MBMC Stroke Survivorship Program Book rv17 Print-Compressed

Stroke Survivor
Journey Guide
program introduction
Stroke Survivorship Program
Stroke Survivorship is a comprehensive and holistic program designed for stroke
survivors and their care partners after discharge from all traditional medical treatment.
Stroke Survivorship educates and engages participants in all five pillars to help
encourage both stroke survivors and care partners to thrive within their new normal.
Establishing and
Thriving in the New Normal
Health Management
Caregiver Tools
Socialization
Education
Lifestyle
Wants and Needs of Stroke Survivor and Care Partner
• Changing • Medication management • Advocating to health • Recognizing • Reestablishing

habits and • Management of other care professional stroke signs routine
behaviors health conditions • Care management and symptoms • Building community
• Nutrition • Using adaptive equipment • Care organization • Competence in • Engaging your
• Fitness and adjusting tasks • Effective communication stroke-related “ABC” community
• Energy conservation with health care education • Returning to
• Management of professionals • Confidence in meaningful
Healthcare Resources • Communication with managing your activities
stroke survivor health
• Effective communication
with your healthcare team • Self-care
LIFESTYLE HEALTH MANAGEMENT CAREGIVER TOOLS EDUCATION SOCIALIZATION
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week 1 | day 1

AGENDA:
• Introduction, Welcome • Identify Your Why
and Program Overview • Community Expectations
What's Your Why?


week 1 | day 2

AGENDA:
• Survey and Data Collection • Review of Program
• Personal Goals
Must be completed online
A. Participant ID: ______________________________________
B. Overall health:
In general, would you say that your health is:
 Excellent (1)
 Very good (2)
 Good (3)
 Fair (4)
 Poor (5)

week 1 | day 2
C. Stroke Knowledge Questions:
The acronym BE FAST is a handy technique to help people quickly recognize common signs of stroke.
1. What does the B, in BE FAST (if you suspect a stroke) mean?
 Can the person smile
 Does the person have a sudden loss of balance
 Is the person having back problems
2. What does the E, in BE FAST (if you suspect a stroke) mean?

 Has the person lost vision in one or both eyes
 Is the person drowzy
 Is the person having leg cramps
3. What does the F, in BE FAST (if you suspect a stroke) mean?

 Is the person moving slowly
 Does the person’s face look uneven
 Is the person’s feet numb
4. What does the A, in BE FAST (if you suspect a stroke) mean?

 Is the person’s arm numb
 Is the person becoming agitated
 Can the person raise both arms for 30 seconds
5. What does the S, in BE FAST (if you suspect a stroke) mean?

 Can the person stand up
 Is the person’s speech slurred
 Is the person being unusually quiet
6. What does the T, in BE FAST (if you suspect a stroke) mean?

 Time - Call 911 if you suspect a stroke
 Is the person losing track of time
 Is the person tired
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M I S S O URI BA P T I S T M E DI C A L C E NT E R STR OKE SURVI VOR J OUR N EY GUI DE

week 1 | day 2
D. Self –efficacy to Obtain Help from Community, Family and Friends:
(Utilization of Social Services and Network)
We would like to know how confident you are in doing certain things. For each of the following
questions, please indicate the number that corresponds to your confidence that you can do the
tasks regularly at the present time.
How confident are you that you can get family and friends to help you with things you need
(such as household chores like shopping, cooking, or transportation)?
[Not at all confident] 0 1 2 3 4 5 6 7 8 9 10 [Totally confident]
How confident are you that you can get emotional support from friends and family
(such as listening or talking over your problems)?
How confident are you that you can get emotional support from resources other than friends
and family, if needed?
How confident are you that you can get help with your daily tasks (such as housecleaning,
yard work, meals, or personal hygiene) from resources other than friends or family, if needed?
E. Self-efficacy to Participate in Social/Recreational Activities: (Leisure Activities)

How confident are you that you can continue to do your hobbies and recreation?
How confident are you that you can continue to do the things you like to do with friends and
family (such as social visits and recreation)?
6 |

week 1 | day 2
F. Frustration with Health Problems:
These questions ask you about how you feel and how things have been with you during the past month.
(For each question, please indicate which number, for each question, comes closest to the way you
have been feeling.)
How much during the past 4 weeks were you discouraged by your health problems?
How much during the past 4 weeks were you fearful about your future health?
How much during the past 4 weeks was your health a worry in your life?
How much during the past 4 weeks were you frustrated by your health problems?
0 - None of the time 1 - A little of the time 2 - Some of the time 3 - A good bit of the time
4 - Most of the time 5 - All of the time
G. The STROKE SELF-EFFICACY QUESTIONNAIRE

These questions are about your confidence that you can do some tasks that may have been difficult
for you since your stroke. For each of the following tasks, please circle a point on the scale that
shows how confident you are that you can do the tasks now in spite of your stroke.
Where 0 = not at all confident and 10 = very confident
How Confident are you now that you can:
1. Get yourself comfortable in bed every night

[Not at all confident] 0 1 2 3 4 5 6 7 8 9 10 [Very confident]
2. Get yourself out of bed on your own even when you feel tired
3. Walk a few steps on your own on any surface inside your house.
4. Walk about your house to do most things you want.

5. Walk safely outside on your own on any surface.

6. Use both your hands for eating your food.

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week 1 | day 2
7. Dress and undress yourself even when you feel tired.
8. Prepare a meal you would like for yourself.

9. Persevere to make progress from your stroke after discharge from therapy.
10. Do your own exercise program every day.

11. Cope with the frustration of not being able to do some things because of your stroke.
12. Continue to do most of the things you liked to do before your stroke.
13. Keep getting faster at the tasks that have been slow since your stroke.
What are your personal goals?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
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week 2 | day 1

AGENDA: • Introduction to Exercise

• Energy Conservation
• Rehabilitation
– Health Expectations • Introduction of SMART Goals
– Formal and Informal Rehab • BE FAST
What do you think of when you hear the word “rehab”?

This is how we view rehab: ____________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Expectations on improvement & overall health
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

week 2 | day 1
• Benefits of ongoing therapy
– Gains vs. Regressions
• Formal & Informal Rehab

– How are you continuing physical gains and progression
after discharge from formal therapy?
• Fitness at Home
TIP
Journaling regularly can
help you see the gains
WHAT IS ENERGY you have made.
CONSERVATION?
Energy conservation is a means of
adapting the way you carry out your
TIP
day-to-day activities, at work, rest
and play. It also allows you to assess
and adapt the environment in which
Know what your insurance
you conduct these activities.
covers for annual therapy –
schedule therapy tune-up
sessions!
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week 2 | day 1
Three exercises I am going to do this week to continue my physical recovery:
1.
2.
3.
DOING:
Ankle ABCs Chair March Seated Leg Kicks
• While in a seated • Sit toward the edge of • Sit toward the edge of a
position, write out the a stable chair with a stable chair with a good,
alphabet in the air with good, upright posture. upright posture.
your big toe.
• Begin by raising up • Slowly kick one leg out,
• Your ankle should one arm and the keeping a slight bend in
be moving as you opposite side leg. the knee. Do not lock
perform this. out the knee. Hold for
• Lower arm and leg back 5 seconds and return.
down and then raise
opposite sides as you • Next, perform on the
alternate back and forth. other leg.
Complete 2 sets of the full Complete 10 sets of chair Complete 10 sets of seated
alphabet on each ankle. marches on both sides. leg kicks on both sides.

week 2 | day 1
MET LEVEL ACTIVITY LEVEL
1 MET Sitting at rest
1-3 METS Writing, desk work, using the

(light activities) computer, light walking
3-6 METS Light housework such as

(moderate activities) sweeping, walking around
the neighborhood
>6 METS Yardwork, lifting heavy objects

(vigorous activities)
Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
ENERGY CONSERVATION
TIPS & TRICKS
1. Complete the 3. Complete high- 4. Use adaptive

activity in chunks. energy tasks during equipment (AE)
the time of day you or durable medical
2. Rest between
feel more energized. equipment (DME) to
each activity.
support you during
the task.

week 2 | day 1
TIP
While we are still
– Introduction to SMART Goals
looking for ways to
improve, don’t forget
What are your personal goals for recovery? to celebrate how far
you have come in your
recovery journey already!
Now that you have your goals, how do you break them down to achieve them?
SMART GOALS:
Specific Measurable Achievable Relevant Time-bound

State what Provide a way Within your Makes sense State when you’ll
you’ll do to evaluate scope within your get it done
recovery process
Use action Use metrics or Possible to Be specific
words data targets accomplish, Improves recovery on date or
attainable goals in some way timeframe
Write down at least one SMART goal for the week. ______________________________
The steps that I will take to achieve my SMART goal this week are:
•
•
•
•

week 2 | day 1
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week 2 | day 2

AGENDA: • Navigating Challenges

• Energy Conservation Outside the Home
– Strategies • Planning a Day Trip
– Application – Backpack
• First Encounters • Balance Exercises
Draw a line to rank each activity to your corresponding MET Level:
ACTIVITY LEVEL MET LEVEL

Arranging a ride
Trip to grocery store Light Activites
(1-3 Mets)
Walking from car to store
Social event such as a
wedding or graduation
Dining at a restaurant Moderate Activities
(3-6 Mets)
Visiting a friend at home
Leisurely outing
Doctor’s appointment
Vigorous Activities >
Therapy Appointment 6 Mets
Faith or Social gathering
Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

week 2 | day 2
What are some energy conservation strategies?
•
•
•
•
•
•
Where can energy conservation be applied outside of the home?

