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Disability in stroke
Stroke is the largest single cause of severe physical disability in adults in the developed world [1]. Despite recent advances in the treatment of stroke [2], there are approximately 900,000 stroke survivors in England, half of whom remain dependent on others for everyday activities [3]. Many of these stroke survivors require long-term support from community services and at least one in 20 require institutional care [3]. Even the less dependent survivors remain housebound and isolated because of unsuitable housing or lack of appropriate transport facilities [4]. The cost of stroke is considerable, with the National Audit Office estimating an annual spend of GPR£2.8 billion in the UK in direct care costs, and almost the same again in informal care costs [5]. These costs are predicted to increase as the numbers of people living with stroke increases owing to the success of new treatment interventions [6].
The considerable human and societal costs of stroke can be reduced by adopting multidimensional strategies aimed at prevention to reduce the incidence of stroke, acute interventions to limit brain damage and impairments caused by stroke, or by rehabilitation to reduce the functional, psychological, social and occupational consequences of this damage [7]. Once stroke has occurred, rehabilitation to reduce functional deficits has proven to be one of the most effective treatments available for stroke patients [7], in which occupational therapists play a central role as members of a multidisciplinary team [8].
Rehabilitation after stroke
Stroke patients suffer a range of impairments depending upon the regions of the brain affected by the primary pathology. Important stroke-related impairments include: loss of muscle power, proprioception or sensation, which affect mobility, balance and upper limb function; speech deficits such as dysarthria or dysphasia, which affect communication; visual problems (e.g., hemianopia or inattention); and a range of perceptual and cognitive deficits, which affect a patient's ability to carry out day-to-day tasks, even when power, sensation or communication may not be affected [9]. Stroke rehabilitation is a multidisciplinary process that enables stroke patients to regain as much independence as possible and go on to live a productive and meaningful life. Another role of rehabilitation is to enable patients to adapt to their limitations, environment and level of personal support in the event that...