Are you having a hard time preparing for an occupational therapy treatment for your patients with a stroke?
I love stroke intervention.
It’s actually my favorite population and I was always so excited to get a CVA OT eval and treat orders in the hospital. My dilemma was always coming prepared to the patient’s room.
You’re probably thinking - how can she be unprepared for treatment? Well, as you know strokes can vary greatly from patient to patient depending on the lesion. I can sort of prepare on what to expect from viewing MRI or CT results, but I still found myself going back and forth from the patient’s room to the supply room to get needed equipment or saying “Tomorrow I’ll bring _______ so we try ______.”
I got tired of feeling unprepared or winging my treatment sessions in a hospital setting (You know how it is. We really don’t have much supplies to go with in a hospital, anyway, which is why the Learning Lab is so great for out of the box ideas!), so I decided to prepare myself for stroke interventions.
In comes my handy dandy stroke basket!
Well, it wasn’t really a basket, more like a small crate with handle, but I think basket sounds better than crate! ☺
Now, every time that I knew I had a patient with a stroke, I grabbed my stroke basket and took it along with all the tools or utensils I could possibly need. I usually didn’t use it all in one treatment, but I had it all handy in case it was needed, saving time from going back and forth to get the needed supplies and allowing me to fully focus on my patient.
Ready to make your own stroke basket? It’s super simple!
Here’s the 10 item you need:
1. A basket, crate, or small and easy to carry space to store tools
2. Tennis ball for gross grasp strength (of course!)
You can also use the tennis ball for grasp and release, increase pinch, opposition of thumb, or flexion/extension of digits while rolling ball on the table. I’m sure you have much more ideas in your OT repertoire, too!
3. Pinwheel for oral motor strengthening
As you know our patients with a stroke can suffer from facial droop. Blowing on the pinwheel can increase facial muscle strength and can help increase oral motor strength for eating, for smiling, and so much more. You can also use the pinwheel for finger isolation!
Now, you can use it in the traditional sense for strengthening exercises, of course, but I love using theraband in functional activity. For example, place a theraband loop in the patient’s hand (between the thumb web space to the wrist) while you hold the two ends from behind providing resistance while the patient participates in hygiene and grooming, fine motor tasks, or reaching. This provides input during the task and is great for strengthening as well.
5. Eye patch, matie
The eyepatch is great for vision confrontation assessment and for intervention for diplopia, or double vision. Just remember, eye patch for diplopia should be limited as its not recommended for long term use. It can cause increased deficits over time.
6. Leukotape or Kinesiotape or both
Great for reducing pain and increasing support to the hemiparetic extremity (here is a great shoulder taping technique: California Tri-Pull).
7. Dry erase marker
So simple yet so efficient!
I love using a dry erase marker in treatment for visual perception! I’ve used it to post wayfinding to a large window in the hospital so they can scan their visual field for trees, for example. “Circle each tree you see.”
I’ve even used it before or after hygiene and grooming tasks at the sink for identification of body parts in the mirror. “Circle your eyes; your nose; your mouth.”
Bonus tip: Don’t forget to erase the evidence from the window or mirror! It will probably save you some trouble in the long run ☺
8. A washcloth
It can be used as a tactile cue between scapula for scapular retraction/protraction, for functional hygiene and grooming tasks, or for positioning in supine to increase anterior pelvic tilt. You can even use it to have your patient wipe the dry erase marker from the mirror or window - great shoulder stabilization!
9. Ace wrap
This may also be beneficial for the patient that is lower level and requires some assist to facilitate grasp.
10. Built up tubing for utensils
These can be used on toothbrush, eating utensils, writing utensils - you name it!
Well there you have it! My easy to make and ready to go stroke basket ready for any deficit that may arise. Feel free to add your own spin to the basket, of course.
Bedazzle it up, add to the tool list, or take away from the list - make it yours!
I hope this helps to make stroke intervention more efficient and effective for you. Oh! and this handy dandy stroke basket can be used across all settings, not just acute care. That’s what makes it so great. ☺
by Guiselle Miranda, MOT, OTR, CSRS