If we know anything about stroke recovery, it’s that every persons’ experience is different. Recovery is unique and requires problem-solving for the specific things you’re dealing with. Using the threefold approach to your recovery is the best way to ensure you’re able to do what you need to do while still making progress.
What is it?
The threefold approach to stroke recovery uses a combination of remediation, compensation, and adaption. It’s a way to continue making progress while also using adaptive equipment or compensatory strategies so that you can still do the things that are important to you.
Remediation is focused on actually improving underlying issues. For example, let’s say you’re having trouble holding on to a fork at dinner time with your dominant/affected hand. Under the remediation approach, you’d practice grip strengthening exercises, or you might still attempt to eat using your affected hand. To remediate or restore function, the principles of neuroplasticity come into play.
Compensation is focused on strategies or techniques that route around current limitations so that you can still do what you need to do. If we use the same example from a compensatory approach, you might use your non-dominant, unaffected hand to eat meals.
Adaptation is focused on adapting either a task or the environment. Using the same example from an adaptation approach, you might use foam tubing, scoop bowls, or built-up silverware. This would allow you to eat using your affected hand by adapting the task.
Why use it?
I like the threefold approach for several reasons. It allows you to continue working to restore underlying functions using the principles of neuroplasticity and remediation. However, the combined approach also gives you ways to do what you need to do now.
It can be incredibly frustrating if it takes a long time for those functions to come back online. You may feel like you’ve lost independence if you have others help you with all of your daily tasks.
Using all three approaches in your recovery allows you to do the things that are important to you while continuing to work on underlying issues.
How do I use it?
I want to stress the importance of focusing on remediation, even if you need to use compensatory or adaptive strategies. Let me break down how I’d encourage one of my clients to incorporate the threefold approach using the example I’ve threaded through this article.
Let’s say one of my clients has right-sided (dominant) weakness and decreased range of motion that impacted their ability to feed themselves. Their particular issues are decreased grip strength, trouble with in-hand manipulation, fine motor control, and decreased wrist extension (bending the wrist back). These issues make it difficult to grasp and hold a utensil, scoop food, and bring the food to their mouth. This may sound familiar to some of you who have experienced this.
Here’s what I’d recommend to them. Start off each meal by practicing using your affected hand without adaptations or compensatory strategies. Do this for a few minutes as it can be super frustrating, especially if you’re really hungry.
It’s okay to practice even if you’re only focused on certain parts like picking up the fork from the table. You don’t have to practice each separate part ( picking up the fork, holding it, getting food on it, bringing it to your mouth) if it’s too much for you. After a few minutes of practice, swap to either your compensatory strategy or adaptive equipment so that you can actually eat your food.
Some people may feel more confident trying to eat their whole meal with their affected side, even it takes 15 minutes longer. Others might become really frustrated after a short time and need to swap to their adaptive or compensatory strategies so they can eat.
You can incorporate the threefold approach into any aspect of your recovery from getting dressed to mowing the yard. It’s about finding the right balance of improving underlying issues and still doing the things you need to do. Your combination of approaches may look different to other survivors, but it’s about finding what works for you!