April 30, 2015

Asking For Help Can Be Difficult

It was hard to ask for help after I had a stroke.  I was an OT who helped others and a divorcee who knew how to take care of herself.  When an independent person suddenly feels helpless it is easy to fall into a pattern of complaining or criticizing.  I knew my reaction to feeling helpless would influence how others would treat me.  It is easier for me to be gracious about accepting help when I know I have done everything I can for myself.

I learned a kind way to respond to people who are uncomfortable watching me work so hard.  When I was in rehab I overheard another patient say "I think I can do it myself, but thank you for offering."  I use this gracious way of responding to kind-hearted people who take a risk of being rebuffed when they offer to help.  Sometimes this polite refusal is not enough so I invoke the
my-spouse-would-groan rule.  I cannot ask someone to do something for me that would have made my husband groan.  John puts the four pieces of my artificial Christmas tree together, but I cannot ask him to do all the prep that goes with putting up a real tree (shaping the trunk to fit the stand, etc.).  I ask Peggy to tighten the knobs on my kitchen cabinets that keep getting loose, but I cannot ask her to scrub my kitchen floor. 

Volunteers do simple tasks that keep me in my home.  I can hire people to clean my house.
I cannot get a home health agency to send an aide to change the batteries in my smoke alarms when they start chirping.  If I live long enough, living alone at home will wear me down.  I foresee the day when I will be glad to pay other people to take care of me.  When I am 94 years old I will not be so cautious about asking for help.  If my requests for help exhausted people they might think "how much longer can she live?"   But I am 69 so I have to be careful about wearing out my support system.

April 26, 2015

A Physiatrist Has My Back

When I was an OT I did not realize stroke survivors deal with challenges for years after treatment ends.  Eleven years after my stroke I am grateful I still have access to a physiatrist (doctor who specializes in rehabilitation medicine).  (1) Dr. Terry, a physiatrist, has a deep understanding of my situation.  He listened attentively when I expressed concern about the increasing tightness in my hemiplegic (paralyzed) hand.  Instead of ignoring my concern he talked about when muscle tightness helps or interferes with function.  I did not have to explain why I wanted to go back to OT.  A physiatrist is one of the reasons I do not go downhill when a new challenge appears.

Here are four more reasons to see a physiatrist.  (2)  Regular in-patient meetings mean the staff have to think clearly about my case in order to present it to the physiatrist and to each other.
(3)  Physiatrists know how hard clients work to become independent.  Dr. Terry is one of the few doctors who does not try to undress me like I am a child.  After he asked to see my hemiplegic foot he hesitated for a moment.  This gave me a chance to take off my leg brace.  (4)  He asks about my personal life because he sees me as more than a paralyzed arm and leg.  (5) He knows the buzz words insurance company adjustors are looking for.  He has never given my insurance company an excuse to deny coverage for services he has ordered. 

Kinoshita compared outcomes for stroke survivors whose care was coordinated by a physiatrist versus other types of physicians (1).  The study found that stroke survivors whose care was coordinated by a physiatrist had significantly more frequent regular conferencing (see #2 above), had significantly higher scores on the Functional Independence Measure (p< .005), and were more likely to be discharged to their home (p< .005).  This is a huge advantage.

1. Kinoshita S, Kakuda W, Momosaki R, Yamada N, Sugawara H, Watanabe S, Abo M. Clinical
    management provided by board-certified physiatrists in early rehabilitation is a significant
    determinant of functional improvement in acute stroke patients.  Journal of Stroke &
    Cerebrovascular Diseases. 2015;24(5):1019-1024.

April 14, 2015

Chedoke Arm and Hand Activity Inventory

The Chedoke is a bimanual hand test that captures additional data because it lets clients decide if they want their affected hand to hold the jar or turn the lid (1).  Yet OTs who used the Chedoke wondered why they needed another ADL test (2).  One OT said "So am I really that worried about exactly how much effort the other one [hand] is putting in [to complete the task]?"  To be fair, insurance companies want therapists to document improved independence regardless of whether it comes from recovery or compensation.  Yet ignoring whether the affected hand does any work during a task defeats the purpose of working on recovery.  Clients deserve a test that gives us credit for transferring what we gained from exercise.

Unfortunately, OTs who gave the Chedoke to stroke survivors concluded it has too many high level tasks for clients with severe motor impairments (2, 3). The Chedoke includes high level tasks that have been a part of hand evaluations for years such as buttoning, zipping, and cutting with a knife and fork.  This is disappointing because many advances target clients who do not regain function with traditional treatment.  How can researchers test the efficacy of new treatments if they use tests with poor basements that do not test when hand movement emerges?

After a stroke I discovered easier bimanual ADL tasks that show hand movements can be functional much earlier than clients think is possible.  Level 3 on the Test of Bilateral Hand Use (TEBHU) is being able to reach out and hold an object still as the other hand manipulates the object (4).  Able-bodied adults do this dozens of time a day but take this skill for granted which is why it never appears on hand evaluations.  Levels 1 & 2 on the TEBHU evaluate hand simple movements able-bodied adults never use.  For example, the sound hand places a deodorant bottle in the affected hand which then places the bottle on the thigh and holds it still so the sound hand can remove the cap.  Hand-to-hand transfers done close to the body are easier than opening the hand as clients struggle to lift a heavy arm to table top height.

Bottom-Line: See easy bimanual tasks in the Hand Evaluation page at the top of my blog. 

April 3, 2015

Garbage Can Send You to a Nursing Home

I live alone so I cannot stay in my home if stinky garbage piles up on my patio.  People would call the health department.  After my stroke a neighbor took my garbage to the curb for a few months.  However, I do not want neighbors to think if they help me for a short while they have volunteered for life.  Paying a nursing home $8,000 a month is a really expensive way to get rid of garbage (Genworth Survey of Long-Term Care).  Here are adaptive devices that make me independent.

Garbage. I use Hefty Ultimate garbage bags.  They have an elastic drawstring built into the top of the bag which grips the top of the garbage can in my kitchen.  I place the full garbage bag on the seat of a kitchen chair so I do not have to lean down to tie a knot in the drawstring with my teeth and sound hand.  Once the bag is tightly sealed I drag it across the floor and kick it down my front steps without any spills.  I put the bag in a rolling garbage can to take the garbage to the curb.  I learned not to push the garbage can by tilting the can and rolling it on the wheels.  The first time I did this I almost fell when the garbage can got away from me.  By putting the wheels in front (see arrow) I can push it like a rolling walker.  CAUTION: I used to drag a cane in my hemiplegic hand so I could walk back to the house.  Now my balance is good enough to walk back without a cane.

Recycling. My town recycles glass, metal, and plastic containers.  The short yellow container I was given is too heavy and awkward for me to carry to the curb.  The photo shows the Devault Plant Dolly.  Six casters under the dolly make it roll smoothly.  To pull the dolly back to the house, I threaded a long strap through the central hole that is designed to let plants drain.