September 30, 2016

Braces Can Create a Leg Length Discrepancy

I acquired a leg length discrepancy from a brace so I was not surprised that a study found shoe inserts improved stroke survivors' gait.  Here is what Mohapatra and his associates found (1).  Eleven stroke survivors were given two weeks of PT, but people in the experimental group were also given a shoe insert for the sound leg.  The insert added height to the sound leg just as the brace did for the affected leg..  After two weeks the group who had shoe inserts walked significantly faster.  Their weight bearing was also more symmetrical.  

Every PT is taught how to check for leg length discrepancy.         Yet my in-patient PT did not check my leg length after I got my brace.  A simple way to check is to put your thumbs on the         two hip bone that stick out in front (anterior superior iliac spine) and look to see if your two thumbs are level.  If one leg is longer, one thumb will be higher. 

Three years after my stroke I saw a PT who was trained in myofascial release which addresses good body alignment.  Tracy put her thumbs on my hip bones and told me to buy a shoe insert at the store where I buy orthopedic shoes.  I could feel a difference the moment I stood up with shoe insert under my sound foot. Stroke survivors should be evaluated for leg length discrepancy after they get a brace and taught about shoe inserts so we know what to do the next time we buy a new pair of shoes.

Spenco shoe inserts come in four different shoe sizes in full versus 3/4 length and thick versus thin.  A shoe insert can be a low tech, relatively cheap way (e.g. $30) to improve gait.

1.  Mohapatra, S., Eviota, A., Ringquist, K., Muthukrishnan, S., & Aruin, A. Compelled body weight shift technique to facilitate rehabilitation of individuals with acute stroke. International Scholarly Research Network. ISRN Rehabilitation Volume. 2012;  article ID 328018:7 pages.       

September 27, 2016

Bathing Does Not Have to Be Exhausting

As an OT I had my clients practice a single ADL skill in isolation, but I never watched a client do a whole morning routine.  I did not know how tiring bathing, grooming, and dressing can be until I did all of them one after the other as a stroke survivor.  Self-care is not supposed to be so exhausting that all I can do is watch TV and become a zombie who cannot stop clicking the TV remote. 

I want to be independent so I can close the shower curtain and take as much time as I want to enjoy the feeling of warm water cascading over my body while I sit on my shower chair.  I want to leave the shower feeling refreshed - not exhausted and frustrated.

Washing.  Using shower gel and a nylon poof means I do not have to struggle one-handed to soap up a washcloth or chase a bar of soap after I drop it.  I pour shower gel on the nylon poof and knead it a few times to get it soapy.  To wash my sound arm I need only a gross grasp to hold the nylon poof.  Instead of struggling to wring out a washcloth one-handed I hang the nylon poof on a suction hook and hose it down the way you rinse a car and then let it air dry.  I use shampoo suds to wash my face
OT helped me regain the ability to open my hemiplegic hand and use a gross grasp to hold the head of the shower hose close to my crotch.  This leaves my sound hand free to deal with the nooks and crannies that running water does not reach.  Even if my husband were still alive I would want to bathe this private part of my body myself.  It may look like a pathetic amount of hand function to an able-bodied person, but it keeps me from feeling embarrassed which is priceless.

Drying.  My towel rack is close enough to the shower that I can reach it while sitting on my shower chair.  I drape the towel over one shoulder to dry my arms and trunk.  After I get out of the shower I don a terrycloth bathrobe which dries my buttocks and thighs.  This means I do not have to twist around to dry these hard-to-reach places.  While standing I dry my crotch with the towel draped over my shoulder.  It is easier for my sound hand to manipulate the free end when it does not have to deal with the full weight of the towel.  Keeping the towel draped over my shoulder makes it easy to put the towel on the towel rack.  Letting my calves air dry while I brush my teeth means I do not have to huff and puff while holding up my leg to dry it.  In the summer when evaporation is not as effective, I air dry my calves while lying on the bed and listening to music.  I put a towel under my calves to keep my bedspread from getting wet.

September 14, 2016

Some High Tech Designers Don't Get It

There is lots of news about how technology can help disabled people recover the use of their affected hand.  Here is what drives me crazy.  Watch this video of a high tech rehab device and DO MORE than look at the flashy movement on the screen and the client's happy face. 
Look at what the woman's hand is doing.

