Not Making Exercise Personal = Non-Compliance

Rebecca Dutton
Home After a Stroke

June 4, 2013

I stop doing a home exercise if I don't see what I hope to get from it even though I'm an OT.

I think non-compliance is more likely when therapists do not make exercise feel personal.  PTs have an easy time explaining exercise.  When I was in rehab my PT had me slide a towel around on the floor with my hemiplegic foot.  Every exercise my PT gave me was to help me walk.  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, get a soda can out of the refrigerator, or sign a credit card slip.  Unlike the foot, the hand is so versatile it is hard to picture what sliding the towel on the table would do for me.  

Here's 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 who was 80 years old 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 didn't know my neighbor well enough to know why she needed a strong tip pinch in her non-dominant hand.  If one OT can't tell what another OT's end game is how can clients understand the value of the exercises we prescribe?

Barb wrote she is more goal oriented than her aquatics PT.  I suspect what Barb means is she thinks about functional goals while her PT thinks about gradually making swimming more difficult until Barb hits a plateau.  Barb wants to resume team rowing but it's difficult to open her hand after it slips off an oar.  Will swimming which uses the upper extremities help her achieve this goal?

When possible I do an exercise just before the task it's supposed to improve.  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.  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 abdominals and hip flexors on my hemiplegic side.  Doing leg lifts before I start walking keeps me from stubbing my toe on the edge of boards that stick up.  Pairing ADLs with specific exercises motivate clients AND creates memory aids.  Don shirt = stretch shoulder.  Boardwalk = leg lifts.

See the original article + 6 comments:
      Not Making Exercise Personal = Non-Compliance
      in Home After a Stroke