Stroke recovery: daily activities and personal care
Because a stroke can cause the loss of control over an arm and a leg, people's abilities to care for themselves in simple ways (things like washing or getting dressed) and to undertake taken for granted daily activities (things like preparing a meal, cleaning or going to the shops) are often affected.
Even the most simple tasks like brushing your teeth, shaving or getting toilet roll out of a dispenser became seemingly unmanageable.
Part of stroke rehabilitation is to help people relearn basic skills or to learn new techniques to look after themselves and to prepare for tasks like cooking and cleaning on their return home. This process was usually carried out hand in hand with exercises that helped restore physical function. A man describes how he can relate back to exercises he did lifting small pegs when he is doing tasks like making a cup of coffee.
He could see the importance of exercise to improve strength and things like lifting small pegs...
I really, really think just about everything. That's, that's not going to help you but I think, honestly, I really think almost everything has helped me from' the very, very start of the physiotherapist therapy, lifting the wee pegs. It sounds daft but it's been great. It still impacts on the home when your, imagine making a cup of coffee, you know, lifting the spoon, which again, it's no great control but I can lift coffee and stirring it, you know. And that is, it brings into effect your wrist and your arm movement all these types of exercises.
The occupational therapist has obviously worked on these kind of things, which has been a great, great help. It really has been a great help. One of the things that we done which is, it sounds daft but it's really, really simple was lifting a kettle, a jug kettle. I couldn't lift a jug kettle because... if you can the imagine the handle coming at the side and my hand was going through at an angle and I couldn't see it but the occupational therapist said, 'If you adjust the plane of your hand to go through the handle, then you tighten your grip, you know. And it made such a difference. It's amazing, you know. Lifting a cup. Lifting a cup. I couldn't lift a cup without the cup going forward and spilling, you know. I spilled a bowl of soup within the early, early days because of my control of the spoon and I knocked the bowl, it's a horrible feeling to think, 'I can't even have a plate of soup without spilling it, you know'. But it's these kind of things but between the physiotherapist working on stretches and strengthening exercises, various push-ups, like strengthening various parts of your body, and the occupational therapist working on these type of exercises, if you like, in the kitchen and these kind of things, you know, it's come together to the physio's getting you stronger, the occupational therapist is getting me working at the actual operations, you know, and it's the cardiac rehab gym.
Again, I've got to keep saying, it brings out the confidence to try these things anyway, you know, because I was finding, I didn't have the confidence to try these things because you're thinking, 'God, I've not got the strength, you know, I've not got control, so I'm not going to try it', you know, but, to me, it all worked part and parcel, you know. Occupational therapist, physiotherapist, the gym, confidence building up, strength building up, your ability to do the actual operations is building up, you know. And it's absolutely, absolutely superb. I can't speak highly enough about the, the help I've had. I really can't.
Learning to do things for themselves was important for most people, but family members sometimes found it difficult to watch their relative struggle. The wife of one man said it was part of their culture to help the less able. He, however, wanted to become independent.
Part of their culture is to help the less able when they are struggling, but the rehabilitation...
Wife' Having a bath and all?
Wife' They, they help.
Husband' They. Yes.
Wife' The four month rehabilitation, because I can't stay with him, I only go for a certain time and sit with him and talk to him and when he was sleeping and all this, they said I know your feelings but try to be independent, you know, don't help him a lot, you know, he need to be independent. That's the way they treat him, you know, they, they want him to do many thing as possible, you know. So I always, because in our culture, we always, you know, as soon as somebody is struggling, we trying to help them, if he can't drink so I, we are feeding, we are trying to feed him and they said, don't treat him like a child, let him do it, you know, and I remember that.
So you were encouraged to wash yourself?
Husband' Yeah. Yes.
And was that good?
Husband' Yeah. Yes.
Wife' And still when I go to the festival or wherever I go, take him, people said he's going to fall, you know, why can't you go with him but the thing is he doesn't like to treat him as a child, you know, somebody is behind me, it's irritate for him, you know. So I remember his feeling the beginning I was behind him all the time but he doesn't like it at all, you know, when I walk behind him and we I try and help him, he doesn't like. So nowadays I be calm and sit and I let him do whatever he wants but people think I'm not interested to help him or what, why can't you go and help him but I know his feeling. He doesn't want help, you know, it's irritated for him, isn't it?
Husband' Mm hmm.
Wife' He doesn't like it at all [laughs].
