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.

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

Are Sadness and Anger Bad?

The holiday season often evokes strong feelings.  I used to think positive emotions like joy and love are good while negative emotions like sadness and anger are bad.  Now I believe that how I react to my emotions is what is good or bad.  When I let moments of joy fly past me unnoticed because I am pre-occupied by internal mental chatter it is bad.  When I stop what I am doing and take a few seconds to appreciate when I am happy it is good.  When I rerun upsetting episodes in my head it is bad.  When I use anger to propel me towards a solution it is good.

When I was young I had the tremendous energy it takes to sustain emotional drama.  A stroke took away the energy I need to stay upset for a long time.  Being snubbed recently reminded me of how intense emotions can be.  I was upset the day I was snubbed.  By the next day -- not so much.        By the third day I remembered letting this person upset me gives her power.  By the fourth day I remembered I was upset for decades when I was young but can not remember most of what upset me.  Hence the irritating platitude -- this too shall pass.  

How I react to my emotions is a conscious choice, but I forget this again and again.  Fortunately, as I get older I remember this insight sooner and suffer less.  homeafterstroke.blogspot.com

Walking in Snow with a Cane

Warning: I do NOT use my cane to walk through snow.  I wait until a neighbor I pay shovels my walkway and digs out my car.  I must be able to see the ground to tell if there is an icy patch that could make the spikes of my Briggs Ice Cane/Crutch Attachment slip.  Checking the ground for ice slows me down, but it gets me to my car safely so I can drive.

The photo shows the attachment in the up position to keep it out of my way.  I bought it at a medical supply store near my home.  The advantage of buying it in a store instead of on-line was the saleswoman got out a screwdriver and fastened the device to my cane.  














To lower the prongs, I place the cane in my affected hand and my sound hand pushes the device down until I hear it snap into position.

The device makes my cane slightly heavier which slows me down which is not as bad thing.

I use a different cane during warm weather rather than take this device off and try to put it back in the same place each winter.  homeafterstroke.blogspot.com

Glad I was a Therapist Before I was a Professor

I am glad I worked as a therapist before I became a professor.  School creates a false sense of security.  If you do not know the answer, you can ask teachers what they think the right answer is.  Book learning is a good place to start, but it does not tell you what to do when some clients do not respond to treatment that works well for many clients.  Therapists are humbled when they have to say "I don't know" when information taught in school does not work.  Therapists have to generate their own solution and watch carefully to see if it helps.

In school you learn information in one unit and then move on to the next unit.  However, the right thing to do in the clinic is a moving target that keeps changing as the client improves.  I was reminded of this when my in-patient PT said I was getting better.  I complained that walking was not getting any easier.  She said she was helping me less.  I never thought to tell my clients this either.  homeafterstroke.blogspot.com

Keeping My Christmas Spirit

This is a photo of the artificial Christmas tree my friend John put together every year since my stroke.  Placing a small folding chair next to this big tree meant I could sit close and lean forward instead of leaning down to decorate the bottom half.  However, decorating this six foot tree is tiring.  Since fatigue is one of my triggers for falling I ordered a small table top tree.

I enjoy seeing the 3 kings, shepherd, and sheep visiting the Christ child.  I made these figures years ago when my hobby was needlecraft.  I also love the tiny pink and blue Christmas tree balls.  I am amazed by how happy small things make me.

After two years I gave my big tree and normal-sized decorations to my church for their annual sale that raises money for local charities.    homeafterstroke.blogspot.com