•
•
•
•
•
•

week 2 | day 2
Brainstorm:
What are some possible challenges when
navigating outside of the home?
Strategies to overcome challenges outside the home:

•
•
•
•
•
•

week 2 | day 2
What do you need to prepare for a trip outside of the home?

week 2 | day 2

recovery process

week 3 | day 1

AGENDA: • Safe Eating

– Speech Language Pathologist
• SMART Goal Recap – Adaptive Equipment in the kitchen
• Meal Prep
OAL RECAP
G
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GO
AL RECA

week 3 | day 1
Brainstorm:
What are some challenges in cooking
and meal preparation?
Strategies to overcome challenges in cooking and meal preparation:

•
•
•
•
•
•

week 3 | day 1
REDUCING RISK
TIPS & TRICKS

WITH DYSPHAGIA
• Using a straw • Brushing teeth before and
after meals
• Crushing medications
• Alternating bites and sips
• Remaining upright after meals
Take note of ideas for your food safety

Modified foods and
liquids include:
- Ground meat
- Steamed vegetables
- Canned fruit
- Pureed foods
- Adding a thickening
agent to all
liquids consumed

week 3 | day 1
Adaptive Cooking & Eating Equipment
Name: Picture: Description: Use:
Universal Cuff A leather cuff that fits around

the palm of the user’s hand,
secured with a strap.It allows
for more control of utensils
and writing tools.
Built-Up The built-up handle utensils

Handle Utensils allow for an easier grip on
utensils, reducing stress on
joints and requiring less
hand strength.
Rocker Knife The rocker knife allows food to

be cut with only one hand and
limited strength.
Scoop Plate The scoop plate is designed

to help the user scoop food
onto a utensil by providing a
lipped edge. This is ideal for
individuals who use only one
hand to eat.
One-Handed This food preparation aide

Cutting Board enables the user to hold food
in place for cutting, peeling
and grating. This is ideal for
someone who uses only
one hand.

week 3 | day 1
24

week 3 | day 2

AGENDA:
– Vanilla Overnight Oats
• No Cook Meals
– Mediterranean Tuna Salad

week 3 | day 2
Overnight
RECIPE Vanilla Oats
Enjoy these chilled oats for a make-ahead breakfast or simple warm-weather dessert!
MAKES: 4 servings (about ½ cup oatmeal base) | PREPARATION TIME: 10 minutes | CHILL TIME: 2+ hours
INGREDIENTS: UTENSILS:
1 cup old fashioned rolled oats • Measuring cups and spoons • Knife, as needed to cut fruit
1 cup unsweetened vanilla almond milk • Medium mixing bowl • Cutting board, as needed to
1 cup fat-free, plain Greek yogurt • Spoon for mixing cut fruit
1 tablespoon plus 1 teaspoon honey • 4 medium wide-mouth jars • Adaptive equipment for
2 cups ripe, fresh fruit (such as blueberries, or serving bowls preparation, serving and

eating, as needed
diced peaches or bananas) • Canning funnel, if desired
½ cup sliced almonds, toasted
DIRECTIONS:
1 2
Place all ingredients (except fruit and almonds) Divide mixture between 4 medium-sized
in a medium bowl; stir to combine. wide-mouth jars or serving bowls.
3 4
Cover and refrigerate overnight or up to 4 days. Before serving, stir oats then top each portion
with ½ cup fruit and 2 tablespoons almonds.
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week 3 | day 2
Overnight Vanilla Oats (continued)
NUTRITION PER SERVING: (with blueberries and almonds) 248 Calories, 9 g Total Fat, 1 g Saturated Fat, 3 mg
Cholesterol, 67 mg Sodium, 35 g Carbohydrate, 5 g Fiber, 6 g Added Sugar, 12 g Protein
RECIPE VARIATIONS:
COOK’S NOTES:
• Chocolate Covered Banana: Before serving, stir
1 teaspoon cocoa powder into oatmeal base; top • Go with fruits such as blueberries or raspberries that
with ½ diced, ripe banana and chopped walnuts. don’t need chopping!
• Apple Cobbler: Before serving, stir ¼ teaspoon • Try defrosted and drained frozen fruit or canned fruit
cinnamon into oatmeal base; top with ½ diced packed in water or juice; dice as appropriate.
apple and chopped pecans.
• Vanilla-flavored almond milk means no need to add
• Peanut Butter & “Jelly”: Before serving, stir
vanilla extract!
1 tablespoon peanut butter into oatmeal base;
top with ½ cup diced strawberries. • This recipe is designed for a regular texture diet but
is easy to modify by processing oat mixture and fruit in a
blender or food processor; omit almonds and if appropriate,
stir in almond butter or powdered almond butter before
processing. Process to the texture recommended by your
health care provider. A knife or the side of a fork can
also be used to cut fruit for minced or soft diets.
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week 3 | day 2
Mediterranean
RECIPE Tuna Salad
If you haven’t tried tuna packed in a pouch, you’re in for a treat!
Pouched tuna has fresh flavor and needs no draining.
MAKES: 4 servings (½ cup) | PREPARATION TIME: 10 minutes
INGREDIENTS:
UTENSILS:
2 pouches (2.6-ounces each) 2 tablespoons capers, drained
• Measuring spoons • Knife
reduced-sodium, chunk 2 tablespoons extra virgin
light tuna in water • Medium mixing bowl • Cutting board
olive oil
• Spoon for mixing • Juicer
1 (15-ounce) can low-sodium 2 teaspoons minced garlic
• Can opener • Adaptive equipment for
cannellini beans, rinsed
2 teaspoons dried oregano • Colander preparation, serving
and drained
Juice from 1 small lemon and eating, as needed
DIRECTIONS:
1 2
Place tuna in a medium bowl; break up Add remaining ingredients to bowl;

large chunks with a spoon. toss gently to combine.

week 3 | day 2
Mediterranean Tuna Salad (continued)
NUTRITION PER SERVING: 151 Calories, 7 g Total Fat, 1 g Saturated Fat, 18 mg Cholesterol, 136 mg Sodium,
11 g Carbohydrate, 4 g Fiber, 0 g Added Sugar, 12 g Protein
COOK’S NOTES:
• Enjoy salad as a simple, make-ahead entrée or wrap in “less sodium” or “no salt added” varieties – choose
leafy lettuce leaves or a whole-wheat tortilla – even the options that best meet your taste preferences and
use as a “topping” for a garden salad to boost protein. health goals.
• Minced garlic sold in jars (often in the produce aisle • Draining and rinsing canned beans under cool running
of the supermarket) is the ultra-convenience food! water for about 1 minute reduces their sodium by
40%. You can have the convenience of the can while
• Save time by using an electric juicer and juice several keeping an eye on sodium!
lemons at one time. Store juice in small jars or containers
in the freezer for ready-when-you-are “fresh” juice. Do • This recipe is designed for a regular texture diet but is
the same with limes and oranges to use in other recipes. easy to modify by processing tuna mixture in a blender
or food processor. Process to the texture recommend
• Compare labels on reduced-sodium varieties of pouched by your health care provider. A pastry blender or potato
tuna and canned beans. You may find “reduced sodium,” masher may also help achieve recommended texture.
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week 3 | day 2

recovery process
30

week 4 | day 1

AGENDA:
• SMART Goal Recap • Owning and Advocating
for Better Health
• What is Partnership
• Risk Factors for Stroke
• Communication Barriers
• Communication Assessment
• Communication Strategies
OAL RECAP
G
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AL RECA

week 4 | day 1
PARTNERSHIP:
A person with whom one has a relationship.
What does this mean to you?


week 4 | day 1
When looking at it from a survivor / care partner team, it can be defined many
different ways.
Roles of care partner:
Roles of stroke survivor:

week 4 | day 1
Strategies for communication between stroke survivors and care partners
•
•
•
•
•
HEALTH CARE ADVOCACY:

It's important to find your voice to communicate your concerns, desires
and rights with those around you, including your health care team.
This requires an understanding of your rights and responsibilities in
your health, identifying your needs, creating health goals, and health
ownership. (Center for Excellence in Disabilities, West Virginia University)
Strategies to communicate with health care team

•
•
•
•
•

week 4 | day 1
HEALTH OWNERSHIP:
Requires educating and advocating for yourself, committing
to a plan you are part of developing, and communicating
with care partners, family and your health care team.
What does health ownership mean to you?

How do you currently engage in your health ownership?
Are there any risk factors you would like to change?

What tools would you need to be successful?

week 4 | day 1
Modifiable Risk Factors
What are some changes you can make to reduce your risk?

week 4 | day 1
COMMUNICATION TIPS & TRICKS:
• Show respect • Accept the feeling of others • Do not play the victim
• Be honest about • Be careful with the use • Use “I” messages to express
your emotions of humor your feelings
Understanding your communication style

can be helpful in working with your care partner and care team.
What are your communication strengths/weaknesses?

How do others perceive your communication style?

How does that impact your message being received?

week 4 | day 1
Leading Teams Participant Guide
Colors: Descriptive Meanings

Accurate: Precise, Emotional: Sensitive, Mature: Developed, Restless: Impatient,
correct, careful demonstrative seasoned, ready anxious, unsettled
Aloof: Standoffish, Evaluative: Assesses, Moderate: Balanced, Restrained: Moderate,
doesn’t initiate with determines, judges reasonable, even controlled
others Even-tempered: Calm, Neighborly: Friendly, Risk taker: Adventurous,
Bold: Courageous, level-headed sociable daring, not cautious
fearless Experimental: Obliging: Agreeable, Self-directed:
Cautious: Careful, Innovative, pioneering accommodating Independent, not
guarded, wary Forceful: Powerful, Optimistic: Positive, requiring a lot of
Charming: Appealing, effective, strong hopeful, trusting supervision
engaging Gentle: Nice, pleasant, Outspoken: Blunt, Self-reliant: Comfortable
Colorful: Distinctive, kind candid, unrestrained depending on oneself
lively, spirited and not needing much
Good listener: Attentive, Passionate: Excited,
support from others
Competent: Qualified, patient enthusiastic, intense
capable, skilled Self-promoting:
Good mixer: Works easily Passive: Uninvolved,
Assertive, political
Competitive: Ambitious, with others, sociable disinterested
striving, determined Serene: Peaceful, calm,
Gregarious: Sociable, Patient: Tolerant,
tranquil
Confident: Self-assured, outgoing understanding
unafraid, secure Stable: Reliable,
High-spirited: Lively, Perfectionist: Demands
consistent, predictable
Content: Satisfied, eager, energetic excellence and precision
comfortable, happy Stubborn: Rigid,
Humble: Modest, Persuasive: Convincing,
determined, inflexible
Conventional: Typical, respectful seeks to influence
traditional Systematic: Methodical,
Impatient: Intolerant, Playful: Spirited, fun-
organized
Creative: Innovative, easily irritated loving, good-natured
clever, stimulating Talkative: Outgoing,
Impulsive: Enthusiastic, Popular: Generally liked,
communicative
Daring: Bold, willing to unrestrained admired
try new things, Intelligent: Smart, Practical: Sensible,
courageous knowledgeable reasonable, solid
Devout: Faithful, sincere, Law-abiding: Predictable: Consistent,
genuine Conscientious, honorable does the expected
Direct: Candid, Loyal: Trustworthy, Quick: Abrupt, brief,
straightforward dedicated, faithful brisk
Easy mark: Easily misled, Respectful: Polite,
pushover considerate
45 PROPERTY OF DES - DO NOT COPY WITHOUT PERMISSION

Version 2.0

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Building Blocks of Communication
Show
respect
Share your Be clear

feelings and precise
Don't make Listen first &

assumptions listen well Humor
Accept feeling Do not play Apologize and Use "I"

of others the victim move on message
42

week 4 | day 1
43

week 4 | day 2

AGENDA:
• Defining Independence • Total Body Exercises
• ABC Relationships • Survivor and Care Partner
Breakout Discussion Groups
Brainstorm:
What are your realistic expectations on how
much you can or need to contribute to common
activities (such as getting dressed, chores, etc.)?

week 4 | day 2
Defining Independence:
What does independence look like to you?
Balancing Care and Independence:

