February 24, 2015

More About Cheap Equipment

Having a stroke often means losing income.  In addition, there are expenses that are not covered by health insurance.  So this post is not about cutting up a banana.  It is about saving money.
The last place I look for equipment is medical catalogues where things are always expensive.
I begin by looking for helpful objects in my home and in local stores like Bed Bath and Beyond.
To see previous examples of truly cheap equipment click here and click here.  In this post I talk about two pieces of cheap equipment I use to slice bananas for my cereal. 

#1 is a one dollar non-slip placemat I found at my grocery store that keeps the plate still as I slice.  It is far cheaper than Dycem.
#2 is the cheapest, thinnest paper plate I could find.  Since bananas are curved, I turn the plate so my knife is always perpendicular to the section of the banana I am slicing.  Because slices of banana roll around I turn the plate so my knife is always perpendicular to each slice as I cut it in half.

The thin paper plate bends easily so I can pour the sliced banana into my bowl.

Do you have a cheap solution you would like to share?

February 13, 2015

Does Reaching a Plateau Really Happen?

Regaining a skill eleven years after my stroke made me wonder why I believed in plateaus when
I was an OT.  Here are four factors that changed my belief about recovery after a stroke.

What Has Changed.  1)  Brain plasticity will blow your mind.  Click here to learn how an adult's brain grows new stem cells every night and makes them migrate to where they are needed.
2)  There is lots of new technology like electric muscle stimulation with biofeedback (click here).
3)  Blogging lets stroke survivors share their triumphs.  My continued progress is not unique.  4)  People who have a stroke as young or middle-aged adults have higher expectations placed on them that people who have strokes in their 70s and 80s.  Family members cannot maintain their own health if they do everything for a disabled adult for decades.  Assisted living where assistance costs extra is an expensive long-term solution many families cannot afford. 

What Perpetuates the Myth.  Therapists see clients for days or weeks.  This small window is suited to orthopedic cases like hip replacements because bones and muscles repair themselves fairly quickly.  Brain recovery takes longer because the brain is so complex.  Therapists do not see the progress stroke survivors make in the next stage of rehab (e.g. out-patient) or after therapy ends.

The Alternative.  Using the word plateau shuts down the conversation.  "Will I get better?" is an opportunity to ask if there is something a client wants to do.  Here is something I wanted.  I have baby-fine short hair so I need a good haircut.  Before I sit down in a beauty salon chair I have to back up and then straddle the wide footrest.  The chair was initially an obstacle to having a good hair day so I never get tired of defeating it.  Challenges that pushed my continued recovery were walking backwards, twisting my trunk so I can reach far behind me to grab the armrest, and sitting down with my feet 18 inches apart.

The Bottom Line.  Skill acquisition can stop because of our beliefs as well as our abilities.  My progress has slowed over the years, but I have repeatedly seen
new goals spur new gains.  This evidence has changed what I think will happen to me.   

February 3, 2015

Snow Strategies, Part 3

I was lucky.  Trenton, NJ got only 4 inches of snow from Blizzard Juno instead of the 18 inches they predicted.  I cleared my sidewalk by pushing the light fluffy snow with a small light shovel while wearing snow boots (click here).  However, clearing snow off my car is always a balance challenge.  Before I lean my chest and stomach against the car for support I don an apron I do not tie.  An arrow is pointing at a smudge mark that ended up on the apron instead of my coat.  My sound hand and forearm cannot handle the weight of a long device for pushing snow off a car so I use a shorter, lighter device designed to clean windshields.  By 2 p.m. my car was free of snow. 

As I was driving to my breakfast club the next morning I thought about the people in Maine who got clobbered with 35 inches of snow and 50 mile per winds that created tall snow drifts.  That image triggered memories from my summer vacation in Maine two years ago.  I remembered the people who smiled at me as I walked around.  Instead of pretending they did not see me, many people initiated eye contact and smiled before I did.  Perhaps people who live in a harsh climate feel a connection with people who know how to defeat adversity.

January 26, 2015

Muscle Memory Finally Kicked In

I am stunned.  Eleven years after a stroke my muscle memory still works.  For months I have been doing abdominal exercises to prevent back spasms (click here).  However, arching my back while leaning against the kitchen counter persisted so I used a memory aid to stop this bad habit.  I leaned on my arm after placing my hand on a piece of Dycem.  This created a space between my stomach and the sink.  A few weeks ago I became aware of my body telling me the twisted way I was standing at the sink did not feel good. I immediately stood up tall and straight.  I do not know how long I have been doing this because I no longer have to tell my back and stomach muscles what to do. 