Most people were pleased and surprised at the practical help and advice they got in the hospital from occupational therapists and physiotherapists. Occasionally people were asked to do things that they did not find helpful for example a man was asked to practice filling a washing machine which he had not done before his stroke. Mostly people were given an option of the type of things they wanted to achieve and were asked to set goals that they could work towards.
With time people were able to extend their goals towards more complex tasks such as writing, using the computer, even DIY and shopping.
He explained that as time went on his list of things he cannot do has got smaller and he hopes to...
Well, one was making myself a cup of tea, making myself a lunch now, I've got an electric can opener for my soup, or I can make toasted cheese, beans on toast. That's a big thing for me. Being independent. Making my lunch. Being independent. Take the dog out for a walk now. I had to depend on everybody else taking the dog out for a walk. Go for my paper in the morning, you know. These are all things that somebody had to do for me, mainly my wife but now I can do them myself. As I say, the list of cannots has gone down, is coming down. I'm determined to, the only thing I won't be able to do, to do is DIY, although I've not given up on painting yet, you know. Not yet.
Washing and dressing
Washing and dressing was the first major challenge that people encountered. Most people were helped with this in the first few days after the stroke and then were gradually encouraged to do it themselves. Some had been surprised at how abruptly this had been done and questioned how they were meant to dress a paralysed part of the body. Generally people saw that this was being done for their own benefit to help them to become independent as quickly as possible.
She was quickly encouraged to try to wash and dress herself and was surprised how much she could...
So in each little ward there were 2 beds and there was a basin and taps and the first morning I was in there, they wheeled me up to the basin, because we were all in wheelchairs and we obviously couldn't move at all, so we were wheeled everywhere and we were wheeled to the basin and the first, the first morning we were washed by the nurse who said, you know, 'Just try and, I'll try and get at all the bits of you that I can' [laughter] and then about, I think it was probably about 2 mornings later, we were wheeled up, I was wheeled up to the basin and then you were left on your own and the nurse said, 'I will come back in about 20 minutes but in those 20 minutes I'd like you to try and sort out how you're going to wash yourself with one hand and you're in a wheelchair and I'd like you to clean your teeth'.
Well, it's quite amazing actually what you can do. I found out that if I stuck the toothbrush in my mouth, I could open the top of the toothpaste and I could squeeze the toothpaste onto the brush, I could then put the toothpaste down and I could take the brush in my right hand and I could clean my teeth and I could also get my flannel and I could manage to wash the top half of me but I also wanted to wash the bottom half of me as well and so, somehow, I can't really tell you how I did it [laughter] but I did. I managed to get my right leg over the, the arm of my wheelchair, so that I was able to, to wash the bottom half of myself and I really felt quite pleased that I'd done a fairly good job and so things like that and we were left alone at night when we were told to put on our nighties and we had to do that on our own and the nurse went away and we were left there to struggle with a nighty [laughter] which actually now, when you think about it, it seems so easy doesn't it, to put a nighty on but with one hand and no feeling on one side of you and to get a nighty over your head [laughter] and down is, it's a very, very difficult thing but you felt really quite proud of yourself. I mean, sometimes you got it on inside out [laughter] and it took quite a while to do it but, and that was really how they tried to make us independent.
People found ways to make tasks easier, for example men took to using an electric razor instead of a wet shave. Some things were not possible, for example, cutting finger nails on a non-affected hand was impossible, which some people found frustrating and annoying.
Over time people learnt the best way of dressing using techniques like putting the affected limb into the clothing first. Some also changed the type of clothing they wore, choosing things that were easier to put on like trousers with elasticated waists and t-shirts and getting shoes with a Velcro fastening. Equipment such as hooks to pull up trousers and do up buttons could also help. Some clothing still caused a problem, for example people often required help to do up buttons and women struggled with putting on and fastening a bra.
Even though it was a struggle and took much longer than before the stroke most people preferred to do things for themselves.
She finds it takes her longer to wash and dress but feels it is important to do it herself before...
Right. My right hand side. Yes.
And were you able to get up and out of bed when you were first in hospital?
Yes. Yes. I was able to get up. I always got up and dressed myself and wash and dress myself in hospital, so that was a great help when I came home because I'd always done it. I didn't stop doing it.
Sometimes it was very hard. Sometimes it took me half an hour.
I am very over confident for my age and I think that's the thing that' you see, some people my age and older, they just lie in bed as long as they can and they don't, they don't make much of an effort to help themselves.
