IADLS

Instrumental activities of daily living are essential for managing the complexities of life within the home and throughout the community. Occupational therapists have the unique ability to intervene holistically when performance skills are insufficient for IADL completion. In stroke rehabilitation, especially inpatient rehab, there is often little IADL training in OT. Many factors affect someone's ability to perform IADLs, including physical, cognitive, psychological, and social. Inpatient rehab may not be the place to remediate IADLs due to the limited relative timeframe for patients' length of stay. However, IADLs can make an excellent means of challenge in OT-based HIT.    

Rules and Guidelines

When implementing HIT with IADLs, focus should be given to evidence-based practice. Current evidence supports a dose-response relationship for stepping and functional gains in speed, balance, and coordination (Moore, et al., 2021; Moore et al., 2019; Tapp et al., 2023). Therefore, intensified IADLs should include stepping practice, and context should be provided to increase the salience and purpose of the task. For example, an OT can intensify grocery shopping, community mobility, yard work, and house cleaning, all while targeting stepping practices. Intensity parameters apply just as they would with high-intensity stepping protocols, including age-predicted max heart rate and the Borg rate of perceived exertion. Ensure that vitals are assessed pre-, post, and during activity (if feasible), and apply joint protective equipment when needed.   

Safety Considerations 

Avoid high-intensity training with IADLs that require manipulating objects that would place the patient in harm's way (e.g., cooking). Additionally, IADLs that would otherwise be impractical to intensify outside of the rehab setting should also be excluded from this OT-based HIT protocol (e.g., medication management and budgeting). Therapists should use clinical reasoning and patient insight when implementing IADLs with intensity.