults with stroke living at home: perceptions of four populations. BMC Geriatr.7: 20.