Functional Ergotherapy in Patients With Stroke
Özet
This review highlights the critical role of occupational therapy (ergotherapy) in stroke rehabilitation, focusing on restoring functional independence and improving the quality of life for stroke survivors. Stroke is a leading cause of long-term adult disability globally, often resulting in complex sensory, motor, cognitive, and psychosocial impairments that restrict basic activities of daily living (ADLs). While conventional treatments emphasize motor recovery through range of motion and strengthening exercises, they frequently fail to translate into functional improvements in a patient's everyday environment. Ergotherapy addresses this gap by combining motor training with sensory rehabilitation through meaningful, goal-directed tasks tailored to the individual's socio-cultural habitat. Comprehensive patient evaluation is foundational, involving the assessment of performance areas like self-care and productivity, alongside vital components such as the somatosensory and neuromusculoskeletal systems. Clinicians implement specific interventions—restoration, maintenance, adaptation, and protection—utilizing established neurophysiological methods (such as the Bobath, Brunnstrom, and Rood approaches), biomechanical exercises, and rehabilitative strategies. Ultimately, early and individualized occupational therapy is an effective, well-tolerated, and low-cost intervention that significantly minimizes disability, enhances functional mobility, and reduces the overall burden on healthcare systems.
Referanslar
World Health Organization ve International Society of Hypertension Writing Group, 2003.
Norrving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology; 2013; 80 (3 Supplement 2) DOI: https://doi.org/10.1212/WNL.0b013e3182762397
Kim J, Thayabaranathan T, Donnan GA, et al. Global Stroke Statistics 2019. Int J Stroke: 2020;15(8):819–38.
Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol; 2019;18(5):439–58
Istanbul University Istanbul Faculty of Medicine Basic and Clinical Sciences Textbooks. Istanbul: Nobel Medicine Bookstore 2004;193
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an
American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation; 2005;25;112(17):2735-2752.
Nichols-Larsen DS, Clark PC, Zeringue A, et al. Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke; 2005;36:1480-4.
Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke; 1998;29:986-91.
Duncan PW, Zorowitz R, Bates B, et al. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke; 2005;36:100-43.
Ilic NV, Dubljanin-Raspopovic E, Nedeljkovic U, et al. Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke. Restor Neurol Neurosci; 2016;34(6):935-45.
Edwards DF, Hahn MG, Baum CM, et al. Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair; 2006;20:42-8
Campfens SF, Zandvliet SB, Meskers CG, et al. Poor motor function is associated with reduced sensory processing after stroke. Exp Brain Res; 2015;233(4):1339-49.
Connell LA, Lincoln NB, Radford KA. Somatosensory Impairment after Stroke: frequency of Different Deficits and Their Recovery. Clin Rehabil; 2008;22(8):758-67.
Lindsay MP, Gubitz G, Bayley M et al. Canadian best practice recommendation for stroke care (update 2010). On behalf of the Canadian Stroke Strategy Best Practice and Standards Writing Group. Ottawa, Ontario Canada: Canadian Stroke Network, 2010.
Brandstater ME. Stroke rehabilitation. In DeLisa JA, Gans BM (Eds): Rehabilitation Medicine. Philadelphia, Lippincott-Raven Publishers, 1998, p. 1165-1189.
Roth EJ, Harvey RL, Rehabilitation of stroke syndromes. In Braddom RL (Ed): Physical Medicine&Rehabilitation. Philadelphia, W.B Saunders Company, 1996, p.1053-1087.
Çekmece Ç, Dursun N. Occupational Treatment. Oguz H. ed. Medical Rehabilitation. 3rd edition, Istanbul: Nobel Medicine Bookstores, 2015:351-358
Willard HS, Spackman CS. Occupational Therapy. 4th ed. Philadelphia, JB Lippincott. 1971; p380.
Steulthens EM, Dekker J, Bouter LM, et al. Occupational therapy for stroke patients a systematic review. 2003;34(3):676-87
Landi F, Cesari M, Onder G, et al. Effects of an occupational therapy program on functional outcomes in older stroke patients. Gerontology; 2006;52(2):85-91.
Javaherian HA, Underwood RT, DeLany JV. Occupational therapy services for individuals who have experienced domestic violence. Commission on Practice. Am J Occup Ther; 2007 Nov-Dec;61(6):704-9. doi: 10.5014/ajot.61.6.704.
Occupational Therapy: its definition and function. Am J Occup Ther 26: 204-205, 1972
Welch CD, Polatajko HJ. Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding. The American Journal of Occupational Therapy; 2016; 70(4), 7004360020p1–7004360020p5. https://doi.org/10.5014/ajot.2016.018689
Duncan GJ, Magnuson K. The nature and impact of early achievement skills, attention skills, and behavior problems. Whither opportunity, 2011 - books.google.com
American Occupational Therapy Association (AOTA) Am J Occup Ther. 2020 Aug 1;74(Supplement_2):7412410010p1-7412410010p87. doi: 10.5014/ajot.2020.74S2001.
Harris JE, Eng JJ. Goal Priorities Identified through Client-Centred Measurement in Individuals with Chronic Stroke. Physiother Can; 2004 Jun; 56(3): 171–176. doi: 10.2310/6640.2004.00017
Wressle E, Eeg-Olofsson A.-M, Marcusson J, et al. Improved client participation in the rehabilitation process using a client-centred goal formulation structure. Journal of rehabilitation medicine; 2002; 34(1), 5-11.
