Reading One-Handed

After my stroke I still enjoy reading, but holding a book one-handed is tiring and frustrating.
I am glad I found a book holder that works for every size book.  The clear plastic page holders (see black arrow) move in and out so they adjust to thin and thick books.

The easel arm is also adjustable.  I release the lock (white arrow) and tilt the book holder so it is more horizontal or more vertical.  This gives me a good reading angle regardless of the size of the book or the resting surface I am using.

I found this Actto book holder at amazon.

homeafterstroke.blogspot.com

Working Smarter Instead of Harder

I get reader's fatigue when they read my long procedural posts like Bathing Can Be Exhausting,
I Am the Queen of Velcro, Applying Make-up One-handed, and Things You Don't Learn in Driving Rehab.  However, modifying even 1 or 2 steps makes life easier which reduces frustration.  The good news is repetition turns long adapted procedures into a routine I do not have to think about.  Repetition is a gift that keeps on giving.    homeafterstroke.blogspot.com

Eyedrops After Cataract Surgery

People who do not have someone to put drops in their eyes four times a day need help.  Task modification helped me succeed after my recent cataract surgery.  It is easy to drop a tiny 5 ml bottle.  It is also difficult to squeeze the stiff sides of a tiny bottle.  I am glad I found the Autosqueeze Eye Drop Bottle.  The big wings are easy to hold and require only a gentle squeeze.

Before I lie down on my bed I gather two bottles of eye drops and a Kleenex tissue.  I put a pillow on my chest (not stomach) and put my sound elbow on the pillow.  This support makes my hand remain steady instead of bobbing around as I hold the bottle in the air.  To stop myself from blinking I distract myself by looking through the opening formed by my thumb and index finger instead of the bottle.  I try to get the drop in the inner corner of my eye.

When I put the cap back on I need to stop my hand from bobbing up and down and accidentally touching the tip of the bottle.  I keep my hand still by pressing my elbow firmly against the pillow.  homeafterstroke.blogspot.com

Pain Scales

My knee surgery has been delayed.  I used some of my time to document pain levels.  Dividing pain into mild, moderate, and severe is not enough to identify 10 different levels.  Noting whether pain was intermittent or constant was helpful.  It helped to document when pain disrupted my Activities of Daily Living (ADLs) and how much pain reliever I took.  At 6-10, emotional distress added further refinement.  Here are the 10 levels of pain I have experienced over a lifetime.

1.  Have to think to recall if I had Mild  Intermittent pain during the day.
2 . Spontaneously aware of Mild  Intermittent pain throughout the day.
3.  Mild  Constant pain.  650 mg Tylenol at bedtime.  Must do some ADL tasks differently
     (e.g. walk down stairs backwards).
4.  Moderate  Intermittent pain.  Added 650 mg Tylenol in a.m. because I ache before I get up.
5.  Moderate  Constant pain makes me achy and exhausted by the end of the day.
     Worried about what 9 months of Tylenol is doing to my liver.
6.  I cannot tolerate Constant  Moderate pain much longer.  Irritable!! 
     Need 2 attempts to do some ADL tasks (e.g. stand up).
7.  Severe pain makes me afraid I cannot finish a task (e.g. thought about leaving loaded cart in

     the grocery store and going home).

8.  Severe pain makes me say "Ow that hurts" but I am able to remain still.
9.  Severe pain makes me Yell "OW" and I jerk involuntarily.
10. Excruciating pain: Not able to make any sound because I cannot exhale or inhale.
        homeafterstroke.blogspot.com

Handicapped Bathrooms Are Badly Designed

Handicapped bathrooms in hotels I have stayed at since my stroke are poorly designed.  

The most common error is placing the towel rack on a wall ten feet away from the tub.  It may be dangerous for a companion to turn his or her back on a disabled person and walk across the room to retrieve a towel.  I solve this problem by dragging the luggage rack into the bathroom.  I place my towel and bathrobe on the rack where I can reach them while sitting on my folding shower stool.  In a regular room I place my towel and robe on the lid of the toilet seat which is often super close to the tub. In a handicpped bethroom the toilet is far from the tub to make room for a wheelchair.

I ran into two unique problems at one hotel.
1) The shower curtain was so short and hung on a rod that was so far away from the edge of the tub I could see a speckled beige bathroom tile floor when I looked down.  A wet floor is a Fall Hazard.  Before I got in the tub I put a bath towel on the floor to soak up the water that fell through this gap as I showered.  A cheap solution is to purchase longer shower curtains that can be tucked inside the bathtub.

2) When I detached the shower hose to use in sitting, I had to turn off the water while soaping up because letting the nozzle hang free let it point outwards to spray water on the floor (photo on left).  A wet floor is a Fall Hazard.  

These negative experiences taught me to stop asking for a handicapped bathroom when I travel.  homeafterstroke.blogspot.com

What Therapists Do Not Know About Falling

I recently heard a doctor on TV say elderly people should not look down when they walk.  He said using vision to prevent falls weakens the balance system.  Yet stroke survivors look down because even tiny obstacles can be dangerous.  Here is an example.  I had a terrible fall while walking on a slate walkway.  I fell after I stubbed my toe on the edge of a tile that was tilted up about an inch. Thank God I did not fall forward and smack my forehead on the slate sidewalk.  I instinctively dropped my cane and threw my sound arm forward to try to catch myself.  This sudden arm movement rotated my body slightly to the right so I fell on the grass.  I hit the ground so hard I had dirt and pieces of grass caught under my glasses after my face hit the lawn.