What expectations were realistic? What changes will I have to make to my
initial expectations?

week 4 | day 2
Recognizing Steps to
Greater Independence:
It's important to find your voice to communicate your concerns, desires
and rights with those around you, including your health care team.
This requires an understanding of your rights and responsibilities
in your health, identifying your needs, creating health goals, and
health ownership.
NOW IN __ MONTHS ULTIMATELY
What parts of this activity What parts of this activity What parts of this activity
are you completing now? are you completing now? are you completing now?
Overall Percentage Overall Percentage Overall Percentage

of Involvement: __________ of Involvement: __________ of Involvement: __________

week 4 | day 2
Advocate, partner in conversation - Spouse, children, parents

with Health Care Professional, - Neighbors
immediate response situations - Good friends
A|B|C
levels of
relationships:
Recognizing and
C engaging with key
Potential errands,
relationships
socialization, partner
in therapeutic activities B
- Church community
- Professional community Potential errands, socialization,
- Acquaintances assistance in basic tasks
- Cousins
- Friends
- Extended family

week 4 | day 2
Level of Relationship People/Groups within the level Tasks they could assist with
• •
Primary • •
Support • •
Person
• •
• •
• •
• •
A • •
• •
• •
• •
• •
• •
B • •
• •
• •
• •
• •
• •
C • •
• •
• •
• •
• •
POTENTIAL TASKS:
- Making meals - Household care - Holiday-specific tasks - Rides to Primary Care
- Laundry - Grocery shopping - Care for pets (walk, etc.) Physician appointments
- Rides to therapy - General errands - Taking to and from activities - Rides to follow-up appointments


week 4 | day 2
Primary
Caregiver(s)
A level
PATIENT relationships
Key to Support
Network B level
relationships
C level
relationships

week 4 | day 2

recovery process

week 5 | day 1

AGENDA: • Safety
– Home Safety
• SMART Goal Recap – Safe and Proper Transfers
• First Encounters – Adaptive Equipment
OAL RECAP
G
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AL RECA

week 5 | day 1
SAFETY
Notes from Home Safety video and discussion:

•
•
•
•
•
•
•
Notes from Safe and Proper Transfers video and discussion:

•
•
•
•
•
•
•
Notes from Adaptive Equipment video and discussion:

•
•
•
•
•
•

week 5 | day 1
SAFETY
Review Medications and
Talk to Your Physician
Some medications can impact balance
and awareness.
Exercise for Strength

and Balance
Exercises like Tai Chi can help
with balance and strengthen core
leg muscles that help you feel
strong and confident. Your care
team can help you identify the
Prevent best program for your abilities.
Falls
Annual Checkups
on Eyes and Feet
See where you are going and
get there safely by maintaining
healthy vision and foot health.
Plan to check in with your care
provider at least annually.
Make Home Safer

Remove safety hazards from floors, stairs
and walkways. You may want to increase
lighting or install handrails or grab bars,
transitional ramps and no-slip mats for high
risk areas like doorways and bathrooms.

week 5 | day 1
SAFETY FIRST
IS THIS YOU? WE HAVE THE SOLUTION!
Shoes, Books, Mail and more

Add a basket or shoe tree to your entry to keep stairways
gather at the bottom of your
clear of clutter.
stairs creating a trip hazard.
Your light switch is at the

bottom of your stairs making Talk to an electrician to see about installing a second
your journey down each switch at the top of your stairs.
morning dark and dangerous.
Your hallway carpet has a torn Try to replace the carpet, attach non-slip rubber treads
edge that catches regularly. or remove the carpet entirely.
Your living room is like a maze

making it difficult to navigate Talk to a friend or family member to help create a more
with devices such as a walker movement friendly space.
or wheelchair.
Coil or tape cords next to the wall. Where appropriate you

Your cords seem to tangle may wish to use an extension cord or surge protector or install
themselves in each room! another outlet to reduce the space a cord needs to cross.
Try to keep things you use often nearby at waist height.

Heavy lifting isn’t your thing
If you need something for a special occasion such as a holiday
but your holiday dishes and
platter, use a sturdy step stool with a bar to hold onto, or ask
mixer are up above.
a friend or family member to bring down the item for use.
Your nightlight doesn’t reach Add a lamp near your bed, or install motion activated lights
your bedside. along your walk way.
Many falls happen in the bathroom. Add a non-slip rubber

mat, self stick strips to your tub or shower and grab bars
Rub a Dub it’s a slippery tub! where needed for support. You may also like to have a bench
in your shower and tub to help with energy conservation.
Elevated seats and grab bars can also be helpful for the toilet.
Resources Include: cdc.gov/steadi/patient.html

week 5 | day 1
TRANSFER SAFETY
• Obtain additional assistance whenever in doubt of your own safety or the

safety of the stroke survivor/care partner.
• Communicate throughout the transfer.
• Use a gait belt every time.
• Prepare the environment appropriately.
• Always stabilize where you are currently and where you are going.
• Use proper body mechanics.
Stand with your feet at Keep your neck, back,

least shoulder width apart What are hips and feet aligned
for a sturdy foundation. when you move.
good body
mechanics for
Bend at the knees Avoid twisting or
transfers?
rather than at your waist. bending at the waist.

Notes from transfer and body mechanics discussion and demonstration:

•
•
•
•
•
•
•

week 5 | day 1
56

week 5 | day 2

AGENDA:
• Preparing Your Medical • Quick Tips for Communicating
Binder and Vial of Life with Medical Providers
• Effective Communication • Seated Tai Chi
5 7 | MI S S O U R I B A P T I S T M E D I C A L C E N T E R ST RO KE SURVI VO R J O URNEY G UI D E

week 5 | day 2
MEDICAL BINDER:
This is a term that refers to a single place to keep all of your medical
information. It does not have to be a physical binder. It can be a
thumb drive or a day planner, whatever works best for you. It needs
to be easily accessible and portable.
Medical Binder Worksheet

List of current medications & allergies
Document with medical & surgical history (include what deficits you have from your stroke)
What will you include in your medical binder?
• ____________________________________________________________________
• ____________________________________________________________________
• ____________________________________________________________________
• ____________________________________________________________________
• ____________________________________________________________________
• ____________________________________________________________________
Other items to consider:

• Last blood work results and radiology reports if applicable • Important addresses
• List of community resources (this can include the number • Favorite places to visit
to a ride service if you cannot drive, companies that
provide in-home services, support groups and more) • Emergency money
• List of your “ABC community” names and phone numbers • Next dose of medications

week 5 | day 2
Medical Binder Personal Information Sheet
Name: Phone #:
Address:
Date of Birth:
Emergency contact: Phone #:
Emergency contact: Phone #:
Preferred Hospital:
Primary Physician: Phone #:
Specialty Physician: Phone #:
Specialty Physician: Phone #:

Significant medical history:
Allergies:

week 5 | day 2
VIAL OF LIFE:
A vial of life is a condensed version of your medical binder containing
information that might be necessary in a medical emergency such as
medications, allergies, and medical conditions. These are often placed
on or in your refrigerator where first responders are taught to look for
this information.

week 5 | day 2
TIPS FOR COMMUNICATING

WITH HEALTH CARE PROVIDERS:
1. Prepare your questions ahead of your visit
2. Write them in a direct and simple format
3. Prioritize your list with most important questions at the top
4. Ask your provider to allow you to record your conversation with

your phone or recording device for later reference
5. Request support from a trusted care partner to help with notes

and documenting conversations.

week 5 | day 2

recovery process
62

week 6 | day 1

AGENDA:
• SMART Goal Recap • Planning for Recovery
• Range of Motion Exercises
OAL RECAP
G
P
GO
AL RECA

week 6 | day 1
What are some of your biggest struggles with recovery currently?

week 6 | day 1
What are
the 2-3 things
you would like
help with?
How would the help change things for you?

week 6 | day 1
Upper Extremity Range of Motion Exercise Program
Stroke Survivorship Program
BROOM
• Shoulder Flexion & Extension
– Begin by holding the broom horizontally, hands shoulder-width apart.
– Raise your arms forward and up toward the ceiling.
Keep your elbows straight.
– Slowly lower your arms to the starting position.
Repeat ____ times.
• Shoulder Abduction & Adduction

– Begin by holding the broom horizontally, one hand on the top end of
the broom and the other near the opposite end.
– Raise the arm holding the top end of the broom out to the side and
toward the ceiling. Keep your elbow straight on the elevated arm.
– Slowly lower your arms to the starting position.
Repeat ____ times on each side.
• Shoulder Internal & External Rotation

– Begin by holding the broom horizontally, hands
shoulder-width apart and gripping the broom from below.
– Bend your elbows to 90 degrees.
– Slowly move your one forearm across your stomach,
allowing the broom to guide the other arm.
– Slowly bring your arms back to the starting position.
Created by Oasis, influenced by The Ohio State University Medical Center. (n.d.). Self-Range of Motion Exercises for
Shoulders, Arms, Wrists, Fingers. Self-Range of Motion Exercises for Shoulders, Arms, Wrists, Fingers.

week 6 | day 1
• Elbow Flexion & Extension
– Begin by holding the broom horizontally, hands shoulder-width
apart and gripping the broom from below.
– Start with both arms straight.
– Slowly bend your elbows, bringing the broom toward your body.
– Fully straighten your elbows.
• Pronation & Supination (without broom)

– While seated, begin by interlocking your fingers with the affected thumb on top,
supporting the affected arm. Support your forearms on a table if needed.
– Place the affected arm with the palm of your
hand facing upward.
– Slowly rotate the palm of your hand downward.
PAINT ROLLER
• Shoulder Flexion & Extension
– Begin by positioning yourself toward a wall about a forearm’s length away, seated.
– Holding a paint roller in the hand of the affected arm, roll “paint” upward.
– Slowly lower down to starting position.
• Horizontal Abduction and Adduction

– Begin by positioning yourself toward a wall about a forearm’s length away, seated.
– Using the affected arm with the palm facing downward, grab the paint roller. The
paint roller should be held where the roller will run horizontally against the wall.
– Roll “paint” to move the affected arm across your body.
– Slowly roll “paint” to move the affected arm away from your body.

week 6 | day 1
• Shoulder Abduction
– While seated, position yourself with your hip toward the wall, forming a
right angle, about a forearm’s length away.
– Holding a paint roller in the hand of the affected arm, roll “paint” upward.
– Slowly lower down to starting position.
Picture References
showme.co.za/nelspruit/files/2017/07/Corrective-exercises-for-shoulder-impingement-phase11.pdf
saintlukeskc.org/health-library/shoulder-abduction-flexibility
myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?HwId=zp4450
monthlymale.com/biceps-straight-bar-curls/
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week 6 | day 1
69

week 6 | day 2

AGENDA: • Roles and Responsibilities:

