Activities to Help Improve Motor Skills and Brain Function

Updated: Aug 31




After a stroke, best practice physical medicine and rehabilitation guidelines recommend early intervention of occupational therapy services.


Occupational Therapy for Stroke Patients: Enhancing Motor Skills and Brain Function

Occupational therapy is a scientifically based, health and human services professional dedicated to meeting the holistic needs of the client. The practice framework of occupational therapy facilitates engagement in everyday activities (e.g. occupations) to support participation in life.


Occupational therapy helps those who have experienced a stroke return to function in daily life by providing a comprehensive evaluation followed by interventions that address occupational performance in the following:


  • Activities of Daily Living (basic and instrumental)

  • Health Management

  • Rest and Sleep

  • Education and Work

  • Play and Leisure

  • Social Participation

  • Health Management


A stroke, or a “brain attack,” occurs when there is an interruption of blood flow in the brain. Because the brain is considered the master control center for the rest of the body, even a small disruption in blood supply can be very damaging to basic functions. According to the American Stroke Association in 2022, stroke is the leading cause of disability in the United States and the fifth leading cause of death. Strokes can be caused by blood clots, hemorrhages (e.g. bursting of vascular walls), or inherited vascular problems.


Every brain is unique in its structure and neurological wiring. Therefore, no two strokes are identical in symptoms because no two brains are absolutely identical. This means that recovery also occurs at different paces for every individual.


Occupational therapists recognize that a survivor's progress is not only dependent on the biology of the brain and structural damage, but also on factors related to the stroke survivor’s support system, environment, values, and beliefs.


What Are Some Activities That Occupational Therapists Use to Help Stroke Patients?


Occupational therapy interventions most often involve meaningful and FUNctional activities selected by the stroke survivor. Once the occupational therapist analyzes the survivor’s strengths and limitations, the therapist will design an activity-based program that addresses noted physical, visual, psychological, or cognitive limitations that limit participation in the occupation.


Activities are usually progressive in the challenge. This means that the therapist will use clinical judgment for the appropriate starting point, and then incrementally advance the difficulty level once the stroke survivor achieves certain milestones, otherwise known as goals. The occupational therapist may recommend activity adaptations to the client’s previous way of doing tasks if it means they can be more safe and independent. However, the skilled therapist knows that sometimes it is best to have the client experience “struggle” a little bit during activities in order for the brain to form new connections that restore function to desired areas.


Although this list is regarded as general and not intended to be individualized to the needs of all stroke survivors, the following grid highlights Common Activities in OT for Stroke Survivors


Common Activities in OT for Stroke Survivors

Download Printable Version of Table

Stroke Impairment

Impact on Occupational Performance

OT Activity

Hand incoordination

Difficulty with handwriting

  • Pick up markers or pens to develop tripod grasp

  • Hold tongs while picking up small objects

  • Coloring/tracing

  • Functional writing

Difficulty self-feeding

  • Handle utensils, poke or scoop, cut food, move hand to mouth

  • Self-help devices for feeding

Difficulty picking up objects

  • Pick up, manipulate, sort and move common objects (i.e. bottle caps, keys, buttons, deck of cards)

Difficulty grooming

  • Brush teeth, comb hair, wash face handling and transporting grooming supplies

Difficulty with tools

  • Grasp hammer, pound nail

  • Grasp and turn screwdriver, turn screw

Arm weakness

Difficulty washing hair

  • Reach hand to head

  • Directional changes in high repetition with arms overhead

  • Assist with other arm, if needed

Difficulty holding and pouring gallon of milk

  • Increase liquid volume as tolerated

  • Practice pouring and lifting to various counter/shelving heights

  • Strengthening or range-of-motion exercises for hand/wrist/forearm/upper arm

  • Graded activity

Difficulty carrying groceries

  • Gather various grocery items- remove and place in from bag while holding the bag, hold or carry for determined time

  • Strengthening or range-of motion exercises for hand/wrist/forearm/upper arm

Difficulty with leisure and hobbies

  • Adaptive games/craft/sports to promote independence

Balance issues

Difficulty standing or sitting

  • Postural control and stability exercises during ADLs

  • Using counter or railing to stabilize and let go for brief periods of time

  • Shift body weight in different directions

  • Incorporate daily activity during standing to train activity tolerance in standing

  • Seating options to promote stability

Difficulty transferring surface to surface

  • ​Practice standing and sitting on different seating options with weight shifting during reaching or activity

Difficulty walking

Falls, near falls, unsteady during ambulation

  • Address safe ambulation during daily activities

  • Referrals to physical therapy for gait training

Attention issues

Short attention span, easily distracted

  • Divide activities into short, simple steps

  • Adapt environment from distracting stimuli

  • Provide motivation for finishing task

Cognitive issues

Poor judgment during tasks

  • Provide activities that address real-life scenarios at appropriate level of understanding

  • Protect person from injury

  • Provide simple explanations for doing something a particular way

Memory issues

Difficulty remembering steps during cooking

  • Use step-by-step instruction with visual schedules

  • Supervise for safety

  • Simplify steps

  • Use timers

  • Write things down

Difficulty remembering to take medications

  • Use timers/alerts intended for medication reminders

  • Place medication in dispensers that reduce errors

  • Provide supervision, reduce feedback with noted improvement

Perceptual deficits

Disorientation to time

  • Instruct in calendars, clocks, and pictures of family members to reinforce orientation

