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Stroke and its impact

Occupational justice is often viewed as a component of social justice, a philosophical approach that has traditionally emphasized treating individuals with dignity and distributing societal resources equally. Contemporary perspectives place greater emphasis on respecting differences and on what people are capable of doing and becoming rather than on what they get (Hocking, 2017). It was questioned in this research if working toward occupational justice may contribute to the realization of a just and inclusive society by examining how occupational justice problems have been discussed in the past. Every year, approximately five million people in the world are left with a permanent disability as a result of a stroke, with many of them experiencing ongoing occupational difficulties. Further research on the evolving picture of occupational disruption and identity rebuilding following Stroke is required in order to inform client-centered therapy (Walder and Molineux, 2017). When older adult has a stroke, they may face worry, sadness, and difficulty participating in meaningful jobs, but they may also enjoy excitement, discovery, and satisfaction in finding a new vocational balance.

In the United States, around 795,000 people suffer from a stroke each year, according to official statistics. Approximately 610,000 of them are first-time or unrelated strokes (Tsao et al., 2022). Stroke was projected to be responsible for 1 in every 6 fatalities from cardiovascular disease in 2020 (CDC, 2017). Approximately two-thirds of people who survive a stroke live with a permanent handicap, with many of their requirements being unmet, including long-standing vocational problems (Walder and Molineux, 2017). A twin burden of communicable and noncommunicable illnesses is bearing down on developing countries such as India. As one of the most common causes of mortality and disability in India, Stroke is also one of the most deadly. 84-262/100,000 in rural regions and 334-424/100,000 in urban areas, respectively, is the estimated adjusted prevalence rate of Stroke in the United States. According to recent population-based research, the incidence rate ranges between 119 and 145 cases per 100,000 people (Pandian and Sudhan, 2013).

A stroke survivor's capacity to recover relies on the degree of his or her condition as well as the unique requirements of the individual. However, it has been demonstrated that the majority of stroke recovery occurs during the first six months to a year following the beginning of the Stroke. Occupational therapists collaborate with patients to determine the impact of a stroke on their ability to perform daily tasks, such as personal care, household tasks, work, and recreational activities; and to develop a goal-focused program to help them gain the skills they need to participate in daily life (Sackley et al., 2015). In light of the large range of possible stroke sequelae, occupational therapists must have a diverse repertory of strategies to serve each individual client. Treatment techniques in occupational therapy may include the use of occupational tasks to assist in the improvement of cognitive abilities, the teaching of adaptations to meaningful activities to keep the client engaged, and the use of task-specific movement to assist in improving range of motion and motor control (Kristensen et al., 2016). The occupational therapist can give a patient an assistive device, as well as alterations and adaptations in the environment, such as in the patient's home, to help them function better. In this way, the patient is able to do his or her activities of daily living (ADLs) independently while also coping with any emotional or social concerns that may arise as a result of the Stroke (Bailey, 2017).

Occupational Justice and Injustice

The long-term consequences of a stroke are dependent on which section of the brain was affected and by how much. Early treatment and Rehabilitation following a stroke can significantly enhance recovery, with many patients regaining a significant amount of function. Changes in speech, learning, and understanding, as well as weakness or paralysis on one side of the body, are the most prevalent kinds of impairment following a stroke (State Government of Victoria, 2021). After a stroke, most people will experience some degree of physical handicap for the rest of their lives. However, according to a recent study, the physical repercussions of a stroke are simply one of the numerous fundamental changes that may not be evident to others in the same situation. The findings of the study revealed three primary areas in which stroke survivors had the largest change in their everyday lives: physical function, cognitive capacity, and satisfaction with their social responsibilities, among other things (Katzan, 2018).

