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Section 4
Home Adaptations for Stroke Survivors

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In the last section, we discussed differences between right-brain and left-brain injury as a result of stroke.  In addition, we discussed the time orientation strategies technique.

In this section, we will discuss helping clients the adapting the home technique in order to increase confidence and safety in daily functioning.  I will focus by discussing seven areas of the home, entryways, doors, steps, the bathroom, the bedroom, the kitchen, and electric fixtures.

Dolores, 67, had been brought in by her concerned son, Henry.  Henry stated, "Mom has just seemed so depressed lately.  She’s really doing well, but she hardly wants to get out of bed.  My wife and I are always there to help her if she needs to get in or out of bed, or have something to eat, but she’s just so sad all the time!"

Dolores stated, "Henry has been great, but I just miss being able to do all this by myself.  I feel like a burden on my family!  I’m so weak I just can’t do a thing on my own!"  I felt that many of Dolores’ feelings of impairment had to do with the physical environment of Henry’s home.  I decided to address simple adaptations to the home with Dolores and Henry, since I felt that if the physical environment were conducive to more independence, Dolores would experience less depression.

7 Areas of the Home Adapations can be Made

♦ Area # 1 - Entryway
A first area in which adaptations can be made is the entryway.  Henry had already installed a wheelchair ramp for the house, which had a gentle enough slope that Dolores could wheel herself up and down it.  I also encouraged Henry to check the drive and walkways for cracks and bumps.  I stated, "You might also considering lowering the mailbox so that Dolores could check it from her wheelchair without help.  another improvement you might consider is to install a flashing light connected with your doorbell.  Since Dolores has trouble hearing since the stroke, this will help her be able to tell if someone is at the door.

♦ Area # 2 - Doorways
A second area in which improvements can be made which facilitate independent functioning concerns doorways.  Clearly, doors will need to be adapted to accommodate a wheelchair, whether the client can self wheel or not. 

I stated to Harry, "If you find that your doors are not 32 inches wide, you might have the molding removed, or try adjusting the hinges.  Although most wheelchairs can pass through a 29-inch doorway, the person in the wheelchair needs to keep his or her arms in, which prevents him or her from wheeling him or herself.  If there are any thresholds in your home higher than 1/2 inch, remove or bevel them.  Alternately, you might use wedge-shaped pieces of wood to create a more gentle ramp, cover the wood with a rubber mat, and nail it down securely."

♦ Area # 3 - Stairways
In addition to the entryway and doorways, a third important area concerning adaptations for independence concerns stairways.  Henry had had a stairlift installed right after Dolores came home, which facilitated her movement.  Since Dolores was progressing towards walking with a cane, I suggested that Henry install a different colored carpet for the top and bottom stairs.  Many accidents occur because of difficulty identifying the top and bottom step.

♦ Area # 4 - Bathrooms
A fourth area for improvement concerns the bathroom.  One adaptation I have found many families overlook is to remove the vanity or cabinets directly below the sink, so that the client can easily sit at the sink for personal grooming.  The pipes under the sink can be insulated to prevent scrapes or scalds. 

I encourage Dolores to place color-coded baskets next to the sink to facilitate easy access to toiletries.  I also recommended a bathtub transfer bench, reinforced safety bar, shower stool, and hand held showerhead.  I stated to Dolores, "You might also consider using a terry cloth over the head robe instead of toweling dry.  This can help you conserve energy, but still looks presentable if you decide not to dress right away."

♦ Area # 5 - Bedroom
A fifth area for adaptations for independence concerns the bedroom.  Henry and Dolores had already raised her bed to a height that facilitated her getting in and out independently and purchased a wedge pillow.  I also suggested that Dolores and Henry replace knobs on her dresser with levers or bar handles, since levers are often easier to manipulate.  If pull knobs cannot be easily changed, attaching string loops can serve a similar purpose, allowing the client to more easily manage opening drawers.

