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NOVA HEALTHHome nursing and physiotherapy

Occupational therapy after stroke · home visits across Hong Kong

Occupational therapy after stroke,
rebuilding independence in daily living

What matters most in stroke recovery is more than how much strength has returned to the arms and legs. It is whether the patient can dress, eat and use the toilet independently today, which is called independence in activities of daily living (ADL). Our registered occupational therapists in Hong Kong visit the home and give one-to-one training in the patient's familiar surroundings, helping to turn muscle strength into real independent living.

  • Registered occupational therapists in Hong Kong
  • Home visits across Hong Kong
  • 1 hour $1,000 · from 1.5 hours $800 per hour
  • Rebuilding ADL self-care
WhatsApp for a free enquiry and quote

Understanding stroke recovery again

Common misunderstandings about stroke occupational therapy

A better score on a hand grip test does not mean the patient can do up buttons, get dressed or go to the toilet alone. The real measure of progress in stroke recovery is whether the patient can carry out daily self-care movements (ADL), and not only a strength test number.

Common misunderstandings
  • Regained strength means recoveryBelieving that a higher grip test number means full recovery
  • Earlier and harder is betterBelieving that high-intensity, high-volume training pushed straight after the stroke is best
  • Believing that slow progress means no further improvementBelieving that once recovery stalls there will be no more progress
What is true
  • Look at whether ADL can be doneWhether the patient can dress, eat, use the toilet, wash and move between bed and chair
  • Well timed, enough and continuousTrain once the condition is stable, using the period when neuroplasticity in the brain is strongest
  • Find the hidden problemsFor example, with unilateral spatial neglect, an individual assessment and a combination of methods is needed

The golden recovery period does exist after a stroke. The first few weeks to months after onset are the period of strongest neuroplasticity in the brain. However, starting rehabilitation early does not mean pushing high-intensity training blindly at the moment of onset. The large AVERT trial found that high-dose activity within 24 hours of stroke led to a lower proportion of good recovery at 3 months (AVERT 2015). The measure of the results of rehabilitation is always whether the patient can manage daily self-care (ADL), and not the grip number alone.

Treatment methods aimed at rebuilding self-care

Main areas of intervention in stroke occupational therapy

The four methods below are supported by research, and they share one aim: to help the patient turn arm and leg strength into real independence in daily self-care and not stop at exercise with equipment alone.

01

Training aimed at daily self-care (ADL)

We do not only exercise muscle strength. We practise the real daily movements directly with the patient: dressing, eating, going to the toilet, washing and moving between bed and chair. The aim is to help the patient regain independence in daily living.

CochraneOT focused on daily activities clearly improves self-care (Legg 2017)
02

Repetitive task training

The patient repeats the movements really needed in daily life, enough times and with a real purpose, which helps improve the function of the arms and legs and keeps the effect for a period of time.

CochraneRepetitive task training improves function after stroke (French 2016)
03

Constraint-induced movement therapy (CIMT)

The movement of the good (unaffected) hand is restricted to encourage the patient to use the affected hand more. This method suits patients whose affected hand already has some basic movement, and it clearly improves arm function with an effect that lasts longer.

RCTCIMT clearly improved arm function, lasting more than a year (Wolf 2006)
04

Mirror therapy and assessing hidden problems

A mirror reflects the movement of the good hand, creating a visual illusion that helps train the affected hand. The therapist also assesses whether the patient has unilateral spatial neglect, a cognitive problem that is easily missed but can hold back progress.

CochraneMirror therapy improves motor function and ADL (Thieme 2018)

Why therapy at home

Home training settings for rebuilding self-care

Practising daily self-care movements at the patient's own home, with the objects used every day, means the skills learned are easiest to apply directly in everyday life. Four everyday places in the home are where we practise self-care.

Self-care training areas in the patient's home HOME SETTINGS

Bathroom · shower areaWashing and toileting, where difficulty is most commonPractise showering, using the toilet, washing the face and brushing teeth in the patient's own bathroom, and assess on the spot how to fit grab rails, non-slip mats and a shower chair.
Kitchen · dining tableTraining for eating and preparing mealsPractise preparing simple food with one hand, using non-slip place mats and cutlery with thick handles, and make sure chewing and swallowing are safe.
Bedroom · bedsideBasic training for dressing and moving between bed and chairPractise dressing and undressing on the patient's own bed and moving from bed to chair, and give advice on bed height and bedside rails.
Corridor · doorwaySafety and barrier-free access in and out of the homeClear clutter from the corridor, assess the width of the doorway and practise going in and out of the home safely in the real environment.
Guiding carers on the spot: The occupational therapist teaches family members directly how to support the patient safely when moving between bed and chair, how to feed so that choking is less likely, and how to help from the side without doing everything for the patient, so that the patient does as much as possible themselves.

