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.