Researchers found that clients do not use the skills they gain in rehab to engage in meaningful activities (1). Therapists address basic Activities of Daily Living (ADLS), but getting dressed, walking to the couch, and watching TV is NOT my reward for the hard work I did in rehab.
Clients and therapists need to think about deeper needs that make the hard work worth it. The Engagement in Meaningful Activities Survey asks clients what they care about without requiring therapists to explain what meaningful means. The survey asks clients to rate how much a specific activity gives them pleasure, gives them a feeling of control, helps other people, expresses their values, etc. This survey was used to improve participation in meaningful activities as part of a behavioral activation approach (1).
However, thinking about meaningful activities would have been difficult for me during in-patient rehab. After my stroke I was distraught and depressed about what had happened to me. I focused on concrete skills that would keep me out of a nursing home, like toileting independently. Home health therapy also had to focus on concrete challenges, like how to get in my house and in my shower. When I began out-patient therapy I was calmer and the thrill of mastering basic ADLs had faded. I was ready to think about why I was still trying so hard to use my rehab gains. homeafterstroke.blogspot.com
1. Brick R , et al. A need to activate lasting engagement. American Journal of Occupational Therapy. 2020;74:7405347010.