Do you think that's important?
That's important and I' I concentrate and place great emphasis on helping myself, doing as much as I can for myself, dressing myself, washing myself or vice versa and' and' I think people of my age often give up. They just want to lie in bed' for most of the day. The carers come in at 12 o'clock and they say that the last, the last customer, she doesn't want to get up for another hour [laughs].
But you, you're not like that.
No [laughs] No, I get, I get up first thing in the morning like I've always done.
Getting dressed particularly putting her bra on takes a long time but she feels it is important...
Everything but the bra. The bra takes me twenty-five minutes to, you know, get it clipped. And, you know, you can get quite frustrated with it but, you know, but'
You've learnt the best way to do it?
[Laughs] Aye put it on back to front and clip it at the front but still it's taking some length of time but, it's quite frustrating but it's just part of life isn't it. I've tried other types, you know, that can pull over your head and that but I don't like them. So, I'm definitely not wearing a vest because I'm too young [Laughs]. That's, that's the thing, I feel, was the hardest thing of all. Not being able to, to fix because you do it in seconds normally but I mean it's taking us twenty-five minutes.
And how about outing the clothes on? Do you put it on the'?
You've got to put it on the bad arm first, get it all up to the elbow and then pull up the rest of the material on. At the start I found it quite hard but now, as I've said the occupational therapist was really good. Patience, patience of a saint [laughs]. Showed me how to do it.
How about when you were first in the hospital? Did they maybe initially you couldn't do things, but how did you get back to doing things, what was important in helping you do that?
As I say the occu..., the thing that helped me most as I say was the occupational therapist that came round. Nice girl, she'd come and she'd sit and talk to you and say' 'Well, you know, you want to do this yourself don't you?' and I'd be like 'Yeah I want to do it myself,' and she would say' 'Well I'll show you a way.' And if she showed you one way and it didn't work she'd show you another way. Really, really good.
Did you feel a bit like just giving up and letting other people do it?
Sometimes you do feel like that, you know but you can't afford to do that.
Cooking and cleaning
During the time in hospital most people were given the opportunity to practice tasks in the kitchen from simply making a cup of tea to preparing a full meal. Tasks like this gave people a great sense of achievement particularly when they were able to prepare something for a relative.
Practicing these skills once they had returned home was sometimes quite a challenge. Although some were happy for others to take on these tasks others wanted to relieve the burden on their relatives and even took on domestic tasks that they had not done before. A few people had had regular visits from a community occupational therapist or nurse who could help them with planning these tasks which they found reassuring and helped them build confidence. This kind of support is not always available.
Carrying hot pots and pans could be quite scary if the person did not have full control and preparing a meal or doing the cleaning was tiring.
He was worried about cooking a meal at home because of the safety but the occupational therapist...
But I certainly did feel, and now, again, thanks to, and it's only been within the last, last 6 weeks, thanks to the occupational therapist that she said, 'Is there anything now', and this was the start of December, she said, 'Is there anything now that you feel you'd like to do, that you, you, that you were doing before your operation?' And I said, 'Well, actually, I miss cooking'. And she said, 'Right, next week'. And she said, 'Why have you not been cooking?' and I said, 'Because I feel the health and safety aspect, you know, lifting hot pots, hot pans, woks or anything like that' and she said, 'No, I think, I think you're ready enough. I think your balance is good enough to stand there and I think your grip's good enough and your, your control is actually good enough to do that'. She said, 'Next week, we'll prepare a meal. Just pick a meal and we'll prepare it. Something you've, you've to chop, peel, that kind of thing', you know. So I said, 'Right.' So the next again week, we prepared a meal and she said, 'What have you got?' I said, 'Well, I've picked a meal that I've got to prepare and chop and peel and scrape.' It was a stir fry. A chicken stir fry. Right? And it involved chopping peppers and peeling bits of potatoes and, you know, things that go into a stir fry. And she stood and watched and now, and since that day, I've cooked the Christmas dinner, you know or helped, you know.
And it's been, it's just one of these things that since then, I've really, really felt a lot more confidence, I was talking about the confidence thing and this has really, really helped because now I don't feel that, I don't feel there's anything I can't do now that I was doing pre-operation. Granted, it takes me slower. It takes me longer but I give myself longer, you know, I give myself more time to prepare the meal. I'll give myself an hour longer, just to make sure that I've got things prepared and I can get things in, in the pans in the oven, or whatever, you know.
