Post-Stroke Paralysis: A Quick Guide From Observation to Functional Activities

Stroke is the most common diagnosis treated by occupational therapists^{, and hemiplegia, paralysis of one side of the body, is one of the most common symptoms of stroke. 2 Therefore, knowing how to evaluate hemiplegia and improve function is a primary concern} for occupational therapists. Jan Davis addresses these topics in Part A: Functional Treatment Ideas and Strategies in Adult Hemiplegia. ⁴Here are my main takeaways after watching her course.

Evaluation

What you see, hear, and feel is important for a thorough evaluation of a client with hemiplegia.

See. Observe your client's body alignment and symmetry, first stationary and then in motion. Pay attention to any changes in muscle tone, posture, and alignment. Look at all sides of your client and note the proximal and distal movement patterns.

Hear. Listen to what your client has to say. Ask what they are most concerned about and what functional activities they want to be. able to perform. Listen for their main complaints.

Feel. Use your tactile sensation to see how the muscles and movement feel. How does it feel at the end of the range of movement? Does it hurt when they move or when you gently move their limb? What kind of pain do they feel? Feel for muscle tightness and resistance, or loose joints and muscle atrophy.

Clinical Reasoning

Now that you've used your senses, it's time for you to use your clinical reasoning. Hemiplegia often leads to long term impairments in a client's functional abilities.³

You should identify key underlying limitations and determine those most likely to impact your client's ability to perform functional activities. You may also need to evaluate a client's environment, equipment, and other factors (sensation, vision, and cognition) to determine if they contribute to functional limitations.

Functional Activities

Functional activities play two major roles in rehabilitation. Not only are they the goal of interventions, but they can also be the means of addressing identified deficits (e.g., reduced strength and range of motion). When participating in functional activities, your client is likely to have the motivation to move with more range of motion, push harder, and stay engaged for longer periods of time.⁵