Table Of Content

Medications Commonly Used to Treat Stroke and Its Comorbidities Drug Use Dosage Route Side Effects Other Medical Issues Antispasmodics/Spasmolytics Carisoprodol (Soma) Skeletal muscle relaxant 350 mg tid and qhs PO Drowsiness, ataxia, tremor, nausea/vomiting (N/V), tachycardia Chlorzoxazone (Parafon Forte) Skeletal muscle relaxant 250 to 500 mg tid-qid PO Drowsiness, dizziness, N/V, angioedema Cyclobenzaprine (Flexeril) Decrease muscle spasm via brainstem 10 mg tid PO Drowsiness, dry mouth, dizziness, N/V, angioedema Diazepam (Valium) Central nervous system (CNS) depressant 2 to 10 mg bid-qid PO Drowsiness, ataxia, urinary retention, anxiety Avoid in first trimester Methocarbamol (Robaxin) Skeletal muscle relaxant 1 to 1.5 g qid PO Drowsiness, dizziness, N/V, headache (HA) Orphenadrine (Norfl ex/Norgesic) Skeletal muscle relaxant 100 mg bid 60 mg every 12 hours IV PO, IV Drowsiness, dry mouth, dizziness, HA, weakness Skelaxin (Metaxalone) Skeletal muscle relaxant 800 mg tid-qid Antispastics Baclofen (Lioresal) Skeletal muscle relaxant 5 to 20 mg tid-qid PO Drowsiness, dizziness, weakness, N/V, confusion Dantrolene sodium (Dantrium) Skeletal muscle relaxant 25 mg qd to 100 mg qid PO, IV Drug-induced hepatitis Diazepam (Valium) CNS depressant, skeletal muscle relaxant 2 to 10 mg bid-qid PO Drowsiness, ataxia, urinary retention, anxiety Avoid in first trimester Tizanidine (Zanaflex) Central alpha 2 adrenergic agonist; central skeletal muscle relaxant 4 to 8 mg tid-qid PO Asthenia, drowsiness, ataxia, abnormal liver function tests, dry mouth Rare cardiac events Anticonvulsants Beclamide (Beclase) Grand mal, psychomotor seizures 990 to 1980 mg/day PO Drowsiness, ataxia, aphonia, agitation, leukopenia Carbamazepine (Tegretol) Grand mal, partial complex, mixed seizures; neuropathic pain 300 to 600 mg bid PO N/V, dizziness, complete blood count (CBC) changes, drowsiness, unsteadiness Therapeutic level 6 to 12 mcg/mL Clonazepam (Klonopin) CNS depressant, a benzodiazepine; neuropathic pain 0.5 mg tid to 5 mg qid PO Drowsiness, ataxia, aphonia, agitation, confusion, anemia Diazepam (Valium) CNS depressant, for status epilepticus 5 to 10 mg IV push IV Respiratory arrest, hypotension, bradycardia Total dose IV up to 30 mg Ethosuximide (Zarontin) Suppresses 3 cycle/ sec spike, petit mal seizures 500 mg up to 1000 mg/day PO Anorexia, N/V, lethargy, incoordination, CBC changes Not in pregnancy/ nursing Ethotoin (Peganone) Grand mal, partial complex seizures 2 to 3 g/day in 4 to 6 doses PO Ataxia, sedation, HA, N/V, cardiac dysrhythmias Monitor blood counts, blood level 15 to 50 mcg/mL Felbamate (Felbatol) Partial seizures Up to 2400 to 3600 mg/day in divided doses PO Anorexia, gastrointestinal (GI) discomfort, fever, acute liver failure, bone marrow suppression Monitor liver function Gabapentin (Neurontin) Partial seizures, social phobia 900 to 1800 mg total in tid divided doses PO Ataxia, sedation, mania, lability, mood alterations, rare edema and hypertension (HTN) Drug Use Dosage Route Side Effects Other Medical Issues Lacosamide (Vimpat) Partial onset seizures 150–200 mg bid PO, IV Neutropenia, tinnitus, constipation, irritability, paresthesia, memory altered, dysarthria, confusion, dry mouth, nausea, headache, somnolence May have mild abuse potential from euphoric feeling Lamotrigine (Lamictal) Partial seizures 200 to 500 mg/day PO Leukopenia, anemia, disseminated intravascular coagulation, hepatitis, Stevens- Johnson syndrome Must stop immediately in presence of rash Levetiracetam (Keppra) Grand mal, partial, psychomotor seizures Maximum daily dose of 3000 ng PO Somnolence, asthenia, infection, dizziness Methsuximide (Celontin) Absence (petit mal), refractory to other medications Start at 300 mg, up to 1200 mg/day PO Diarrhea, nausea, blurred vision, drowsiness, ataxia, headache Oxcarbazepine (Trileptal) Partial seizures, either as adjunct or monotheapy in adults and children over 4 years 300–1200 mg bid PO Nausea, Vomiting, Abdominal pain, Headache, Dizziness, Drowsiness, Ataxia, Nystagmus, Altered