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Section 6
Recovery of Functional Status Following Stroke

Question 6 | Test | Table of Contents | Geriatric & Aging CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

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On the last track, we discussed the Affirmation Statements technique.

On this track, we will discuss four core concepts of regaining normalcy after a stroke.  These four core concepts are understanding dressing apraxia, the structured dressing technique, the energy management technique, and rebuilding physical intimacy.

4 Core Concepts of Regaining Normalcy After a Stroke

Concept # 1 - Dressing Apraxia
Marta, 68,
had suffered a recent stroke that had left her wild paralysis in her left arm and some minor cognitive difficulties.  Marta had returned home to live with her husband George, 70, who had recently become concerned that Marta was becoming depressed.  George stated, "Marta has always been a very elegant dresser.  She has a closet full of beautiful clothes, but since she came home from the hospital, she hasn’t even looked at them!  Most days she doesn’t even want to get dressed!" 

When I spoke with Marta, she stated, "I do want to wear those clothes, it’s just that they are so hard to get in and out of with my arm being paralyzed.  And even when I do try, I can see what needs to be done in order, but I can’t seem to do it right.  I’ll end up buttoning my shirt in the wrong order or putting my skirt on backwards!"

I explained to Marta that this kind of difficulty in dressing can be due to a post-stroke cognitive impairment known as dressing apraxia.  Dressing apraxia is a form of spatial dysfunction.  Clients with dressing apraxia, like Marta, can clearly see what needs to be done in what order, but lack the sense of spatial perspective to do it correctly. 

In Marta’s case, the dressing apraxia resulted in her feeling ‘disabled,’ and she became increasingly discouraged about trying to address her difficulties.  As you are well aware, wearing pajamas or hospital clothes during the day may encourage clients who have experienced a stroke to think of themselves as a sick person or invalid, so I encouraged Marta to wear street clothes as often as possible in the home.  I stated, "Dressing up can help your self image.  Soon, dressing more like you used to can help you start thinking of yourself as well again."

Concept # 2 - Structured Dressing Technique
I suggested to Marta that she, George, and their daughter Betty try implementing the Structured Dressing Technique.  First of all, I encouraged Betty and George to find catalogues that specialize in easy on, easy off clothing and to help Marta pick out some stylish clothes that would be more easy for her to dress in independently. 

I stated to Marta, "When you get your new clothes, there are some simple steps that can help you simplify the task of dressing.  You may want to enlist George and Betty’s help at first.  Focus on learning how to position your clothes first.  You might practice by holding the clothes in your lap and practicing with George or Betty.  Try to keep an eye out for labels.  Labels can be your best reminder of what is the ‘right’ and ‘wrong’ side of a garment."

Structured Dressing Technique, 4 Steps

  1. Lay out all of the clothes you will need in order.  Clothes that you need first, like socks or underwear, should go on the top of the pile.
  2. Put the weaker limb in the sleeve or leg of the article of clothing first.  Then arrange the clothing a bit before putting the stronger limb, or your head, through the appropriate openings. 
  3. Use your body weight to arrange the clothing around yourself
  4. Sit, rather than lie down, to dress yourself.

Concept # 3 - Energy Management Technique
Marta stated, "that makes sense.  I guess it won’t be as hard as I thought to try looking like myself again.  But I’m still a bit leery.  Everything takes so much effort these days, and I just don’t have as much energy as I used to."  I suggested that Marta try the following Energy Management Technique with the help of her husband. 

Energy Management Technique, 4 Steps

  1. Assign priorities to your activities.  Decide in the morning what are the most important things for you to accomplish in a day.  On days when you feel you do not have much energy, only do those things of the highest priority.  On days when you feel that you do have more energy, add some of your lower priority items to your schedule. 
  2. Use your energy wisely.  I stated to Marta, "Don’t spend time and energy on things you cannot change.  Make sure you use aids that are appropriate for your level of ability.  It may be that your abilities may change from day to day.  If walking without your cane makes you feel too tired on a particular day, use your cane.  If you don’t need the cane the next day, try walking without it."
  3. If you feel tired from thinking, remind yourself that this is a normal experience.  Try taking a break from your activity and moving around.  Try swinging your arm, walking a bit, or have George help you move around a bit if you feel physically tired.
  4. Develop the best communication skills you can.  Marta and I developed a script for a clear, brief way in which she could explain her limitations without expending a lot of energy.  I also suggested that Marta carry printed cards that she could pass out explaining her specific limitations if she did not feel that she had the energy to verbally explain at that time.

Concept # 4 - Reclaiming Intimacy Technique
In a later session, Marta stated, "I’ve been improving a lot physically, but I’m concerned about my sexual life with George.  We haven’t been intimate since my stroke, and honestly I can’t imagine he’s interested.  I’m just afraid it would be too difficult!" 

I stated to Marta, "Returning to a satisfying sexual life after stroke often does require some changes.  Both you and George will need to work to accommodate changes in body awareness and other challenges.  But it certainly can be done."  I suggested the seven step Reclaiming Intimacy Technique to help Marta and George address their intimacy as a couple. 

Reclaiming Intimacy Technique, 7 Steps

  1. Stay as attractive as you can through good grooming and hygiene.  This is important because it can help increase your self esteem, decrease a sense of embarrassment, and help you feel more comfortable with your own body.
  2. Talk openly with your partner about different needs and other changes that the stroke may have prompted.
  3. Plan in advance for sex or other intimacy.  Choose times when you both are rested, and set aside plenty of time with no interruptions.
  4. Try relaxing together before you begin.  Soak in a bath together, listen to music, or give each other massages.
  5. Be realistic.  Old positions may no longer make sense.  Find comfortable positions that support the weaker side and conserve energy.
  6. Consider using water soluble lubricants to make penetration easier and more comfortable.  Petroleum jelly is not water soluble and can increase the risk of vaginal infections.
  7. Consider alternative intimacy.  Hugging, kissing, caressing, and touching can all be satisfying ways to show love and affection.  Using these alternatives can also reduce stress and tension about performance, which can make the experience more satisfying for both partners.

Think of your Marta.  Would the structured dressing, energy management, or reclaiming intimacy techniques be useful to him or her?

On this track, we have discussed four core concepts of regaining normalcy after a stroke.  These four core concepts are understanding dressing apraxia, the structured dressing technique, the energy management technique, and rebuilding physical intimacy.

On the next track, we will discuss four important factors for a caregiver of a stoke victim to consider.  These four factors are disabling with kindness, TEA, meanness, and complaining.  We will also discuss the family task chart technique.

Peer-Reviewed Journal Article References:
Davis, C. G., Egan, M., Dubouloz, C.-J., Kubina, L.-A., & Kessler, D. (2013). Adaptation following stroke: A personal projects analysis. Rehabilitation Psychology, 58(3), 287–298.

Seale, G. S., Berges, I.-M., Ottenbacher, K. J., & Ostir, G. V. (2010). Change in positive emotion and recovery of functional status following stroke. Rehabilitation Psychology, 55(1), 33–39.

Uswatte, G., & Hobbs Qadri, L. (2009). A behavioral observation system for quantifying arm activity in daily life after stroke. Rehabilitation Psychology, 54(4), 398–403.

What are the four steps in the energy management technique? To select and enter your answer go to Test.

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