Hard to carry over skills acquired during exercise

  

The transition from exercise to functional tasks can be difficult.  Functional tasks require clients to divide their attention between thinking about what their body is doing and watching what objects are doing.  For example, I kept dropping a tube of toothpaste until I realized only my thumb and middle finger contact the tube of toothpaste.  The photo shows this precarious grasp.  Dropping an open tube produces a splatter of sticky toothpaste on the floor.  So I press the end of the tube against my stomach to hold it still while I watch my sound hand remove the cap.   

Fortunately I have a strategy for dealing with my negative emotions when I fail during functional tasks. The first time I try a new task, one or more steps are difficult or impossible for me to do.  This means I cannot finish what I started.  To help me persist in the face of failure I call my first attempt a rehearsal.  The purpose of a rehearsal is to discover solutions that will make my second attempt awesome.  Waiting until the next day also gives me time to think of new things I can try next time.    homeafterstroke.blogspot.com

Donning a Bra One-Handed

Women with small breasts have the last laugh.  I need a bra because my large breasts are closer to my waist than I thought was possible.  Being able to don a bra means I do not have to go to dinner at a friend's house and say "Could you fasten my bra when I get there."  Living alone makes social occasions a source of happiness I do not want to give up.

In sitting, I put the hook end in front of my stomach.  To keep the bra still, I fasten a clothes pin to the hook end and tuck the free end of the clothes pin under the elastic band of my underpants.  Then I flip the free end of the bra behind me until both ends are in front.          I hook the 1st hook, remove the clothes pin, and hook the remaining clasps.  It it not enough to rake the hooks over the clasps.  I have to press down on each clasp to make it slip under the hook.  I turn the bra around and put my arms* in the straps.  Then I lean over to get my breasts fully in the bra cups.   

*Putting bra on - affected arm goes in first.  Taking bra off - affected arm comes out last.

In the winter, I keep the bra straps from repeatedly slipping off the dry skin on my shoulders by putting a small dab of lotion on a Kleenex tissue.  Then I use a Q-tip swab to transfer the lotion to the top of each shoulder.  Aveeno lotion with oatmeal creates friction.  In summer when my skin is dewy with sweat, it is easier to turn the bra around if I shake a light coating of corn starch along the bottom elastic band before I don the bra.  homeafterstroke.blogspot.com

Achieving Long-Term Goals is Complicated

Achieving long-term goals is complicated for people who have a chronic condition like a stroke.
It took five OTs a year to transform my relationship with food.  My in-patient OT made sure I knew how to make myself presentable when I went to live with my friend Arlene after rehab.  I would have been embarrassed to sit at Arlene's dinner table with sweaty pajamas and greasy hair.  My 

in-patient OT also addressed cold food prep so I could prepare my breakfast and lunch while Arlene was at work.  My home health OT addressed advance cooking skills I would need when I returned to my home.  Two rounds of out-patient OT prepared my arm and hand to maneuver a shopping cart around numerous obstacles at a grocery store.  A fifth OT provided certified driver training so I no longer had to spend two hours with paratransit to go to and from the grocery store.

Progress towards long-term goals is difficult to achieve for two reasons.  First, institutional autonomy does not allow communication between staff who work at in-patient, home health, and out-patient agencies.  Only the client sees all the steps towards a long-term goal.  I kept the momentum going by telling my OT "the next thing I want to do is ...".  Second, in the 16 years since my stroke no doctor recommended out-patient OT or PT.  They gave me a prescription for therapy when I asked for it, but they never asked how it helped me.  I had to go on-line to find out-patient clinics near me and ask friends if they would recommend a therapist they had gone to.
homeafterstroke.blogspot.com

What I Did Not Know as an OT

A friend told me how disappointed she was after she wore a light backpack while walking on the boardwalk at the beach.  It has been six months since her shoulder surgery so she did not expect her shoulder to ache after this walk.  Her story reminded me of how I felt when I had setbacks in my recovery from a stroke and total knee replacement surgery.  Her story reminded me of when I told my therapist I was discouraged because of a setback.  My therapist tried to reassure me by saying lots of people have setbacks.  This made me realize that seeing a setback is not the same as experiencing one.  

What I did not know as an OT was that being able to deal with powerful emotions and negative thoughts is as important as dealing with the pain and fatigue created by physical challenges.  I no longer wonder why some people die soon after they have surgery to repair a broken hip.  Half of recovery is mental and emotional.  homeafterstroke.blogspot.com