gait, tremor, fatigue Peganone (ethotoin) Grand mal and complex partial seizures 2000–3000 mg daily in divided doses PO Lymphadenopathy, systemic lupus, ataxia, gum hypertrophy, nausea Phenobarbital (Luminal) CNS depressant 50 to 100 mg tid serum 15 to 40 mcg/mL PO, IV HA, vertigo, confusion, N/V, respiratory depression; respiratory arrest with IV 15 mg/kg IV in status epilepticus Phenytoin (Dilantin) Grand mal, psychomotor seizures; neuropathic pain 100 mg tid PO, IV Ataxia, sedation, HA, N/V, cardiac dysrhythmias Level: 10 to 20 mcg/mL Pregalbin (Lyrica) Adjunt for partial onset seizures 150–600 mg/ day in divided (bid-tid) doses PO Dizziness, somnolence, peripheral edema, dry mouth Lower dose in renal failure Primidone (Mysoline) Barbiturate; grand mal, focal, psychomotor seizures 250 mg tid to 500 mg qid PO Ataxia, sedation, HA, N/V, irritability Level: 5 to 12 mcg/ mL Rufinamide (Banzel) Adjuctive treatment for patients ith Lennox-Gastaut Syndrome (LGS) 200–1600 mg bid PO Headache, Dizziness, Fatigue, Nausea, Somnolence Tiagabine hcl (Gabitril) Adjunct in partial siezures 4 mg–32 mg/day PO Dizziness, asthenia, drowsiness, nausea, nervousness, tremor Use in patients over age 12 Topiramate (Topamax) Grand mal and partial omplex seizures 400 mg bid PO Acute myopia and narrow angle glaucoma, hyperthermia, oligohydrosis, sudden death, kidney stones, paresthesias, suicidal ideation, dizziness, somnolence, ataxia Monitor for glaucoma, do not use in pregnancy, Several other warnings Medications Commonly Used to Treat Stroke and Its Comorbidities—cont’d Continued on back endsheets Anticonvulsants—cont'd Evolve Student Resources for Gillen: Stroke Rehabilitation, 4th Edition, include the following: • Activities for students to test their application and clinical thinking skills. • References linked to PubMed. • Glossary. Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Gillen/ YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. FOURTH EDITION STROKE REHABILITATION A Function-Based Approach Glen Gillen, EdD, OTR, FAOTA Associate Professor of Regenerative and Rehabilitation Medicine (Occupational Therapy) Columbia University Medical Center Programs in Occupational Therapy Columbia University College of Physicians and Surgeons; Honorary Adjunct Associate Professor of Movement Sciences and Education Teachers College New York, New York 3251 Riverport Lane St. Louis, Missouri 63043 STROKE REHABILITATION: A FUNCTION-BASED APPROACH, FOURTH EDITION ISBN:978-0-323-17281-3 Copyright © 2016 by Elsevier Inc. All rights reserved. Copyright © 2011, 2004, 1998 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www. elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instruc- tions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Stroke rehabilitation (Gillen) Stroke rehabilitation : a function-based approach / [edited by] Glen Gillen.—Fourth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-17281-3 I. Gillen, Glen, editor. II. Title. [DNLM: 1. Stroke—rehabilitation. 2. Evidence-Based Medicine. WL 356] RC388.5 616.8'106—dc23 2015008982 Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 Vice President and Publisher: Loren Wilson Content Strategy Director: Penny Rudolph Content Development Manager: Jolynn Gower Content Development Specialist: Brandi Graham Publishing Services Manager: Hemamalini Rajendrababu Project Manager: Kiruthiga Kasthuriswamy Multimedia Producer: Greg Utz Designer: Maggie Reid To the hundreds of stroke survivors that I have interacted with over the past 26 years. iv Birgitta Bernspång, PhD, OT Professor of Occupational Therapy Department of Community Medicine and Rehabilitation Umeå University Umeå, Sweden Karen A. Buckley, MA, OT/L Clinical Assistant Professor Department of Occupational Therapy New York University New York, New York Helen S. Cohen, EdD, OTR, FAOTA Professor Otolaryngology-Head & Neck Surgery Baylor College of Medicine Houston, Texas Susan M. Donato, OTR/L Occupational Therapist Andover, Massachusetts Anne