♦ Area # 6 - Kitchen
In addition to the entryway, doorways, stairs, the bathroom, and the bedroom, a sixth locations for adaptations is the kitchen.  To encourage Dolores to engage in preparing her own meals, I helped Henry and Dolores come up for a strategy for arranging the cabinets, cookware, and refrigerator for Dolores’ ease of use.  Henry also added a makeshift lower counter which Dolores could sit at comfortably in her wheelchair.  Many adapted appliances and utensils are available for clients dealing with the consequences of stroke.

♦ Area # 7 - Thermostats, Electrical Outlets, & Switches
A final location in which clients and their families may consider making adaptations concerns thermostats, electrical outlets, and switches.  I recommended that Henry and Dolores arranged for an electrician to move switches and thermostats to no more than 54 inches off the floor, and raise plugs and outlets to no less than 18 inches from the floor.  In addition, I suggested that Henry might switch to digital thermostats, since digital readouts may be easier for stroke victims to interpret.

Sharon, 62, had been able to return to independent living following recovery from her stroke, but she and her family were understandably concerned about arrangements for her safety.  I recommended the 4-point security technique to increase Sharon’s sense of self reliance and confidence in her ability to live independently. 

♦ Four-Point Security Technique
-- # 1 - First, I advised Sharon to arrange for someone to call her once a day. 
-- # 2 - Second, I encouraged Sharon to develop a signal system with her neighbors that will alert them if she found herself in trouble and unable to speak or operate the telephone.  Sharon spoke with her neighbor Allan, and they agreed that Sharon would open her bedroom curtains every morning, and close them every night.  if the curtains did not open by mid afternoon, Allan would call or check in on Sharon. 
-- # 3 - Third, I asked Sharon to inform the fire department of her condition and give them her information, to improve their ability to assist her in an emergency. 
-- # 4 - Finally, I encouraged Sharon to talk with her local postmaster.  I stated, "There is a program called the US Postal Alert.  An identifying sticker is placed on the mailbox.  If mail accumulates the postal carrier will notify the appropriate agency or service to check on you." 

Think of your Sharon.  Would the 4-point security technique increase his or her confidence, or his or her family’s confidence, in his or her ability to live alone?

In this section, we have discussed helping clients the adapting the home in order to increase confidence and safety in daily functioning. 

Peer-Reviewed Journal Article References:
Davis, C. G., Egan, M., Dubouloz, C.-J., Kubina, L.-A., & Kessler, D. (2013). Adaptation following stroke: A personal projects analysis. Rehabilitation Psychology, 58(3), 287–298.

Forducey, P. G., Glueckauf, R. L., Bergquist, T. F., Maheu, M. M., & Yutsis, M. (2012). Telehealth for persons with severe functional disabilities and their caregivers: Facilitating self-care management in the home setting. Psychological Services, 9(2), 144–162.

Marquardt, M. K., Oettingen, G., Gollwitzer, P. M., Sheeran, P., & Liepert, J. (2017). Mental contrasting with implementation intentions (MCII) improves physical activity and weight loss among stroke survivors over one year. Rehabilitation Psychology, 62(4), 580–590.

Terrill, A. L., Reblin, M., MacKenzie, J. J., Cardell, B., Einerson, J., Berg, C. A., Majersik, J. J., & Richards, L. (2018). Development of a novel positive psychology-based intervention for couples post-stroke. Rehabilitation Psychology, 63(1), 43–54.

Webb, S. S., Moore, M. J., Yamshchikova, A., Kozik, V., Duta, M. D., Voiculescu, I., & Demeyere, N. (2021). Validation of an automated scoring program for a digital complex figure copy task within healthy aging and stroke. Neuropsychology. Advance online publication.

Zapata, M. A. (2020). Disability affirmation and acceptance predict hope among adults with physical disabilities. Rehabilitation Psychology, 65(3), 291–298.

QUESTION 4
What are the steps in the four point security technique? To select and enter your answer go to Test.

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