Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Overview

A stroke may result in temporary or permanent weakness or paralysis on one side of your body. Stroke can affect your vision, muscle strength, balance, memory, thinking, and speech, making it difficult to perform daily activities.

Occupational therapy focuses on helping you safely perform activities of daily living (ADLs) after a stroke or other cerebrovascular accident.

Occupational therapy helps you take advantage of your current abilities and remain as independent as possible. We may recommend that you: 

  • Use adaptive equipment to perform daily activities. 
  • Modify your surroundings to prevent falls. 
  • Stay active to avoid associated depression.
Additional References:

What to Expect: Your Initial Evaluation

Before we begin occupational therapy sessions, we evaluate your current daily routine and personal needs. Stroke often affects your ability to move one side of your body.

We may ask you to perform certain movements and tasks without help and then again using adaptive equipment.

We use a team approach to care, working with other health professionals, such as your primary doctor, physical medicine and rehabilitation doctor, neurologist, speech therapist, and physical therapist, to provide your overall medical care.

During Initial Evaluation

We ask many questions about your ability to bathe, dress, cook, use the toilet, and shower on your own. Be prepared to answer all questions honestly about how your daily functioning may have changed.

We know it can make you uncomfortable to discuss personal habits, but we are here to help you stay independent and safe. Examples of questions we might ask include:

  • How are your attention span and memory? 
  • Do you have any problems using your arm? Is it painful?
  • Have you had any changes in your vision? Do glasses help you see more clearly?
  • Do you need help eating, bathing, going to the toilet, or getting dressed?
  • Can you use a telephone if you need to call for emergency help?
  • What is your daily routine, and how do you enjoy your free time?
  • Have you had any recent falls?
  • Are you driving?
  • Do you have difficulty going out into the community or being around people?

Preparing for Initial Evaluation

To prepare for occupational therapy:

  • Wear comfortable clothing and shoes. 
  • Bring splints, walkers, or wheelchairs that you currently use. 
  • Bring any exercise handouts or instructions that you have been previously given.

Life Skills

Occupational therapy helps you regain strength, perform activities of daily living (ADLs), and remain as independent as possible.

When needed, we may also train a caregiver to provide additional help for you.

Self-Care

Once we identify any challenges with daily activities, we may recommend adaptive equipment to help you do things on your own. 

Dressing aids help you dress, put on socks without bending over, button and zip clothing, and put on shoes on your own.

Cooking aids help you prepare meals. Examples are a one-finger-touch can opener and a rocker knife with an upright handle.

Lifting, standing, and moving aids help you move. For example, you may need a transfer board or transfer belt, cane, brace, walker, or wheelchair.

Transfer aids help you move safely from a toilet, bed, or wet shower or bathtub to getting fully dressed.

Visual aids help you see more clearly when your vision is affected, such as a magnifying lens and large print on household items like clocks.

Depression

Depression is common after you have had a stroke. You may feel alone or tend to withdraw from others when you are unable to move easily, get around without help, or speak clearly.

It is important to schedule regular social activities, even when you might not feel up to it. We are here to help, so let us know and tell your doctor if you are feeling depressed.

Rehabilitation Methods

We may use a variety of methods to increase your strength and help you become independent after a stroke.

Often, we focus on managing an affected arm, visual changes, and problems with balance.

Arm Management

After a stroke, you may have muscle spasms, pain, and changes in sensation in the affected arm. To improve arm movement, we may recommend that you:

  • Practice your home exercise program every day that was provided by your therapist.
  • Practice small movements every day, such as brushing your hair and drinking from a cup.
  • Imagine moving your affected arm without actually moving it. This stimulates the area of the brain that controls the arm.
  • Put a sling on your unaffected arm, which will cause you to move the weaker arm more often.
  • Receive treatment with low electrical currents to stimulate the muscles in the weak arm.

We may also teach you how to use one arm to perform certain activities, such as dressing, opening mail, and using a computer.