E. Dickerson, PhD, OTR/L, FAOTA Professor Department of Occupational Therapy East Carolina University Greenville, North Carolina Salvatore DiMauro, MD Lucy G. Moses Professor of Neurology College of Physicians and Surgeons Columbia University New York, New York Catherine A. Duffy, OTR/L Private Practitioner Sag Harbor, New York Janet Falk-Kessler, EdD, OTR, FAOTA Director, Programs in Occupational Therapy Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy) at CUMC Columbia University, College of Physicians and Surgeons; Honorary Adjunct Associate Professor of Movement Sciences and Education Teachers College New York, New York Contributors Guðrún Árnadóttir, PhD, OT Coordinator of Occupational Therapy Research and Development Projects Occupational Therapy Landspítali, The National Hospital Iceland; Clinical Associate Professor Faculty of Medicine University of Iceland Reykjavík, Iceland Sandra M. Artzberger, MS, OTR, CHT Lecturer, Consultatnt, Hand Therapist Rocky Mountain Physical Therapy Pagosa Springs, Colorado Wendy Avery, MS, OTR/L Occupational Therapist Amedisys Home Health Bluffton, South Carolina Matthew N. Bartels, MD, MPH Chair of the Rehabilitation and Physical Medicine Department Montefiore Medical Center; Professor and Chair of Physical Medicine and Rehabilitation Albert Einstein College of Medicine Yeshiva University Bronx, New York Clare C. Bassile, EdD, PT Assistant Professor of Rehabilitation and Regenerative Medicine Program in Physical Therapy Columbia University New York, New York Carolyn M. Baum, PhD, OTR, FAOTA Elias Michael Executive Director & Professor of Occupational Therapy, Neurology, and Social Work Program in Occupational Therapy Washington University Saint Louis, Missouri Heather Edgar Beland, MS, OTR/L Senior Occupational Therapist Meridian Neuroscience at Riverview Medical Center Red Bank, New Jersey Contributors v Jessica Farman, MS, OTR/L, CDP Director of Rehabilitation Belmont Manor Nursing Center Belmont, Massachusetts Susan E. Fasoli, ScD OTR/L Associate Professor Occupational Therapy Program MGH Institute of Health Professions Boston, Massachusetts Judith Dicker Friedman Private Practitioner Boca Raton, Florida Glen Gillen, EdD, OTR, FAOTA Associate Professor of Regenerative and Rehabilitation Medicine (Occupational Therapy) Columbia University Medical Center Programs in Occupational Therapy Columbia University College of Physicians and Surgeons; Honorary Adjunct Associate Professor of Movement Sciences and Education Teachers College New York, New York Sheila M. Hayes, BSN, MS, PY Physical Therapist Convent of Mary the Queen Yonkers, New York Mary W. Hildebrand, OTD, OTR/L Assistant Professor Department of Occupational Therapy MGH Institute of Health Professions Boston, Massachusetts Leslie A. Kane, MA, OTR/L Manager of Occupational Therapy New York-Presbyterian Hospital and Columbia University Medical Center; Instructor in Clinical Occupational Therapy Programs in Occupational Therapy Columbia University, New York, New York Vicki Kaskutas, OTD, MHS, OTR/L, FAOTA Associate Professor of Occupational Therapy and Medicine Program in Occupational Therapy Washington University School of Medicine St. Louis, Missouri Megan Kirshbaum, PhD Founder and Executive Director Throught the Looking Class; Co-Director The National Center for Parents with Disabilities and Their Families Berkeley, California Josefine Lampinen, MSc Council Certified Specialist in Occupational Therapy Norrlands University Hospital Umeå, Sweden Virgil Mathiowetz, PhD, OTR/L, FAOTA Associate Professor Program in Occupational Therapy University of Minnesota Minneapolis, Minnesota Barbara E. Neuhaus, EdD, OTR, FAOTA† Professor Emeritus Columbia University Medical Center New York, New York Dawn M. Nilsen, EdD, OTL Assistant Professor of Rehabilitation and Regenerative Medicine Columbia University Medical Center New York, New York Christine M. Nugent, OTR/L Occupational Therapist OT Solutions, Inc. Greenlawn, New York Karen Halliday Pulaski, MS, OTR/L Trauma Team Leader Conehealth Inpatient