– Definitions
• Embracing Independence
– Reflection

• Tai Chi

DEFINITIONS:
Defining roles:
• Traditional vs. current
Relationship:
• What changes have happened in your relationship?
• How do you have a healthy relationship during all of these changes?
• How do you maintain that healthy relationship?
Self-care:
Prior to the stroke, what types of roles, responsibilities and tasks were you
responsible for?

week 6 | day 2
How did this change after the stroke?
Who has taken on these tasks, roles or responsibilities since the stroke?
Based on the changes you listed above:

How are you and your partner navigating through these changes?
What are your biggest frustrations?
How are you communicating these frustrations?

week 6 | day 2

recovery process

week 7 | day 1
AGENDA:
• SMART Goal Recap • Community Support Programs
• Recovery Strategies • Review & Evaluation
• Keeping Brain
and Body Active
OAL RECAP
G
P
GO
AL RECA

week 7 | day 1
Brainstorm:
What strategies have helped
in recovery and re-integration
into the community?
Brainstorm:
What topics or strategies do you want to learn more about?

week 7 | day 1
KEEPING OUR MIND ACTIVE
Brainstorm:
What mentally stimulating activities
have you/do you like to engage in?
•
•
•
•
•
•
•
Make a check to indicate how you feel about each statement.
Never Sometimes Always

I feel engaged in activities that I enjoy and that
stimulate my mind
I am able to do these activities as often as

I want to, or should for my wellness
I feel there is a roadblock keeping me from these activities

and the community I used to do this activity with
I feel that changes to my brain and body have made

engaging in this activity too challenging for me.

week 7 | day 1
KEEPING OUR BODY ACTIVE
Brainstorm:
What physical activities have you/do you
like to engage in?
•
•
•
•
•
•
•
TIP: Refer to members of your “ABC” community. Who could you engage in this activity
from your core relationships?
Negative Neutral Positive

I feel engaged in activities that I enjoy and that
stimulate my body
I am able to do the physical activities, therapies, and

exercises as often as I want to, or should for my wellness
I feel there is a roadblock keeping me from these activities

and the community I used to do this activity with
I feel that changes to my brain and body have made

engaging in this activity too challenging for me.

week 7 | day 1
What are some barriers and possible adaptations you could make to your environment, or the
physical or mental activity that could make it accessible and enjoyable? For example if you
love movies but do not enjoy navigating in the dark – perhaps you could arrive 10-15 min
earlier to find your seat and snacks before the lights go down.
Mind Body
Barriers
Adaptations
TIP: Refer to members of your “ABC” community. Who could you engage in this activity
from your core relationships?

week 7 | day 1
OASIS STROKE SURVIVORSHIP MID-PROGRAM EVALUATION
1. I am learning things that are helpful to me:
[Strongly Disagree] 1 2 3 4 5 6 [Strongly Agree]
2. I am incorporating information and activities discussed in this program into my life when
I am not in class: [Strongly Disagree] 1 2 3 4 5 6 [Strongly Agree]
3. So far, my expectations of this program are being met:
[Strongly Disagree] 1 2 3 4 5 6 [Strongly Agree]
4. Is there anything you have not learned about yet, that you want to? Yes No
If yes, what?
5. What have you liked best, or found most helpful?

6. What have you liked least and why?
7. In this program, which participant are you? Stroke Survivor Care Partner
0 1 2 3 4 5
For each question, please indicate NONE A LITTLE SOME A GOOD MOST ALL
which number comes closest to OF THE OF THE OF THE BIT OF OF THE OF THE
the way you have been feeling. TIME TIME TIME THE TIME TIME TIME
How much during the past

4 weeks were you discouraged
by your health problems?

4 weeks were you fearful
about your future health?

4 weeks was your health a
worry in your life?

4 weeks were you frustrated
by your health problems?

week 7 | day 1

week 7 | day 2

AGENDA: – Avocado Cream with Dill

– Pumpkin Spice Dip
• Condiment Style Recipes
– Restaurant-Style Salsa

week 7 | day 2
Avocado Cream
RECIPE with Dill
This avocado cream makes the quintessential avocado toast! But don’t stop with toast –
use the cream to top a baked potato or prepared white fish. Or stir in chopped eggs for a
unique take on egg salad!
MAKES: about ½ cup | PREPARATION TIME: 10 minutes
1 medium ripe avocado • Measuring spoons • Spoon for scooping avocado
1 teaspoon dried dill weed • Small mixing bowl • Fork or pastry blender for mashing avocado
½ teaspoon garlic powder • Knife • Adaptive equipment for preparation, serving
½ teaspoon onion powder • Cutting board and eating as needed
DIRECTIONS:
1 2
Cut avocado in half; scoop flesh into small bowl and Add seasoning and stir to combine;
mash with fork or pastry blender until desired texture. enjoy immediately.

week 7 | day 2
Avocado Cream with Dill (continued)
NUTRITION PER SERVING: (about 3 tablespoons) 87 Calories, 8 g Total Fat, 1 g Saturated Fat, 0 mg Cholesterol,
5 mg Sodium, 5 g Carbohydrate, 4 g Fiber, 0 g Added Sugar, 1 g Protein
COOK’S NOTES:
• To prevent browning, store leftover • For super simple preparation, • This recipe is designed for a
avocado cream in the refrigerator purchase already mashed 100% regular texture diet but is easy
and covered with plastic wrap avocado from the fresh produce to modify by processing avocado
(pressing the wrap into the aisle of your supermarket. mixture in a blender or food
surface). Stir in a bit of lime processor. Process to the
juice before storing if you like. texture recommended by your
health care provider.
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week 7 | day 2
Pumpkin
RECIPE Spice Dip
Pumpkin and peanut butter combine into a tasty dip for fresh fruit or
baked sweet potato fries. Stir into oatmeal for an unexpected treat!
MAKES: about 1 ¼ cups | PREPARATION TIME: 10 minutes
1 cup canned pumpkin puree (not pie filling) • Measuring cups and spoons
½ cup natural peanut butter or almond butter • Small mixing bowl
2 tablespoons brown sugar • Spoon for mixing
1 teaspoon vanilla • Can opener
1 teaspoon pumpkin pie spice • Adaptive equipment for preparation, serving and eating,
as needed
DIRECTIONS:
1 2
Place all ingredients in a small bowl. Stir until smooth.

week 7 | day 2
Pumpkin Spice Dip (continued)
PHOTO
NUTRITION PER SERVING: (2 tablespoons dip) 97 Calories, 6 g Total Fat, 1 g Saturated Fat, 0 mg Cholesterol,
44 mg Sodium, 6 g Carbohydrate, 2 g Fiber, 2 g Added Sugar, 3 g Protein
COOK’S NOTES:
• Turn Pumpkin Spice Dip into a “dessert” dip by • For a variation, trade peanut butter for part-skim ricotta
alternating fruit dippers with vanilla or chocolate cheese for a smooth, pudding-like spread reminiscent
wafers, graham crackers or ginger snaps. of cannoli filling!
• How to keep the oil from separating in a jar of natural • This recipe is designed for a regular texture diet
peanut butter? After opening the jar, stir the oil but is easy to modify by processing dip in a blender
completely into the butter then store tightly capped or food processor with liquid, as needed, to achieve
upside down! Storing the jar inverted will prevent the the texture recommended by your health care provider.
oil from separating again. Unsweetened vanilla almond milk is a good option
for liquid.
• Pumpkin pie spice is delicious sprinkled on roasted
carrots, butternut squash or mashed sweet potatoes.
Add to coffee grounds before brewing or stir into
smoothies or pudding.

week 7 | day 2
Restaurant-
RECIPE Style Salsa
Think outside the chip bowl when it comes to salsa! Consider this simple, fresh salsa your
go-to condiment. Spoon over scrambled eggs, top baked fish or mix with plain yogurt for a
fiesta-style dressing. Even add cucumber and bell peppers for a quick “gazpacho.”
MAKES: 2 cups | PREPARATION TIME: 20 minutes
1 (14.5-ounce) can no-salt-added diced tomatoes • Measuring cups and spoons • Immersion blender, blender
½ sweet onion, roughly chopped • Medium mixing bowl or food processor
¼ cup roughly chopped cilantro • Can opener • Adaptive equipment for
preparation, serving and
1 jalapeno, roughly chopped • Spoon eating, as needed
1 teaspoon minced garlic • Knife
½ teaspoon ground cumin • Cutting board
DIRECTIONS:
1 2 3
Place all ingredients in Use immersion blender to blend Cover and refrigerate
a medium bowl. until desired consistency. up to 5 days or freeze for
(All ingredients can also be placed up to 6 months.
in a blender or food processor and
pulsed to desired consistency.)
85 | M I S S OURI BA P T I S T M E DI C A L C E NT E R STR OKE SURVI VOR J OUR N EY GUI DE

week 7 | day 2
Restaurant-Style Salsa (continued)
PHOTO
NUTRITION PER SERVING: (1/4 cup) 18 Calories, 0 g Total Fat, 0 g Saturated Fat, 0 mg Cholesterol, 23 mg Sodium,
COOK’S NOTES:
• Using no-salt-added canned tomatoes in place of meat shreds easily with a fork. Use the shredded
chopped fresh tomatoes is the secret to a quick salsa! chicken in salads or tacos or top brown rice and
You can enjoy the convenience of the can while keeping vegetables for a Mexican-style bowl.
an eye on sodium.
• This salsa is very low in sodium (less than 35 mg
• Minced garlic sold in jars and pre-chopped onion and per serving). Allow your taste buds time to adjust to
cilantro (in the produce aisle of the supermarket) a lower sodium eating style. Let personal taste and
are the ultra-convenience foods. health goals be your guide to adding salt.
• Consider this salsa your base recipe, then get creative! • Adding ¼ teaspoon of coarse salt to the finished
Increase garlic and cumin, add other salt-free seasonings recipe will add 480 mg of sodium or bring the
such as oregano or smoked paprika — even stir in black sodium count to 83 mg per ¼ cup serving.
beans, chunks of mango and a sprinkle of cinnamon
after processing! • This recipe is designed for a regular texture
diet but is easy to modify by processing salsa with
• For a simple meal, place fresh or frozen boneless, an immersion blender, blender or food processor
skinless chicken breasts in a slow cooker; cover with and adjusting the liquid to achieve the texture
the salsa. Cook on low until cooked through and the recommended by your health care provider.

week 7 | day 2

recovery process
87

week 8 | day 1

AGENDA:
• Neurogame
• SMART Goal Recap
• Homework (MET Worksheet)
• Anatomy of a Stroke Located in Week 8 Day 2
OAL RECAP
G
P
GO
AL RECA

week 8 | day 1
PARIETAL LOBE:
Language | Touch | Taste | Smell
FRONTAL LOBE:
Thinking | Speaking | Memory | Movement
OCCIPITAL
LOBE:
Vision | Color | Letters |
Left/Right
TEMPORAL LOBE:
Hearing | Learning | Feelings | Fear
CEREBELLUM:
Balance | Coordination
BRAIN STEM:
Breathing | Heart Rate | Temperature | Blood Pressure

week 8 | day 1

week 8 | day 2

AGENDA: • Role Shift and Role Reversal

• Review MET Worksheet • Task Analysis and Energy Conservation
• Planning Your Day • Breakout Session
• House Assessment • SMART Goals
DEFINE
• Energy Conservation:
• Task Analysis:
TIME LEVEL OF FATIGUE

