Staying Out of a Nursing Home

Today I got a splinter in my sound hand as I walked down my front steps while holding onto a wooden railing.  Thank God I know how to remove a splinter one-handed so I do not need live in a nursing home to get nursing care.  My mother removed splinters by picking at the skin over the splinter with the end of a sewing needle.  This was painful and required delicate fingertip pinch.  A stroke took away my ability to grasp a needle between my thumb and index finger.

My solution is to use a rasp which removes callouses on the bottom of the feet.  I trap the rasp on a counter with my affected hand.  Then I rake the rasp over the splinter.  I apply gentle pressure and make repeated passes to slowly remove skin.  Today the splinter popped out as soon it was fully exposed.  I followed with Betadine solution.  CAUTION: This method only works for splinters that are close to the surface.

I also know how to put a band aid on my finger one-handed.        I put the band aid close to the edge of a counter.  I put the affected area of my finger on the pad in the center.  Then I roll my finger to the left to get the left side of the band aid to stick to my finger.  Without lifting my hand I roll to the right so the right side of the band aid sticks to my finger.  There is usually a small tail that is not stuck down so I grab it with my teeth and stick it to my finger.  A 2nd reason I do not need to live in a nursing home to get nursing care.  homeafterstroke.blogspot.com

Toilet Training is a Disaster

OTs evaluate how clients get on and off the toilet.  However, aides are the ones who deal with dressing and undressing during toileting.  Aides have large caseloads so they speed up toilet time by doing everything for their clients.  This assistance masks safety issues.  

Small weight shifts while pulling my pants up threw me off balance.  I had to repeatedly twist my trunk so my sound could reach across the front of my body to get my underpants over the paralyzed hip and reach behind me to get my underpants over the paralyzed hip in back.  Continue to twist when I pull my pants up over my affected hip.  It took 2 weeks for my standing balance to improve enough for me to feel safe when I pulled my pants up without an aide in the bathroom. 

Toileting also requires repeated turning.  After I walk into the bathroom I have to turn 180 degrees to close the door at home or a doctor's office.  I am facing the door I just closed so I have to turn 180 degrees to walk to the toilet.  When I get to the toilet I have to turn 180 degrees so I can sit down.  I have to turn 180 degrees after I stand up so I can flush the toilet.  

OTs do not evaluate gait in the bathroom because ambulation is PT's domain.  PTs do not evaluate standing balance while twisting the trunk and repeatedly turning 180 degrees because toileting is OT's domain.  Yet needing 24 hour assistance for toileting can lead to a nursing home.  This is a severe consequence so OTs and PTs need to stop worrying about stepping on each others toes.  homeafterstroke.blogspot.com

Rehearsal Saves Me Again

My moving company will keep my belongings in storage containers for 2 to 3 weeks until there is a truck heading to west to Michigan.  The facility I am moving into will put a few pieces of furniture in my apartment so I will have a place to stay while I am waiting.  However, my car must be filled to the max because I need supplies to take a shower, do laundry, and make breakfast until the moving truck arrives.  I turned to rehearsal to make sure I can pack what I need in my car.  

The purpose of rehearsal is to make me feel awesome when I tackle a new task.  My 1st attempt shows me what I have to change.  My 2nd attempt lets me test new ideas to fix problems I discovered in step 1.  My 3rd attempt gives me an opportunity to combine and test the steps from attempts 1 and 2.  My 4th attempt gives me an opportunity to get faster.  Here are two examples of learning how to pack stuff in my car so I can stay calm on the day I leave for Michigan.

I need a rolling cart to take my clothes to the laundry room.  I need to know: 1) if I can lift the rolling cart into my car with one hand and 2) if it will fit in my back seat. I could not lift it straight upwards to put it in the car because it is too heavy.  However, when I leaned down and moved my hand close to the wheels, the weight of the long handle swung the cart horizonal. That made it easy to place the wheels on the floor of the car and then tilt the cart upright.  I was surprised to learn the small front wheels nested nicely under the driver's seat.