Breaking tasks up into smaller chunks (called pacing), resting in between and taking more time could help people achieve the things that they wanted to do.
She still likes to do some of the cleaning but breaks it up now so she doesn't get so tired.
Oh well, I do, I do. Uh huh. I do the dusting and I mop the kitchen floor, which isn't really' it's not very hard, you know, with a mop and a pail, one of the mop pails and I do wee jobs and keep the dusting under control and, but [the home help] does the rest.
Is there anything that you've found difficult to do since your stroke?
I tire easily' You know. I don't like doing too much [laughs] at the one time, I sort of' spread it out, you know. [Ha Ha].
Some people were provided with equipment to make things easier including an electric tin opener, spikes to hold vegetables, kettle tippers, perching stools so they could sit instead of stand and trolleys to carry things between rooms.
He has been given equipment make peeling vegetables with one hand easier.
Yes. Started doing cooking in there as well. I'd done cooking when I was at home. I done all the cooking because my wife's idea of cooking is to open a tin, which I don't mind. She laughs about it as well because I like cooking but in there, they'd come in on a Friday night, I sometimes made a meal for them coming in on a Friday night. It was just '
How did you find that with maybe not having the use of your hand?
It's a bit' well, you get a thing for holding vegetables and that but they don't tell you, they think it's just a case of putting the vegetable on and peeling it and that. It doesn't work that way. I found out now if you get big carrots and potatoes, the biggest, you can stick them on that you've no bother peeling them but it's sort of medium sized or anything like that, you have an awful job peeling them because they'll no stick on to the machine, you can't get in proper to peel them.
So is that sort of a spike that you put it on?
There's three spikes, yeah, and there's a grater in the middle. It's just a circle that sits on.
Getting out and about
Gaining the confidence to get out and about after a stroke was important for some people because they wanted to be able to get out and do their own shopping. Again, setting and working towards goals and using pacing and taking regular rests could be a great help.
She wanted to be able to get to the shop on her own so she set herself a goal of taking the bus...
Well, sorts of things that you can't do. Now, after my stroke, I couldn't drive and so friends were really, really good. They gave me lifts to supermarkets, they helped me with shopping and everything and then I thought, 'Well, you know, this is, this is got to stop. I've got to become more independent.' So I got a bus guide and I'm very lucky because there are 2 bus stops at the bottom of this road, one for coming back and one for going that way and I looked up the times and I thought, we've got a, we've got a shopping centre very near us which contains big stores, a supermarket and a very well big well known chain store and I thought, 'Right, if I can get down there, I can do my shopping, I can look round at the clothes, I can buy myself something to wear' and so getting on the bus was horrendous because you have to get up steps onto the bus but I found that the bus driver was really nice. Everybody was so helpful and he said, 'Just take your time' when he was sitting, you know, in his seat where you actually go up to pay and he could see that I had a problem and he said, 'Just take your time' so you see, when I got on, actually got up the steps and inside, everybody sort of made way for me and I sat down and I got to the shopping centre. I actually did some shopping and I bought myself something to wear and I waited for the bus to come back and of course, I'd got this bag and I'd bundled everything into it and was holding it with my good hand, very wobbly.
Anyway, the bus came along and I went up the steps with my bag and there was an old lady [laughter] just inside. I mean, she must have been about 90 and she said, 'Come on dear, I'll help you' [laughter] I thought, 'Oh my goodness', you know, there's this dear old lady, years and years older than me, helping me. And, I did that a few times and I felt very proud of myself. I felt I was independent and then I set myself a goal for walking and we've got a shopping centre which is probably about 10 minutes, 15 minutes walk along, you know, when you can walk normally. But on the way, there's a bus shelter with seats inside and there are some stone walls along the way as well and then when you get farther on into the shopping centre, there's another bus stop and there's another seat. So I thought, 'One day, I'll make it to those shops' and I did. One day I made it. I sat at the bus stop for about a quarter of an hour, to calm myself down and I made it a little further on and I sat on a wall and I got up and I made it to the next bus centre, the bus stop and the seat, I sat down. I went in a shop and bought things and I came back the same way and I did the same thing. I stopped and I sat, I walked and then when I thought it was really bad, I just stood where I was and I didn't move and then I continued walking and I, I'd done it. I'd made it. I'd made it to the shops on my own and I was getting to feel, and then of course, it was after that I started my driving and I, that was the real big thing, you know, I was independent.
Last reviewed June 2017.