7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM

week 8 | day 2
This chart builds off the foundational knowledge of energy conservation, referring back to day one
of week two. This chart uses METs, metabolic equivalent of task. A MET is the ratio of the rate at
which a person expends energy within a certain task compared with the rate the person expends
energy at rest. METs are often used within therapeutic exercise to help therapists, doctors and
patients get a better understanding of how much energy a particular activity requires.


the neighborhood

However, the MET ratings for activities are not true for everyone across the board. Based on a
person’s ability, endurance and strength, certain activities may fall differently on the MET scale.
This chart compiles a list of activities of daily living within the home. We ask you to think about
your experience of completing these tasks and rate what you think YOUR energy requirement for
the activity is. We have also provided more general energy conservation tips and adaptations that
can potentially help you expend less energy while completing these tasks. This will help you to
have more energy at the end of the task, and hopefully allow you to complete more activities
throughout the day.
If you are interested in more specific strategies and suggestions for adaptations and energy
conservation strategies, speak with your Primary Care Physician about a referral for a home
evaluation from an Occupational Therapist or a Physical Therapist.
This sheet breaks down activities within the home. Reflect on your recent experiences of
completing these tasks. Rate what you think your MET level is during the activity. It’s OK if it’s
not perfect — what’s important is to just get a general idea of exertion required to complete the
activity. Underneath each rating, we have offered some general energy conservation techniques
to help potentially lessen the energy required to complete the task. Think about your home and
your set up, and brainstorm some techniques that could be helpful for you.

week 8 | day 2
KITCHEN
Meal prepping Light Activity Moderate Activity Vigorous Activity
(retrieving ingredients,
chopping, measuring, etc.)
3.0 METs 6.0 METs

Possible Adaptations • Rocker knife
• Plan item retrieval to limit unnecessary walking/carrying
• Carry items around kitchen on roller cart
• Take breaks in between item retrieval and meal preparation
• Complete meal preparation while seated
• Cook in bulk, store extra meals to be reheated
• Purchase pre-cut items (i.e., onions, lettuce, etc.)
•
•
•
Cooking Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Start with simpler recipes with fewer steps

• Complete cooking tasks while seated
• Set timers or alarms for time-limited cooking tasks (using a kitchen or phone timer)
• Slide heavier pots and pans across the counter to the stovetop
• Use pots and pans made with lighter material
• Use lighter plates (paper, etc.)
• Place frequently used ingredients on the countertop
• Have one full placesetting on the countertop/dishdrain for easy reuse
• Use recipes that allow you to stop and rest periodically and do not require constant,
prolonged attention
•
•
•

week 8 | day 2
Loading/Unloading Light Activity Moderate Activity Vigorous Activity
dishes into the
dishwasher
3.0 METs 6.0 METs
Possible Adaptations • Load and unload dishes while seated
• Only unload the upper shelf; ask for help on the lower shelf
• Load dishes onto the counter, rest and then load into the appropriate cabinets
• Run dishwasher more frequently so unloading is less cumbersome
• Only load the top rack
•
•
•
Handwashing dishes Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete handwashing while seated
• Rest in between rinsing, washing and drying
• Wash and dry dishes while resting them in the sink/on the counter
• Let dishes air dry
•
•
•
Wiping off counters Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use your stronger hand or both hands to complete the task
• If possible, complete the task while seated
• Chunk out the task, taking rest breaks between wiping each counter
• Keep counters uncluttered to avoid moving items while cleaning
• Keep a basket on the countertop to collect items that need to be put away.
•
•
•

week 8 | day 2
Putting clean Light Activity Moderate Activity Vigorous Activity
dishes away
3.0 METs 6.0 METs
Possible Adaptations • Keep one full placesetting on the countertop/dishdrain for easy reuse
• Keep frequently used dishes in easily accessible places
• Do not put heavy dishes away in high or low cabinets
• Consider reorganizing the kitchen— keeping frequently used items at an easily
accessible waist level; lighter, infrequently used items overhead; heavier, infrequently
used items at knee level; and avoid floor level if possible
•
•
•
BEDROOM
Retrieving clothes Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Store frequently worn clothing items in a dresser or closet at waist level
• Plan outfits ahead for the week and hang/store as a full outfit within arm’s reach
•
•
•
Making bed Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Start in one corner and work around to the opposite, making only one trip
• Avoid using fabrics that cling (i.e., flannel, jersey, etc.)
•
•
•

week 8 | day 2
Decluttering Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Take rest breaks in between tasks
• Use a rolling cart to move items around the kitchen
• Create a daily task chart; don’t leave all tasks to be completed on one day
• After use, return items to where they belong to avoid clutter
• Have a “junk drawer or basket” in each room to store items that need to be returned to
where they belong. When you have energy, you can clear the drawer or basket as needed.
•
•
•
Organizing Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Create daily task chart; don’t leave all tasks to be completed on one day
•
•
•
BATHROOM
Cleaning the toilet Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Clean the toilet while seated
• Use a long-handled reacher/long-handled sponge to access hard-to-reach places
• Clean the toilet in a well-lit area
• Do light cleaning daily to decrease the need for frequent heavy cleaning
•
•
•

week 8 | day 2
Cleaning the Shower Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Squeegee daily to avoid frequent deep cleaning

• Use long-handled tools
• Use a hand-held shower head to rinse walls
• Avoid use of oils in the shower (baby oil, lotions, etc.) to avoid slippery surfaces
• Spray cleaner on the shower. Use a hand-held shower head to rinse the shower off.
•
•
•
Wiping the mirrors Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use a long-handled device to avoid over-reaching
•
•
•
Wiping off the sink Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Perform daily to decrease the need for deep cleaning
• Use your stronger hand or both hands to complete the task
•
•
•

week 8 | day 2
Changing out Light Activity Moderate Activity Vigorous Activity
bath towels
3.0 METs 6.0 METs

Possible Adaptations • Move when towels are dry to decrease weight
• Store at an easily accessible level
• Use towels for more than one day
•
•
•
GENERAL TASKS
Gathering Light Activity Moderate Activity Vigorous Activity
dirty laundry
3.0 METs 6.0 METs

Possible Adaptations • Use a bag/basket with a handle to take from room to room to collect clothes
• After use, put all dirty laundry in one spot; this limits the need to collect dirty laundry
from multiple locations
• If laundry is located in the basement, drop or push clothes (in bag) down the stairs to be
collected at the bottom of the stairs; use a laundry chute
•
•
•
Loading laundry & Light Activity Moderate Activity Vigorous Activity

starting the machine
3.0 METs 6.0 METs

Possible Adaptations • Load/unload laundry while seated
• Use a long-handled reacher to grab laundry from inside machines
• Take breaks as needed
• Do one load a day, instead of multiple loads at one time
•
•
•

week 8 | day 2
Folding Light Activity Moderate Activity Vigorous Activity
clean laundry
3.0 METs 6.0 METs
Possible Adaptations • Complete the task while seated

• Use a folding table
•
•
•
Getting mail Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Think about your route to and from the mailbox — are there stairs? Will you need a
mobility device?
• Have a place to sit (bench, chair, etc.) en route to the mailbox to rest if needed
Get the mail during the time of day you have the most energy and when there is
appropriate light
• Avoid going out on icy, snowy and rainy days
•
•
•
Getting the Light Activity Moderate Activity Vigorous Activity

newspaper
3.0 METs 6.0 METs

Possible Adaptations • Think about your route to and from getting the paper– are there stairs? Will you need
a mobility device?
• Have a place to sit (bench, chair, etc.) en route to the paper to rest if needed
• Get the newspaper during the time of day you have the most energy and when there is
appropriate light
• Use a long-handled reacher to access the newspaper
•
•
•

week 8 | day 2
Paper filing Light Activity Moderate Activity Vigorous Activity
(bills, etc.)
3.0 METs 6.0 METs
Possible Adaptations • Complete the task in a well-lit area

• Complete the task while seated
• Use a magnifying class/large print if necessary
•
•
•
Sweeping Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Wear non-slip shoes while completing the task to limit your fall risk
• Complete sweeping room by room, taking rest breaks
• Use a long-handled dust pan to eliminate bending
•
•
•
Mopping Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Use dry mops to limit weight and lifting requirements throughout the task
• Complete mopping room by room, taking rest breaks in between rooms
•
•
•
100 | MI S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE

week 8 | day 2
Vacuuming Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete vacuuming room by room, taking rest breaks in between rooms
• Use your stronger hand or both hands to hold/propel the vacuum
• Complete vacuuming tasks during the time of day when you have the most energy
• Use short strokes instead of long
• Walk with the vacuum, instead of only pushing/pulling
• Empty the vacuum before it gets too heavy
•
•
•
Dusting furniture Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete dusting tasks room by room, taking rest breaks in between rooms
• Use your stronger hand or both hands to dust furniture
• When possible, complete dusting while seated
• Use Swiffer dusters or similar devices
•
•
•
Feeding pets Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use a long-handled reacher to grab bowls
• Bring food and water bowls to your level to fill to minimize bending over
• Retrieve food and water before you begin the task to minimize unnecessary movement
• Elevate bowls to the appropriate height for the pet; this makes it more accessible to
both you and the pet
•
•
•
101 |
M I S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE

week 8 | day 2
Letting out the dog Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations Use an ambulatory device if needed

•
•
•
Tidying & Light Activity Moderate Activity Vigorous Activity

Decluttering
3.0 METs 6.0 METs

•
•
•
102 |
MI S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE

week 8 | day 2
Bath-
Bedroom
room
Living room
Kitchen
Laundry/basement
Level or Energy/METs Required Area of the Home

Highest Level of Energy/METs Required
Lowest Level of Energy/METs Required
For me, this means that …
When I am feeling the most energized, I should complete the following tasks:
•
•
•
•
103 |

week 8 | day 2
When I have my normal amount of energy, I should complete the following tasks:
•
•
•
•
When I have low energy, I should complete the following tasks:

•
•
•
•
Notes from Breakout Discussion:
104 | MI S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE

week 8 | day 2

recovery process
105

| MI S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE
week 9 | day 1

AGENDA:
• SMART Goal Recap • Red Flag Behaviors
• Tune Up • Intervention Plan
OAL RECAP
G
P
GO
AL RECA
106 |

week 9 | day 1
TIP Know what your insurance covers for annual therapy.
Be sure to schedule tune ups when needed.
Intervention Plan
Describe what needing a tune up looks and feels like to you?

