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.

Tying Shoe Laces One-handed

It broke my heart when I saw a photo of the big toe nail Dean lost because loose Velcro fastenings allowed his feet to slide in his shoes.  I do not want sliding motions when I walk because my hips already hurt from time to time.  I am glad I can tie my shoelaces tightly with one hand (1).        Staying out of a wheelchair is definitely worth the effort.  

Tighten the Lace: If the holes in your shoes are punched through the leather, friction holds the lace in place after you pull on it and let go.  

The lower part of my shoe has D-rings (see bottom of arrow).  At the topmost D-ring I pull the lace tight and then maintain the tension by pressing down with my little finger.  Then I use my thumb and index finger to pull the slack (arched part of lace) through the next hole.        I pull the lace tight in the remaining top holes.

Make a Half Loop:  First my last 3 fingers grab the free end of the lace.  Then I slip my index under the top horizontal lace so my index finger is pointing back at my body.  This allows me to drag the lace under the horizontal lace to create the loop seen in the next photo.

Tighten Lace at Top Hole: The top horizontal lace is loose because my finger was under it so I pull to tighten it (see arrow).  Then I make the messy looking loop neater like in the photo.

Make a Slip Knot: My hand looks fisted while I grab the free end of the lace with my last 3 fingers.          I use my thumb to push the lace through the 1st loop (see arrow) that I created in the photo above.  This creates a 2nd loop.  I pull my thumb free and vigorously yank the loop sitting on the index card from side-to-side to tighten it.  

See tomorrow's post for how I relace my shoes so there is only one free end at the top.  homeafterstroke.blogspot.com

1. Dutton.R.  My Last Degree: A Therapist Goes Home After a Stroke, 2nd ed. Booklocker; 2013. 

Do Not Throw Away Your Bananas

Part of my healthy diet is putting a banana on my cereal instead of sugar.  But there is no "honey do" at my house so to cut down on trips to the store I buy a bunch of bananas.  I live alone so a bunch of bananas turns brown and becomes mushy before I can eat them all.  

To get the bananas off my kitchen counter, I separated them and put them in a container in my refrigerator.              I discovered when I put green bananas in the refrigerator, the peels turn brown but the bananas do not.  

The trick is remembering to put a banana on the counter    1 or 2 days before I want to eat it so it will ripen.            Green bananas are difficult to peel.  homeafterstroke.blogspot.com