Stroke is a term used to describe a collection of illnesses that have an abrupt onset and result in brain injury. As a result, it is the most frequent cause of disability in Western countries, as well as the most common cause of mortality in Western nations. A quarter to seventy-four percent of the 50 million stroke survivors throughout the world are believed to be suffering from some level of physical, cognitive, or emotional disability, necessitating partial or complete assistance with activities of daily life (ADL). Because of advancements in stroke therapy, fatality rates from stroke have decreased in recent years, which, when paired with the phenomenon of ageing, has resulted in a rise in the number of individuals who survive a stroke. Developing theoretical models was important in order to better comprehend and build connections between the concepts of inadequacy, impairment (and the need for assistance), and the demand for assistance (Carmo et al., 2015). When compared to the general population, participation in physical activity among people who have had a stroke or another incapacitating condition is much lower than in the overall population. It has been demonstrated in a number of studies that persons who have recently suffered a stroke may benefit from adopting a more sedentary lifestyle to delay the beginning of functional decline. Lower cardiorespiratory fitness, which is related with a lack of physical activity, may be a secondary issue that makes it harder to transfer walking abilities obtained during Rehabilitation into the community (Maredza et al., 2016). Additional research has shown that low levels of physical exercise might exacerbate the functional decline of a person and impede his or her ability to work and play, as well as participate in community events and activities. Exercise participation is expanding at both the person and environmental/facility levels, and the identification of "high level" qualities that encourage participation is becoming a significant and important area of research in the field of physical exercise. Many physical activity programmes implemented in a range of communities have focused almost exclusively on individual characteristics, with little consideration given to the physical environment in which the programmes were carried out (Bailey, 2016).

In most cases, patients who have suffered a stroke develop deficits that are connected with a decline in their functional skills. It is motor impairments that are by far the most common type of disability when it comes to these illnesses. Stroke has an exceptionally high incidence and prevalence, and it is one of the most prevalent causes of disability in the world, impacting one out of every four individuals. It is also one of the most preventable causes of disability. It is also one of the most avoidable causes of disability since it can be avoided. It is believed that approximately 90 percent of stroke survivors have a reduction in their functional skills as a result of the event. Patients' health and functioning can be improved by healthcare professionals such as physical therapists who give proper follow-up and aid them in regaining health and functionality. As part of this, they will be assisted in preventing the development of new diseases or impairments, as well as encouraged to preserve or enhance their health and functionality. In certain cases, simply determining the health and function profile of the general population in a given location may be sufficient to determine the common requirements of the individuals who live in that location. Following the publication of these findings, it is now feasible to better direct the care provided to people who reside in the same place and have comparable issues, as well as to identify potential improvements or adjustments in treatment techniques for this group of patients (Carvalho-Pinto and Faria, 2016). For all of its devastation, Stroke remains the world's second most lethal cause of death and the leading cause of disability, behind only heart disease in all categories. The frequency of this disease is increasing as a result of the growing number of elderly people in society. Another aspect to notice is that in low- and middle-income nations, a larger proportion of young individuals suffer from strokes than in high-income ones. Despite the fact that hemorrhagic Stroke is more common than ischemic stroke, it is responsible for a greater number of fatalities and disability-adjusted life years lost than ischemic Stroke, the fact that the latter is more common (Katan and Luft, 2018). The most important goal of rehabilitation treatment after a stroke is to restore the patient's capacity to stand and walk again. It will be possible to plan targeted and appropriately timed rehabilitation measures ranging from targeted exercise to the provision of assistive devices or adaptations to the built environment if we have a comprehensive and detailed understanding of functional deficits and their recovery patterns (Rössler et al., 2020; Rössler and colleagues, 2020).

According to medical professionals, a stroke is regarded to be one of the most serious vascular catastrophes that can result in the loss of consciousness. As a result of the operation, individuals who have survived it are beginning to experience physical limitations. The patients who suffer from this disability may become crippled or reliant on others as a result of their condition. Stroke survivors may experience psychological issues as a result of the loss of functional activity and the transition back to a more normal way of life after the Stroke. Physical and emotional issues are frequent in stroke patients, which further confuses the clinical picture and makes it more difficult to diagnose (Lou et al., 2016). To ensure patient acceptance of a wide range of treatment options, all health care professionals must be able to effectively communicate information about patients' emotions, general symptoms, anxiety and concerns about their own health, as well as about their neurological handicaps, therapies, and co-morbidities (Kuluski et al., 2014). It is more typical for stroke victims to suffer from the following mental repercussions: Depression, anxiety, memory impairment, apathy, irritability, impatience, impulsivity, poor social awareness and insensitivity toward others, eating problems, and poor social awareness are all symptoms of bipolar illness, according to the American Psychological Association (McCarthy and Bauer, 2015).

