Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.