What is different in times when needing a tune up is obvious versus other times of your life?
(Like “bad days” for instance)
Tune Up Type Examples How it looks… How it feels….
Mental
Physical
Social
Emotional
107 |

week 9 | day 1
When you’ve needed a tune up before what kinds of support did you seek?
What (people, places, services) things were the most helpful? Why?
Identifier (“red flag”) Moving forward, is

Past Support What was helpful? you needed support this type of support
a smart option?
108 |

week 9 | day 1
When you determine that you need help, how do you communicate that to others?
Think about different kinds of help you need from time to time.
How do you communicate the type of help that you need?
During week four, we discussed the A, B, and C levels of relationships. Think about the similarities
and differences in ways you communicate you need help and the type of help to each level.
A B C
Communicating
you need help
Communicating
the type of help
you need
109 |

week 9 | day 1
110

week 9 | day 2

AGENDA: • Skin Care and Mobility Devices

• Medication Management • Open Discussion
MEDICATION MANAGEMENT
• Follow your physician's instructions
• Ask your home health team for strategies best for you
• Have your medication delivered
• Check in with your support team weekly about how your
medication management is working
• Consider an Occupational Therapy tune up to improve
fine motor and visual skills
111 |

week 9 | day 2
SKIN CARE TIPS FOR HIGH

RISK AREAS:
• Keep skin clean and dry
• Check for changes Shoulder Blade Shoulder Blade
• Prevent problem areas
• Move more and shift weight
• Maintain a healthy diet
• Stay active
Elbow Elbow
• Quit smoking
• Use Resources Hip Hip
Bone Bone
Coccyx
(Tailbone)
Heel
112 |

week 9 | day 2

recovery process
113

week 10 | day 1

• Make Ahead Recipes
AGENDA:
• Southwest Chicken Soup
• 1-2-3 Banana Bread Bites
OAL RECAP
G
P
GO
AL RECA
114 |

week 10 | day 1
Southwest
RECIPE Chicken Soup
Frozen veggies, carefully selected convenience foods and a slow cooker are the
secrets to this simple, tasty soup!
MAKES: 6 servings (1 generous cup) | PREPARATION TIME: 10 minutes | COOK TIME: 2 ½ hours
2 (10.5-ounces each) cans “healthy” condensed cream • Slow cooker • Cutting board
of chicken soup (reduced sodium and fat) • Measuring spoons • Adaptive equipment for
1 (14.5-ounce) can no-salt-added diced tomatoes • Measuring cups preparation, serving and
1 (9.5-ounce) bag Green Giant Simply Steam Southwest eating, as needed
• Can opener
Chipotle Sweet Corn Blend • Spoon for stirring
1 cup water • Knife
1-2 teaspoons ground cumin • Tongs (for removing
½ pound boneless, skinless chicken breast halves, trimmed chicken from slow cooker)
DIRECTIONS:
1 2 3
Place all ingredients in Cook on “high” 2 ½ hours Remove chicken to cutting

slow cooker in order listed, or until chicken is cooked board and shred with 2 forks;
stirring together before through (internal temperature return to slow cooker and
adding chicken. at least 165 degrees F). warm through.
115 |
M I S SOURI BA P T I S T M E DI C A L C E NT E R STR OKE SURVI VOR J OUR N EY GUI DE

week 10 | day 1
Southwest Chicken Soup (continued)
PHOTO
NUTRITION PER SERVING: 166 Calories, 3 g Total Fat, 1 g Saturated Fat, 34 mg Cholesterol, 381 mg Sodium,
COOK’S NOTES: • This recipe can be frozen two ways! Combine all
uncooked ingredients in a heavy zip-top freezer bag and
• This soup dishes up 50% less sodium than
freeze. Then simply defrost in the refrigerator overnight
traditional versions! Read labels carefully when
before emptying the bag into a slow cooker. Or freeze
selecting ingredients and opt for brands lowest
prepared soup in freezer bags or other containers; defrost
in sodium and saturated fat.
before reheating in the microwave or on the stovetop for
• For an extra kick, trade diced tomatoes for ready-when-you-are meals!
1 (10-ounce) can no-added-salt diced tomatoes
• This recipe is designed for a regular texture diet but is easy
with chilies.
to modify by processing prepared soup with an immersion
• One (15-ounce) can no-added-salt black beans blender, blender or food processor and adjusting the liquid
(rinsed and drained) and I cup frozen corn can to achieve the texture recommend by your health care
be substituted for frozen vegetable blend. provider. Water, milk or no-added-salt chicken broth are
good options if liquid is needed.
116 |

week 10 | day 1
1-2-3 Banana
RECIPE Bread Bites
Just like banana bread — only easier to make and bite-sized! Three ingredients
combine into soft, naturally sweet morsels perfect for a make-ahead snack.
MAKES: 12 bites | PREPARATION TIME: 10 minutes | COOK TIME: 12-15 minutes
1 small very ripe banana • Measuring cups • Scoop for portioning
½ cup chopped, pitted dates • Medium mixing bowl • Baking sheet
1 cup old-fashioned rolled oats • Fork for mashing banana • Knife, if chopping dates
Cooking spray or oil mist • Spoon for mixing • Cutting board, if chopping dates
DIRECTIONS:
1 2
Preheat oven to 350 degrees. Place banana Add dates and oats; stir to combine.
in a medium bowl; mash to make ½ cup.
3 4
Using a tablespoon or small scoop, drop mixture onto Cool slightly before transferring to cooling rack.
baking sheet coated with cooking spray or oil mist.
Bake for 12-15 minutes or until lightly browned.
117

| M I S S OURI BA P T I S T M E DI C A L C E NTER STR OKE SURVI VOR J OUR N EY GUI DE
week 10 | day 1
1-2-3 Banana Bread Bites (continued)
NUTRITION PER SERVING: (2 bites) 103 Calories, 1 g Total Fat, < 1 g Saturated Fat, 0 mg Cholesterol, <1 mg Sodium,
COOK’S NOTES:
• Be sure to use a ripe banana — the banana should peanut or almond butter. Crumble over vanilla
have some brown flecks. A ripe banana will be sweeter yogurt. Or simply enjoy with a cup of coffee!
and will mash more easily.
• This recipe is designed for a regular texture diet but
• Dates can be purchased already chopped if desired. is easy to modify by softening prepared bites in milk
then processing in a blender or food processor to
• Bake just until lightly browned being careful not to
the texture recommended by your health care provider.
over bake — bites will be soft and chewy!
The bites will not be appropriate for a puree texture,
• Serve alongside scrambled eggs at breakfast in as dates will not process to a smooth consistency.
place of toast. Sandwich 2 bites with a bit of
118 |

week 10 | day 1
119

week 10 | day 2

AGENDA:
• Depression Warning Signs • Filling Your Bucket
• 100% • Leisure and Activities
• Big Emotions • Yoga
DEPRESSION:
Depressive disorder, frequently referred to simply as depression, is more
than just feeling sad or going through a rough patch. It’s a serious mental
health condition that requires understanding and medical care. Left
untreated, depression can be devastating for those who have it and their
families. Fortunately, with early detection, diagnosis and a treatment plan
consisting of medication, psychotherapy and healthy lifestyle choices,
many people can and do get better.
Depression: Signs & Symptoms:

•
•
•
•
•
•
•
•
•
•
120 |

week 10 | day 2
Brainstorm:
When you feel down, what are some appropriate
activities you do to feel better?
121 |

week 10 | day 2
What are the most difficult Think about what happens when these feelings get overwhelming.
feelings for you to experience? Consider the following:
Please check the Most difficult What does it feel like inside your body?
feelings or add any you What do you need when this happens?
don’t see listed here: What can you do for yourself?

What has been helpful before?
Happy
Joy
Sad
Grief
Afraid
Angry
Rage
Anxiety
Overwhelmed
Boredom
Loneliness
Emptiness
122 |

week 10 | day 2
Brainstorm:
What leisure activities do you enjoy
participating in?
*NOTE: there will likely be over

lap from the previous activity!
123 |

week 10 | day 2
Is there anything affecting your engagement in these activities?
 Ability?
 Energy Levels?
 Time constraints?
 Other? _______________________________________________________
Thinking about the obstacles you checked above that inhibit your ability to
participate in your favorite leisure activities, collaborate with others & brainstorm
work-arounds, adaptations, or even supplemental activities that can help you
engage in your favorite activities!
124 |

week 10 | day 2

recovery process
125

week 11 | day 1

AGENDA: • Task Analysis and

Energy Conservation
• Assess Progress:
• Collect Buzzbook Information – Week 8, Day 2 to Now
• Fatigue & Stress – energy and daily activities
– Signs and symptoms within the home
– Appropriate ways to combat them – Reflection Questions
OAL RECAP
G
P
GO
AL RECA
126 |

week 11 | day 1
Brainstorm:
What are signs and symptoms in your life that
you are experiencing fatigue and stress?
127 |

week 11 | day 1
When I notice the signs
and symptoms of fatigue
SELF-CARE
Taking the time to do things that help you
and stress in my life, what
are some appropriate ways live well and improve both your physical
to engage in self-care? health and mental health.
•
•
•
•
•
•
•
TIME LEVEL OF FATIGUE

7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
128 |

week 11 | day 1
This chart builds off the foundational knowledge of energy conservation, referring back to day one
of week two. This chart uses METs, metabolic equivalent of task. A MET is the ratio of the rate at
which a person expends energy within a certain task compared with the rate the person expends
energy at rest. METs are often used within therapeutic exercise to help therapists, doctors and
patients get a better understanding of how much energy a particular activity requires.


the neighborhood

However, the MET ratings for activities are not true for everyone across the board. Based on a
person’s ability, endurance and strength, certain activities may fall differently on the MET scale.
This chart compiles a list of activities of daily living within the home. We ask you to think about
your experience of completing these tasks and rate what you think YOUR energy requirement for
the activity is. We have also provided more general energy conservation tips and adaptations that
can potentially help you expend less energy while completing these tasks. This will help you to
have more energy at the end of the task, and hopefully allow you to complete more activities
throughout the day.
If you are interested in more specific strategies and suggestions for adaptations and energy
conservation strategies, speak with your primary care physician about a referral for a home
evaluation from an Occupational Therapist or a Physical Therapist.
This sheet breaks down activities within the home. Reflect on your recent experiences of
completing these tasks. Rate what you think your MET level is during the activity. It’s OK if it’s
not perfect — what’s important is to just get a general idea of exertion required to complete the
activity. Underneath each rating, we have offered some general energy conservation techniques
to help potentially lessen the energy required to complete the task. Think about your home and
your set up, and brainstorm some techniques that could be helpful for you.
129 |

week 11 | day 1
KITCHEN
Meal prepping Light Activity Moderate Activity Vigorous Activity
(retrieving ingredients,
chopping, measuring, etc.)
3.0 METs 6.0 METs