Clinical evidence

The research on stroke occupational therapy

Evidence and data EVIDENCE

OR 0.71Occupational therapy focused on daily activities improves self-care ability and lowers the risk of long-term dependence on others9 RCTs, 994 people (Legg et al., Cochrane 2017)
Lasting 1 year+Constraint-induced movement therapy (CIMT) improves arm and hand ability, and the effect lastsEXCITE trial, 222 people (Wolf et al., 2006)
Burden ↓After training, carers have less strain, anxiety and depression, and the cost of care over a year also fallsRCT of 300 patient and carer pairs (Kalra et al., 2004)

The improvements above build up slowly through enough, continuous training that suits the individual, and do not appear after one or two sessions. For cognitive problems that are harder to notice, such as unilateral spatial neglect, there is currently no single effective treatment, and the therapist needs to assess the patient individually and combine several methods (Longley 2021).

If you are not sure about the patient's current level of self-care, or whether home treatment suits, contact us and tell us the situation. An occupational therapist will answer your questions.

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Further reading and other related therapies

Stroke · rehabilitation across professions

To learn more about physiotherapy and speech therapy after stroke, see the content below.

Physiotherapy after stroke 01

Limb and walking rehabilitation (physiotherapy)Arm and leg movement, balance and walking training

Speech therapy after stroke 01

Speech therapy after strokeAphasia, dysarthria and swallowing difficulty

FAQ · cost and results

Stroke occupational therapy: frequently asked questions

NOVA HEALTH・FAQ01 – 06
When is the best time to start occupational therapy after stroke?

Earlier and harder is not always better. Research (AVERT) shows that high-dose activity pushed within 24 hours of onset may actually slow recovery. However, the following weeks to months are the period of strongest neuroplasticity in the brain, so once the condition is stable the patient should be assessed by a therapist as early as possible, and a sufficient amount of repeated, meaningful training arranged. The ideal is an individual assessment and not a one-size-fits-all approach.

Is stroke recovery measured by how much strength returns in the arms and legs?

Strength is only one part. The more important measure is ADL (activities of daily living): whether the patient can dress, eat, use the toilet and wash independently. A Cochrane review found that occupational therapy focused on daily activities clearly improves self-care performance and lowers the risk of depending on others, which is the core of whether recovery is successful.

Does occupational therapy need to continue at home after discharge?

Yes. Recovery is in fact only just beginning. Research shows that early supported discharge, with a multidisciplinary team following up at home, reduces the risk of death or dependency. A home-visit OT can train the patient in the real home environment (their own kitchen and toilet) and modify unsafe areas, so the results are closer to real life.

Which stroke occupational therapy methods have scientific evidence?

They include repetitive task training (improves arm and leg function, with the effect lasting up to 6 months), constraint-induced movement therapy (CIMT, which clearly improves arm function and lasts more than a year), and mirror therapy (improves motor function, daily activities and pain, as an addition to usual rehabilitation). Which one to use is decided by the therapist according to the patient's situation.

Do family members who are carers need training?

It is strongly recommended. A randomised controlled trial of 300 patient and carer pairs found that trained carers had lower burden, anxiety and depression, the patients had a higher quality of life, and the overall cost of care over one year fell significantly. An occupational therapist can teach correct transfers, feeding and ways of helping with self-care.

Why is the patient's recovery stuck? Could it be unilateral spatial neglect?

Some stroke patients develop unilateral spatial neglect, in which one side of the visual field or of the body is ignored. This affects eating, dressing and safety, and is one of the hidden reasons why recovery stalls. Current research shows that no single method can solve it completely, and a therapist needs to assess the patient individually and combine several strategies.

To find out whether the patient is suited to rebuilding self-care through a home service, you are welcome to message us.

WhatsApp for a free enquiry and quote

1 hour $1,000 · 1.5 hours or more $800 per hour · no minimum charge · Prices for all services

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Legg, L. A., Lewis, S. R., Schofield-Robinson, O. J., Drummond, A., & Langhorne, P. (2017). Occupational therapy for adults with problems in activities of daily living after stroke. Cochrane Database of Systematic Reviews, (7), CD003585. PubMed
  2. Wolf, S. L., Winstein, C. J., Miller, J. P., et al. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095–2104. PubMed
  3. Langhorne, P., & Baylan, S. (2017). Early supported discharge services for people with acute stroke. Cochrane Database of Systematic Reviews, (7), CD000443. PubMed
  4. Kalra, L., Evans, A., Perez, I., et al. (2004). Training carers of stroke patients: randomised controlled trial. BMJ, 328(7448), 1099. PubMed
  5. French, B., Thomas, L. H., Coupe, J., et al. (2016). Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews, (11), CD006073. PubMed
  6. Thieme, H., Morkisch, N., Mehrholz, J., et al. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, (7), CD008449. PubMed
  7. Longley, V., Hazelton, C., Heal, C., et al. (2021). Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database of Systematic Reviews, (7), CD003586. PubMed
  8. Winstein, C. J., Stein, J., Arena, R., et al. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98–e169. PubMed
  9. Lang, C. E., Lohse, K. R., & Birkenmeier, R. L. (2015). Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Current Opinion in Neurology, 28(6), 549–555. PubMed
  10. AVERT Trial Collaboration group (Bernhardt, J., et al.). (2015). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386(9988), 46–55. PubMed
  11. HKUMed. (2022). HKUMed finds a 30% increase in ‘young stroke’ incidence in Hong Kong over the past two decades. HKUMed Press Release. HKUMed