Camille Skubik-Peplaski, Cheryl Carrico, Laurel Nichols, Kenneth Chelette, Lumy Sawaki; Behavioral, Neurophysiological, and Descriptive Changes After Occupation-Based Intervention. Am J Occup Ther 2012;66(6):e107-e113. doi: 10.5014/ajot.2012.003590.
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© 2018 American Occupational Therapy Association
OBJECTIVE. We evaluated the effects of occupation-based intervention on poststroke upper-extremity (UE) motor recovery, neuroplastic change, and occupational performance in 1 research participant.
METHOD. A 55-yr-old man with chronic stroke and moderately impaired UE motor function participated in 15 sessions of occupation-based intervention in a hospital setting designed to simulate a home environment. We tested behavioral motor function (Fugl-Meyer Assessment, Stroke Impact Scale, Canadian Occupational Performance Measure) and neuroplasticity (transcranial magnetic stimulation [TMS]) at baseline and at completion of intervention. We collected descriptive data on occupational participation throughout the study.
RESULTS. All behavioral outcomes indicated clinically relevant improvement. TMS revealed bihemispheric corticomotor reorganization. Descriptive data revealed enhanced occupational performance.
CONCLUSION. Occupation-based intervention delivered in a hospital-based, homelike environment can lead to poststroke neuroplastic change, increased functional use of the affected UE, and improved occupational performance.
Grahic Jump Location
Opening, closing, filling, and emptying storage containers (such as sandwich bags, jars, and bottles)
Removing food items from refrigerator
Putting away dishes after washing
Tearing aluminum foil or wax paper for placement on food containers
Intermittently self-managing spastic response interfering with performance
Opening or closing different trash bags
Removing trash bags from can with the affected hand
Carrying full bag a distance similar to that needed at home
Folding or stacking towels with both hands
Folding clothes at dryer height
Hanging clothes on rack
Educating client and spouse in use of counter, table, and chairs in kitchen and living room for stretching
Strumming simple chords of E, G, and A and strumming while singing
Positioning (upper extremity, seating) and adapting task (selecting guitar with best width of bridge)
Intermittently self-managing spastic response interfering with performance and self-increasing range of motion (supination) using a mop handle (available at home)
Squeezing out a wet sponge
Washing dishes with the affected extremity
Picking up soda bottle with left hand to drink
Opening a toolbox with a key
Holding nails with left hand and hammering with right
Pulling nails out of wood
Using an electric wood sander
Self-managing spastic response interfering with performance
Intervention entailed bimanual tasks, which may have led to neuroplastic change related to each UE (rather than the affected UE only).
Because stroke can unmask the 10% of the corticospinal tract that remains uncrossed, intervention could affect this normally latent tract, in which case the results of intervention would not be restricted to ipsilesional (i.e., unilateral) neuroplastic change.
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