Pollock N. Client-centered assessment. American Journal of Occupational Therapy; 1993; 47(4), 298-301.
Law M, Baum CM, Dunn W. (2005). Measuring occupational performance: Supporting best practice in occupational therapy: Slack Incorporated.
Phipps S, Richardson P. Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure. American Journal of Occupational Therapy; 2007; 61(3), 328-334.
Pedretti LW. Occupational Therapy: Practice skills for physical dysfunction. Second Edition. The Mosby Company. St Louis.307-330, 1995.
McColl MA. What Do We Need To Know To Practice Occupational Therapy in the Community? The American Journal of Occupational Therapy, 1998, Vol. 52(1), 11–18.
Trombly CA. Occupation: Purposefulness and meaningfulness as therapeutic mechanisms. The American journal of occupational therapy; 1995; 49(10), 960–972. doi.org/10.5014/ajot.49.10.960
Roland PE. Tactile Discrimination After Localized Hemispheric Lesions in Man. Arch Neurol; 1976;33(8):543-550. doi:10.1001/archneur.1976.00500080021004
Johansson RS, Westling G. Roles of glabrous skin receptors and sensorimotor memory in automatic control of precision grip when lifting rougher or more slippery objects. Experimental Brain Research; 1984; 56: 550–564.
Newton RA. Joint Receptor Contributions to Reflexive and Kinesthetic Responses. Physical Therapy; 1982; 62(1):22–29. https://doi.org/10.1093/ptj/62.1.22
Barrack RL, Skinner HB, Cook SD. Proprioception of the knee joint. Paradoxical effect of training. American Journal of Physical Medicine; 1984; 63(4):175-181.
Bowsher D. Pain syndromes and their treatment. Current Opinion in Neurology and Neurosurgery; 1993; 6(2):257-263.
Mauguıère F, Desmed J, Courjon J. Astereognosıs And Dıssocıated Loss Of Frontal Or Parıetal Components Of Somatosensory Evoked Potentıals In Hemıspherıc Lesıons: Detaıled Correlatıons Wıth Clınıcal Sıgns And Computerızed Tomographıc Scannıng. Brain; 1983; 106,(2): 271–311, https://doi.org/10.1093/brain/106.2.271
Robertson SL, Jones LA. Tactile sensory impairments and prehensile function in subjects with left-hemisphere cerebral lesions. Archives of physical medicine and rehabilitation; 1994; 75(10): 1108-1117. https://doi.org/10.1016/0003-9993(94)90086-8
Moberg E. Objective methods for determining the functional value of sensibility in the hand. The Journal of Bone and Joint Surgery. British volüme; 1958; Vol. 40-B, No.3. https://doi.org/10.1302/0301-620X.40B3.454
Moore JC. Recovery Potentials Following CNS Lesions: A Brief Historical Perspective in Relation to Modern Research Data on Neuroplasticity. The American Journal of Occupational Therapy; 1986; 40(7): 459–463. https://doi.org/10.5014/ajot.40.7.459
Scholz JP, Campbell SK. Muscle spindles and the regulation of movement. Physical Therapy; 1980; 60(11): 1416–1424. https://doi.org/10.1093/ptj/60.11.1416
Fisher AG. Uniting practice and theory in an occupational framework. The American Journal of Occupational Therapy; 1998; 52(7): 509–521. https://doi.org/10.5014/ajot.52.7.509
Çevikol A, Çakcı A. Stroke Rehabilitation. Oguz H. ed. Medical Rehabilitation. 3rd edition, Istanbul: Nobel Medicine Bookstores,
Rood MS. Neurophysiological reactions as a basis for physical therapy. Phys Ther Rev; 1954; 34(9):444-9. doi: 10.1093/ptj/34.9.444
Connolly BH, Montgomery PC. A framework for examination, evaluation, and intervention. Clinical applications in motor control. 2nd ed. Thorofare: Slack incorporated; 2003. p. 1-24
Bobath K. Adult Hemiplegia: Evaluation and Treatment. Adult Hemiplegia. Teks Book Fısıoterapı Adult Hemiplegia; 1974.
Chen JC, Shaw FZ. Progress in Sensorimotor Rehabilitative Physical Therapy Programs for Stroke Patients. World J Clin Cases; 2014; 16;2(8):316-26.
Kollen BJ, Lennon S, Lyons B, et al. The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? Stroke; 2009;40(4):e89-97.
Twitchel T. The restoration of motor function following hemiplegia in man. Brain; 1951; 74(4):443-80. doi: 10.1093/brain/74.4.443.
Brunnstrom S. Movement Therapy in Hemiplegia: A Neurophysiological Approach; 1970; 7-33.
Johnstone M. (1983), Restoration of Motor Function in the Stroke Patient: A Phsiotherapist’s Approach, 2, Edinburgh: Churchill Livingstone.
Spielholz P, Davis G, Griffith J. Physical Risk Factors and Controls for Musculoskeletal Disorders in Construction Trades. Journal of Construction Engineering and Management; 2010; 132(10). DOI: 10.1061/(ASCE)0733-9364(2006)132:10:1059.
Dorothy V. Proprıoceptıve Neuromuscular Facılıtatıon. American Journal of Physical Medicine; 1967; 46(1): 838-898.
Stromberg BV. Contralateral therapy in upper extremity rehabilitation. Am J Phys Med; 1986;65(3):135-43.
Osternig LR. Isokinetic dynamometry: implications for muscle testing and rehabilitation. Exerc Sport Sci Rev; 1986; 14:45-80.
