1. SECTION 13 Activities of daily living

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3. ► Toileting ► Bathing ► Grooming ► Dressing 3

4. Key point Helping a stroke survivor with the activities of daily living means letting the survivor be as independent as their abilities will allow. Your challenge is to make sure the task is not too hard, tiring, or frustrating. You must always keep safety in mind. 4

5. Stroke and daily routines A stroke can affect a survivor’s ability to complete activities of daily living due to: ► Loss of movement on one side ► Impaired ability to grasp ► Impaired fine motor control ► Lack of sensation on the affected side ► Neglect (loss of awareness of the affected side) ► Difficulty planning and sequencing tasks ► Short attention span 5

6. How you can help 1. Set the stage Make sure that the survivor is ready Let the survivor know what you’d like to do. Limit distractions 2. Prepare the tools ► Be ready ahead of time ► Get tools and supplies - Put them in a convenient place ► Arrange the items in the order they will be needed. 6

7. How you can help 2. Prepare the tools (cont’d) For a survivor with neglect: ► Arrange items on the affected side ► Point out the items on the affected side if necessary ► If severe neglect makes this approach too frustrating, place grooming items on the unaffected side to enhance independence 7

8. How you can help 3. Position properly ► Make sure you and the survivor are both properly positioned to prevent injuries. This also helps the survivor’s ability to do the task more independently. ► Make sure the affected arm is properly supported. ► Encourage the survivor to take part so that they become more aware of the affected side. 8

9. How you can help 4. Encourage use of affected limb Using the affected limb improves awareness, stimulates the brain, provides exercise, and builds independence. ► The amount of movement and feeling in the affected arm determines how much help the survivor needs to perform an activity. Assist only as much as necessary. ► Watch to see how much effort the survivor uses for a specific task. High muscle tone after completing a task indicates too much effort. 9

10. How you can help 5. Cue and guide Stroke survivors may have problems like a short attention span or an inability to plan or remember how to do a task. ► You may need to help the survivor by giving instructions and cues. You may need to use “hand-over-hand” guidance. 10

11. How you can help 5. Cue and guide (cont’d)- Tips ► Break the task into small steps ► Give clear, simple instructions ► Talk the survivor through steps ► If problems with communication - demonstrate the task ► Use consistent steps or cues ► Help them succeed by doing for them only the parts of the task that they cannot do themselves 11

12. How you can help 6. Use assistive devices Assistive devices, like glasses, hearing aids and any special prescribed equipment, can make it easier and safer for survivors to do more for themselves. An occupational therapist or another member of the healthcare team can advise on the best equipment for the individual’s abilities and environment. Make sure you know how to use a particular device. If you don’t know, ask someone to demonstrate. 12

13. How you can help 7. Recognize and encourage Relearning everyday tasks you have done for years can be challenging and frustrating for a survivor. ► Recognizing each success is the key to maintaining self-esteem. That will motivate the survivor to keep relearning tasks. ► Encourage participation in every stage of the activity. 13

14. Toileting Prepare the tools ► Position properly:  Using a toilet  Using a commode  Toileting in bed 14

15. Key point Always consider the survivor’s dignity and privacy when helping with toileting. For example, respect the survivor’s wishes if they do not want the bathroom door open, even if you are the only one present. 15

16. Assistive devices - toileting ► Wall grab bars ► Raised toilet seats ► Commode chairs ► Toilet frames ► Toilet paper holders ► Hygiene products 16

17. Bathing ► Bathing safety ► Prepare the tools ► Position properly ► Use assistive devices 17

18. Bathing – Danger points The danger points for survivors involve maintaining balance while: ► Getting in and out of the tub ► Moving around the bathroom ► Being positioned and transferred Bathroom hazards include: ► Wet or slippery floors and fixtures ► Small bathrooms, hard surfaces ► Bathtubs that challenge survivors with limited mobility ► Bath mats and rugs that slide 18

19. Assistive devices - bathing ► Tub transfer bench ► Grab bars ► Hand-held shower head ► Bath seats and bath boards ► Non-skid mats or decals ► Bathing tools ► Hydraulic lift 19

20. Grooming ► Position properly ► Use assistive devices:  Denture brush with suction cups  Toothbrush or comb with built-up handle  Electric toothbrush  Liquid soap in a pump container  Nail clipper mounted on a board 20

21. Dressing ► Prepare the tools ► Position properly ► Encourage use of the affected limb ► Use assistive devices:  Adaptive clothing  Adaptive devices 21

22. How you can help Loose-fitting or adapted clothing is easier: Shoes with Velcro fasteners or elastic laces ► Front-closing brassieres ► Pre-tied or clip-on ties ► Pants, shorts, and skirts with an elasticized waist band. Adaptive devices that make it easier: ► a long-handled reacher or shoe-horn ► a button hook ► a footstool 22

23. One method for putting on a shirt 23

24. One method for putting on socks 24

25. One method for putting on trousers 25

26. Upon reflection Think of a time when you adapted your approach to a routine activity to suit a survivor’s abilities. What was the stroke survivor’s experience when you took the time? How did they feel? How did the family feel? How was it worth the time? Were you able to meet their need to do things independently without getting overwhelmed? How? 26