Return to mind task 1 and your thoughts about task- oriented approach and the tasks you planned for Peter. Would you do anything different now? Write down which things support your present ideas about stroke physiotherapy and what new ideas you got?
This task has taught a significant amount about the focus of physiotherapy during the initial and chronic stages after stroke. In the first place, when considering the use of neurofacilitation or oriented-task approaches, the most influencing variable to make this decision is time.
Another major consideration relates to negative impairments (loss of dexterity and strength). Immediately following stroke, strength training aims to reduce number of non-functioning motor units. Once an initial level of strength has been established, the training’s target may also include dexterity. These 2 factors are major contributors to loss of ability following stroke, and should be a focus of rehabilitation.
Depending upon the condition and the patient’s ability to recover lost function, the following strategy can be used:
-Acute (including temporary/changeable impairments): emphasis placed on recovery of normal function à STRENGTH TRAINING AND NEUROFACILITATION APPROACH
-Chronic (including permanent, unchanging impairments): emphasis placed on maximizing function through compensatory strategies à STRENGTH AND DEXTERITY TRAINING AND TASK-ORIENTED APPROACH
Depending upon Peter, due to the acuteness of the impairment, I would include strength training exercises for weakness areas as lower limbs. However, I might include dexterity training for strongest areas as upper body and do the previously suggested exercises.
Jehanne Crouzier 