A Person-Centered Approach to Rehab & Recovery

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Lisa Milliken
Director of Education, Select Rehab

“If my therapist asks me to do something that makes sense to help me achieve I want to do, then I would be motivated to do it. It would make sense to me. But how is this bicycle thing going to help me work in my garden or wash my clothes? That doesn’t make sense, so why should I have to do them?”

These are often the thoughts of residents in a community’s rehab department who are there to regain a prior function. I’m reminded of a story shared by a colleague about one man (Tom) who was in short-term rehab following his stroke. His goal was to regain function of his left arm and leg to go home and resume work on his farm. Initially Tom did not like doing the same old exercises, which were assigned to him by the physical therapist to improve his leg strength. And he surely didn’t enjoy the tabletop pegboard and exercise putty his occupational therapist gave him to work on. His comment to all of this was, “This is ridiculous, why I am doing this?” So they stopped and asked “What would you like to be able to do again?” To this he responded, “Well, I want to go home and get on my tractor and get back to work!” So the therapist called Tom’s son and they arranged for the tractor to be brought to Tom’s senior rehab community and parked it in the parking lot. Every therapy task from that point included goals to get on and operate the tractor. This meaningful therapy had a purpose and Tom’s progress then increased dramatically.

Each elder’s rehab goal is different. We should not assume that everyone wants to walk 100 feet and improve standing balance to 15 minutes. There may be no meaning or purpose to such goals. But if we ask them, they will often tell us exactly what they want. It may be that they want to sweep their own floors, go get their mail or walk to the living room to visit with other elders by themselves. Or maybe it’s to independently work in the kitchen because they’re a chef and frequently volunteer at a local shelter to help with meals.

A successful meaningful therapy task includes the following components:

  • Person-centered and individualized

– Based on preferences o Meaningful versus rote

– Graded to abilities

  • Volume and content are appropriate to skill level
  • Therapy and nursing team members’ attitudes are supportive of the elder’s goals

According to a study by Port and others in 2011, we can effectively solicit an elder’s preferences through a series of steps, including the systematic narrative history of activities enjoyed prior to admission and a direct interview of the elder about activity preferences and available choices. We can then identify health-related or contextual obstacles and develop novel interventions to re-engage each elder in their preferred task. Historically, traditional therapy would focus on impairment-based treatment approaches. And components of such approaches may still be necessary and beneficial at specific points of treatment, such as to collect baseline data for range of motion, strength and activity tolerance.

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