My favorite part of my post-graduate studies was by far the research. I like trying to solve a problem, testing different hypotheses, and coming up with a solution or finding the next steps to get to a solution. When conducting research, one of the most important things you must do is to take notes and track your different trials and experiments. Keeping notes and tracking progress is important because we will never remember everything from months ago, and we don’t know what an important aspect of that session might be. We will be able to spot trends, good or bad. Taking occasional videos is extremely helpful too. Videos are great because you can go back and watch how your form was in each exercise, and it can be a very helpful thing to compare videos months and years down the road. Stroke improvements are a slow process and being able to compare larger time frames can help us see improvements, which is very motivating.
In this post, I will talk about how you can take your own notes at home during your therapy sessions. These will help you have continued improvements even if you don’t go see a PT/OT officially anymore. You can use these to figure out what to work on and iterate your exercises based on your past notes. I’ll talk about how to determine your goals and some questions you can ask yourself to answer in your notes.
When we first meet our physical therapist or occupational therapist, they always begin with some sort of assessment. Not only is this showing them our current abilities, but it also gives them ideas on exercises to assign us moving forward. This assessment is also our starting line or baseline. It is how we will be able to gauge improvements. Using this same concept for our therapy at home is important as well. I argue we should be doing more therapy exercises at home than we will be doing at our PT/OT appointments.
I was reading an article in the American Journal of Occupational Therapists (1999). They were talking about goal setting and functional outcomes in therapy. Summing it up, it said that patients should be involved in goal setting for what we want to get out of our rehab process and that we need to find activities that have meaning for us to do. In their study, the patients who did these two things got better results. I am going to keep a journal of my exercises and numbers. In doing this, we can easily see gains along the way. And, when we see those small wins, it really helps our mindset. It helps us keep our why in mind and gives us that satisfaction in seeing improvement; and the motivation to keep working on it. Stroke recovery is a long process, and it can be easy to say, “I’m not getting better” and quit. But if we can look back and see what we have accomplished, no matter how small, it can give us that encouragement to keep going.
Determining and writing our goals
- When thinking about setting goals, we want to think about the things we want to improve. These are going to be our big goals, such as, “I want to get functional use of my hand.”
- Breaking these “big goals” into smaller actionable tasks makes them feel more manageable. That big goal can feel overwhelming and unachievable, but breaking it into smaller tasks/actions makes it feel more doable. Some examples would be:
- Work on grip strength.
- Work on a functional pinch
- Work on moving the fingers independently.
- Goals are most effective when written in a SMART way:
- S-specific- We want to say exactly what we will be doing.
- M- measurable- It should have some sort of “test” that gives us a numerical number to gauge our results. I’ll talk more about this in a minute.
- A-Achievable-The goal needs to be within our capability. It should be just beyond our current capability, and,
- R- realistic—Something that is realistically something we can reach in a
- T- timely-Specific timetable. We are giving ourselves a certain amount of time to judge our results in. This will remain the same throughout subsequent iterations of our processes.
- Using the SMART goal-setting process, our goals can be written out like:
- To improve my grip strength, I am going to use a grip strengthener set at X lbs. and count how many times I can squeeze it today and then 30 days from now
- Each of these could even be broken down into daily actions we will do. For example:
- To improve my grip strength, I am going to use a grip strengthener set at X lbs. and count how many times I can squeeze it today and then 30 days from now.
- For the next 30 days, I am going to squeeze my grip strengthener 15 times, 3 times every day
- This will give us daily tasks to complete the goal and a timeline for us to re-evaluate the small goal.
Knowing the daily actions we take and then measuring progress before, and at the end of a specific time will tell us if those daily actions improved based on a quantitative measure. So, we then know if this was a good action to take or if we need to work on a different action to get to our goal of improved grip strength. By breaking down the goals into daily tasks the goal seems more manageable and then seeing progress with that “test” at the end of our timeline gives us a little motivation to keep working on our goals. Another good habit to get into with goal setting is to physically write our goals with pen and paper. There is just something about physically writing them that really connects them from our brain into action.
More on the ways to measure progress with a “test”
There are a few ways that we can track our progress:
- When it comes to strength, we can you can keep track of how many times you can squeeze something or how heavy the weight is you can lift, as well as how many times you can do a certain exercise with a specific weight
- We can keep track of the time it takes us to do a task like stacking a certain number of blocks or,
- We could give ourselves a time limit and keep track of how many times we could do something or how many objects we were able to put somewhere
Choosing a “test”
You may be wondering what the best “test” for you is to use as a measure. Well, it should be something we can quantitatively measure (with numbers). I call it a test, for lack of a better word. It should be measuring the things we want to ultimately improve. For example, if you want to improve grip strength, you could place a 3-pound weight in your hand and time how long you can hold it down at your side, or you could count how many times you squeeze a grip strengthener that you may have purchased from, say, Amazon, such as this. If you are working on being able to pinch your fingers, you could count how many pegs you can put in a bowl, or if you have a peg board, you could put them in the holes, or you could count how many blocks you can stack in a specific amount of time. Alternatively, for both the peg or blocks, you count simply time how long it takes you to complete the board or a specific number of blocks stacked. For the pinch, you could count the number of reps you can pinch on a chip clip (I know your therapist gave you one too!) Ultimately, this “test” should give you information to draw on later about what you are trying to improve.
If you are someone who does not go to see a PT or OT and is doing your own at-home therapy (which we should ALL be doing!) we want to write down all the details. This is to help us determine what kinds of exercises are working and allow us to see improvements.
Having the details written down gives us a record to draw upon when we are trying to come up with the next things to work on. Stroke recovery is a slow process. I often look up my notes from 2 and 3 months prior because I want to know what I have tried and all the different tweaks I’ve made, so I’m only doing the things that benefit me or trying new things. This is helping us not waste time on the things we have already tried. Although I talk a lot about quantitatively measuring and tracking progress, it is also equally important to track your thoughts and observations. These are a little more subjective, so they can be harder to compare against another session. However, if you take detailed notes about how long you stretched or wore a brace that day, and how you felt during the session these can still be valuable for knowing what we did and determining the next possible steps. Some things you could take note of are:
- If your fingers moved easier than normal or not
- If you felt you were able to walk faster or felt more stable.
- Sometimes the time of day can be useful.
When I say be detailed, I mean write down anything you can think of. You never know what could be valuable to know further down the road and what could be a hypothesis for improvement you can test out in a different 30-day iteration.
Questions you could ask yourself are:
- “What do I need to do to change_____?”
- “What helped _____?”
- “Where did I feel a stretch?”
- “What feels awkward?”
- “Where am I not in alignment?”
This is a good outline to follow all your at-home therapy, but especially if you are doing therapy on your own, without a therapist to bring your notes to and talk about the results and next steps. These notes will give you an idea of the next steps you can take, or the next iteration of your process. If you are interested in having a 30-day PDF Therapy Tracker, I created one that takes you through 30 days with daily questions to answer, motivational quotes, goal-setting prompts to start, and a monthly review at the end. You can get it here for $7.