I also need to know if 2 clothes baskets packed with bed linens and nested waste baskets will fit on my back seat.  I slid the 2 empty clothes baskets down my front steps and transported them to my cart using a small cart I keep on my patio.  I put them on my back seat and learned I could close the car door with room to spare.  The height of the basket raised the handle of the cart, but not enough to obstruct my vision in the rear view mirror.

There were so many constraints to take into consideration!                I would be a nervous wreck if I had not rehearsed these tasks. homeafterstroke.blogspot.com

I Never Thought I Would Say This

I thought the hardest thing I have ever done was to recover from a stroke.  A very close 2nd source of stress is moving to Michigan.  My single spaced To-Do List shows what I have to do in the next 4 weeks.    I have a 2nd To-Do List for selling my house.  😢    

In the 1st year after my stroke a gratitude list helped me deal with stress.  Each day I wrote 3 to 4 word phrases describing events that gave me 5 seconds of happiness.  Reading that list at the end of the day changed the way I felt about how my day had gone.  I hope writing a gratitude list now will help me cope too.  When I feel sorry for myself I also say "I am moving towards a time when I am happy and safe."

Thank God I started working on my move two months ago.  For example, I struggled to find ways to get rid of monstrously big furniture.  I am also glad I paid a woman to come one hour every week to do tasks that require two good hands.  Taking a table to the curb for my township to pick up is too much for me.  homeafterstroke.blogspot.com

My Dreams Have Changed

My dreams have changed over the years.  As a young woman my 1st dream was to get married and have a family.  But I was not able to have children and my husband did not want to adopt.  Thank God I got a scholarship to a master's program in occupational therapy. That degree allowed me to support myself without needing to work two jobs after I got divorced.  This helped me achieve my 2nd dream of financial security as a single woman.

My 2nd husband liked to travel so my 3rd dream was to see the world.  I have precious memories of Paris, London, New Orleans, Prince Edward Island, the Grand Canyon, Yellowstone National Park, and Alaska.  An actor in a commercial asked "When we are on our deathbed will we regret what we didn't buy or the experiences we missed?"  I have thrown away many of the items I bought but my memories of traveling still make me happy.

Moving into an independent living community has given me a 4th dream.  Except for short visits with family and friends, I have not been around people every day since a stroke forced me to retire 18 years ago.  After retiring I had intermittent social contact at my breakfast club, church, and dinners and day trips with friends.  However, after spending 2 years in isolation because of covid I crave human contact.  I do not expect to form deep friendships, but covid taught me how comforting it is to have someone say "hello."  I might even learn what I am thinking when I hear what I say to other people.  homeafterastroke.blogspot.com

Getting Hand Use Earlier than Stroke Survivors Think is Possible

Hand tests begin by asking clients to pick up objects from a table.  Stroke survivors would discover their affected hand can be useful earlier than they think is possible if hand-to-hand transfers were added to adult hand tests.  A small amount of finger movement done close to the body can make an affected hand functional.  If you pick up an object with your sound hand and open your affected hand 2 inches to receive the object, you may be able to do the tasks shown below.   

A hand-to-hand transfer allows me to do 21 bimanual ADL tasks.

Example #1- Using a shower hose to spray water at the crotch does not take care of the nooks and crannies.  After a hand-to-hand transfer, my affected hand holds the shower hose close to my body which frees my sound hand to do its job.  This little bit of hand function means my mother, a nurse's aide in the hospital, and I are the only people who have washed my crotch.  If my husband were still alive I would be mortified to have him do this intimate task.    

Example # 2 - When my affected hand was flaccid, I used to squeeze a deodorant bottle between my thighs so my sound hand could remove the cap.  Now my affected hand opens to receive a deodorant bottle from my sound hand and then holds the bottle still while it is resting on my thigh.  The two black lines show how little shoulder movement is needed when ADLs are done close to the body.

Example # 3 -  There used to be teeth marks on the cap of my toothpaste tube.  Now my affected hand can open to receive a tube of toothpaste from my sound hand which then removes the cap.  The end of the tube is propped against my stomach because this new tube is heavy.  I do not want to drop the tube and splatter sticky toothpaste on the floor.  I live alone so I would have to clean up the mess.

homeafterstroke.blogspot.com

An Unexpected Delight

Yesterday was a gorgeous day.  I took time to sit on my patio because I have never forgotten how depressed I felt when I was kept inside for 3 months after I had a stroke.      I had a stroke in March so I did not get to smell the blooming trees and flowers, feel the sun on my face, or feel a breeze.  Yesterday the sun was hot but there was a cool breeze.  I got to hear the breeze rustling through the trees behind my house and feel the wind blowing my hair around.  I craved these sensations when I was home-bound.

