There are plenty of reasons a cva can't use movement for function including altered perception. visual field deficits and neglect, motor planning problems. one way to test for motor planning if you do not have an OT assessment is to set up a situation were the patient can react of his or her own volition. If they can do this but not follow through in the same situation when you verbally cue a movement it is likely that they can not connect a concious thought to a movement but can function on an automatic level. Then this is how you have to gear your therapy. Fatique can be pronounced following stroke and can last up to a year but usually improves slowly. Short treatment in the AM may be all they will tolerate at first.

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