Possible Adaptations • Rocker knife
• Plan item retrieval to limit unnecessary walking/carrying
• Carry items around kitchen on roller cart
• Take breaks in between item retrieval and meal preparation
• Complete meal preparation while seated
• Cook in bulk, store extra meals to be reheated
• Purchase pre-cut items (i.e., onions, lettuce, etc.)
•
•
•
Cooking Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Start with simpler recipes with fewer steps

• Complete cooking tasks while seated
• Set timers or alarms for time-limited cooking tasks (using a kitchen or phone timer)
• Slide heavier pots and pans across the counter to the stovetop
• Use pots and pans made with lighter material
• Use lighter plates (paper, etc.)
• Place frequently used ingredients on the countertop
• Have one full placesetting on the countertop/dishdrain for easy reuse
• Use recipes that allow you to stop and rest periodically and do not require constant,
prolonged attention
•
•
•
130 |

week 11 | day 1
Loading/Unloading Light Activity Moderate Activity Vigorous Activity
dishes into the
dishwasher
3.0 METs 6.0 METs
Possible Adaptations • Load and unload dishes while seated
• Only unload the upper shelf; ask for help on the lower shelf
• Load dishes onto the counter, rest and then load into the appropriate cabinets
• Run dishwasher more frequently so unloading is less cumbersome
• Only load the top rack
•
•
•
Handwashing dishes Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete handwashing while seated
• Rest in between rinsing, washing and drying
• Wash and dry dishes while resting them in the sink/on the counter
• Let dishes air dry
•
•
•
Wiping off counters Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use your stronger hand or both hands to complete the task
• Chunk out the task, taking rest breaks between wiping each counter
• Keep counters uncluttered to avoid moving items while cleaning
• Keep a basket on the countertop to collect items that need to be put away.
•
•
•
131 |

week 11 | day 1
Putting clean Light Activity Moderate Activity Vigorous Activity
dishes away
3.0 METs 6.0 METs
Possible Adaptations • Keep one full placesetting on the countertop/dishdrain for easy reuse
• Keep frequently used dishes in easily accessible places
• Do not put heavy dishes away in high or low cabinets
• Consider reorganizing the kitchen— keeping frequently used items at an easily
accessible waist level; lighter, infrequently used items overhead; heavier, infrequently
used items at knee level; and avoid floor level if possible
•
•
•
BEDROOM
Retrieving clothes Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Store frequently worn clothing items in a dresser or closet at waist level
• Plan outfits ahead for the week and hang/store as a full outfit within arm’s reach
•
•
•
Making bed Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Start in one corner and work around to the opposite, making only one trip
• Avoid using fabrics that cling (i.e., flannel, jersey, etc.)
•
•
•
132 |

week 11 | day 1
Decluttering Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Have a “junk drawer or basket” in each room to store items that need to be returned to
where they belong. When you have energy, you can clear the drawer or basket as needed.
•
•
•
Organizing Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Create daily task chart; don’t leave all tasks to be completed on one day
•
•
•
BATHROOM
Cleaning the toilet Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Clean the toilet while seated
• Use a long-handled reacher/long-handled sponge to access hard-to-reach places
• Clean the toilet in a well-lit area
• Do light cleaning daily to decrease the need for frequent heavy cleaning
•
•
•
133 |

week 11 | day 1
Cleaning the Shower Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations • Squeegee daily to avoid frequent deep cleaning

• Use long-handled tools
• Use a hand-held shower head to rinse walls
• Avoid use of oils in the shower (baby oil, lotions, etc.) to avoid slippery surfaces
• Spray cleaner on the shower. Use a hand-held shower head to rinse the shower off.
•
•
•
Wiping the mirrors Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use a long-handled device to avoid over-reaching
•
•
•
Wiping off the sink Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Perform daily to decrease the need for deep cleaning
• Use your stronger hand or both hands to complete the task
•
•
•
134 |

week 11 | day 1
Changing out Light Activity Moderate Activity Vigorous Activity
bath towels
3.0 METs 6.0 METs

Possible Adaptations • Move when towels are dry to decrease weight
• Store at an easily accessible level
• Use towels for more than one day
•
•
•
GENERAL TASKS
Gathering Light Activity Moderate Activity Vigorous Activity
dirty laundry
3.0 METs 6.0 METs

Possible Adaptations • Use a bag/basket with a handle to take from room to room to collect clothes
• After use, put all dirty laundry in one spot; this limits the need to collect dirty laundry
from multiple locations
• If laundry is located in the basement, drop or push clothes (in bag) down the stairs to be
collected at the bottom of the stairs; use a laundry chute
•
•
•
Loading laundry & Light Activity Moderate Activity Vigorous Activity

starting the machine
3.0 METs 6.0 METs

Possible Adaptations • Load/unload laundry while seated
• Use a long-handled reacher to grab laundry from inside machines
• Do one load a day, instead of multiple loads at one time
•
•
•
135 |

week 11 | day 1
Folding Light Activity Moderate Activity Vigorous Activity
clean laundry
3.0 METs 6.0 METs
Possible Adaptations • Complete the task while seated

• Use a folding table
•
•
•
Getting mail Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Think about your route to and from the mailbox — are there stairs? Will you need a
mobility device?
• Have a place to sit (bench, chair, etc.) en route to the mailbox to rest if needed
Get the mail during the time of day you have the most energy and when there is
appropriate light
•
•
•
Getting the Light Activity Moderate Activity Vigorous Activity

newspaper
3.0 METs 6.0 METs

Possible Adaptations • Think about your route to and from getting the paper– are there stairs? Will you need
a mobility device?
• Have a place to sit (bench, chair, etc.) en route to the paper to rest if needed
• Get the newspaper during the time of day you have the most energy and when there is
appropriate light
• Use a long-handled reacher to access the newspaper
•
•
•
136 |

week 11 | day 1
Paper filing Light Activity Moderate Activity Vigorous Activity
(bills, etc.)
3.0 METs 6.0 METs
Possible Adaptations • Complete the task in a well-lit area

• Complete the task while seated
• Use a magnifying class/large print if necessary
•
•
•
Sweeping Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Complete sweeping room by room, taking rest breaks
• Use a long-handled dust pan to eliminate bending
•
•
•
Mopping Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

• Use dry mops to limit weight and lifting requirements throughout the task
• Complete mopping room by room, taking rest breaks in between rooms
•
•
•
137 |

week 11 | day 1
Vacuuming Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete vacuuming room by room, taking rest breaks in between rooms
• Use your stronger hand or both hands to hold/propel the vacuum
• Complete vacuuming tasks during the time of day when you have the most energy
• Use short strokes instead of long
• Walk with the vacuum, instead of only pushing/pulling
• Empty the vacuum before it gets too heavy
•
•
•
Dusting furniture Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Complete dusting tasks room by room, taking rest breaks in between rooms
• Use your stronger hand or both hands to dust furniture
• When possible, complete dusting while seated
• Use Swiffer dusters or similar devices
•
•
•
Feeding pets Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs

Possible Adaptations • Use a long-handled reacher to grab bowls
• Bring food and water bowls to your level to fill to minimize bending over
• Retrieve food and water before you begin the task to minimize unnecessary movement
• Elevate bowls to the appropriate height for the pet; this makes it more accessible to
both you and the pet
•
•
•
138 |

week 11 | day 1
Letting out the dog Light Activity Moderate Activity Vigorous Activity
3.0 METs 6.0 METs
Possible Adaptations Use an ambulatory device if needed

•
•
•
Tidying & Light Activity Moderate Activity Vigorous Activity

Decluttering
3.0 METs 6.0 METs

•
•
•
139 |

week 11 | day 1
Bath-
Bedroom room
Living room
Kitchen
Laundry/basement
Level or Energy/METs Required Area of the Home

Highest Level of Energy/METs Required
Lowest Level of Energy/METs Required
140 |

week 11 | day 1
Overall, have you noticed any changes in your ability to complete activities
within the home?
If so, what do you think contributed to this?
What, if anything, surprised you about your answers?

141 |

week 11 | day 1
142

week 11 | day 2

AGENDA:
• Define Community • Discuss community
engagement & support
• Look at ABC relationships
• Discuss re-integration into
• Building Healthy Relationships community after stroke
and Building Community
Pages 143-144 are for the Stroke Survivor to complete
How do you define community?
What communities are you involved in?
143 |

week 11 | day 2
How has your relationship with your communities changed since your stroke?
Any new communities or communities you are no longer a part of?
What changes would you like to see with your communities moving forward?
What steps can you take towards making those changes?
144 |

week 11 | day 2

recovery process
145

week 11 | day 2

AGENDA:
• Define Community • Discuss community
engagement & support
• Look at ABC relationships
• Discuss self-care
Pages 146-148 are for the Care Partner to complete
How do you define community?
What communities are you involved in?
146 |

week 11 | day 2
How has your relationship with your communities changed since your partner’s
stroke? Any new communities or communities you are no longer a part of?
Define self-care.
147 |

week 11 | day 2
What are you doing to care for yourself?
Are any of the communities you are involved in helping with self-care?
Who can give you a break for self-care? (List at least 3 people or community
support agencies)
148 |

week 11 | day 2
Advocate, partner in conversation - Spouse, children, parents

with Health Care Professional, - Neighbors
immediate response situations - Good friends
A|B|C
levels of
relationships:
Recognizing and
C engaging with key
Potential errands,
relationships
socialization, partner
in therapeutic activities B
- Church community
- Professional community Potential errands, socialization,
- Acquaintances assistance in basic tasks
- Cousins
- Friends
- Extended family
149 |

week 11 | day 2

recovery process
150

week 12 | day 1

AGENDA:
• Supermarket Tour and Nutrition Discussion
• Discuss Next Steps in Goal Setting
• Complete Online Survey and Assessment
Task analysis in the grocery store:

• Find recipes and plan meals before going to the grocery store
– This helps inform your list and minimize extra trips to the store
• When writing your shopping list:

– Group the items by category
– Organize the categories based on the grocery store layout
• Make sure you allot an appropriate amount of time:

– For travel to and from the grocery store
– To navigate the grocery store and rest as needed
Task analysis once you return home:

• Think about your energy levels and time availability throughout the day
and schedule in time to prepare your grocery haul; it doesn’t have to be
right after the grocery store
• Pre-chop ingredients for the week’s recipes and snacks
• Re-package larger items into individual portion sizes
151 |

week 12 | day 1
Brainstorm:
We’ve worked hard on our weekly SMART goals
over the last 12 weeks. Zooming out, what are
some more general areas of your life and health
you are looking to make improvements in?
NOW IN __ MONTHS ULTIMATELY
152 |

week 12 | day 1
A. Participant ID: ______________________________________
B. Overall health:
In general, would you say that your health is:
 Excellent (1)
 Very good (2)
 Good (3)
 Fair (4)
 Poor (5)
153 |

week 12 | day 1
C. Stroke Knowledge Questions:
The acronym BE FAST is a handy technique to help people quickly recognize common signs of stroke.
1. What does the B, in BE FAST (if you suspect a stroke) mean?
 Can the person smile
 Does the person have a sudden loss of balance
 Is the person having back problems
2. What does the E, in BE FAST (if you suspect a stroke) mean?

