Occupational Therapy plays a vital role in the total rehabilitation of the patient. It embarks the patient both physically and mentally, which enables the patient to use its functional abilities within the limits of the handicaps and his inabilities. It absorbs the patient through capturing his concentration, which ultimately is achieved by keeping the interest of the patient into consideration. We should not forget that the bent of his mind is also to be considered and that is where we catch hold of the patient psychologically. Its role in hemiplegia is very important as far as the rehabilitation is concerned.

        THE GENERAL O.T. AIMS ARE AS FOLLOW IN HEMIPLEGIA

1. To maintain correct position of the paralyzed parts

2. To relieve/ reduce spasticity

3. To maintain range of motion and to increase R.O.M. if limited

4. To strengthen muscles and then to re-educate them

5. To improve pinch, opponence and grasp

6. To improve Co-ordination

7. To improve finer finger dexterity

8. To contribute to psychotherapy

9. To prevent the development of contractures and deformities

10. To provide self- help devices, splints and calipers if need arises

11. To activate speech therapy

12. To give gait training

13. To give A.D.L. (activities of daily living) training

14. To check development of complications and management if occur

15. To give diversional and recreational therapy

16. To give prevocational and vocational training

          Keeping in view the above-mentioned aims of Occupational Therapy, the Occupational activities are used to fulfill the above aims of the treatment. The discussion proceeds are as follows :

1. To Relieve Spasticity
                        Before it is discussed how activities are beneficial to relieve or reduce spasticity, it will be very essential to define it. It is defined as "an augmented stretch reflex which is very sensitive to heat, light, touch and pressure." So it is very often seen that the presence of this phenomenon is in anti-gravity muscles i.e. flexors of the upper extremity and extensors of the lower extremities.

                       Before giving any activity in the Dept. the patient should be taught to relax himself as far as possible so that this inhibition is lessened up to some extent and some amount of the facilitatory mechanism creeps in making the patient able to move the affected limb with some voluntary control over the muscles. As it is said that in the early stages of illness the affected extremity is flail [ ½ side of the body] and in the due course of the time, the return of the spasticity is witnessed clinically. This is elicited clinically exaggeration of the reflexes of the upper and lower extremities on the affected side. Sometimes this may not be the case and we find that the reflexes are not elicited at all.

         The important techniques used to relieve spasticity are :

(a) Kabbat's mass pattern of movements

(b) Rude's technique i.e. proprioceptive neuro-muscular facilitation techniques.

(c) Bobath's technique of pattern of movements

(d) Cold therapy or ice technique

(e) Plasticine Technique : This is the technique used with the help of a sort of modeling clay, which is known as PLASTICINE. This is rolled by the patient on the table in the front or the therapist helps the patient to roll his hand in such a way that roll of Plasticine rolls under the palmer surface of the hand. Starting the fingers to roll over and gradually the hand of the patient is held by the therapist who is by the side of the patient, then therapist's right hand holding the forearm near the wrist joint in such a way that joint is free and left hand of the therapist is under the fingers of the patient and the thumb of the therapist resting over the dorsal aspect of the tips of the fingers. The process is repeated so that the stimulus thus produced decreases the spasticity. This is very useful to reduce hypertonicity in the wrist and the fingers. To reduce spasticity around the bigger joints, the technique used is mass pattern of movements or Kabbat's Technique.

    Application : Peg Lifting
     The patient sits on the chair and the therapist stands on the affected side of the patient. The mass pattern is performed on the patient's affected U.E. by the therapist as follows :

          The patient is made to hold the peg - from the peg board in front of the table. The left hand of the therapist stabilizes shoulder joint near the neck, the right hand of the therapist rests under the elbow joint of the patient and the therapist lifts the arm up to an extent that it moves through an arc of motion in overhead position. Then the shoulder is abducted (of the patient), the forearm is supported which is pronated and wrist is flexed which automatically releases the peg from the fingers due to the synergic action of the wrist muscles. This is repeated number of times. Initially patient feels tired and in due course of time performs it without any signs of fatigue.

                   This technique involves the use of all the joints of the affected extremity.