December 31, 2014

Cracks on the Ends of My Fingers

Winter is finally here and I have a crack in the skin at the end of the fourth finger on my sound hand.  Every time the end of my finger contacts an object the crack opens painfully.  I wash my sound hand so often that my skin is as rough as sandpaper.  I felt desperate because my thumb develops an even bigger crack which is even more painful. 

I Googled paraffin bath because warm wax softens the skin.  On-line users said it takes 6 hours for the wax to melt.  To prevent burns, the heating element is too weak to melt the wax quickly.  This means leaving the unit on 24 hours a day to keep the wax liquid.  Then there were users who said wax leaked out of the bottom of their unit.  

Bath and Body Works makes a product called True Blue Super Softening Hand Lotion with paraffin.  The sandpaper rough skin on the end of my thumb disappeared after one application. 
It took 5 days for the crack on my fourth finger to close up after using one small dab the size of a pea each day.  This is good because the lotion costs $12 for a 2.5 fluid ounce tube.

I let the lotion sink in after I go to bed at night.  I put a dab of lotion on the back of my hemiplegic hand, use the remote to turn off my ceiling light, and get into bed.  I use the index finger of my sound hand to transfer the lotion to the ends of my fingers.  I need all five fingers working on my sound hand.

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 30, 2014

Finger Exercises

When I grasped thin objects like a zipper tab my thumb and index finger used to bend ferociously.  Trapping the zipper tab against my thumbnail made the zipper tab slide out of my hand.  After analyzing the muscle imbalance in my hand, my OT gave me exercises.  Caution: Bad practice can strengthen muscles that are already too strong. The photos below illustrate the kind of individualized exercise program an OT can create for you.  



The 1st exercise is touching my thumb to my index finger.  The vibrator stimulates the weak muscles at the base of my thumb that were not working (see black arrow).   





The 2nd exercise is straightening my fingers against a rubber band.  Initially my middle finger straightened more than my index finger (see arrow on left). 

 


To correct this muscle imbalance my OT added a 3rd exercise. Tendon stroking is pressing firmly along the tendon from my wrist to the 1st knuckle.  For me this sensory input stimulates both index finger and thumb extension.  

November 17, 2014

Preventing Volunteer Burnout

If I live long enough I may need to go to a nursing home.  Nursing home residents who constantly complain or who are hostile find themselves medicated so they are less "anxious."  I do not want the aggravation of seeing my favorite sweater on another resident or being told "we do not do it that way here."  Treating my volunteers with kindness makes it more likely they will continue to help so I can stay in my home longer.  I use 7 strategies to keep my volunteers from burning out (11 years and counting).

1. Prioritize.  I cut down on the number of requests by identifying need versus want.  I need someone to get on a ladder to change the batteries in my smoke detectors.  These detectors are connected to my electrical system that maintains an ear-splitting screech when the battery dies.

2. Build trust.  People do not need special rehab training to know when they are being taken advantage of.  When I ask for help I let my volunteers know I always do everything I can before I contact them.  For example, when I asked Peggy to tape a bag shut so I could return a coat, I explained I had affixed the return label but did not trust my sound hand to tape the end of the bag securely.  People feel good about helping when they know they are really needed.  This strategy builds trust.

3. My husband would groan rule.  I cannot ask people to do things that would make a husband groan.  I cannot ask someone to buy a live tree, transport it, drag it into my house, use an axe to trim the base so the tree fits in the stand, and tighten and loosen the tree stand to reposition the tree until it is straight.  After having live trees my whole life
I bought an artificial one.  John takes it out of the box and snaps the four pieces together.  This rule helps me identify tasks I need to hire a handyman to do, like clean out my gutters. 

4. Let them choose WHAT to volunteer for.  I e-mail a request and let people choose things they want to do. This makes my request less of a burden.  Peggy who loves to sews repaired the sleeve on my raincoat.  Barbara who is a computer technician volunteered to help me set up the Bluetooth system in my new car.  Parts of a large task that a volunteer hates will not get done, but letting people choose what to do means I do not risk rejection because I have asked the wrong person.

5. Let them choose WHEN to volunteer.  After they volunteer I ask them when would be a good time for them.  Everyone has busy lives so it is less of a burden when I fit into their schedule.

6. Make a list and stick to it.  Before someone comes I make a list of the things I need done so my volunteer knows when he or she is done.  I stick to the list instead of looking around and saying "there is one more thing I need you to do."  This list also reminds me to get materials my volunteer needs.  Before John comes to replace the batteries in my smoke detectors I buy 9-volt batteries.