1.  Media reports and even many research articles do not explain that using technology is only the beginning.  The goal is to have a person's hand manipulate objects - not just touch objects on the screen so the computer makes objects blow up or move.  To be fair, the technology helped a woman move her arm so she could bring her hand to the location the task required.  However, photos show that using an expensive robotic arm is not the only way to show clients they have hand function when shoulder and elbow muscles are weak.  Instead of grasping objects resting on a table, clients can rest objects in their lap or stand to reduce how far weak shoulder and elbow muscles have to move the arm, which is remarkably heavy.

2.  Cherry picking high level clients to demonstrate technology is misleading.  I am suspicious when I see stroke survivors begin by using a gross grasp to hold a cylinder-shaped Wii controller and end up grasping a small object between the tips of their thumb and index finger.  Where are the videos of stroke survivors who have trouble opening their hand after they make a fist?  A meta-analysis of 44 studies done on 1362 subjects found that robot-assisted therapy improved only arm movement (1). High functioning clients benefit from the fun aspects of computer games, but I think clients who have less recovery need technology the most.

3.  Proof-of-concept videos are misleading when they have able-bodied people demonstrate the product.  Able-bodied people move at a lightening speed that many stroke survivors never regain.  Speed requires effortless control of every joint.  I can tell my hand to open or close, but I cannot simultaneously tell all the joints in my arm what to do.

The Bottom Line:   Promotional material for technology is not always honest about the ton of work that many clients must do to close the gap between what the computer is doing to objects and what clients want their hand to do. 

1. Veerbeck J, Langbroek-Amersfoort A, Wegen E, Meskers C, Kwakkei G. Effects of robot-
    assisted therapy for the upper limb after stroke.  Neurorehabilitation and Neural Repair. Sept
    5, 2016, doi,10.1177/545068316666957.

September 1, 2016

The Non-Dominant Hand Cries Out

The non-dominant hand cries out to be recognized as a full partner.  Unlike leg movements that often do the same motion (e.g. walking), the two hands have different roles.  I had to have a stroke to learn what a non-dominant hand does all day.  Adaptive devices like rocker knives draw a veil over the staggering number of times we use our non-dominant hand.  If you want to know what your non-dominant hand is doing when it is not texting read the list below.  DH = dominant hand.

Self-care 
        Hold shampoo bottle, toothpaste tube, and deodorant bottle so DH can open them
        Hold hair dryer so DH can run a brush through hair to style it
        Hold waistband of pants so DH can help pull pants up, zip, and put belt through belt loops
        Hold fork in meat so DH can maneuver knife to cut it
        Hold bottle of water or soda can so DH can open it
        Hold bottom of jacket or coat so DH can zip it
        Hold every bottle of medicine you have so DH can open them
        Hold objects you are carrying so DH can turn door knob to open a door

Cooking
        Open refrigerator door so DH can put food in and take food out
        Hold milk container so DH can take cap off
        Hold pots, pans, and mixing bowls still so DH can stir the food
        Hold one handle of baking dish as DH holds other handle to place dish in oven
        Hold bottles of olive oil, soy sauce, vinegar, etc. so DH can take off caps
        Hold spice jars so DH can remove lids
        Hold banana, cucumber, carrot, and other food you want the DH to peel
        Hold onion, garlic, cilantro, and other food you want DH to chop
        Hold zip-lock bag and other food storage containers so SH can open them
        Hold folded-over edge of frozen food bag so DH can put on a food clip

Shopping
I need two hands to open purchases that range from make-up to meat. People who can't use their hemiplegic hand resort to what I call the "Honey do" strategy.  Stroke survivors who are one-handed experience task disruption every time they get to the step in a task that requires two hands.



Vacuum/Laundry
      Hold cord out of the way so you won't trip when DH uses the vacuum cleaner
      Hold lint trap of clothes dryer so DH can clean it
      Hold up shirt, pants, dress, etc. so DH can put clothes on hangers
      Hold corner of clean piece of laundry so DH can fold it

Pay Bills
        Hold wallet open so DH can take out money to pay cashier
        Hold envelope so DH can pull bill out and put return slip into the envelope
        Hold checkbook register open so DH can write check information
        Hold sheet of return stamps so DH can remove stamps and put them on envelope
        Hold several sheets of a bill in a neat stack so DH can staple them together
        Hold file folder open so DH can file away paid bills