ADLs for Trunk Rehabilitation after Stroke with Occupational Therapy

One of the most effective interventions occupational therapists can use for trunk rehabilitation is ADLs, IADLs, and mobility tasks. Often after a stroke, there is a loss of trunk control and subsequently a loss of functional independence. Hsieh and colleagues found a strong correlation between how trunk control can be an early predictor of comprehensive ADL activities and function.((Hsieh CL, Sheu CF, Hsueh IP, et al: Trunk control as an early predictor of comprehensive activities of daily living function in
stroke patients. Stroke 33(11):2626–2630, 2002.))

Eating

Even self-feeding and eating can promote trunk control. Movements required include trunk flexion, extension, rotation, and lateral flexion when reaching for objects across the table. Basic demands include static sitting balance and partial weight shifts in all directions in front of the patient. Some factors that affect the amount of trunk movement include the size of the table, the surface that the patient is sitting on and the available support, the placement of food and related items, the type of food, and the rest of the patient’s function such as their coordination, and grip strength in their upper extremities. As self-feeding is likely a meaningful activity for almost all patients, it is a good activity to begin right away with patients eating sitting at bedside with a tray or in the dining room in a social situation. This depends on the patient’s level of attention and concentration when eating. Patients should be discouraged from eating in bed as early as possible and if possible.

Dressing

Upper body dressing promotes a wide range of trunk movements such as trunk flexion, extension, and rotation. With lower body dressing, lateral flexion is required as well. Patients can begin upper body dressing such as wearing a pullover shirt. The patient performs trunk flexion when preparing the shirt in their lap and reaching down low. Trunk extension is performed when the patient places their head into the shirt. Finally, trunk rotation may be initiated when adjusting the shirt’s orientation for proper alignment. A button-down shirt adds to the complexity of movement as they need to align the shirt correctly and more specific parts of the shirt are manipulated, e.g., collar, buttons, and shirt-tail to tuck into pants.

Lower body dressing while seated can be used to put on underwear, pants, socks, and shoes. The trunk movements used include trunk flexion, extension, rotation with flexion, and lateral flexion. Lateral flexion is used whenever the leg is crossed.

Grooming

Even more fine-motor activities such as grooming involve some degree of trunk control. These include trunk flexion and extension for oral care such as rinsing the mouth and reaching for supplies. With hair care such as combing, the head may tilt and simultaneously promote lateral flexion. Patients may move their trunk to see themselves in the mirror in various directions.

Bathing

Bathing promotes some of the most trunk movements as the patient reaches for supplies and bends to reach to clean their body. As a result, it is also one of the most demanding and fatiguing. Even in seated, trunk movements such as flexion, extension, rotation, and lateral flexion are used while bathing – with or without adaptive equipment such as long-handled sponges.

Toileting

Similarly, with toileting, lateral flexion is required for clothing management, transfers, and hygiene. Trunk rotation may be used when reaching for toilet paper. Finally, trunk flexion is performed for specific management of things such as catheters and hygiene products.