Rehabilitation Greensboro, NC Ashwini K. Rao, EdD, OTR/L, FAOTA Associate Professor of Rehabilitation & Regenerative Medicine (Physical Therapy) In the G.H. Sergievsky Center Columbia University New York, New York †Deceased Contributors vi Karen Riedel, PhD, CCC-SLP Assistant Clinical Professor School of Medicine New York University Medical Center; Adjunct Professor Communicative Sciences and Disorders Department Steinhardt School of Culture Education and Human Development New York University New York City, New York Judith Rogers, OTR/L Pregnancy & Birthing Specialist; Parenting Equipment Specialist Through the Looking Glass, Berkeley, California Kerry Brockmann Rubio, MHS, OTR/L Director for Rehabilitation Services Maria Parham Hospital Henderson, North Carolina Patricia A. Ryan, MA, OTR/L Student Coordinator and Senior Occupational Therapist New York Presbyterian Hospital Columbia University Medical Center New York, New York Joyce S. Sabari, PhD, OTR, FAOTA Associate Professor and Chair Occupational Therapy Program State University of New York—Downstate Medical Center Brooklyn, New York Mary Shea, MA, OTR, ATP Clinical Manager, Wheelchair Clinic Kessler Institute for Rehabilitation West Orange, New Jersey Celia Stewart, PhD, MS, CCC-SLP Associate Professor Communicative Sciences and Disorders Steinhardt School of Culture, Education, and Human Development New York University New York, New York Jennie W. Sullivan, OTR/L Occupational Therapist Knoxville, Tennessee Carolyn A. Unsworth, PhD, OTR, AccOT, Associate Professor and Research and Higher Degrees Coordinator School of Occupational Therapy La Trobe University Melbourne, Victoria, Australia Jocelyn White, BSc, OT Senior Occupational Therapist Fiona Stanley Hospital: State Rehabilitation Service Perth, Western Australia Timothy J. Wolf, OTD, MSCI, OTR/L Assistant Professor Program in Occupational Therapy and Department of Neurology School of Medicine Washington University St. Louis, Missouri CONTRIBUTORS TO PREVIOUS EDITIONS Lorraine Aloisio Beverly K. Bain Ann Burkhardt Michele G. Hahn Lauren Joachim Denise A. Supon Jeffrey L. Tomlinson Nancy C. Whyte vii This edition has been fully reorganized to place a clear focus on resuming everyday living skills as the outcome of therapy. Part I: Foundations of Stroke Rehabilita- tion includes five chapters that provide the necessary medical and therapeutic foundations that should be the basis of any intervention plan. The first chapter not only includes medical management but also a comprehensive approach to acute stroke rehabilitation because current practice dictates that rehabilitation services begin within 24 hours of stroke in many cases. Acute care evaluations and interventions are clearly delineated for those working in intensive care units, step-down units, and the acute hospital settings. Chapter 2, “Improving Participation and Quality of Life through Occupation,” is included early in the text to remind clinicians that maximizing participation in life is the overarching goal of stroke rehabilitation. Chapters 3, “Task-Oriented Approach to Stroke Rehabili- tation,” and 4, “Activity-Based Intervention in Stroke Rehabilitation,” provide readers with an overall view of current therapeutic approaches and should be understood before the chapters on specialized topics are read. Finally, Chapter 5, “Client Centeredness: A Survivor’s Perspec- tive” is also included early in the text to remind clinicians about the human experience of surviving a stroke. Part 2: Maximizing Participation in Everyday Activities serves to provide clinicians with strategies to maximize involvement in specific aspects of daily living after a stroke, such as driving and community mobility, sexuality, leisure, instrumental activities of daily living, resumption of parenting roles after stroke, gait and mobility, return to work, and self-care. A new chapter on caregiving after stroke has been included in this section to remind clinicians that a team approach includes care partners. Part 3: Maximizing Outcomes for