I also got to watch white clouds in a blue sky floating towards the Atlantic ocean 40 miles away.  I grew up in Chicago were the sky is usually a light uniform gray so I have never gotten tired of looking at the beautiful New Jersey sky.  I used to think artists who painted skies like this were imaging them.

homeafterstroke.blogspot.com

A Window Into My Soul

For a month I have worked hard to get rid of many possessions before I move to an independent living facility in Michigan.  A friend has loaded up my car five times with things to donate and put possessions on the curb on four garbage days.  This friend has expressed remorse about some of my decisions to get rid of stuff.  Today I realized why I have been steadfast and relentless about my decisions to get rid of so many possessions.

For 18 years I have been living in a spacious home that makes me happy.  I would be depressed if I saw boxes stacked against the living room and bedroom walls of my apartment because they do not fit in my walk-in closet.  

Getting a bigger apartment to store my stuff would use money I could spend on fun activities, like going on a tour of a local winery and hearing great musicians drawn to perform in Kalamazoo by the big music department at Western Michigan University.  

On my deathbed I believe I am going to regret the things I did not do rather than the possessions I gave away. homeafterstroke.blogspot.com

Reasons for Letting Go

I am getting ready to move to an independent living facility in Michigan and have spent the last three weeks giving nice things to charity and throwing others in the garbage.  Living in 9 different residences in 5 different states over the years has given me plenty of practice with the process of letting go of objects.  Early moves when I was in my twenties taught me to think about getting rid of belongings that my husband and I never took out of boxes since the previous move.  

I am also motivated to let go by the high cost of facilities for old people.    I used graph paper to plot the small apartment I can afford and put my furniture in it.  I  learned I have to get rid of more than I anticipated.  Every piece of furniture has to do double duty.  For example, my small kitchen table will be used as a desk and a breakfast table.  My small bookcase will hold belongings I used to keep in the big buffet below and a big roll top desk.  My radio/CD player will sit on top of the bookcase. 

The payback for a stressful move is that I will be in a safe environment and be closer to my family.  homeafterstroke.blogspot.com

Open & Close Cereal/Bread One-handed

Opening and refolding the plastic bag inside a cereal box is a two-handed task.  I would have to use my teeth and my sound hand.  Instead I take the bag out off the box, cut one side open (see arrow), and pour the cereal into a container.  Each morning my sound hand flips open the lid and pours.

To open a loaf of bread, I pull off the plastic tag and use the pointy end of a bottle opener to rip open the inner plastic liner.  

To close, I fold the open end of the bag under the loaf (see arrow) and slide the loaf inside a bread container made by Rubbermaid.  When I turn the container upright, the weight of the bread keeps the folded end shut.  The next day my thumb flips the lid off, I put the container on its side, and slide the bread out.  homeafterstroke.blogspot.com

Downsizing Begins

After my visit to an independent living center in Michigan, the reality of downsizing became real. After I drew my furniture on a grid it became clear that the one bedroom apartment I can afford is too small for my beloved oak furniture.  For example, it took me two days to empty my desk and find a tiny alternative.  I am testing the efficiency of my new arrangement instead of waiting to figure it out as I unpack in a new environment.  It is better to find out now what I really need and what I can live without.  I took photos to help me remember the complicated new configuration.  homeafterstroke.blogspot.com

From 200 pound monstrosity to   

   

My old night stand

Lucky Shoes

I never win lotteries or raffles so I was stunned when I had good luck finding a discontinued shoe I bought repeatedly for 18 years.  My brace man trimmed my leg brace to fit the shoe shown below.  Buying the same shoe over and over meant I never had to try on shoes to see if they fit.  On a lark, I went to the shoe store I have been using for 18 years and asked if they had this shoe stashed in the back even though it is no longer made.  I was stunned when the salesman walked out of the back room swinging 2 boxes with a grin on his face.  They were not only size 6 double wide, they were the beige color that goes with everything.  He was glad to sell them and I was thrilled to delay wondering if my brace would fit a new shoe. homeafterastroke.blogspot

Equipment that is WalMart Cheap

As an OT I shopped in expensive medical catalogs.  Now I use a cheap over-the-door plastic hook to hang a terry-cloth bathrobe on a towel bar.  Another plastic hook keeps the head of the shower hose off the floor of my tub when I am finished showering.