People who have had a stroke often lose sight of their professional identities as a result of their inability to participate in some of their most treasured activities following a stroke. According to the World Health Organization, a handicap may be divided into three categories: impairments in bodily function, activity limitations, and participation restrictions. Impairments in bodily function are the most common type of disability (among other things). Having a stroke has the potential to have an influence on all three of these qualities if you are affected by it. Consequently, it may be regarded as a life-altering event requiring substantial Rehabilitation in order for you to be able to continue participating in useful activities following the Stroke. We must acknowledge that the biological model of illness has a significant influence on the provision of rehabilitation services throughout the duration of a stroke treatment pathway (Durocher, Gibson and Rappolt, 2013). When it comes to stroke therapy, in particular, the emphasis is on the physical problem, with little consideration given to disability and with just the bare minimum of intervention directed toward participation in society. Rehabilitative programs, which are directed by gains in physical and cognitive functioning, are primarily concerned with physical recovery as their primary goal. Restoration of an individual's sense of self is addressed in just a limited proportion of the program. Given this, it should come as no surprise that stroke survivors perceive that the aims of physicians do not correspond with their own personal wishes when it comes to their recovery from a stroke (Martin-Saez and James, 2019). People found it difficult to sustain social interaction as a result of physical ailments and discomfort or fatigue, and they relied on others for assistance more frequently than they would have preferred, ultimately resulting in their loss of freedom and independence. Aside from that, the loss of highly valued work has resulted in a reduction in occupational opportunities for socializing, which has resulted in a reduction in occupation-related engagement. A contributing component in the processes of occupational identity disruption has been discovered as social isolation, which raises the likelihood of losing one's sense of continuity in one's own identity, according to research (Leahy et al., 2014). It is impossible to overestimate the value of having strong social relationships for a variety of reasons, including support and pleasure of one's surroundings. Also crucial is the ability to maintain a feeling of continuity throughout times of transformation. In part because their self-definition process is no longer capable of providing the meaning and distinctiveness that had characterised them as persons in the prior years, people who have undergone strokes are frequently unsure of their identities after they have suffered a Stroke (Steber et al., 2017). Furthermore, the process of rebuilding one's occupational self is directed by the person's chosen occupational identity and, as a result, differs from one individual to the next. Those who have struggled to maintain their occupations, as well as those who have fought to continue their prior activities, even if it meant making considerable adjustments to their way of life in the process, are just two examples. A common occurrence in the field of physical rehabilitation, according to O'Donovan and Madden (2018), is that there is a misalignment between a patient's rehabilitation goals and the rehabilitation objectives of the practitioner, which is a misalignment between a patient's rehabilitation goals and the practitioner's rehabilitation objectives. The ability to gain a better understanding of occupational identity disruption in the context of not only an individual's past but also his or her anticipated future can be extremely beneficial to everyone who is involved as a result of a collaborative effort between stroke survivors, their caregivers, and doctors on rehabilitation goals. A person's vocational identity might be disrupted and social isolation can occur as a result of not being understood by others, particularly healthcare professionals at work, according to this research (Baatiema et al., 2020). Physicians, stroke survivors, and their caregivers can all benefit from a better understanding of occupational identity disruption. It will be possible to direct rehabilitation therapies not only to functional goals, but also to the restoration of occupational identity continuity as a result of this understanding. Employing the qualities of occupational identity as a fluid and dynamic process in a creative manner may help individuals develop their ability to reconstruct their professional identities. Ultimately, the success of this approach depends on the recognition of the need for a more occupation-focused rehabilitation arena by both healthcare practitioners and the organisations for which they work. According to the American Stroke Association, two aspects of this include creating rehabilitation environments that place stroke survivors and their occupational identities at the centre of the rehabilitation process, as well as providing opportunities for people to engage in valued occupations that allow them to pursue their desired occupational identities (Aguwa et al., 2010). In order to help stroke survivors and their caregivers better understand the human experience of occupational identity disruption after a stroke, it is important to recognise and educate physicians, stroke survivors, and their caregivers about the human experience of occupational identity disruption after a stroke. This will allow them to focus on rehabilitation on not only functional improvements but also occupational identity restoration after a stroke (Martin-Saez and James, 2019).

