Last updated December 20, 2021

Occupational Therapy Practice Guidelines for Adults with Stroke

Interventions to Improve Occupational Performance of People With Cognitive Impairments

  • Visual scanning training to improve performance (A) 
  • General cognitive rehabilitation to improve global cognitive function (B)
  • Visuospatial training to improve cognitive function (B) 
  • Cognitive strategy training to improve performance on trained and untrained tasks (B) 
  • Gesture training to improve ideational, ideomotor, and gesture comprehension with correlational improvements in activities of daily living (ADL) independence in people with apraxia (B) 
  • Computerized memory programs to improve memory performance and occupational performance (C) 
  • Ecologically oriented neurorehabilitation of memory (EON–MEM) intervention to help improve memory performance (C) 
  • Exercise and recreation program to improve memory (C) 
  • Time pressure management to improve speed in daily task performance for people with mental slowness (C) 
  • VMall (a virtual supermarket) to address multitasking (C) 
  • Exercise or recreation program to improve executive function (C) 
  • Compensatory training interventions to improve occupational performance in people with visual dysfunction (C) 
  • Individualized home rehabilitation program to improve cognitive function (I) 
  • Attention processing training to address attention deficits (I) 
  • Visual restoration interventions to improve visual dysfunction (I) 
  • Prism adaptation to enhance functional measures (including wheelchair mobility) and nonfunctional measures of unilateral spatial neglect. (I) 
  • Mirror therapy to improve occupational performance in people with unilateral spatial neglect. (I) 
  • Right half-field eye patching to improve occupational performance in people with unilateral spatial neglect (I) 
  • Neck vibration before occupational therapy to improve unilateral spatial neglect (I) 
  • Family participation in therapy to improve unilateral spatial neglect (I) 
  • Spatial cueing to improve wheelchair use for those with unilateral spatial neglect (I)

Interventions to Improve Occupational Performance of People with Motor Impairments

  • Repetitive task practice to improve upper extremity (UE) function, balance–mobility, and activity–participation (A) 
  • Constraint-induced movement therapy (CIMT) or modified constraint-induced movement therapy (mCIMT) to improve UE function and activity–participation (A) 
  • Strengthening and exercise to improve UE function, balance–mobility, and activity–participation (A) 
  • Bilateral training to improve UE function when facilitated by a device (B) 
  • Virtual reality (VR) to improve UE function and activity–participation (B) 
  • Mental practice to improve UE function, balance–mobility, and activity–participation (B) 
  • Mirror therapy to improve UE function and activity–participation (B) 
  • Action observation to improve UE function (B) 
  • Electrical stimulation to improve UE function (B) 
  • Telerehabilitation to augment the delivery of functionally based training programs (B) 
  • Bilateral training without the use of a device for improving UE function or activity–participation (C) 
  • Electrical stimulation to improve activity–participation (C) 
  • Peripheral nerve sensory stimulation to improve UE function (C) 
  • Repeated muscle vibration to improve UE function (C) 
  • Visual feedback to improve balance–mobility (C) 
  • Robotics to improve UE function or activity–participation (C) 
  • Shoulder supports to improve balance and mobility (C)
  • Positioning devices, orthoses, and stretching to improve UE function and activity–participation (C) 
  • Botulinum toxin A combined with therapy interventions to improve UE function or activity–participation (C) 
  • Brain stimulation in addition to therapy to improve UE function and activity–participation (I) 
  • Neurodevelopmental treatment to improve UE function or activity–participation (D)

Interventions to Improve Occupational Performance of People with Psychosocial or Emotional Impairments

  • Behavioral therapy to reduce depression and improve other psychosocial outcomes (B) 
  • Multicomponent exercise program (e.g., strength and balance training) to improve psychosocial outcomes (B) 
  • Care support and coordination to improve psychosocial outcomes (B) 
  • Community-based rehabilitation to improve psychosocial outcomes (B)
  • Single-component exercise programs to reduce anxiety or depression and improve mental health quality of life (I) 
  • Behavior therapy combined with stroke education to improve psychosocial outcomes (I) 
  • Stroke education to improve anxiety (I)

Interventions to Improve ADLs and Instrumental Activity of Daily Living (IADLs) 

  • Home-based occupation-based interventions to improve ADL performance (A)
  • Community-based occupational therapy interventions to improve ADL performance for older adults (≥65 years) (A) 
  • Activity- and occupation-based interventions to increase participation in leisure activity (A) 
  • Occupation-based interventions to improve ADL performance in the inpatient setting (B) 
  • VR task simulation to improve UE function (B) 
  • Rehabilitation program targeting sexual function to improve frequency of participation in and satisfaction with sexual activity (B) 
  • Community mobility program to increase the number of journeys taken outside of the home (B) 
  • Driving simulation training to improve visuointegrative skills while driving (B) 
  • Occupation-based interventions to improve ADL performance in the outpatient setting (C) 
  • Community interventions to improve IADL performance (C) 
  • VR to improve performance of street crossing tasks (C) 
  • Wheelchair skills program to improve wheelchair performance (C) 
  • Activity- and occupation-based interventions to improve social participation (I) 
  • Exercise and education program to improve reintegration and quality of life (I) 
  • Driving simulation training to improve operational and tactical performance during driving (I) 
  • Hospital-based VR program to improve executive functioning and multitasking during shopping tasks (I) 
  • VR program to improve community mobility skills (I) 
  • Tai Chi to improve quality of sleep (I)

Levels of Evidence for Occupational Therapy Outcomes Research - Definition 

  • Level I Systematic reviews, meta-analyses, and randomized controlled trials (RCTs) 
  • Level II Two groups, nonrandomized studies (e.g., cohort, case control) 
  • Level III One group, nonrandomized (e.g., before-after, pretest and posttest) 
  • Level IV Descriptive studies that include analysis of outcomes (e.g., single-subject design, case series)
  •  Level V Case reports and expert opinions that include narrative literature reviews and consensus statements

Recommendation Grading

Overview

Title

Adults With Stroke

Authoring Organization

Publication Month/Year

November 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care

Intended Users

Speech language pathologist, psychologist, physical therapist, occupational therapist

Scope

Rehabilitation, Management

Diseases/Conditions (MeSH)

D020521 - Stroke, D000071939 - Stroke Rehabilitation

Keywords

stroke, Stroke Rehabilitation