Therapists may not know how violently stroke survivors can fall.  Human subjects committees would not allow researchers to put test subjects on a tilt plate that can cause a sudden fall without first putting test subjects in a safety harness.  PTs have to be conservative when they walk stroke survivors because they cannot have anyone fall on their watch.  homeafterastroke.blogspot.com

Tiny Habits

Fogg explains how to make my life easier after a stroke (1).  He says Behavior = Motivation + Ability + Prompt (MAP).  Motivation is unreliable because it comes in waves that vary from day to day, morning to evening, and even minute to minute.  Motivation also fails because it is usually attached to outcomes like saving $500.  An outcome is not a behavior I promise to do.  Finally, motivation can be highjacked by the "go big or go home" philosophy.   

A is for ability which is how much skill the task requires.  Stroke survivors and caregivers can find ways to make a task easier by reading blogs and books written by stroke survivors (see About Me page and my Blog List on the right side bar).  Although I am an OT sometimes I need help solving a problem.  However, an OT or PT evaluation never identifies all my concerns.  I start every new round of therapy by walking in the door with a list of problems I want them to solve.

P is for prompt.  Prompts like to-do lists and calendar alerts on my iphone are SO easy to ignore.  Fogg and I believe in the power of established routines to trigger a new behavior.  The tricky part of using an established behavior to prompt a new behavior is finding what Fogg calls the trailing edge of an old behavior.  For example, I kept forgetting to put drops in my eye after eating breakfast.
I did not succeed until I discovered the last thing I do after breakfast is rinse my cereal bowl.
Now I rinse the bowl and think about using eyedrops to rinse my eye after my recent cataract surgery.  "After breakfast" was too vague.   homeafterastroke.blogspot.com

1.  Fogg BJ.  Tiny Habits.  New York: Houghton Mifflin Harcourt; 2020.

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 instead of eye liner 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 in the photo.  But I had to change to a non-irritating brand of mascara that comes with a funky handle.   

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).    So 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 too poor for me to lean over to be close to a bathroom mirror.  Years ago I put florescent lights on the mirror over my dresser and put a mirror on my dresser.  Leaning my sound elbow on the edge of the tall dresser gives me control when applying eye make-up.  A food container keeps make-up organized.  A small round container holds vertical objects upright.  It does not fall because it is clipped to the square container with a metal binder clip (white circle) from an office supply store.

A piece of non-slip shelf liner stops eye shadow and face powder from sliding when I sweep side-to-side.  I did not know age would rob my lips of pink color.  They are now 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 my face when I look in the mirror.
homeafterstroke.blogspot.com

Solutions for My Extreme Sleep Deprivation

I have had insomnia all my life, but my stroke brought this problem to a new level.  I had a stroke in the brainstem which puts us to sleep and wakes us up. Since my stroke I have repeatedly had nights where I get only two hours of sleep per night.  When I did not sleep and did not feel sleepy for two days I FREAKED OUT so I got aggressive about addressing this problem.

Daytime routine.  I avoid caffeine after lunch time.  This meant changing to decaffinated iced tea for dinner and drinking water when I eat out at night.

Bedroom environment.  I sleep in a dark bedroom with no TV.  The alarm clock is placed where I cannot see it.  Sometimes I wake up and find I am sweating.  So I lowered the room temperature because a lower body temperature tells the brain to sleep. 

Preparing for bed.  If I am sleepy at 9 p.m. I go to bed.  If I wake up in the middle of the night at least I have slept for 4 or 5 hours because I went to bed early.  If I am still wide awake at 10 p.m.
I go to war.  I turn off the TV, wash my face and brush my teeth, and come back to the living room to listen to a calming CD.  If my body aches I take Tylenol.  The constant burning in my hemiplegic foot keeps me awake so I provide a competing sensation by taking a warm gel pack to bed.

Back up plans.  (1) If I lay in bed and cannot fall asleep, I get up and eat a tiny bowl of cereal with milk.  (2) If I wake up at 3 a.m. to go to the bathroom and cannot fall asleep, I get up and turn on a calming CD or a fan at a low volume for background noise.  These back up strategies work only IF I realize I have been lying awake for an hour or more.  homeafterstroke.blogspot.com

Sitting In the Dark

I live alone so when the electricity goes out 2 to 3 times a year I have to handle it.  My stroke took away my ability to know where vertical is unless I can see my surroundings.  So I put flashlights in every room.  My plan worked until last night when the house went completely black while I was watching TV at 10 p.m.  I reached down for the flashlight on the floor next to my couch.  I started to freak out when I could not find it.  The electricity has gone off for hours in the past and sitting on my short couch until sunrise would be awful.  I finally found the flashlight, but after the lights came back on I moved it to the tray on my couch that holds my remote control devices.  

Thank God I have another flashlight on the counter directly behind the place I sit at my kitchen table and a flashlight on the floor right next my computer desk.   homeafterstroke.blogspot.com