Continuing to participate in social activities after a stroke necessitates a person's willingness to accept their stroke-related deficits, as well as their willingness to alter their behavior and attitude via the use of active decision-making and self-management abilities. Rehabilitation Despite the fact that individuals' experiences of social inclusion following a stroke tend to be a dynamic and continuing process, taking a more personalized and long-term approach to Rehabilitation following a stroke appears to be favorable. When someone has suffered from a stroke, Rehabilitation should be focused on the activities that are most meaningful to the person who has been affected by the disease. Stroke survivors may benefit from the use of questions that examine what they want to achieve, what they perceive to be significant hurdles, and what skills and support networks they believe they will need in order to achieve their objectives. As we discovered in our previous study, it is critical for rehabilitation practitioners to encourage stroke patients to participate in meaningful self-selected social activities, and it is equally critical for stroke survivors to be given the flexibility and autonomy to define their own goals while undergoing recovery. When it comes to being able to engage in self-selected valued activities in a delightful manner, having the ability to adjust one's behavior and attitude while being positive, hopeful, driven, resilient, and bold is vital. Through the rehabilitation process, it is critical to emphasize the relevance of these behaviors and attitudes, as well as their understanding and appreciation of the value of these behaviors and attitudes (Woodman et al., 2014). As stroke survivors and their families negotiate the homemaking and community-reintegration processes, Rehabilitation should devote more resources to assisting them in regaining control of their handicapped bodies and renegotiating their altered identities as a result of the event. This has significant implications for anyone working in the field of Rehabilitation. Rather than focusing just on functional recovery in the initial post-stroke period, it is essential to address the self-body division that has occurred, as well as identity confusion and the mourning process immediately following a stroke. Because of this, stroke survivors will be more capable of comprehending and coming to terms with their altered bodies and identities, which will be useful to them during their Rehabilitation and recovery from their Stroke. In the months following release from the hospital and reintegration into society, the stroke survivor should be supported through the process of reestablishing meaningful relationships with their body, their homes, and their surrounding communities (Nanninga et al., 2014).

According to the definition, mirror therapy (MT) is the use of a mirror to create an optical illusion of a damaged limb in order to mislead the brain into believing that movement has happened without pain, or to provide a positive visual feedback to the patient while the limb is moving. The process described above entails concealing the sick limb behind a mirror that is strategically placed such that its reflection appears in lieu of the concealed limb on the opposite side of the body from where the diseased limb was hidden. Using the diagram, the patient arranges the good leg on one side of the bed while the stump is placed on the opposite side of the bed, as depicted (Antoniotti et al., 2019). With the use of a mirror placed on the opposite side of the body from where the diseased limb is located, the patient performs "mirror symmetric" motions that are similar to those made by a conductor or those made when we clap our hands, as seen in the video, to relieve pain. This is done in order to assist the patient in comprehending what is happening within his or her body. In fact, it appears that the phantom limb is moving because the individual is seeing the mirrored image of his or her own good hand moving, which is seen from the subject's point of view. Patients are able to "move" the phantom limb and unclench it from potentially uncomfortable postures when artificial visual input is used (Pérez-Cruzado & colleagues, 2016).

A new study has found that MT increases cortical and spinal motor excitability, which may be a result of the drug's effects on the mirror neuron system, which researchers believe is the cause of this effect. The Mirror Neurons in the human brain, according to some estimates, account for around 20% of all the neurons in the brain (Chinnavan et al., 2020). The capacity to separate between the left and right sides of the body is subject to the movement of these mirror neurons, which are especially significant for laterality remaking. Reflect neurons are energized as an outcome of the utilization of the Mirror box, and this excitement assists with supporting the recovery of the harmed areas. In this methodology, the perception of development is utilized to set off the engine processes that would be occupied with the development being noticed, as per the ongoing theory (Mirela Cristina et al., 2015). Be that as it may, while there have been a few equals among MT and engine symbolism, where the individual intellectually envisions movements instead of noticing the impression of developments in a mirror, there have likewise been a few distinctions recognized in the cerebrum components supporting the two strategies. Due to the cerebrum's inborn tendency to focus on visual input over any remaining kinds of criticism, it is theorized that engine preparing will turn into an undeniably powerful method (Shabaani Mehr et al., 2019). At this point, there is lacking proof to help this theory in light of existing exploration information. Especially essential is that while utilizing a mirror box, the neurons of the ipsilateral half of the globe give association with similar side impacted appendages as opposed to the traditional treatments, which focus on the neuronal rearrangement of the contralateral half of the globe, just like with most of regular treatments. Utilizing a mirror box enjoys the benefit of being less intrusive than customary treatments.

