Current Concepts and Controversies in Stroke Recovery: Rehabilitation Implications

This paper summarises the stroke incidence crude rate as 3.02 per 1000 people of 25 years and over and that of ‘mini-strokes’ as 2.89 per 1000 people. Many people with a mini-stroke may develop a full stroke within one year. Occupational therapists therefore need to shift their attention first to primary prevention to alter original organic pathology and then to restitution of hemiplegia.

A number of issues in neurological recovery following hemiplegia are then highlighted. These include ‘penumbra’, a metabolic disorder, the understanding of which helps to know if a hemiplegic lesion is able to tolerate the loss of oxygen and whether it can adapt to the ischaemia, early mortality and implications of regional cerebral circulation changes for treatment of hemiplegia and for prognosis. In the treatment of hemiplegia, there is a need to understand the role of ipsilateral brain, that is, brain plasticity in stroke recovery, the role of uncrossed pyramidal fibres, the parallel versus hierarchical operation of the descending cortical influences, and the interactions of the pre-motor systems with the primary cortex. In treatment, the paper explains the implications of the use of Bobath-type therapeutic procedures, the use of unilateral or bilateral tasks in occupational therapy and the learned non-use of the hemiplegic side.

Contemporary Issues in Cardiac Rehabilitation: Implications for Occupational Therapists

Since the acceptance of the beneficial effects of early mobilisation for patients after myocardial infarction, cardiac rehabilitation has undergone dramatic change. Highly structured and inflexible exercise programmes have given way to flexible and comprehensive modern programmes, which embrace the use of education, counselling and risk factor modification principles. Contemporary skills required by occupational therapists include being able to adapt services to a vast array of cardiac conditions, foster risk factor modification, enhance compliance, tailor education to learning and coping styles, assess the patient's level of risk and need for rehabilitation, and provide accelerated and alternate programmes. This article discusses the principles, directions and benefits of modern cardiac rehabilitation and the implications for occupational therapists.