Specific Problem Areas Following Stroke includes standardized evaluations and evidence based intervention for a variety of post-stroke challenges, including loss of motor control related to upper limb control, trunk control, and balance. Chapters related to robotic technology, orthotic interventions, vestibular rehabilitation, and edema control are included to promote a comprehensive overall approach to managing impaired motor control. Part 3 also includes chapters on other challenging impairments that interfere with daily living such as visual and visuospatial involvement, cognitive impairments, perceptual dysfunction, and speech and language deficits. Finally, this section includes detailed chapters related to dysphagia management, seating and wheeled mobility prescription, and home evaluation and modifications. This fourth edition also includes a robust web-based platform. This platform contains two additional chapters, The fourth edition of Stroke Rehabilitation: A Function- Based Approach continues to strive to be the most up-to- date text on this topic, incorporating state-of-the-art and evidence-based tools and techniques to maximize function and quality of life for those living with stroke. This edition’s contributors include expert clinicians, researchers, and scientists from across the globe. Contributors are experts in various disciplines, including neurology, occupational therapy, physiatry, physical therapy, psychology, and speech and language pathology. The current text combines aspects of background medical information, a comprehensive review of standardized and nonstandardized evaluation procedures and assessments, and evidence-based interventions. It contains the most up-to-date research on stroke rehabilitation from a variety of rehabilitation settings and professions without losing its holistic perspective on the overall care of the people whose lives we as clinicians touch. This text has overarching themes. First and foremost, clinicians are provided with specific suggestions to main- tain a client-centered approach when working with stroke survivors. Furthermore, clinicians are challenged to use the most up-to-date treatment approaches (including both remediation and adaptation approaches) to decrease impairments; prevent secondary complications; improve the client’s ability to perform meaningful activities; and, most important, decrease participation restrictions and improve quality of life. Although this book is written primarily by occupational therapists, it is an appropriate reference for a variety of rehabilitation professionals, including physiatrists, physical therapists, speech and language pathologists, rehabilitation nurses, social workers, vocational counselors, and therapeutic recreation specialists. The immense value of an interdisciplinary team approach when working with the stroke survivor population cannot be overestimated. This text may also be beneficial to therapists who practice vir- tually alone in the community or as case managers because its research on the specific topic of stroke rehabilitation is comprehensive. The terms patient and client have been used interchangeably; it is recognized that stroke rehabilitation can take place in multiple settings. Educators and students can use this text in the classroom setting. Key terms, chapter objectives, review questions, and case studies have been provided as learning tools. A text that can appeal to basic learners and specialists alike, this book is a good investment for any clinician who plans to work with neurologically impaired persons—specifically, adults who have had a stroke. This text spans the continuum of care—from acute to long-term management—in a variety of roles and settings. Preface Preface viii “How Therapists Think: Exploring Clinicians’ Reasoning When Working with Patients Who Have Cognitive and Perceptual Problems Following Stroke” and “A Survivor’s Perspective II: Stroke.” This platform also contains additional material to support Chapter 27, “Interventions for