If I did not have non-slip shelf liner under the pill container it would start slipping away from me as soon as I reached in to get a pill.  I am glad non-slip shelf liner comes in neutral colors that do not clash with my decor because I have small pieces of it all over my house. 
                                                      homeafterstroke.blogspot.com

Bathing When I Travel

I am traveling at the end of April.  I have not used this shower stool for 4 years so I practiced using it home before I left.  Rehearsal always gives me confidence. 

Caution.  This stool may not be safe if you need assistance to stand up or sit down or are heavy.

It is not safe for me to stand in the shower.  When I travel I use a folding shower chair.  This adaptive device allows me to visit with family and friends and present at conferences.  I bought the stool at a local medical supply house. Before I bought it I wanted to see if I could open it myself and sit on it to feel how sturdy it is.    It is too big for anything but the widest luggage so a luggage saleswoman suggested I transport it in a nylon garment bag.

When I travel I cannot count on towel racks being close to the shower.  Before I get in the shower I check to see if the toilet is close to the shower.  If it is far away I drag a chair from the bedroom and place it close to the shower.  Then I open a towel and put it on the closed toilet seat or chair.  This gives me a clean place to sit after I get out of the shower.  I also put a folded towel on the closed toilet lid or a chair so I can dry myself.  After I am dressed I take the stool out of the bathtub.  I fold the stool and place it on the towel covered toilet seat and use the ends of the towel to wipe off the water.  homeafterstroke.blogspot.com

Good News about arthritis in my Good Hand

Eighteen years of overuse damaged the cartilage in the finger joints of my sound hand.  This produced bone-on-bone pain and swelling.  Fear about losing the use of my good hand motivated me to follow the joint protection principles I wrote about on February 11th, 18th, and 25th.    

After 2 months the pain and swelling in my good hand receded.  For example, a painful hand no longer wakes me up before my alarm clock goes off.  To see if the brief pain in my middle finger also disappears I decided to stop doing crossword puzzles.  Currently I am reading books I got from the library while I drink my morning coffee.  Thank God I have a book easel.  My post of          April 28, 2020 shows how I read hands-free.   

Now I have to figure what to do with my aching good shoulder.  Moving objects I use regularly to the bottom shelves in my kitchen cabinets has helped.  Now I have to tackle the ache I feel when I drive for 45 minutes.  When I visited Point Pleasant Beach recently, I was concerned about the ache I felt in my shoulder towards the end of the ride. This was a surprise because my good shoulder does not hurt when the steering wheel pulls to the left as I slow down to stop for a light.  However, keeping my car in its lane during long slow curves on the highway takes sustained effort.  My plan is to see if new tires and a front end alignment makes a difference. 

Bottom Line: Pain turned into a guide for what to do about arthritis.  homeafterstroke.blogspot.com

My Pill Map

I take 10 pills a day so I need a system to make sure I take them correctly.  I am highly motivated because my pills can help prevent another stroke.  For example, taking a baby aspirin every day thins my blood.  Once a week I open all my bottles to put my pills in a 7 day pill box.  Two or three times a year I put 2 tiny pills in one day's compartment but no pill in the next day's compartment.  They are so small they can slip out of my hand without my feeling it.  I catch this mistake with my back-up strategy. 

When I dump the pills I need for the day, the first thing I do is put my 3 bedtime pills in a small blue container.  Fortunately, these 3 pills are oblong and different colors.  Then I put my daytime pills on a hot pad that has a floral pattern and stitched seam lines.  I place each daytime pill in the same position to create a V shape.  If there is a gap in the V shape I know I am missing a pill.  

