Stroke intervention from occupational therapy

Occupational therapist and University of Burgos lecturer Olalla Saiz, together with several of her students, presents a stroke intervention from occupational therapy using NeuronUP.

What is a stroke?

A stroke or cerebral infarction is caused by a lack of blood supply in the brain’s blood vessels. Stroke is also the third leading cause of death in Spain among men and women.

It is most prevalent in people over 65, although cases in people under 45 have increased in recent years (1).

Types of stroke

Depending on the etiology of the cerebral infarction, we can distinguish (1):

1. Ischemic stroke: This occurs when a blood vessel is blocked by a clot.
2. Hemorrhagic stroke: This is caused by a ruptured blood vessel.

Consequences of stroke

The consequences of a stroke are the following (2):

●   Loss of strength,

●   reduced sensitivity,

●   attention problems (hemineglect),

●   comprehension and pronunciation deficits,

●   increased body instability and reduced balance,

●   in some cases, visual field deficits.

In this case, after having a stroke affecting the right side of the body, the user has several motor and cognitive impairments. Focusing on the cognitive level, the function to be addressed is hemineglect. Hemineglect is the difficulty attending to stimuli on the side opposite a brain lesion.

As a result of this lesion, the person also has a dysfunction in half of the body, which leads to the omission of the contralateral visual field and affects smell, touch, pain, hearing, and imagination. The impairment will depend on the type of hemineglect the person has.

As mentioned, there are several types of hemineglect, but in this case the group being treated falls under attentional or sensory hemineglect, which is the difficulty responding to unexpected stimuli on the affected side.

Stroke intervention from occupational therapy

Goals

To intervene from a therapeutic standpoint, the group’s interests or needs must be taken into account, setting a common goal between therapist and patient. Below, therefore, are the general objective and the specific objectives proposed for the upcoming intervention.

General objective

The general objective of this stroke intervention from occupational therapy is to improve attentional/sensory neglect.

Specific objectives

• Improve mental representation,
• strengthen visuoperceptual ability,
• increase orientation.

Methodology

• Each session will last 45-50 minutes,
• each session will involve only 1 participant,
• the session will take place in a room away from numerous external stimuli to prevent the user from losing concentration,
• depending on how the time is distributed, 3-4 activities per session are planned.

Activities to carry out a stroke intervention from occupational therapy

To meet the proposed objectives, these skills must be worked on to stimulate them and achieve a positive intervention, thus reaching the desired goal. Therefore, below is a series of activities related to mental representation, visuoperceptual ability, and orientation, carried out with NeuronUP.

Below, we explain in detail the activities chosen for this intervention proposal for children with ADHD:

1. Angles

What does it consist of?

Users have to form the indicated angle based on the given reference line. To do this, the user must look carefully at the position of the lines in the model and form the angle in the central image by tapping the line they think, together with the green one, represents the same drawing.

What does this activity work on?

The cognitive functions it works on are:

• spatial relations
• hemineglect

Play by levels

The game is divided into 9 phases, phase 1 being the easiest and phase 9 the hardest. The activity will be adapted to the person according to their degree of impairment.

2. Bottlecaps with Letters

What does it consist of?

This NeuronUP alphabet game for adults involves putting a sequence of moving letters in order. In this video, we explain how to play:

What does this activity do?

It works on the alphabet with adults in a fun way. It also works on the following cognitive functions:

• Working memory,
• inhibition,
• hemineglect,
• sustained attention.

Play by levels

The game is divided into 9 phases, phase 1 being the easiest and phase 9 the hardest. The user will automatically move up or down a level according to their correct answers and mistakes. To move up a phase, the user has to pass 5 exercises, and to move down a phase, they have to get 3 exercises wrong.

Personalization of the activity

In addition, you can create customized phases and set:

Parameters

•  The number of letters.
• The range of letters. For example, from A to M.
• The order: from A to Z or from Z to A.
• The letter format: uppercase or lowercase.
• Whether or not the letters move.
• The maximum number of errors.

General settings

You can also configure general settings, such as the mode of operation (correction or free mode and maximum number of errors allowed), the maximum time, whether or not to show a visible timer for the activity, and an inactivity alert. You can also edit the instructions.

Play by levels

The game is divided into 9 phases, with phase 1 being the easiest and phase 9 the hardest. The user moves up or down a level automatically based on their correct answers and mistakes.

3. Hidden Letters

What does it consist of?

The user has to look for only the indicated letter within a set of letters, in this case the letter “Q”.

What does this activity do?

This activity works on:

• Selective attention,
• hemineglect.

Customizing the activity

You can also customize the activity to suit each user’s abilities.

Parameters

You can select:

• the size of the matrix,
• the type of letters: vowels, consonants, all, or similar,
• uppercase or lowercase letters,
• the number of letters,
• whether or not you want different colors.

General settings

You can adjust the mode of operation, the maximum time, whether or not to show a visible timer for the activity, an inactivity alert, editing the instructions, and more.

References

(1).  Benavides Bautista PA, Sánchez Villacis L, Álvarez Mena P, Manzano Pérez VA, Zambrano Jordán D. Diagnóstico, imagenología y accidente cerebrovascular.  Enferm Inv (Ambato). 2018; 3 (sup. 1): 77-83.

(2).  Díaz Cabezas, R. (2015). Conocimiento de síntomas y factores de riesgo de enfermedad cerebrovascular en convivientes de personas en riesgo. Acta Neurológica Colombiana. 2015;

31(1): 12-19.

In addition to Olalla Saiz, Elena Maeztu Martínez and Claudia Manchado Lagrené contributed to this article.

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“This article has been translated. Link to the original article in Spanish:”
Intervención del ictus desde la terapia ocupacional