7. 80% rule.  The 80% rule means some things can be mostly correct rather than perfect.  After my stroke I gave myself permission to not make everything perfect.  For example, I do not make multiple trips around my bed so the bedspread is perfectly straight.  The seam of my bedspread is supposed to be where the edge of the mattress is (see the black line).  I think it is only fair to extend the 80% rule to my volunteers. Nobody wants to hear they did not do something the way I used to do it.

November 6, 2014

Addendum - Walking in Snow with a Cane

Bottom Line: I am not ready to go to an assisted living facility were the center's van will take me to Wal-Mart once a week.

The photo on the left shows the Briggs Ice Cane/Crutch Attachment.  I bought it at a medical supply store near my home.  The advantage of buying it in a store instead of on-line is the saleswoman got out a screwdriver and fastened the device to my cane.  It stays out of my way in the up position until I put it down.(photo below). 
I place the cane in my hemiplegic (paralyzed) hand which holds the cane still while my sound hand pushes the device down until I hear it snap into position.

The device makes my cane slightly heavier which slows me down.  I use another cane during warm weather rather than take this device off and try to get it back in the same place each winter.





Warning #1: I do NOT poke my cane through the snow.  I wait until after a neighbor I pay shovels my walkway and digs out my car.  I must be able to see the ground to tell if there is an icy patch that could make the spikes slip.  Checking the ground for ice slows me down, but it gets me to my car safely so I can drive. 

Warning # 2: People who plow store parking lots do not always do a good job of removing ice from handicapped parking spots.  Before I get out of my car I open the door and look at the ground to see if I want to leave the device down or push it up out of my way.

October 31, 2014

Dysarthria is More Than a Slip of the Tongue

I had a stroke in the brain stem which connects the brain to the spinal cord. My stroke attacked a part of the brain stem that is the bridge to the cerebellum which controls coordination.  The inability to coordinate muscles of my lips, cheeks, and tongue made my speech severely slurred (dysarthria).  The good news is that I never lost the ability to understand what people were saying.  The bad news is that people could not understand me. 

Incoordination of my diaphragm, which controls breathing, also made speaking difficult.  To speak you have to let your breath out slowly.  At first I exhaled explosively in one big gasp.  I had to repeatedly take extra breaths to finish even one sentence.  I gradually regained the ability to say more before running out of breath.  It is still tiring to speak in a group because I have to take many deep breaths to be heard.  Thankfully people never have trouble understanding me on the telephone.  I speak into an ear bud so I never have to raise my voice which requires more air.

My dysarthria has never fully disappeared.  When I am tired my speech is still somewhat slurred.
I know this because people start staring at my mouth start saying "What?" after I speak.  Then I have to remind myself to take a full breathe because I am speaking too softly.  I asked for help in the grocery store last night.  The woman who helped me scowled and looked at me like I was retarded.  After she left, I realized I was incomprehensible because I was speaking so softly.

October 5, 2014

Memory Aids Have to Be in My Face

When I forgot to pick up a friend who has a brain injury I felt guilty.  She blamed herself because she thought she had remembered the wrong date.  This painful experience taught me that memory aids have to be in my face.  I can repeatedly ignore reminders sitting in an out of the way place.  Now I use classic memory aids in some unusual ways.

The current month sits on my kitchen table where I eat breakfast.  I used to highlight important events, but the page of bright colors was distracting by the end of the month.  Now I use 2 colored tabs to mark important dates and move the tabs when the events are over.  I fold the page for each month in half and put future months in a napkin holder.  Every piece of paper is stuffed in it's respective month.  The arrow is pointing to a month that has a postcard from my dentist reminding me to make an appointment.  I got that postcard six weeks ago.  If I had put the postcard on my kitchen counter, who knows where it would be now.  
 
I also keep sticky Post-It notes and a pen every where I sit so I can write notes and stick them on my shirt.  If I leave the note on my shirt too long it falls off when I walk.  When that happens I stop what I am doing and do what is written on the note.

A word of caution about memory aids.  What helps one person remember does not make a bit of sense to another person.  The memory aids I use are only examples that may help you discover memory aids that work for you.  There are also lots of places that meet the "where you sit down every day" criteria.  Negotiate with your family to find a prominent place that you can put your memory aids. It requires others to adjust to a few changes, but they will appreciate your improved memory.  Readers of my blog have said how organized I am.  I fooled you.

