February 29, 2016

A Good Quality of Life is Complicated

Rehab for stroke survivors focuses on physical recovery and functional skills like dressing.
Yet physical and functional abilities only partially predict a person's quality of life (1).  Clarke discovered factors that explain why some clients experience a sense of well-being after a
stroke and others do not (2).  Physical and cognitive disabilities are less disruptive when they:
(a) permit participation in self-defining activities that contribute to a positive self-identity and
(b) are counterbalanced by adaptive strategies and social resources.

Self-defining activities.  Three of Clarke's subjects defined themselves as very physically active before their stroke (e.g. skiing, gardening, etc.).  One subject who used to be physically active said "What quality is there left?"  Five of Clarke's subjects did not define themselves by their physical activities so their sense of well-being was higher.  For example, they appreciated things like modifications that allowed them to drive again.  Teaching and helping others used to define me and they still do.  I present to stroke support groups, OT students. and OT conferences.  Participation in these activities has been an important way to reclaim a feeling of self-worth.

Adaptive strategies.  Six of Clarke's subjects successfully adapted to their stroke.  Prior education helped them get the most out of their rehab.  A school principal felt being an educator helped him listen closely and "tap into" instructions he was given.  A systems analyst used her logical reasoning skills to create memory aids.  Being an OT made me aware of a cornucopia of adaptive strategies, like energy conservation, so I can defeat deficits like exhaustion.   

Social resources.  Some of Clarke's subjects got support from family and friends.  One spouse helped his wife both physically and emotionally.  He was described as "being very gentle and humorous."  Other subjects felt a lack of social support.  One woman talked about being "dropped" by her neighborhood friends and feeling stigmatized because she could not drive.  No one walks in her neighborhood except cleaning ladies.  A second woman felt rejected because her husband would not walk down the street with her because she "cannot walk well enough."  A third woman's husband was critical of the memory aids she created and wanted them removed from the house.  My family lives far away so I am blessed to have many supportive friends.

1.  Wilson, I Cleary, P Linking clinical variables with health-related quality of life: a conceptual
      model of patient outcomes.  Journal of the American Medical Association. 1995;273:59-65.
2.  Clarke, P. Towards a greater understanding of the stroke experience: integrating quantitative
      and qualitative methods. Journal of Aging Studies. 2003;17:171-187.

February 14, 2016

Nails Do Not Stop Growing After a Stroke

         CAUTION: CLIPPING NAILS REQUIRES GOOD SENSATION AND COORDINATION

I live alone so I have to cut my nails.  I cut the nails on my sound hand by operating an adapted nail clipper with my affected hand.        I returned the small nail clipper shown on the bottom.  The pointed end (see V-shape) dug into my palm when I pushed down.  The short handle also meant I had to press hard to get enough force to cut my nail.  I use the larger nail clipper shown on top.  The end of the handle is square which is more comfortable.  The longer handle gives me better leverage when I push down.

Notice the emery boards in the large nail clipper held by pegs that are tightened by hand.  I use these emery boards often to remove sharp points at the corners of my nails. This is safer than trying to get the clipper into these tight spaces.  The clipper came with four emery boards, but replacing them will be a challenge.  All the stores near my home sell only wide, thick boards (pink board) that do not fit in the clipper.  The Internet sells short 4 inch emery boards except for this link.

My sound hand cuts nails on my affected hand with a regular nail clipper.  Spasticity in my affected hand makes my fingers curl.  To straighten them, I prop them one-at-a-time on a the edge of an opened drawer.  The open drawer allows my sound hand to get low enough to get a good cutting angle.  I put a piece of non-slip shelf liner under the finger to keep it from slipping, but the shelf liner got in the way when I photographed my hand.


Bottom Line: I cringed when I learned the large nail clipper costs $37.50, but nails do not stop growing so I do not have a choice.

February 3, 2016

Update on Applying Make-up One-Handed

Applying eye liner requires the ability to close one eye while you keep the other open.  I can only blink (close both eyes at once).  So I use mascara to give my eyes more definition.  My affected hand can squeeze tubular shaped objects between my index and middle finger so my sound hand can open the mascara.  Then I had to change to a non-irritating brand of mascara that comes with a funky handle.  Rehab never ends! 
I kept dropping the curved top of the mascara.  This left dark stains on my rug.  I used too much carpet cleaner which left white spots (see black circle).     I put a bandaide that has texture around the top of the mascara to give me better traction. I have stopped dropping the mascara.
My balance is not good enough for me to lean close to the bathroom mirror.  Years ago I attached florescent lights to the mirror hanging over my dresser.  I have a mirror on my dresser with clear Dycem under it to keep it from moving.  Leaning my sound elbow on the edge of my tall dresser gives me good control when applying eye make-up.  A food container keeps make-up organized so it does not spread out on my dresser.  A small round container holds vertical objects upright.  It does not fall over because it is clipped to the square container with a small metal binder clip (see white circle) I got at an office supply store. 
 
A piece of non-slip shelf liner stops eye shadow and face powder from sliding when I open the container and sweep the brush side-to-side.  I did not know age would rob my lips of the pink color that keeps them from being the same color as my face. It is easy to apply lip gloss with a hint of color because I do not have to draw a precise outline like I do with lipstick.  Now I see lips on the bottom half of my face when I look in the mirror.