Hemiplegia & Acute Services

So this is going to be the first of a few posts I would like to make in relation to stroke recovery. Because the implications of a stroke are so varying and many, I have chosen to stick with hemiplegia because of its relevance to occupational therapy and because it is probably the most common disability (due to stroke) I have worked with as a student.

Hemiplegia is originally a Greek word, "hemi" meaning half and "plegia" meaning paralysis. It is a common side affect after a CVA where if a lesion occurs on the right side of the brain, the paralysis will be on the left side. And if the lesion is on the left side of the brain then the same for the right side of the body (namely the head, arm and leg of that side). Hemiplegia is similar to another condition called hemiparesis, but it is far more serious. Hemiparesis is usually characterized by one side of the body that is affected not by paralysis, but by a less severe state of weakness.

In acute services, care is focus on diagnosing the the cause, the type of CVA, and the site in order to prevent further lesion progression, secondary medical complications and the treatment of acute neurological symptoms (Trombly Latham & Radomski, 2008). Intervention in an intensive care unit is usually of the pharmacological and surgical kind. During my 3rd placement, I heard about a few drugs that are used for ischemic strokes: aspirin, heparin and warfarin. Out of curiosity I perused a nurse's drug guide and discovered these drugs are commonly used as a blood thinner which restores flow of oxygen and prevents further damage. Once a client/patient is in a stable condition they are then transferred to the acute neurological ward. In a qualitative study done in Australia to define the role of occupational therapy in acute neurology, participants stated that after head injuries, strokes were the most common diagnosis on their caseload (Griffin, 2002).
In relation to hemiplegia these outcomes in acute services are described as:

• Thorough assessment in order to a. make a timely and appropriate referral to rehabilitative and/or community services if necessary and b. establish the patient's baseline performance in order to plan & prioritise intervention, and to help MDT in organising appropriate discharge planning.
• Assisting the patient to reach highest level of independence (re self care & functional activities)
• Prevent/reduce occurrence of deformities that will have an impact on the aforementioned.
• Establish, maintain & improve functional upper limb movements
• Provide education to patient and/or family members on compensatory techniques and aides.

References 

Griffin, S. (2002). Occupational Therapy Practice in Acute Care Neurology and Orthopaedics. Journal of Allied Health, 31(1), 35-42.


Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Latham Trombly. Occupational Therapy for Physical Dysfunction (pp1001-1041). Baltimore, MD: Lippincott Williams & Wilkins.