December 27, 2015

Not Making Exercise Personal = Non-compliance

Even though I am an OT I stop doing a home exercise if I do not see what I hope to get from it.
I think non-compliance is more likely when exercise does not feel personal.  My OT had me slide a towel on the table with my hemiplegic hand.  That exercise was to help me........  what was that exercise for?  The hand can reach to pull up pants or sign a credit card slip.  Unlike the foot, the hand is so versatile it is hard to know what sliding the towel on the table would do for me.    

Here is another example of how confusing exercise can be.  My neighbor complained to me about OT.  Her OT had her put clothespins on a clothesline.  My neighbor said "I told that young girl I had a clothes dryer, but she made me use the clothespins anyway."  As an OT I knew her therapist was working on tip pinch.  However, I did not know my neighbor well enough to know why she needed a strong tip pinch in her non-dominant hand.  If one OT cannot tell what another OT's end game is how can clients understand the value of the exercises we prescribe? 

Linking a specific Activity of Daily Living (ADL) to a specific exercise motivates clients. 
Stretch shoulder = Don shirt.  When my shoulder was tight I laid on my back on the bed and stretched it while I rested after a shower.  Stretching my shoulder just before I dressed made it easier to get my arm in the sleeve when I donned a shirt. 
Leg lifts = Boardwalk. Before I walk on the boardwalk at Point Pleasant Beach, I hold onto the railing and do a few leg lifts to wake up the weak hip flexors and abdominals on my hemiplegic side.  Leg lifts keep me from stubbing my toe on the edge of boards that stick up.  

8 comments:

  1. I love the story about the clothes pins :)

    On the occasional day when I take the kids to school in the morning, it helps a lot if I do any kind of exercises before I set out. I wish I had realized that earlier.

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  2. It's all about wanting to feel better and taking personal responsibility for your health. And sometimes that involves hard work that isn't much fun and that you don't want to do.

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    1. I would put it differently. It's a therapist's job to help clients see how working hard gets them get things they want. Without a meaningful goal exercises are just "shoulds" that fade away with time.

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    2. Yes we do see that much differently.

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    3. I'm nine years post stroke so I've had to find ways to motivate myself to do home exercises because progress is slow.

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  3. Great post. I'm a student occupational therapist and I keep forgetting to do my physiotherapy exercises, even though I know how important they are! They seem an additional task in an already busy day. I have recently been reading about integrating exercises into daily activities and how this seems to increase adherence and performance(this article was about strength and balance training in falls prevention) so it is interesting to hear how you use a similar approach. I have now started trying to embed these exercises into daily life by going to pilates classes or incorporating them into my normal gym routine. OK I'm not doing them as often as I should, but I'm doing them more often than I was. I have been reading your blog for a while and think it is useful and inspirational. Thanks, the OT process, http://theotprocess.wordpress.com/

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  4. Hi, in response to my previous comment, I have written a blog post about this now and it would be great if you could come and take a look. I've talked about your methods too, Rebecca. http://theotprocess.wordpress.com/2013/09/05/the-power-of-routine-or-why-i-didnt-do-my-physio-exercises/

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