MT has been shown to be useful in the treatment of stroke patients who are experiencing pain as well as deficits in motor function, according to certain studies (Wittkopf and Johnson, 2017). It has been demonstrated in clinical studies that mirror therapy combined with normal Rehabilitation produces the most effective results. However, there is no clear consensus on whether it is effective or not. Even after years of research, it is still difficult to evaluate if massage treatment may assist individuals in regaining the use of their lower limbs. At this point, just one research has been completed, and it did not uncover any advantages (Cho and Cha, 2015).

The consequences of a stroke, as well as the limits that result for the patient and the healthcare system, have been well-documented in the medical literature for many years. When it comes to chronic pain, medication is typically the first line of defense. However, the negative side effects and high cost make it impossible to use for extended periods of time. In addition to pharmaceutical pain management, nonpharmacological therapies such as mirror therapy, which are affordable, safe, and easy to give by the patient, are recommended as adjuncts to pain management. The purpose of this study is to explain the notions of employing mirror therapy in order for it to be adopted as a supplemental therapy in a healthcare delivery system in the future. Also discussed in greater depth are the physiological justifications for mirror therapy in the management of chronic pain, as well as the evidence of clinical effectiveness based on current systematic reviews of the literature. Among the disorders that have been treated using the mirror therapy is pseudo-limb pain, complex regional pain syndrome, neuropathy, and low back pain. Mirror therapy is a technique in which a mirror is strategically placed so that the patient may see a reflection of a specific body component. According to a study, a course of treatment using mirror therapy (for a total of four weeks) may be useful in treating chronic pain (Lee, Kim and Lee, 2017). There are only a few contraindications and side effects to be aware of. Mirror therapy has not been proven to have a specific mechanism of action as of yet, but it is anticipated that reintegration of motor and sensory systems, the restoration of body image, and the capacity to control fear-avoidance will all have an influence on the result. There is some evidence to suggest that mirror therapy is effective in the treatment of depression. However, this is not definitive at this time. The use of mirror therapy (MT) can be effective even in completely paralyzed stroke patients, as opposed to other forms of rehabilitation procedures such as physical therapy. This is because mirror therapy (MT) leverages visual cues to generate a desired reaction in the injured limb. Numerous studies have demonstrated that MT can be effective in the treatment of not just motor impairments but also emotions, visuospatial neglect, and pain following a stroke (Gandhi et al., 2020).

Conclusion 

The disease of the brain, Stroke, can have ramifications throughout the entire body. It is the primary cause of impairment, yet at the moment, the general public is only vaguely aware of its existence. In the aftermath of a stroke, paralysis is one of the most common problems that occur. Hemiplegia is a type of one-sided paralysis, while hemiparesis is a type of related impairment that is a one-sided weakness on one side of the body. It is possible to suffer damage to the portion of the brain that is responsible for thinking and consciousness as well as attention, learning, judgment, and memory during a stroke. In some cases of Stroke, the patient develops a condition known as "neglect." It is possible for a stroke patient to be completely oblivious of one side of his or her body, as well as one side of their visual field, or to be completely unaware of the deficiency. In other cases, a stroke patient may be completely ignorant of his or her surroundings, as well as of the mental deficiencies that have developed as a result of the Stroke. After a stroke, it is possible to experience emotional difficulties. Emotional lability is a term used to describe the inability of stroke patients to regulate their emotions, as well as their tendency to display inappropriate emotions such as sobbing or laughing. Frustration is one of the feelings that virtually all stroke patients must cope with, and it can eventually progress to hostility and violent conduct. In stroke patients, depression is the most prevalent type of impairment to be encountered. It is possible that post-stroke melancholy is more than just a general feeling of grief as a result of the stroke episode. Post-stroke depression is treated in the same way as other types of depression are, with antidepressant drugs, psychosocial treatments, and Physical Rehabilitation. Mirror therapy may be an effective method of assisting stroke sufferers in regaining mobility in their arms and legs. Mirror therapy is a technique in which a mirror is used to produce a reflection of an unaffected arm or leg in lieu of the diseased limb during treatment. It is believed that when the unaffected limb moves, the mirror image confuses the brain into believing that the afflicted limb is moving.

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