September 30, 2014

Fall Hazards Are Subtle

Babies learning to walk do not get hurt when they fall because they are 18 inches (45 cm) tall.  When I fall I go crashing to the ground like a tree that has just been cut down.  Stroke survivors with impaired balance need procedures and equipment that prevent falls.  It is the small things we do not pay attention to that trip us up.  I do not fall because I crash into my sofa.  I fall when I do not lift my paralyzed leg high enough to stop my toe from catching the edge of a rug which lifts the rug up. The rugs in the photo keep the floor dry when people at church track in rain and snow.  I have fallen when my toes caught the edge of this type of rug.  I learned the hard way to look down to see where the edge of the rug is before I step onto it. 

Another procedure keeps me safe at bedtime.  I rely on my vision to tell me if I am vertical.  If I turn around after I darken a room by turning the lamp off I stumble badly.  I quickly learned to make sure I am turned to face the lighted room I am heading towards before I look down to find the light switch.  It is a relief to find the lit room as soon as I look up. 

If these procedures sound trivial, let me tell you about a stroke survivor who could have ended up in a long-term care facility because of a bad fall.  He has impaired balance so the hospital staff gave him a long-handled reacher so he would not lean over to pick up objects on the floor.  But using a reacher at home was frustrating.  If he was downstairs the reacher was upstairs.  If he was at one end of the house the reacher was at the other end of the house.  This repeated aggravation tempted him to reach down to pick up something even though he knew it was not safe.  He fell and broke his sound wrist.  When he finally got back home he bought three more reachers.  A reacher is always close because he has two reachers per floor with one at each end of the house.

I learned not to let subtle fall hazards lull me into a false sense of security because they do not make me fall every time I encounter them.  Are there hazards in your home you are not paying attention to, like a poorly lit front porch or extension cords snaking across a room?

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.  

August 31, 2014

Fatigue is a Deal Breaker

The fatigue I felt the first year after my stroke was unlike anything I had ever experienced.  I repeatedly felt a crushing fatigue I couldn't push through.  Using a timer to force myself to rest was annoying because the timer would go off at the worst time.  I tried to rest by watching TV, but that turned me into a zombie who couldn't stop clicking the remote because nothing good was on at the moment.  I tried reading and going on the Internet, but got so absorbed in these activities that I ended up being more tired.  When I did not rest I could barely hold my head up after dinner.

I found two strategies that work for me.  (1) Lying on top of the bedspread with a towel under my shoes and a small blanket covering me doesn't feel like I'm going back to bed.  I can lie down for fifteen minutes without having to get undressed.  (2) When I listen to a CD I can stop after a few tracks and come back to it later.  Instead of staring at the clock and resenting having to rest I enjoy the music.  Even seven years after my stroke I make sure to get enough rest when I have an outing planned for the day.  I don't want to start wishing I could go home a few minutes after I arrive.  A stroke survivor I met resents having to rest but I think preventing fatigue lets me do more rather than less.

August 26, 2014

Reviewing One-Handed Knives Again


I am reviewing one-handed knives again because I have found a rocker knife that actually works.  The dull rocker knife on the left cuts only soft food and sticks out of my purse.  I'm not going to buy a big over-the-shoulder purse that would hide this nine inch long rocker knife.  I have to push my purse to the front where it will not hit my cane.  I do not want a big purse making my stomach look huge (vanity).

I love the Verti-Grip Professional Knife from caregiverproducts.com.  The Verti-Grip knife is held vertically so my whole arm can press down as I rock the blade side-to-side.  The rocker knife shown above is held horizontally so I create downwards pressure only with my index finger. 

The VertiGrip's sharp blade cuts though steak and pork chops.  It is only six inches long so it fits completely inside my purse.  It has a protective cover that slides off easily so I put the VertiGrip in a small zip-lock bag to protect the inside of my purse.  The Verti-Grip costs $17.95 + S&H, but I think it is worth it.

July 31, 2014

Back Pain + Stroke = Disaster

I herniated a disc in my back and had sciatica 20 years ago so I've been stretching my back for years.  After my stroke I was worried my back pain would come back.  It did.  A recent bout of back spasms taught me stretching my back every morning is not enough.  Freezing in place when a back spasm hits and hoping I can walk slowly to sit down without dropping my cane is scary. 