Athletes call the ability to quickly execute a practiced movement muscle memory.  Muscles do not remember - the brain remembers.  A part of the brain called the cerebellum stores motor memories so it can automatically tell muscles what to do.  Motor memory kicked in during the first few years after my stroke, but I did not know this could still happen to me.  Relearning movement is mentally exhausting because stroke survivors have to tell their body to do EVERY LITTLE movement.
Moving without thinking about it is a blessing.

Bottom Line: My back and my brain are happy about this unexpected development.

January 17, 2015

Part of OT is Hidden

Some people think OTs are the dressing or handwriting guys.  Yet OT's official slogan is Living Life to Its Fullest (R).  The disparity between what people think OT is and how OTs see themselves occurs because OT is like an iceberg.  An important part of what OTs are trying to accomplish is hidden.  There are three components of OT treatment, but you see only two in an OT session.

1. The Preparation.
Preparation addresses each client's individual deficits.  Examples include exercises to open the hand while reaching, scanning strategies for visual neglect, learning what the parts of a memory notebook are for, and learning how to stop negative self-talk.  

2. The I Shoulds
Many people have the same shoulds.  We all should get dressed so we can leave the house, do laundry so we have clean clothes, write legibly so we can sign credit card slips, and have good memory strategies so we get to appointments on time.  OTs call "I shoulds" functional outcomes.  Insurance companies will not pay for therapy if clients do not show some functional gains.

3. The I Want Tos.
"I want to" is personal, like petting a beloved cat.  Valued activities occur outside of therapy so clients may not see how they are connected to OT.  OTs need to make linking statements so clients understand the full value of OT.  A linking statement might be "don a bra so I will not be embarrassed when I eat lunch with friends."  I live alone so donning my bra enhances my social life.  If a client wants to feel the sun on his or her face, pointing while saying "leg brace - patio" can make a client's face light up. 

Preparation and functional training are essential but they do not sustain our commitment to action when we recover slowly.  Practicing a tip pinch so I can zip my coat needs to be followed by "because I want to..........."  Valued activities help us maintain the physical, cognitive, language, and social skills we work so hard to regain.  Living life to the fullest does not mean going to Paris.  It means satisfying deep human needs like feeling needed and having fun.  It means turning
"I should" into "I want to."

January 4, 2015

Kinesio Taping Reviewed

A subluxed shoulder is painful because the upper arm (humerus) has slipped out of the shoulder socket.  Subluxation is rated by how many fingers you can fit in the space created by this abnormal shoulder separation.  I had a one finger subluxation so the hospital staff put a small lap tray that slid over one armrest of my wheelchair.  I made sure the staff put the tray on every day because I knew nerve damage can occur if nerves in the shoulder are stretched too much. 

The lap tray could not support my shoulder when I walked and did exercises while sitting on a mat table.  My shoulder ached constantly during these times until my OT bound it up with Kinesio tape. This wide tape provides support but is stretchy enough to allow movement.  I wore the tape 24 hours a day - even in the shower.  It eventually came loose and had to be replaced every third day.

Hanger and associates found stroke survivors who had their shoulder Kinesio taped had less shoulder pain (1).  The improvement got very close to statistical significance (p = 0.11 instead of the required 0.10) because some people were helped while others were not.  I am glad Kinesio tape worked for me because having a subluxed shoulder felt like someone had punched my arm very hard. The only thing that made that constant ache go away was Kinesio tape.

1.  Hanger H, Whitewood P, Brown G, Ball M, Harper J, Cox R, Sainsbury R. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clinical Rehabilitation. 2000;14(4):370-380.

December 25, 2014

Is the Glass Half Full or Half Empty?

Major holidays raise our expectations for happiness so it feels like an appropriate time to ask
"is my glass half empty or half full?"  I did not know being an OT made me a glass is half empty person.  Insurance companies do not reimburse therapists for documenting assets so they focus on what no longer works.  This is why I hate being in a crowd of therapists.  They can not see that every head is turned in my direction as I walk by.  They are evaluating my deficits.  They can not help it.  It is what they do for a living.  I prefer to be around able-bodied people because most of the time they see my assets.  When I join friends and family they notice when I do not ask for help.

