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