Fortunately I have excellent pill recognition.  For example,  I know the baby aspirin has rounded edges and tiny letters printed on one side (top arrow).  The medicine I take for my thyroid is also a tiny white pill, but it is completely flat and has a line through the center (bottom arrow).  homeafterstroke.blogspot.com

Carts Keep Me and My Stuff Safe

A cart saves me from making numerous turns when I bring home groceries. Food that goes in the refrigerator is scattered in several shopping bags.  I collect cold items on my cart, push the cart to the refrigerator, and stand in front of the open refrigerator - no turning and walking back to collect the next item and then turning to face the refrigerator again.  Turning increases the chance of a fall because it is more difficult than walking in a straight line.

Here I am 3 months after my stroke taking a meal to the table.  When 

I got tired of eating frozen dinners heated in the microwave I started cooking.  Initially I cooked one food, ate it out of the pot, and then cooked the next food.  The day I put three kinds of cooked food on a plate was a triumph.  Now I cook regularly and the cart keeps me from burning my hand while transporting hot food. 

A three-tiered cart allows me to sort my dirty laundry by color while sitting instead of repeatedly leaning over and standing up.  This cart also helps me safely transport dirty clothes to my 1st floor laundry room. 

P.S.  I am sitting on a folding metal chair that is stored behind an open door.  homeafterstroke.blogspot.com 

Freaked Out and Then Aggravated

I took Tylenol for three years because osteoarthritis had created bone-on-bone pain in my neck and low back.  I read on line that Tylenol can damage the liver so I freaked out when my feces turned yellow.  The liver secretes bile which turns feces brown.  My gastroenterologist said my feces would have been gray if my liver was not working at all.  I read the liver can repair itself, but I was not taking any chances.  On February 18th I stopped taking Tylenol.  Two weeks and 5 days later my feces turned brown. 

Now my arthritis pain kicks in every night which makes it difficult to fall asleep.  So I use hot packs that CVS calls Peas.  I put them in my microwave but am very careful to not overheat them.  When I touch them briefly they do not feel hot, but if I keep my hand on them I can feel the heat.  I am very conservative about the time I set the microwave for - 45 seconds for the big Peas and 30 seconds for the Peas I put on my neck.  The heat takes half an hour to be affective which is aggravating.  But it is better than rubbing my body and rocking while I watch TV at night because the dull ache makes me suffer.  homeafterstroke.blogspot.com 

A Painful Lesson About Need versus Want

After driving 51 miles every morning in rush hour traffic, I love relaxing while I sip coffee and do a puzzle from the Simon & Shuster Mega Crossword Puzzle Book.  When I do not know the name of a Greek God or other obscure facts, I look up the answer in the back of the book.  I have the satisfaction of doing a challenging puzzle while also finishing it.  Unfortunately, painful osteoporosis in my sound hand threatens my ability to drive a car one-handed.

Using paratransit to stay in my home would be difficult.  NJ paratransit can require riders to wait 40 minutes to be picked up and sometimes ride for an hour while other riders are delivered to their destinations.  It also has a two bag limit which requires multiple trips to the grocery store.  If I cannot find a way to make writing less painful, I will have to choose between something I love to do and driving which I need to do.  

Two adaptive devices that increase the diameter of a pen to discourage a tight grip did not work.  The hard plastic cylinder on the right has a tiny opening that does not accommodate my pens.  The soft tube on the left requires my painful hand to forcefully push the tube up onto the pen while I hold the pen in my mouth.  More pain is counter productive.  

My current strategy to make writing less painful has four parts.               1. Use double-sided tape to attach sticky Dycem to my pen.                         Increased friction means I do not have to grip as forcefully.              2.  Use a gel pen that allows ink to flow at a variety of angles.  

     Ball point pens are finicky about the angle you hold the pen.

3.  Put 2 or 3 fingers on top of the pen instead of the usual one.                     More fingers = less effort for each individual finger.                            4.  Keep all my fingers as straight as possible.  Bending my fingers               increases the pain. 

homeafterstroke.blogspot.com

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 small knife on the left in the photo looks like an assassin's weapon so I use it at home to cut vegetables.  The long knife on the right is the most commonly used one.  The photo below shows that this rocker knife does not fit in my purse.