My PT showed me I arch my back because my abdominal muscles on my paralyzed side are weak (bottom half of red line on left).  To stop myself from falling forwards while standing I lean back (top half of red line).  I also arch my back every time I lift my leg to walk.  Leg muscles (small arrow pointing upwards) need a stable base to pull on.  Abdominal muscles (arrows pointing downwards) are suppose to hold the pelvis and spine still when my leg moves.  

It gets worse.  I discovered I arch my back when I lean down to pick up an object, like when I reach down to get a pot from a bottom cabinet, get milk from the bottom shelf of the refrigerator, or pick up something from the floor.  I arch my back when I wash a dish because I am leaning my stomach on the edge of the counter for support.  

My PT taught me to do leg lifts with bent rather than straight knees.  I decided to intensify the workout.  I clasp my hands together, lift both arms over head, and lift my head while twisting to the left until my right shoulder blade lifts off the bed.  Before I start doing a leg lift I press my low back against the mattress and take a deep breath.  When I move I slowly let my breath out through pursed lips.  Holding my breath would increase my blood pressure.  I was dismayed that my NDT certification course did not teach that hand function comes from my gut.

Bottom Line: It takes both stretching my tight back and strengthening my weak abdominals to keep back spasms away.

July 27, 2014

Writing Aids I Cannot Live Without

The long boring weekends in the rehab hospital drove me crazy.  When Kathy, my recreational therapist, gave me an opportunity to practice writing with my sound, non-dominant left hand I jumped at her offer.  My friend Arlene did not volunteer to write checks to pay my bills for the rest of her life.  Kathy helped by bringing me clear Dycem and crossword puzzles she had enlarged on a Xerox machine to make the spaces bigger.  Colored Dycem is thick and rubbery.  Clear Dycem is thin and slightly sticky so it holds the paper still as I write.  Solving crossword puzzles was more fun than writing letters of the alphabet over and over like I did as a young child in school.

When I got home I found clear Dycem at www.pattersonmedical.com but was shocked at the price.   However, I splurge on a small roll of clear Dycem which costs $55 + shipping and handling because it is a writing aid I cannot live without.  I have pieces of it every where I sit down to take phone messages, pay bills, do crossword puzzles, write reminders on Post-It Notes, etc.  I make it last longer if by washing it.  A small roll (8 inches x 2 yards) lasts almost two years. 

I keep a small piece of clear Dycem in my purse (see arrow) to hold credit card slips still when I sign them.  As you can see, this dirty piece of Dycem is well used.  I also splurge on gel pens that cost $15 a box.  Gel pens are more forgiving that ball point pens that must be held at a precise angle to make the ink flow.
When I eat at restaurants that have tables with slippery surfaces this small piece of clear Dycem stops my plate from sliding as I cut food.  I appreciate not having to whip out a big brightly colored Dycem placemat to announce to everyone in the restaurant that I am disabled.

July 16, 2014

What a Fractured Arm Taught Me

I fell in the laundromat while struggling to move a queen-sized comforter.  I broke a forearm bone called the radius.  To heal the radius I had to stop using my hemiplegic (paralyzed) hand.  I was not able to do SaeboFlex exercises because this splint has a cuff that puts pressure on the forearm.  I lost lots of hand function and the ability to turn my hand palm up.   Below are four lessons I took away from this experience.

1.  It is too risky for me to do heavy housework anymore.  I tried to find a cleaning person in the past, but friends were reluctant to give me their housekeeper's phone number.  My broken arm moved a friend to take pity on me.  When I learned Isabel would charge $70 I gulped.  Even though she makes my home spotless, it took me 3 months to be at peace with this indulgence.
I finally relaxed when I realized I would be paying an assisted living facility $3,000 or more every month to get a cleaning lady.

2.  My fall at the laundromat began with a turn.  Weeks later I felt my back arch before I made a partial turn and fell against the kitchen counter. I realized I have been bouncing off my kitchen counters for a long time.  Hitting the floor of the laundromat has made me turning more slowly. 
 
3.  I felt my stomach push me away from the bathroom counter while I put rollers in my hair -- one more example of arching my back to lean on a counter so I will not lose my balance.  Now I place my hemiplegic hand on a piece of Dycem to make my abdominal muscles hold me away from the counter when I use curlers.  Arching my back contributes to back spasms
4.  Thank God for out-patient OT.  I could not have coped emotionally or physically with this setback on my own.  Cathy used contrast baths, retrograde massage, and gentle active range of motion to bring down the painful swelling, and help me regain strength in my shoulder and elbow.  When my forearm bone healed she began resistive exercises.  