 Has the person lost vision in one or both eyes
 Is the person drowzy
 Is the person having leg cramps
3. What does the F, in BE FAST (if you suspect a stroke) mean?

 Is the person moving slowly
 Does the person’s face look uneven
 Is the person’s feet numb
4. What does the A, in BE FAST (if you suspect a stroke) mean?

 Is the person’s arm numb
 Is the person becoming agitated
 Can the person raise both arms for 30 seconds
5. What does the S, in BE FAST (if you suspect a stroke) mean?

 Can the person stand up
 Is the person’s speech slurred
 Is the person being unusually quiet
6. What does the T, in BE FAST (if you suspect a stroke) mean?

 Time - Call 911 if you suspect a stroke
 Is the person losing track of time
 Is the person tired
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D. Self –efficacy to Obtain Help from Community, Family and Friends:
(Utilization of Social Services and Network)
How confident are you that you can get family and friends to help you with things you need
(such as household chores like shopping, cooking, or transportation)?
How confident are you that you can get emotional support from friends and family
(such as listening or talking over your problems)?
How confident are you that you can get emotional support from resources other than friends
and family, if needed?
How confident are you that you can get help with your daily tasks (such as housecleaning,
yard work, meals, or personal hygiene) from resources other than friends or family, if needed?
E. Self-efficacy to Participate in Social/Recreational Activities: (Leisure Activities)

How confident are you that you can continue to do your hobbies and recreation?
How confident are you that you can continue to do the things you like to do with friends and
family (such as social visits and recreation)?
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week 12 | day 1
F. Frustration with Health Problems:
These questions ask you about how you feel and how things have been with you during the past month.
(For each question, please indicate which number, for each question, comes closest to the way you
have been feeling.)
How much during the past 4 weeks were you discouraged by your health problems?
How much during the past 4 weeks were you fearful about your future health?
How much during the past 4 weeks was your health a worry in your life?
How much during the past 4 weeks were you frustrated by your health problems?
0 - None of the time 1 - A little of the time 2 - Some of the time 3 - A good bit of the time
4 - Most of the time 5 - All of the time
G. The STROKE SELF-EFFICACY QUESTIONNAIRE

These questions are about your confidence that you can do some tasks that may have been difficult
for you since your stroke. For each of the following tasks, please circle a point on the scale that
shows how confident you are that you can do the tasks now in spite of your stroke.
Where 0 = not at all confident and 10 = very confident
How Confident are you now that you can:
1. Get yourself comfortable in bed every night

2. Get yourself out of bed on your own even when you feel tired
3. Walk a few steps on your own on any surface inside your house.
4. Walk about your house to do most things you want.

5. Walk safely outside on your own on any surface.

6. Use both your hands for eating your food.

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week 12 | day 1
7. Dress and undress yourself even when you feel tired.
8. Prepare a meal you would like for yourself.

9. Persevere to make progress from your stroke after discharge from therapy.
10. Do your own exercise program every day.

11. Cope with the frustration of not being able to do some things because of your stroke.
12. Continue to do most of the things you liked to do before your stroke.
13. Keep getting faster at the tasks that have been slow since your stroke.
H. Only on Post: Satisfaction with class:

To what extent do you agree with the following statements? (Please circle one answer,
with 0 being strongly disagree and 5 being strongly agree.)
I recommend this program to others.

[Strongly disagree] 0 1 2 3 4 5 [Strongly agree]
I will incorporate information and activities discussed in this program into my life.
[Strongly disagree] 0 1 2 3 4 5 [Strongly agree]
Please rate the following by filling in one circle for your response:
The class overall [ Excellent, very good, good, fair, poor ]
The Instructor(s) overall [ Excellent, very good, good, fair, poor ]
The instructor’s knowledge of the material:
How the material was presented (clear, organized) [ Excellent, very good, good, fair, poor ]
The quality of the material presented (relevant, helpful) [ Excellent, very good, good, fair, poor ]
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week 12 | day 1
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week 12 | day 2

AGENDA:
• Discussion, Feedback, Pearls of Wisdom • Goal Discussion
• New Class Resources Through OASIS • Launch Celebration!
Brainstorm:
What helps you stay motivated to achieve a goal?
Group Discussion Notes:
•
•
•
•
•
•
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week 12 | day 2
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week 12 | day 2
STAYING MOTIVATED
TIPS & TRICKS

• Use an accountability partner • Reward yourself at smaller
milestones within your big goal
• Make it fun and meaningful!
• Take time to remember why
– Don’t like running?
you’re doing what you’re doing
Try a dance or yoga class
Try new things until you • Look back at how far you’ve

find something that is a come and congratulate yourself

good fit for you on the progress you’ve made!

BE FAST
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week 12 | day 2
STROKE DISCHARGE: WHEN TO SEEK MEDICAL ADVICE OR EMERGENCY
MEDICAL CARE.
Tear out of booklet and place somewhere you and others can easily access when needed (such as on the refrigerator)
GREEN FATIGUE • Swallowing remains the same after

• May increase as the day goes on. stroke or improves; continue to follow
ZONE Be sure to take rest breaks as needed. your swallowing precautions (if you
These have them).
ACTIVITY LEVEL
experiences • Keep moving after your stoke. STROKE DEFICIT
are all normal You may tire easily, so take breaks as • Deficits from your stroke may be more
during recovery. needed; this is a very important part noticeable at the end of the day or when
of your recovery. you are tired.
BOWEL MOVEMENTS EMOTIONAL HEALTH

• Should be the same as your normal • Feeling frustrated is normal after a
bowel movements prior to the stroke. stroke; reach out to people; do not
isolate yourself.
NUTRITION • Celebrate your accomplishments.
• May be challenging to change your diet. • Be sure you understand what your
If you are having difficulty changing your medications are for and take them
diet, contact a dietitian in your area. as prescribed.
YELLOW •
. Unusual bruising or bleeding • Excessive pain or swelling of
lower extremities
ZONE • Blood pressure: if outside specific
parameters given by physician • Fever, cough, unusual phlegm –
These after discharge greenish in color
experiences
• Blood sugar: if outside specific • Sudden increase in urination,
need attention parameters given by physician foul smell and color, pain
and require a after discharge when urinating
phone call to
• No bowel movement 2 days after • Loss of interest in activities, purposeful
your primary hospital discharge with hardened isolation, sadness that is not situational
care provider abdomen and pain and does not go away
(PCP) or – Take stool softener as ordered • Experience side effects from
neurologist. and increase water intake the medication
• Swallowing becomes more difficult or
you notice coughing or choking while
eating or drinking
Call 9-1-1 immediately if you experience:

RED
• Chest pain, trouble breathing, or shortness of breath
ZONE
• A sudden and severe headache especially if associated with increased blood pressure
These
experiences • Black tarry stools or blood in your stool
require an • New symptoms, different from current stroke symptoms:
IMMEDIATE – Loss of balance, headache, – Arm or leg weakness, numbness
call to 9-1-1. or dizziness or tingling
– Blurred vision – Speech difficulty
– Facial drooping on one side – Time to call 911 immediately
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week 12 | day 1
This program is dedicated to all those affected

by stroke – those navigating the complexities of
recovery, mentoring others, and advocating for
stroke awareness and improved stroke care.

THANK YOU TO…

The Missouri Baptist Healthcare Foundation and “Back to the Eighties” event
attendees whose generosity made this program possible.
The Oasis Institute and Missouri Baptist Stroke Program for their support, resources,
and expertise toward the development of this program.
The co-developers of this program who spent years bringing their vision of helping
stroke survivors thrive:
• Rachel Sargent-Linder, RN, MSN, SCRN • Marissa Sandbothe, OTR/L
Those who contributed their expertise and experience to develop the program’s content:
• J.M. Hatlelid, MD • Sara Paige, OTR/L, PMP
• Kathy Howard, ABC Brigade President • Matt Schlueter, PT
• Sherri Hoyt, RDN, LD • Stefanie Sorrentino, MOTR/L
• Tim Marti, MSW, LCSW • Anne Young, MS, CCC-SLP
• Ebow Tawiah Nketsiah, MSW • ABC Brigade survivors and care partners
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Stroke Survivor

Wants and Needs of Stroke Survivor and Care Partner

• Changing • Medication management • Advocating to health • Recognizing • Reestablishing

LIFESTYLE HEALTH MANAGEMENT CAREGIVER TOOLS EDUCATION SOCIALIZATION

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What's Your Why?

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Must be completed online

A. Participant ID: ______________________________________

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2. What does the E, in BE FAST (if you suspect a stroke) mean?

3. What does the F, in BE FAST (if you suspect a stroke) mean?

4. What does the A, in BE FAST (if you suspect a stroke) mean?

5. What does the S, in BE FAST (if you suspect a stroke) mean?

6. What does the T, in BE FAST (if you suspect a stroke) mean?

E. Self-efficacy to Participate in Social/Recreational Activities: (Leisure Activities)

G. The STROKE SELF-EFFICACY QUESTIONNAIRE

How Confident are you now that you can:

1. Get yourself comfortable in bed every night

4. Walk about your house to do most things you want.

5. Walk safely outside on your own on any surface.

6. Use both your hands for eating your food.

8. Prepare a meal you would like for yourself.

10. Do your own exercise program every day.

What are your personal goals?

AGENDA: • Introduction to Exercise

What do you think of when you hear the word “rehab”?

This is how we view rehab: ____________________________________________

Expectations on improvement & overall health

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• Formal & Informal Rehab

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Ankle ABCs Chair March Seated Leg Kicks

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MET LEVEL ACTIVITY LEVEL

1 MET Sitting at rest

1-3 METS Writing, desk work, using the

3-6 METS Light housework such as

>6 METS Yardwork, lifting heavy objects

Light Activity Moderate Activity Vigorous Activity

3.0 METs 6.0 METs

1. Complete the 3. Complete high- 4. Use adaptive

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Specific Measurable Achievable Relevant Time-bound

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AGENDA: • Navigating Challenges

Draw a line to rank each activity to your corresponding MET Level:

ACTIVITY LEVEL MET LEVEL

Light Activity Moderate Activity Vigorous Activity

3.0 METs 6.0 METs

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Where can energy conservation be applied outside of the home?

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Strategies to overcome challenges outside the home:

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Specific Measurable Achievable Relevant Time-bound

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AGENDA: • Safe Eating

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Strategies to overcome challenges in cooking and meal preparation:

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TIPS & TRICKS