I use an across-the-body purse because straps slide off my shoulder. When I was able-bodied I had a free hand to keep pushing the strap back up.  I found a small purse called the Terrace Shoulder Pouch at ebag.com.  The long knife sticks up so people can see I am carrying a knife - not good.   

I love Verti-Grip Professional Knife from caregiverproducts.com.
It is held vertically so my whole arm can press down as I rock the blade side-to-side.  The rocker knives shown above are held horizontally so I can only create downwards pressure with my index finger. The Verti-Grip is only six inches long so it fits completely inside my purse.  The protective cover slides off easily so I put the knife 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.  homeafterstroke.blogspot.com

2nd Hardest Challenge to My Independence

Learning to drive a modified car is the hardest task I had to master after my stroke.  The 2nd hardest is dealing with the New Jersey ban on stores providing and selling disposable plastic bags.  Reusable bags sold in stores and on-line are big.  They hold a lot so they are too heavy for me to carry up my front steps.  They also do not nestle together in the rolling cart I use to transport bags from my car to my front door.  Section 1.18 of the law allows customers to use disposable bags so I reuse bags I have saved until they rip.  Going to a long-term facility because I cannot get food in my house is a severe consequence.  Meals-on-Wheels supplies only 2 meals a day Monday to Friday.

Solution # 1.  I carry my plastic bags in a canvas bag from LL Bean.  The small canvas bag was not tall enough to let the plastic bags hang down fully.  The large canvas bag sags.  The medium canvas bag with short handles is just right (see photo below).

Solution # 2.  I pre-bag a few items like a half gallon of milk and packages of meat that tend to leak.  I bring extra bags to shake open.      I place one handle over the metal arch shown in the photo.  Then I drop the item in the open bag.  This allows me to work at my own pace before I get to the check-out line.

Solution # 3.  When thin plastic bags are nested inside each other, the friction between bags makes several bags pull out at once.  Hanging them side-by-side vertically stops them from sticking together.  However, when I strung the handles of the plastic bags over the handles of the canvas bag it created a messy pile (see left handle).  I had trouble finding a handle that paired with its mate. 

So I weigh down one handle of each plastic bag with a big key ring.  I hang these key rings over the side of the canvas bag where they are easy to grab.  This strategy lets me quickly find one handle so I can pull the bag open, fill it, and lift it out of the canvas bag.

Solution # 4.  Bulky items like a box of cereal and a pack of toilet paper are hard to put in a small plastic bag.  I put a cereal box on the belt last so I can put it in the empty canvas bag which stays open because it is stiff.  For a pack of toilet paper, I make a hole in the top with my car key after I take it off the shelf.  I stick my finger in that hole to put the toilet paper on the belt and in my cart.

P.S.  I am grateful to a kind cashier at Shoprite named Michelle.  When no one was behind me in line Michelle waited patiently while I made numerous mistakes during multiple shopping trips.    The ban begins on May 4th.  I am glad I had all of February to find the solutions listed above.  Rehearsal saved me again.  homeafterstroke.blogspot.com

Joint Protection Principles Part 2

Avoid a Prolonged Grasp.  A phone with a head set means my painful sound hand does not have to hold a phone for an hour when I talk to family and friends.  

I have an Accto book holder.  Movable arms (see arrow) accommodate different size books.  A lever in the back adjusts the tilt.  I recently read for half an hour while holding a magazine.  Pain in my hand woke me the next morning before my alarm clock went off.

Lift with the Strongest Joint: I use my elbow to lift heavy objects like

cereal and milk containers.  My painful sound hand acts as a pivot to aim the container opening while my affected arm controls how far I lift the containers. homeafterstroke.blogspot.com

Joint Protection Principles Part 1

I am trying not to freak out because I have osteoarthritis from overusing my sound hand for 18 years.  Xrays confirm I have bone-on-bone contact which causes pain.  I cannot count on another disease killing me before my sound hand becomes useless.  So I am using the pain in my index and middle finger to tell me which joint protection strategies are helpful.  For example, when I put away a stack of clean cereal bowls, it hurts to lift a stack of 3 bowls but not 2.  My hope is that reducing pain means I am putting less stress on my joints which will make my hand useful longer.