July 5, 2014

Pictures Can Explain What OTs Are Doing

Aphasia is the inability to understand the spoken word and/or to express oneself verbally. Yet aphasic clients may retain procedural knowledge.  This is the ability to execute the steps of a task that often requires visual information.  We do not talk ourselves through the steps of tying shoelaces.  We remember what the steps look like and what our hands do.  Visual-motor information is stored in a different location than language so procedural knowledge may be spared after a stroke.  Printing out clip art or photos found on the Internet may help OTs explain what they are doing to help their clients.  Here is an example. 



If clients want to go home to eat a home cooked meal I am pretty sure they are not picturing themselves eating in bed wearing sweaty pajamas while the family eats at the dinning room table. 




To close the deal salesmen offer customers something they want.  Guessing what a person wants is risky.  Better to show a client pictures of hugging a child, petting a cat, sitting on the patio, etc.  It would be ideal if the family could bring in photos of activities the client enjoys. 
Good salesmen watch a customer's face to see what makes his or her face light up.

June 30, 2014

Hand Use Able-bodied Adults Take for Granted


When my hand was flaccid I had to put objects in my mouth or squeeze them between my thighs to hold objects still.  This made me aware of the dozens of times each day I used to reach out to hold an object still so the other hand could manipulate it.  Here is an example of what I mean.  It is aggravating to get out cereal, a bowl, and a spoon, but not be able to open the milk.  My hand can now hold the milk container still so it does not spin around when I remove the cap, but first I have to reach for the handle. 

Using my hemiplegic right arm to reach for and hold a lint trap so my sound left hand can clean the lint trap sounds like a deceptively easy skill.  If shoulder muscles struggle to lift the arm, high muscle tone can cascade down the arm and make hand muscles tighten.  It is difficult to open a tight hand.  I am grateful that my OTs, NeuroMove, and Saeboflex helped me regain  this simple skill.  Being able to reach out and open my hemiplegic hand to hold objects helps me do 26 ADL tasks

June 26, 2014

The World's Tiniest Hand Splints


Problem #1.  When I drive for 30 or more minutes my paralyzed hand gets tight from the constant vibration.    Solution #1: To keep my hand open I use foam tubing designed to slip over the handle of eating utensils.  It has a 5/8 inch opening that runs down the center of the tube.  The fit is not tight enough to keep my fingers absolutely straight, but the foam traps body heat which relaxes my muscles.  My hand starts out stiff as the photo shows and ends flat on my thigh by the time I arrive at my destination.  The foam also provides traction so my hand does not slip off my thigh. 

Problem #2.  Pushing a heavy shopping cart makes my thumb bend severely.    Solution #2.    I slip a piece of foam over my thumb.  The foam keeps my thumbnail from digging into the side of my index finger.

Problem #3.  I have to grip a peanut butter jar tightly which makes my index finger and thumb bend sharply (see black line). 
A severely bent thumb means I am strengthening a bully who is already too strong!  I eat a peanut butter sandwich every day because Smart Balance peanut butter has omega-3 oil which lowers my high triglycerides (a bad fat in the blood).


Solution #3: I keep my thumb and index finger straight by donning rubber finger cots used to count money.  The finger cots give me traction that keeps my fingers straight as my sound hand uses a knife to dig peanut butter out of the jar.  I keep the finger cots in a shot glass for measuring liquor.  The shot glass sits on the windowsill in my kitchen.

June 15, 2014

Reviewing Adapted Knives

When I eat out I order soft food that can be cut with a fork, like fish and pasta.  At home I have rocker knives that let me press down on the food to hold it still while a rocking motion cuts the food.  The photo shows two rocker knives.  The long knife in the photo on the right is the most commonly used one.  However, the photo below shows that this rocker knife does not fit in my purse.
I have to use an across-the-body purse because straps keep sliding off my shoulder.  Straps that slide were OK when I was able-bodied and had a free hand to keep pushing the strap back up.  Fortunately I found a small purse called the Terrace Shoulder Pouch at ebag.com.  Putting the purse in front of my body keeps it out of the way when I reach forward with my cane.  I have larger over-the-shoulder bags, but they stick out so far I look like a pregnant walrus.  
Another alternative is the smaller knife in the photo above.  I think it looks like a weapon for an assassin so I use it to cut vegetables at home.  I am the least fashion conscious person I know,
but even I am vain enough to want to look like everyone else in a restaurant.