You are feeding a client with hemiplegia who has had a stroke. which action should you take?

The activities of daily living are the basics of self-care:  tasks oriented towards taking care of one’s own body and enabling basic survival and well-being.

They include nine activities: eating/swallowing, feeding (setting up and bringing the food to your mouth), bathing, dressing, grooming, toileting, personal device care (using/maintaining personal care items), functional mobility, and sexual activity.

After a stroke, patients may struggle with the activities of daily living, which indicates a critical need for rehabilitation to boost independence. This independence is the ultimate goal that your therapists — and especially your occupational therapist — is there to help you with.

You’re about to learn more about the activities of daily living after stroke. Use the links below to jump straight to any section:

Is it Possible to Relearn Activities of Daily Living After Stroke?

In order to relearn activities of daily living after stroke, it is highly recommended to participate in rehabilitative therapies.

Rehabilitation after stroke revolves around the concept of neuroplasticity, which refers to the brain’s ability to reorganize itself based on experience. This is how we learn new skills and, particularly after a stroke, relearn impaired skills such as the activities of daily living.

The most effective way to promote neuroplasticity is through highly repetitive and task-specific practice. This stimulates the brain and reinforces demand for those functions.

For example, your occupational therapist may help you practice cutting putty with utensils, to simulate cutting food in preparation for eating. When practiced on a regular basis, this experience helps stimulate the brain and improve your ability to use utensils, which you can then carry over to the task of self-feeding.

If you struggle with the activities of daily living after stroke, it’s likely that you will work closely with a team of therapists to help improve your self-sufficiency and independence with these tasks.

Next, we’ll look at two specific types of therapy that help improve your independence with ADLs.

Physical vs Occupational Therapy to Relearn Activities of Daily Living After Stroke

Regaining the ability to perform the activities of daily living involves intensive participation in occupational therapy (OT) and physical therapy (PT). Even participation in speech therapy (if indicated for you) can help with ADLs, because you will need skills such as attention, memory, and good judgment to engage in these tasks safely. However, OT and PT are more directly focused on ADL, so we will highlight these therapies here.

Occupational therapy helps individuals learn how to be functional and independent by focusing on activities of daily living. Practicing activities of daily living is helpful because they provide direct, task-specific applications to the real world, which helps individuals prepare for the transition back to everyday life.

In contrast, physical therapy focuses on improving mobility through targeted exercises. By working on balance, strengthening the muscles, and maintaining full range of motion at physical therapy, individuals can perform activities of daily living with more ease.  

While both of these rehabilitative therapies help individuals relearn activities of daily living, occupational therapy utilizes a more direct approach. But while OT is often more specific to the ADLs, it works best to do both types of therapy in conjunction with one another.

Fortunately, this is often what happens during the early stages of the stroke recovery process.

After a stroke, many survivors spend time at an inpatient rehab facility where they spend 3+ hours per day doing PT, OT, and possibly speech therapy. After discharge from inpatient rehab, therapy often continues at outpatient rehab on a less frequent basis.

Because the brain requires consistent stimulation and experience in order to rewire itself, it’s imperative for stroke survivors to continue with rehabilitation at home. Practicing therapeutic exercises on a daily basis can help feed the brain the stimulation it needs to strengthen essential functions, such as the activities of daily living.

Up next, we’ll discuss how PT and OT are used to improve one’s ability to perform activities of daily living after stroke.

How to Perform Activities of Daily Living After Stroke

Depending on the severity of an individual’s motor impairments, the techniques used to relearn activities of daily living after stroke will vary.

Below, we’ll discuss some of the rehabilitative techniques used to help individuals become more functional.

1. Eating

Sometimes, secondary effects of stroke like dysphagia impair motor control over the oral muscles, which affects one’s ability to chew and swallow.

Working with a speech-language pathologist to practice speech therapy exercises can help strengthen the oral muscles.

Paralysis of the arm after stroke can also affect the ability to eat. While it may be easier to just use the unaffected arm to feed yourself, it’s essential to practice tasks with your affected arm to promote recovery and avoid learned non-use.

To encourage you to use your affected arm to eat after a stroke, an occupational therapist may teach you how to use adaptive utensils. They can help supplement for limited grip or control over the wrist.

2. Bathing

Practicing good hygiene after a stroke can be difficult. Due to paralysis or weakness, individuals have an increased risk of falling in the shower. Your occupational therapist will have you practice bathing and getting in/out of a shower during your therapy time to teach you how to be more safe and independent with this task.

Another way to promote better safety is to install grab bars and seats in the shower. Additionally, placing a rubber mat in the shower helps make the floor less slippery.

Working with your physical therapist to practice stroke rehab exercises can help improve functional mobility. As you regain strength and control, the risk of falling in the shower will decrease.

3. Dressing

Individuals with paralysis or weakness after a stroke may struggle to get dressed.

Tasks like buttoning a shirt, pulling up a zipper, and hooking a bra require fine motor skills. Similarly, putting on pants generally requires some balance skills.

An occupational therapist can teach you strategies to improve your ability to independently dress yourself, some of which may be compensatory strategies. For example, you may learn how to put your pants on while lying in bed or how to use adaptive tools like button hooks and zipper pulls.

Some stroke survivors may be able to get dressed without utilizing compensatory strategies. However, due to weakness, they generally require more time, and possibly assistance or supervision, to do so. Continuing to practice getting dressed independently may help strengthen their motor skills and gradually increase speed.

Likewise, a physical therapist can guide stroke survivors through exercises that will help restore motor control and balance on their affected side, both of which will help with the task of getting dressed.

4. Functional Mobility

If a stroke causes leg paralysis or weakness, individuals may have to use mobility aids like walkers, canes, or wheelchairs.

At occupational therapy, individuals may practice techniques to help them get in and out of bed, as well as transferring to/from wheelchairs, toilets, and showers in a safe manner. Installing grab bars can help provide a stable surface to hold onto while performing transfers, although this is not appropriate for everyone.  

Generally, independent functional mobility requires increased dependence on the legs, core, and arms. To make transfers and other types of functional mobility easier to perform, a physical therapist may have you practice strengthening, bed mobility, and sitting balance exercises.

5. Grooming

Impaired gross and fine motor control following a stroke may make everyday grooming tasks like turning the faucet on and off, squeezing products onto your palms, and gripping onto your brush extremely challenging.

An occupational therapist will likely work with you on improving your arm and hand strength and coordination in order to improve your independence with grooming tasks. Additionally, when appropriate, they may have you use an adaptive tool called a universal cuff to help you grip onto items or recommend using an electric toothbrush to clean the teeth more effectively.

6. Toileting

After a stroke, some individuals have difficulty controlling their bladder and bowels, a condition known as incontinence.

An occupational therapist may have you practice urgency control exercises and Kegel exercises to improve control over those muscles.

Additionally, an occupational therapist may suggest following a bowel and bladder management program. By sticking to a schedule and performing the same tasks at around the same time every day, individuals can better predict when they should empty their bowels and prevent accidents.

Another part of OT related to toileting will be practicing the physical act of pulling your pants up and down, and performing hygiene after using the toilet.

Getting Back to the Activities of Daily Living After Stroke

Overall, the best way to recover from a stroke is repetitive practice of the skills you want to rebuild.

If you want to improve eating skills, then practicing speech therapy exercises will help you regain control of your oral muscles. Similarly, to improve the potential for continence, individuals may need to practice urgency control exercises.

By repetitively practicing exercises and engaging in basic self-care tasks, individuals can relearn activities of daily living and significantly improve their quality of life.

Photos: iStock/RobertoDavid/dragana991/GaryRadler