September 25, 2014

OTs are Brainwashed and It's Not Their Fault

As an OT I did not know I was brainwashed by Jebsen to think that only the dominant hand is important.  Jebsen made either hand do what the dominant hand does, like use a spoon to scoop beans out of a bowl.  Jebsen-inspired test items have been adopted by other people who designed hand tests for 35 years.  For example, the Fugl-Meyer Test asks clients to use either hand to pick up small objects.  This is something the dominant hand does.  Asking the non-dominant hand to do tasks it never does is not a valid way to assess recovery.  

When I was able-bodied I did not know what my non-dominant hand was doing except when both hands worked continuously, like typing.  I regret brainwashing hundreds of OT students by showing them a drawing of a palmar grasp that emerges at 6 months.  A palmar grasp involves holding an object with the palm and sides of the fingers instead of the fingertips.  This drawing gives the impression that a palmar grasp is a primitive stage infants pass through on the way to something better.  It does not create an image of adults holding age-appropriate objects.  I wish I could have shown my students the four photos below. 
A palmar grasp lets my non-dominant hand hold the watering can still while my other hand controls the garden hose.

 
A palmar grasp has allowed me to take the cap off the toothpaste tube 6,570 times in nine years.
A palmar grasp lets me hold the hair dryer while my sound hand fluffs my hair.

Notice the ends of my fingers are not in contact with the food scraper, the food, or each other.

Able-bodied adults use the palm and sides of their fingers thousands of times in a life time.  Helping an adult client regain a palmar grasp is a huge gift.  

6 comments:

  1. Right now I'm working towards the palmar grasp even if I have to pry my hemiplegic hand open before I do it. I believe it was your blog that I first heard the term forced use although I now have read about it on several others. Even though when I read it I was almost a year away from even attempting it. I wanted to say thank you for all the information.

    Yes, a palmar grip would be most useful, if I had it consistently. It's coming though.

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    1. When I have trouble opening my hand I press the BACK of my hand against a piece of furniture to bend my wrist. Bending the wrist forces the fingers to relax.

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    2. There in is the rub...the wrist barely moves to neutral. When I do manage to get the wrist past neutral the fingers clench into a fist.

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  2. At this point, I don't even know which hand I should refer to as my "dominant" hand. I just started to get enough strength to twist off a plastic bottle cap with my left hand (formerly my non-dominant hand.) I eat my cereal in the morning with right hand, but by lunch I'm too busy to deal with my right hand. I usually type with my left hand, but I use both hands to type (very, very slowly) my grocery list. I'm all mixed up (and tired!)

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    1. I've seen hand switching in stroke survivors I've evaluated with the Test of Early Bilateral Hand Use. The hemiplegic hand does more during easier tasks and switches to be the assistive hand as task difficulty increases. This is probably what left-handed people do all their lives to survive in a right-handed world.

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    2. Your comment of alternating hand use made me go back and read "Frustrated by a Right-Handed World" that I posted in May, 2011.

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