August 28, 2020

Lasting Gains I Care About

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.

1.  Brick R , et al. A need to activate lasting engagement. American Journal of Occupational                   Therapy. 2020;74:7405347010.    

August 20, 2020

Lowering My Standards After Stroke

My stroke occured in the brainstem which is below the brain.  This means I do not have multiple cognitive and language deficits.  However, I do have some cognitive deficits.  For example, my impaired spelling affects three tasks I care about - writing this blog, writing Power Point presentations for OT conferences, and writing checks.  Sometimes it helps to say the word outloud.  If this does not work I check the spelling by saying the word to Siri on my iphone.              I appreciate Siri because she allows me to hide this deficit.   

Before my stroke I had superb spelling skills.  If I was not sure how to spell a word, I would write it.  When I looked at what I had written, I knew immediately if it was wrong and what I needed to do to fix it.  I did not know how proud I was of my ability to spell until I lost it.

August 11, 2020

I Finally Got Young Adults to Listen

For years I struggled to get young adults who work as cashiers at grocery stores to listen to me.  They always try to fill each grocery bag as full as they can which creates a fall hazard for me.  Initially I asked them to not fill the bags full because I had a stroke.  After I saw a look of disgust on a few faces and still had to ask young cashiers to take some groceries out of a bag, I tried another approach.  Next I told cashiers not to fill my bags too full because I am old.  Middle-aged cashiers understand this concern and change they way they fill my bags.  Young cashiers never give any sign that they heard me say "I am old."  They comply with my request, but several looked irritated.  I got the impression that some of these young people think I am just trying to boss them around.

Recently I said "I have to get these bags up my front steps without falling."  Each time I have said this to young cashiers I have heard them say "Oh" and they begin to keep my bags light.  I did not know learning to get able-bodied people to help appropriately would be an important part of maintaining my rehab gains. 

August 3, 2020

26 times 66 feet

By 7 a.m. it is 75+ degrees F with 90% humidity so now it is too hot to exercise by walking around my neighborhood.  This is a problem because I have not been walking much inside since covid-19 curtailed my trips in the community.  Now I walk laps from one end of my 66 foot long trailer to the other.  It takes 26 laps x 66 feet to walk .32 of a mile (1,716 / 5,280 feet). 

Fatigue ruins everything so I have to be serious about not letting disuse atrophy creep up on me.
Every time I do 2 laps I make 2 hash marks on a sticky note on my kitchen counter.  Then I record the total for each day on a monthly calendar I keep on my kitchen table.  Then I enter the daily totals in a Excel file on my computer.  Finally I compute my monthly totals. 

To stop looking down at the floor as I walk I look for sunlight in each room.

I could not afford to buy a ranch style house after my stroke.  However, I love my 2 bedroom/2 bath trailer that has a full-sized laundry room all one floor.  The central air conditioning and dishwasher are a bonus.