  • Attempt to limit amount of changes in person’s schedule

Disorientation to objects, body, or environment

  • Instruct in the correct use of objects and sequence of how to follow steps

  • Direct individual’s attention to the involved side, providing sensory input and visual stimuli

  • Place only necessary objects in view during tasks to reduce confusion

Visual perceptual difficulty

Difficulty distinguishing forms, perceiving how parts make a whole, understanding depth, difficulty with eye-hand motor skills

  • Adaptive approaches: reduce visual distractions, enlarge font, use lists or schedules, use boundaries, simplify visual

  • Restorative: puzzles, practice of objects in correct orientation, target task games

Visual deficits

Difficulty with scanning environment or loss of visual field

  • Scanning environment tasks to increase safety and independence

  • Use of boundaries/highlighter

  • Adaptive mobility

Psychosocial

Presents with hopelessness and despair

  • ​Provide opportunities for success

  • Provide feedback when individual is improving

  • Selection of tasks directed by individual that provide joy or hold interest

  • Referrals to social work and community programs

​Reduced stress tolerance

  • Promote short, engaging tasks that provide success

Communication

Difficulty with verbal expression (expressive aphasia)

  • Use of picture/symbol boards (augmentative communication)

  • Offer multiple choices

  • Simplify communication to shorter phrases/directives

  • Referral to speech therapy

Difficulty with comprehension (receptive aphasia)

  • Speak clearly and in simple terms

  • Alternative forms of communication

Difficulty with pronunciation (dysarthria and/or apraxia)

  • Provide alternative forms of communication, alphabet or picture boards

  • Allow for practice to improve oral motor

  • Referral to speech therapy

Download Printable Version of Table


It should be noted that an OT will determine what interventions are going to be most appropriate to suit the individual’s needs for where they are at in their recovery. Activities are always dynamic, meaning there is room for flexibility to change the manner in which the activity is done based on the individual’s response. An occupational therapist also grades activities to be easier or made more challenging as the individual continues along their recovery journey.


What Are Activities I Can Do at Home to Help Recover?


The need for therapy often extends beyond the hospital walls and into the home after a stroke. After a period of therapy, it is not uncommon to have to be self-reliant and work through rehabilitation independently.


Many activities that are done in the clinic can also be done at the individual's home. In fact, some would argue that using familiar objects that the individuals have had previous experience with is a great place to start. This is especially true if an individual has difficulty understanding, or generalizing, how to apply tasks they learn in a clinic or hospital environment to real life.


Although this is not a comprehensive list, the following grid can be used to provide ideas on how to work on activities that will help survivors recover abilities that may have been lost or diminished after their stroke.*

* Always consider safety/injury prevention; consult with a physician or therapist if there are specific concerns. Neurolutions Inc. is not responsibly liable for any injury or harm.


Download Printable Version of Table

Activity 1

Activity 2

Activity 3

For hand incoordination, try….

Lacing shoes or tying knots

Screwing/unscrewing tops/jars

Flipping over cards/playing board games

For hand weakness, try…

Squeeze water out of a sponge

Handle wet clothes out of washer; fold clothes

Organize books on shelf, grasping them different ways

For arm weakness, try….

Hang clothes or coats on hangers

Put away dishes or cups that won’t break if dropped

Operate a vacuum or sweeper

For balance issues, try…*


*supervise for safety, if needed


Sitting edge of chair, reach for objects

Stand holding on to counter, reaching for objects

Hold onto counter with one or two hands; step or weight shift different directions, reaching for objects or cupboards, if able

For walking difficulty, try….


*supervise or use assistive for safety, if needed


Remove hazards on floor, walk to different stations in home

Remove hazards on floor, walk to different stations in home

For advanced ambulators, step over objects on floor For advanced ambulators, step over objects on floor

For cognitive issues, try…

Making a meal of appropriate complexity ​

Respond to timers / clocks in the home

Read and sort mail, taking appropriate action

For visual perceptual deficits, try…

Sorting utensils or finding items out of drawers

Put tools, clothes grocery items where they belong

Do puzzles or board games

Download Printable Version of Table



For successful and therapeutic interventions that emphasize occupational performance, consider individual factors such as pain, tolerance to exertion and/or activity, safety, interest, and frustration levels. Remember that most activities can be adjusted in a variety of ways to help “meet the survivor” where they are at. If the activity did not seem to hold a person’s attention, ask the individual what they would rather work on or provide them choices. Offer encouragement throughout the activities, but also offer positive, constructive feedback to help a person learn.


Recovery has Ebbs and Flows


Finally, It is important to note that the survivor is going to have fluctuations in performance. This means that the activity will go more smoothly on some days than on other days. This recovery rollercoaster is very normal, but the overall goal is that eventually, the performance stabilizes on the upward trend.


For optimal results, consult with an occupational therapist experienced in stroke to provide individualized and skilled guidance throughout the recovery process.