Having a stroke transformed me into a glass is half full person.  One of the greatest skills therapists have is the ability to see short-term goals that have a good chance of being realized.  Unfortunately I lost this skill when I had a stroke.  I have to concentrate fiercely to make my hemiplegic side do movements that were once automatic.  While doing a task for the first 100 times I do not have
one brain cell free to evaluate my skill.  I need a therapist to tell me what new skills are possible for me.  Yet at every stage in my recovery I thought my therapists were crazy because I thought they were asking me to do the impossible.  If you ever wake up and discover your leg feels like it weighs 100 pounds (45.4 kg) you will understand my reaction.  Thank God my response to what I thought were crazy requests was "I'll try."  My once flaccid hand can now do this (see photo below).  I became a glass is half full person because wonderful therapists helped me regain skills
able-bodied adults take for granted.  Working in a nursing home years ago helps me appreciate that therapy and my hard work made it possible for me to be in my home at Christmas time.

                                                                            If you want to read about the Releas splint I am wearing on my hemiplegic hand click here.    

December 16, 2014

A Peaceful Christmas by Design

The holidays can be both joyful and exhausting.  I prevent the fatigue that drains my Christmas spirit by simplifying how I decorate.  Smart choices make it less tiring to put up, take down, and pack away Christmas decorations.  I put fewer ornaments on the tree and no longer add tinsel.  The sparse look took some getting used to.  However, feeling happy when I turn on the tree lights and play Christmas music is wonderful.  I no longer think "I will not decorate next year."     

To see how I prevent falls when I decorate the tree click here.  Falls also do not make a peaceful Christmas.

December 4, 2014

Constraint Therapy is Good and Bad

When a new graduate told a blogger that stroke recovery happens in the first two years I decided to write about constraint therapy.  It was designed by Edward Taub who did not believe recovery after a stroke is time limited.  Constraint therapy involves putting a mitt on the sound hand for 1+ hours of therapy that focuses exclusively on the hemiplegic hand plus leaving a mitt on the sound hand for 3+ hours at home each day to force the hemiplegic hand to work.  Since 1993 many constraint therapy studies have found clients can recover hand function for years after a stroke. 

Constraint therapy is good because it challenged long held beliefs about neuroplasticity.  However, it is appropriate for a limited pool of clients.  1. Stroke survivors must already be able to extend (straighten) their fingers 10 degrees and their wrist 20 degrees.  2. It is good for men who have women to take care of them.  It would be nice if every husband would go grocery shopping, cook, and do laundry while their wives constrain their sound hand at home every day.  3. Some stroke survivors experience crushing fatigue.  I had to decide what NOT to do every day for two years.   

Current research offers an alternative.  Hayner found guiding both hands to work while making lunch, eating, and cleaning up helped stroke survivors improve as much as subjects whose hand was constrained during the same activity (1).  Sterr reported that stroke survivors who were helped to use their hemiplegic hand for 90 or 180 minutes improved as much as subjects who received constraint therapy for the same amount of time (2).  These and other studies have shown that mass practice can be less intense and come in several forms and still produce recovery.  

How can stroke survivors force so much hand use?  I do exercises with a spring-loaded splint (SaeboFlex) that helps me open my hand 100 times.  I live alone so my hemiplegic hand opens to hold 100+ objects while my sound hand manipulates those objects.  Even brief hand use adds up.  In 11 years my hemiplegic hand has opened to hold a tube of toothpaste 16,060 times so my sound hand can take the cap off and put the cap back on after I put toothpaste on my toothbrush.

Bottom Line: Taub showed therapists and stroke survivors they need to let go of old myths.

1. Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment
    of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular    
    accident.  American Journal of Occupational Therapy. 2010;64(4):528-539.
2.  Sterr A, Oneill D, Dean P, Herron K.  CI therapy is beneficial to patients with chronic low-
     functioning hemiparesis after stroke. Front. Neurol. 2014;5:

November 26, 2014

Reminded Again to Put Memory Aids in My Face

Lately I have been forgetting to do tasks.  These errors helped me relearn the value of putting memory aids in my face
I see my calendar with plans for the days as soon as I sit down at the table to eat breakfast (see photo).  Before my stroke this morning review was enough to help me remember things I wanted to do later in the day.

Error #1.  The To-Do list for the day goes right out of my head.
Solution # 1.  Immediately after breakfast I move my calendar and the yellow To-Do list to the couch where I sit everyday. For an extra cue I put the TV remote on top of these memory aids.

Error # 2.  I kept forgetting to check my new shoes to see if the tongue is sewn on correctly.  The tongue needs to be long enough (see arrow) so the top row of laces will not slip off the leather and dig into my ankle. 
Solution #2.  I put the new shoe on my couch where I sit to read and do crossword puzzles. 

Bottom Line: Using the environment as a memory aid can make people happy.  Don't able-bodied people place objects they must not forget near the front door at night?  I have a place where I sit every day so why not exploit it?