Cognitive-Perceptual Deficits: A Function-Based Approach.” This material addresses the areas of decreased self-awareness and insight, apraxia, unilateral neglect, agnosias, attention deficits, memory impairment and executive dysfunction in depth including samples of standardized assessment and evidence based interventions. Instructor resources include an Instructor’s Manual, Pow- erPoint Slides, an Image Collection, and a Test Bank. Additional student resources include chapter activities, references linked to MEDLINE, and a glossary of terms. It is my hope that this text will challenge practicing clinicians to consider their present approaches to stroke rehabilitation and serve as a foundation on which students can build their philosophies for intervention with the stroke population. It is my hope that this text will make a positive impact on improving the quality of life of those living with stroke. ACKNOWLEDGMENTS I am grateful to all of the professionals from my own community, across the country, and internationally for their contributions to this book. It literally takes a village! They accepted my challenge to put their knowledge and skill base into words. Their dedication to this project will inspire future generations of clinicians and researchers. I continue to appreciate the dedication and persistence of the staff at Elsevier for supporting my work for almost 20 years, specifically Brandi Graham and Jolynn Gower. Glen Gillen ix 17 Approaches to Motor Control Dysfunction: An Evidence-Based Review, 348 18 Trunk Control: Supporting Functional Independence, 360 19 Overview of Balance Impairments: Functional Implications, 394 20 Vestibular Rehabilitation and Stroke, 416 21 Upper Extremity Function and Management, 424 22 Rehabilitation Technologies to Promote Upper Limb Recovery after Stroke, 486 23 Edema Control, 511 24 Orthotic Devices after Stroke, 529 25 Managing Visual and Visuospatial Impairments to Optimize Function, 553 26 Impact of Neurobehavioral Deficits on Activities of Daily Living, 573 27 Treatment of Cognitive-Perceptual Deficits: A Function-Based Approach, 612 28 Seating and Wheeled Mobility Prescription, 647 29 Managing Speech and Language Deficits after Stroke, 673 30 Dysphagia Management, 690 31 Home Evaluation and Modifications, 710 e32 How Therapists Think: Exploring Therapists’ Reasoning When Working with Patients Who Have Cognitive and Perceptual Problems Following Stroke, e1 e33 A Survivor’s Perspective II: Stroke, e18 PART 1 Foundations of Stroke Rehabilitation, 1 1 Pathophysiology, Medical Management, and Acute Rehabilitation of Stroke Survivors, 2 2 Improving Participation and Quality of Life through Occupation, 46 3 Task-Oriented Approach to Stroke Rehabilitation, 59 4 Activity-Based Intervention in Stroke Rehabilitation, 79 5 Client Centeredness: A Survivor’s Perspective, 96 PART 2 Maximizing Participation in Everyday Activities, 103 6 Enhancing Performance of Activities of Daily Living Tasks, 104 7 Activities of Daily Living Adaptations: Managing the Environment with One-Handed Techniques, 136 8 Functional Mobility, 155 9 Gait Awareness, 194 10 Work after Stroke, 224 11 Driving and Community Mobility as an Instrumental Activity of Daily Living, 237 12 Parenting after Stroke, 265 13 Sexual Function and Intimacy, 280 14 Leisure Participation after Stroke, 296 15 Caregiving after Stroke, 309 PART 3 Maximizing Outcomes for Specific Problem Areas Following Stroke, 329 16 Psychological Aspects of Stroke Rehabilitation, 330 Contents This page intentionally left blank PART 1 Foundations of Stroke Rehabilitation 1 1 part 1 Pathophysiology, Medical Management, and Acute Rehabilitation of Stroke Survivors 2 Improving Participation and Quality of Life through Occupation 3 Task-Oriented Approach to Stroke Rehabilitation 4 Activity-Based Intervention in Stroke Rehabilitation 5 Client Centeredness: A Survivor’s Perspective 1 Foundations of Stroke Rehabilitation

Stroke Rehabilitation: A Function-Based Approach, 4e PDF

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