A synthesis of the effects of occupational therapy for persons with stroke, Part II: Remediation of impairments.

This article is the second of a two-part synthesis of research regarding the effects of occupational therapy to improve activity and participation and to reduce impairment for persons with stroke. Part I synthesized research findings for restoration of role participation and activity performance. Part II synthesizes research findings regarding the effects of occupational therapy to remediate psychosocial, cognitive-perceptual, and sensorimotor impairments. Only 29 studies involving 832 participants (mean age = 64.3 years) addressed these goals. No studies directly researched the effects of occupational therapy on depression after stroke. Eight studies addressed cognitive-perceptual abilities. The findings indicated that homemaking tasks resulted in greater improvement of cognitive ability than paper-and-pencil drills and that tasks that forced awareness of neglected space, including movement of the opposite limb into that space, improved unilateral neglect. Fifteen studies examined the effect of occupational therapy on various motor capacities after stroke. Coordinated movement improved under these conditions: (a) following written and illustrated guides for movement exercises, (b) using meaningful goal objects as targets, (c) practicing movements with specific goals, (d) moving both arms simultaneously but independently, and (e) imagining functional use of the affected limb. Research on inhibitory splinting was inconclusive. Based on these few studies and lack of replication, we could make only tentative recommendations for practice. Further definitive research is needed.