Adaptive Equipment for Lower Body Dressing

For people with chronic back or hip pain, congestive heart failure or respiratory difficulties, bending over to put pants on can be a struggle. Many times I have shown my patients to sit and use a grabber (also called reacher) for this task. The grabber gives patients a few extra feet of reach so they can donn their pants without leaning too far forward. Last Fall I had a patient (90 year old woman with congestive heart failure) show ME how she successfully uses her cane rather than a store bought grabber. She used the curved end to hook her pants so they wouldn't fall while she reached down and sure enough was able to donn her pants! After a current patient of mine expressed to me that she did not have the funds to purchase a grabber, I remembered back to my 90 year old friend and shared the technique. She loved it.

Though I thoroughly believe grabbers can be helpful in much more than lower body dressing, I hope this post helps when considering the pragmatics of adaptive equipment training, as money can often be a barrier.

Apps for Kids with Autism

Here's a link to a page with a GREAT compilation of applications for kids with autism made by a elementary special education teacher (Jeremy Brown). There are apps to help kids increase fine motor coordination, understand cause and effect, improve social skills, and even organize daily routines. I could imagine these links would be very helpful for school teachers, school based occupational therapists, speech and language pathologists, caregivers, parents...really anyone who works one-on-one with kids with autism. Conveniently, Mr. Brown organized this comprehensive list and even displayed the cost of each application.

http://www.scribd.com/doc/47441495/Jeremy-Brown%E2%80%99s-App-Recommendations-for-Students-with-Autism

His list is for apple apps, however, I have an android phone and if you search by the names or even just by "autism" or "life skills," you will find lots of other apps. Hope you can use this information or pass it along to someone who might benefit from it.

Technology is a wonderful way for teachers, therapists and parents to connect with kids and this is one more way for us to have fun with and encourage the development of the children we care for.

http://www.wired.com/gadgetlab/2010/04/apple-scratch-app/

International Clinical Educators (ICE)

Jan Davis is an OT who provides clinical education for therapist and professionals working in stroke care. She has great videos up on specific treatment ideas and handling techniques, and a lot of resources and info to keep us all up to date on what we need to know when treating individuals who have survived stroke. She often asks for ideas of new videos we want to see and uses facebook a lot to promote her page. I highly recommend this resource!

http://www.icelearningcenter.com/about-us/jan-davis

Diabetes Management with Low Vision

Low vision is one of my favorite areas to work in, and would love to share some ideas for adapting equipment for diabetes management. Last Summer, I had a patient with diabetes, diabetic retinopathy (resulting in low vision),  neuropathy (pain and numbness in his hands and fingers), and also happened to be somewhat hard of hearing (for starters). Very rarely do I work with patients who have one single medical diagnosis so it's always important to consider all systems. This particular patient expressed to me that he would really like to be able to independently monitor his blood glucose levels as advised by his doctor.

Due to his low vision, the first thing that came to mind was a Talking Glucose Meter. With Medicare, many patients are eligible for free diabetes supplies so with a doctors order he was able to obtain one for free. 

http://www.independentliving.com/prodinfo.asp?number=235721

 

Once the Talking Glucose Meter arrived, I was able to read the (very small) instruction sheet and rewrite the steps to checking his blood glucose in permanent marker on bold and wide lined paper. I later used more of the same paper to make a chart for his to record glucose readings by date and time. Though the device had large print on the screen, the fact that the screen was relatively made it difficult to see so he preferred to put the device directly up to his ear when it spoke a reading--which he heard loud and clear.

http://www.independentliving.com/prodinfo.asp?number=671999 

In order for the patient to draw blood from his finger, he needed to be able to 1) insert a lancet (needle) into the lancet device (finger prick tool), 2) set the lancet finger prick size, 3) line up and prick his finger. Thankfully with practice the only difficult part about this was that spin knob tended to turn to wider/more narrow settings without his knowing. I was able to mark the preferred setting with bright orange fabric paint for him to line up. (I drew a line on the main devise at the start position and the second line on the spin knob along the "3" line. With these bright and raised lines, the was able to ensure the lancet would always make the correct size prick.

 

http://www.libertymedical.com/perfectpoint-lancet-and-liberty-ii-lancing-device

http://www.independentliving.com/prodinfo.asp?number=785320

Due to the neuropathy in this patient's fingers paired with his low vision, the next problem was in  getting the test strip into the small slit of the Glucose Meter. To solve this problem, I used adhesive white bumps on either side of the small slit as both a visual cue (high contrast of white bumps on dark gray Glucose Meter) and a tactile guide for the strip to fit between.

 

http://www.independentliving.com/prodinfo.asp?number=730152

With these adaptions and lots of practice with supervision, the patient was able to reach his goal in a matter of two weeks!

*Even with specialized equipment, it is important to remember that creativity and personalization can still be necessary in order for one to safely and effectively use diabetic testing supplies. This particular patient was not insulin dependent at the time however, check out http://www.shoplowvision.com/catalogsearch/result/?producttype=&q=insulin&x=0&y=0 for equipment which may make drawing and injecting insulin safer and easier for someone you know with low vision.

Really Helpful Patient Handouts

When I am teaching a new idea, technique or principle to a patient I have found handouts to be really helpful. The whole point is for carry-over from therapy to everyday life and since I am not there all the time, a quick picture and explanation has proved very helpful. Here is a link I use all the time that I hope you find useful!

Ohio State University Medical Center Patient Education Materials


Some of my favorites are:
*Do's and Don'ts with Low Back Pain
*Using Equipment to Help in Daily Activities After Your Total Hip Replacement
*Activities to Improve Fine Motor Coordination in Hands
*Putting on a Button Up Shirt with One Hand
*Doing Daily Activities with One Hand

Hunting and Fishing with Disabilities

I recently had a patient with a below the knee amputation who when I asked, "What sorts of things do you want to work on getting back to?" responded, "Hunting, fishing, playing outside with my kids."  At first I really believe he was saying these things to be sarcastic (although to me these are completely reasonable goals, I'm not sure at this point he realized they were attainable). To his surprise on the next visit (with the guidance of a local Physical Therapist Assistant), I brought him a nice stack of print-outs on handicap accessible fishing sites in his area and information on obtaining a hunting license for people with disabilities. He accepted it, smiled, and said, "I never knew there was such a thing." Until the day I searched and found these resources on the website for the state's Division of Natural Resources, neither one of us knew they existed.

Take home messages:
*Don't let patients give up on the things they love
*Ask locals for advice
*Google is your friend
*Check out your state's website on the Division (Agency) of Natural Resources or Department of Fish and Wildlife for info on hunting/fishing options with disabilities