I love a TV commercial where a father stands outside a gym after a basketball game and says he missed his son's winning shot because he was outside smoking a cigarette. He decides to wear a skin patch to stop smoking. The slogan for this TV ad is "a great why deserves a great how."
This commercial reminded me that the how-tos I know as an OT are not enough to be successful.
As the fear of being home-bound faded over 13 years of living with a stroke my walking endurance declined. However, I live alone and cannot fold a wheelchair or lift it into the trunk of my car. So I tried to improve by setting a goal of a specific number of steps on my pedometer. I was frustrated when my data showed I walked less after I set this goal. When my iphone played an annoying sound I turned it off and thought "I will walk tomorrow." Then I remembered the calf muscle pump.
The heart is not strong enough to pump the blood out of the legs. Blood pooling in the legs can form a blood clot which can break off and go to the brain to cause a stroke. This made me think about what is happening when I sit at the computer, etc. However, when calf muscles contract they squeeze the veins which helps push the blood upwards (see diagram below). Between heart beats when the heart rests blood drops down inside the veins, but valves snap shut and blood is trapped at higher and higher levels. This repeats until all the blood in the legs goes back to the heart.
I have met or exceeded my walking target every day for three weeks. Having a concrete image of what is happening in my legs right this minute is the great why I needed to change my behavior.