What reminds you to do something? Is it a calendar that you keep on your desk, a reminder app on your phone or the old fashioned string around your finger. Regardless of your technique, the cues you set up for yourself are the key to recall.
In the world of therapy, it is just as important to set up cues to help a client continue strengthening and endurance techniques outside of the clinical setting. How do you encourage such recall in this busy world we live in? Could it be as simple as connecting therapy exercises to cues that are heavily present in our daily environment.
Consider the case of Jake and his client Martha. Martha had suffered a stroke months prior and had been working with the physical therapist since her discharge from the hospital. Although she had gained the use of her dominant side, she still suffered from some weakness and balance issues.
Martha was an excellent client in the clinical setting, but showed little progress week to week. Jake asked how her exercise regime was going at home and Martha admitted that she was not doing her daily exercises.
Upon further inquiry, Martha stated that nothing reminded her to do them. She was so busy trying to get back into the routine of watching her grandkids a few days a week and watching the ball game on T.V.with her husband in the evenings, the practice never crossed her mind.
“Out of sight, out of mind” she attributed to the stall in her progression.
“When I’m done here, I check therapy off my mental list and it never resurfaces until the next appointment.”.
Jake considered this for a moment and remembered how he started placing his running shoes at the foot of his bed each night. He recalled how the visual cue and action of putting on the shoes made him more apt to go for his jog each morning, rather than waste time, procrastinating and eventually putting the jog off for another day.
“Would you try an experiment with me?” Jake asked Martha. “I want to see if we can link some visual cues into your routine that will remind you to do your exercises on the days you are not in therapy with me.” Willingly, Martha agreed so together they talked of her schedule again. Jake then made some suggestions based on her normal routine.
“I would like for you to start having 2 mugs at your place setting for breakfast and dinner,” he started. “whatever you drink, put in a mug. I want a second mug filled with water. While you are enjoying your meal, sip from both, using both hands.”
Jake then asked, “When you are with your grandkids, do they watch a particular cartoon?” When Martha nodded in agreement Jake continued, “Great. I want you to watch it with the kids while sitting on the floor…the kids are small, they will enjoy this type of game. Make this your criss-cross time. All of you can sit criss-cross and use a big ball for balancing exercises like the ones we have done here with the fitness ball.” Martha recalled the big colorful ball her grandkids had in their basement and how easy it would be to have them bring it up when she was over.
“Finally,” Jake continued, “at night when you are watching the ball game with your husband I want you to use the commercial time as your 7th inning stretch. Every time an inning ends and goes to commercial, you use that time to do your arm strengthening stretches. Do you still have the stretch bands I gave you?”
Martha said that she did, but that they were in her bathroom. Jake instructed her to put them under her couch, “They can be tucked out of the way, but there when the commercials come on”.
For a week Martha did as Jake had explained and came back to report her findings. “It worked!” she exclaimed, “I have been using 2 mugs at meals, rolling on the floor with the little ones and stretching each night during the game. My husband is jealous and wants stretch bands of his own. He loves the idea of the 7th inning stretch.”
Jake also noticed a difference. Martha’s hand grasp had grown stronger and her balance was improving. When he helped to stretch her arms she no longer winced in pain. Jake and Martha agreed that the experiment was a success and that she would continue using the cues to remind her to stay active. It was Martha’s busy life that provided the cues to stay on track and achieve new therapy goals.