Slide Rather Than Lift.  I used to fill up my kettle and then carry it to the stove.  Now I put in water for only 1-2 coffee cups and slide it on a dishrag from the sink to the stove.  No pain.

I use my kitchen cart to roll clean dishes from my dishwasher to the cabinets.  This means I do not have to make multiple trips to carry all these heavy objects to put them away.  I lift dishes from waist height to only the 1st cabinet shelf.  No pain.   

Avoid Repeated Gripping.  I cannot stand to watch the same commercials 4 times every hour for months so I constantly change the TV channels with my remote control.  My remote is not heavy, but my painful thumb and middle finger have to hold it tightly because it wobbles as my painful index finger pushes a button. 
 

Now I place the remote on my palm while my sound hand rests on my couch. When my thumb reaches over to press a button, my palm presses the remote against my thigh which holds it still. No pain.  homeafterstroke.blogspot.com

My Final Insomnia Solution

I hope I have found my final insomnia solution.  I bought a child size weighted blanket.  I was afraid I would not be able to handle an adult size blanket one-handed.  The small size means it covers me only from the waist down.  I do not think I would be comfortable having that extra weight on my chest.  Bottomline: I occasionally wake up at 3:30 A.M., but I sleep 6 to 8 hours most nights.  A friend also ordered a child size weighted blanket and reported the same results.  The calming effect of the extra weight is not just hype.

Goal Oriented Rehab

A study found people in rehab improved more when they worked on goals that were meaningful (1).  There are three kinds of OT goals, but you often see only two of them during an OT session.

1. The Preparation

OTs see many clients who need 100's of repetitions to rewire the brain and rebuild the body.  Examples include opening the hand with help from of a spring-loaded splint and scanning to the left for visual neglect.   

2. The I Shoulds
Many people have the same shoulds.  We all should get dressed so we can visit with others, do laundry so we have clean clothes, write legibly so we can sign credit card slips, and have good memory strategies so we get to appointments on time.  The photo shows my affected hand opening to hold the lint trap.

3. The I Want Tos

"I want to" is something personal that makes a client's face light up - like cuddling with a beloved cat without getting your bare thighs scratched.  Many valued activities do not take place during therapy because they require special equipment or environments.  OTs must link "I should" to        "I want to" so clients can understand what OT is trying to accomplish.  A linking statement might be "don a bra so you will not be embarrassed when you eat lunch with friends."  I live alone so donning my bra enhances my social life.  Or if a homebound client wants to feel the sun on his or her face, an OT can point to pictures or say "leg brace - patio."  homeafterstroke.blogspot.com

1. Lenze ER, et al.  Effect of enhanced medical rehabilitation on functional recovery in older adults
    receiving skilled nursing post-acute rehabilitation.  JAMA Network Open (in press).

Relacing Shoes One-handed

Yesterday's post about tying shoes one-handed means I did not have to push a wheelchair across carpeting with one hand and one foot when I got home.  The door jambs in my house also do not have gouges because it is hard to keep a wheelchair going straight when you do not have 2 hands.

Relace the Shoe: There can be only one free end at the top when you tie shoe laces one-handed.  I have the lace come out of the top hole on the same side as my affected foot.  This dictates which bottom hole I lace through first.    

Adjust Length of the Lace: I wear a leg brace so I need the full length of the shoe lace on my affected foot.  However, the shoe on my sound foot closes more tightly so I cut off 3 inches before I relace the shoe.  Trimming the bottom means I do not have excess lace at the top of this shoe.

Make an Anchor Knot: I put the lace through the bottom hole, leaving a 6 to 8 inch tail hanging out of the hole.  The "tail" gives me something to wrap around my affected hand so I can hold the lace while my sound hand makes a double knot.  I place one knot on top of each other rather than two side-by-side knots like pearls on a necklace.  A scout leader told me this sailing knot holds against great pressure.  Sometimes I leave the plastic aglet at the end of the lace and sometimes I cut it off which creates a tiny fuzzy pom-pom.  Both tuck out of sight (see bottom hole in photo above).  homeafterstroke.blogspot.com.