Visual Rehabilitation

A stroke might cause changes in your vision that lead to:

  • Hand-eye coordination problems
  • Visual inattention, in which you are not aware of objects on one side of your visual range
  • Visual field cut, in which you cannot see objects in part of your visual field

With visual inattention, you may hear a person but not see him or her standing on your affected side, or you may eat from only one side of a plate because the other side is not visible. This condition affects your ability to:

  • Walk, because you may walk into objects
  • Read, since you see only half of the page
  • Tell time, because you see only one side of a clock face
  • Perform activities such as dressing, grooming, and preparing food

Occupational therapy for visual inattention may include:

  • Using mirrors, eye patches, and visual games 
  • Doing eye exercises
  • Placing colorful lights, people, or interesting objects on the affected side to stimulate your brain
  • Placing a piece of tape down the left-hand side of reading materials so you know where the next line begins
  • Moving your affected arm to make your brain aware of that side

You may need to have someone with you when you cook or perform certain activities. You cannot drive when you have visual inattention. Fatigue may make this condition worse.

Balance Training

You must have good balance to sit and walk. We may recommend occupational therapy to improve balance while you:

  • Do activities such as reaching for or carrying an object.
  • Walk, stand, or sit, often using an assistive device. 
  • Become aware of your arms and legs, even when your eyes are closed.
  • Stand or walk in water, which supports your weight.
Additional References:

Stay Safe

Stroke affects different people differently. When you have active or worsening symptoms, it is important to avoid injury by modifying your physical environment.

Make it easier to stand from a seated position by using helpful aids and movements:

  • Use a tall toilet or raised toilet seat.
  • Install grab bars by the toilet and bathtub or shower.
  • Sit in chairs with arms and use the arms to push up to a standing position.

Address your safety by following these recommendations:

  • Remove all throw rugs to prevent falls.
  • Accept help when needed.

We will talk with you about modifying your home to prevent falls.

Additional References:

For Caregivers

Caregiving is hard work. Do all you can to increase your self-care, including getting support.

Consider joining a support group for caregivers. You can talk with people who are going through similar situations and may share solutions to common problems.

To help the person recover from stroke, follow these tips. 

Attend occupational therapy sessions to learn ways to help the person become more independent and follow instructions given at occupational therapy.

Encourage the person to continue occupational therapy at home to get stronger and recover skills.

Become educated about how stroke affects the person.

Reassure the person that stroke recovery takes time and patience.

Encourage the proper use of any adaptive equipment we give the person to independently perform ADLs.

Keep him or her safe by modifying the home to prevent falls.

Watch for changes in thinking, memory, and attention span.

Be aware of any signs of depression, such as sadness, irritability, feelings of worthlessness, or loss of pleasure in favorite activities.

Be patient while you wait for the person to speak, think, and move.

Let us know right away if you notice physical or emotional changes so we can determine if additional treatment is needed.

Additional References:

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician or other specialist, who will evaluate your health and symptoms.

If an occupational therapy evaluation is needed, your doctor will refer you to our department. Your needs and schedule will be considered when we make your appointment.

I will review your medical history prior to your appointment. On your first visit, I will ask you a variety of questions and perform an occupational therapy assessment. The assessment may include:

Observation. I may observe the way you walk, stand, or perform other activities.

Movement and strength testing. I may perform additional tests to establish your muscle strength and range of motion.

Functional assessment. I will consider how your condition is affecting your ability to function during everyday activities.

We will discuss the results of your exam. I will recommend a treatment plan and talk with you about your condition, and together we will decide on the best course of rehabilitation. Performing activities of daily living and educating yourself about safety will be part of your program.

We may schedule a number of visits so that you can learn how to perform your activities correctly and feel confident about continuing your program at home.

Contacting Me

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you call the Appointment and Advice line

  • Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location.
  • The advice nurse has access to your medical record and can often start your treatment by telephone, depending on the situation.

Convenient Resources for You

As your specialist, I have a goal to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

  • View and compose secure e-mail messages
  • Manage your prescriptions 
  • View your past visits and test results
  • View your preventive services to see whether you are due for a routine screening or updated immunization
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love. 

Learn more about your condition

  • Read about causes, symptoms, treatments and procedures
  • Find interactive health tools, videos, and podcasts to help you manage your condition

Stay healthy

  • Locate health education classes and support groups offered at every medical center
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Interactive Programs
Podcasts
Videos

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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