Ways to Encourage Independence With Activities of Daily Living (ADLs) After a Stroke

https://amzn.to/3AClYBMStroke, a leading cause of disability, affects patients physically, emotionally, psychologically, and financially. Imagine what it’s like to lose some or most of your independence at a time when you didn’t expect it. While some stroke survivors don’t seem to mind having most everything done for them, others experience anxiety and frustration when they are unable to do it for themselves. In general, most people, sick or not, take pride in being able to take care of themselves. I will share effective ways that I used in rehabilitation nursing, to encourage independence or self-help in activities of daily living (ADLs: eating, dressing, bathing, toileting, and transferring) after a stroke. Principles used to encourage independence in a hospital can be used at home, by the caregiver, with some home adjustments.


Eating:

After a stroke, eating can be very challenging for some, especially If the dominant hand is affected, there is a facial droop, swallowing difficulty, difficulty communicating, or depression. Ways To encourage independence in this area are:


  • Having proper eating set up with bib, adaptive equipment such as built-up utensils, plate guards, sipper cup, and dycem tape are very helpful.

  • Built-up utensils and sipper cups allow for a better grip, allowing the individual to feed themselves with little or no assistance.

  • Plate guards keep the food on the plate allowing for some independence.

  • Dycem tape keeps the container from sliding away from the individual, decreasing the need for help or supervision. embarrassment and encouraging independence at the same time.

  • Cut up food in smaller pieces if necessary, to improve chewing and swallowing

  • Feed patient only if necessary, but may offer reminders

  • Don’t rush patient to eat, be patient

  • Give feedback and let the individual know how he/she is progressing

  • Praising appropriately is always very encouraging

Dressing can be very challenging after stroke, especially for those who are paralyzed on the entire upper and lower extremities of the same side. Encourage independence by these actions:

  • Check to see if the person is experiencing pain before getting dressed. Giving pain medication a half-hour before getting dressed helps encourage participation in physical activity. This is especially important for those individuals who complain of pain during activity and tend to not participate as much. I have seen the difference in those who were medicated before engaging in an activity.

  • Making appropriate clothing choices: loose pullover tops, adjusted clothing with velcro fasteners, pullups, or sweatpants are easier for individuals to work with. Zippers and buttons create frustration.

  • Teach the individual how to dress the affected extremity first. For example, the weak/affected left arm would be put through the shirt sleeve with the use of the right hand. Achieving success with this boosts their confidence in being able to help themselves.

  • It is safer to have the client sit for dressing. This also takes away some of the anxiety that comes with the fear of falling.

  • The less frustrating the process, the more relaxed and motivated the patient would be.

  • Ensuring that the patient gets a good night’s rest is very helpful in promoting activity participation. The resulting tiredness from poor sleep will determine how well the individual participates, or if they participate at all.

  • If possible, assist the individual in selecting clothing for the next day the night before, to save time and promote workflow.

Bathing

To encourage independence with bathing, do the following:

  • The proper set up in the bathroom needs to be in place. Certain products such as grab bars, raised toilet seats with rails, shower chairs, safety mats, long back brushes are highly recommended. These help to lessen workload and promote self-help and safety. Having ample bathroom space also makes bathing easier and safer.

  • The more relaxed and comfortable the environment the more individuals would try to bathe themselves.

  • Involve the individual as much as possible in the process. Demonstrate how to do a task(s) and then encourage the individual to try.

  • Praise appropriately as this helps to boost confidence in bathing self and becoming more independent.

Toileting

Toileting can be very challenging depending on the condition of the individual after stroke. Some need more help than others. Encourage independence by:

  • Providing appropriate clothing: loose-fitting clothing is recommended to prevent accidents. Pullup pants with elastic waist are much easier to manage than those with zippers and buttons in preventing wetting/soiling pants while trying to unzip. Accidents are very embarrassing.

  • Providing supervision as needed but allowing the individual to do as much for themselves as possible to encourage independence and promote dignity. There is nothing better than performing self-help

  • Providing adequate lighting to decrease anxiety related to falls.

  • Toileting every two hours has been very effective after stroke but might not work for everyone. Design a plan based on individual needs.

  • Praising appropriately. This is very encouraging.

  • Being consistent with proven methods of toileting. Consistency helps to promote learning.

Transferring

After the individual has been taught transfer steps, then reinforce those principles. Encourage independence or self-help in the following ways: