November 2020 – Knowledge in Neuro

Kitchen Hacks

November 29, 2020November 29, 2020NMccantsPTLeave a comment

Cooking, cleaning and preparing meals in the kitchen can pose unique challenges to anyone with mobility impairments or difficulty using their hands or arms. Sharp knives, unusually shaped fruits and vegetables and suddenly boiling pots keep you on your toes (or wheels) in the kitchen. Just because you don’t have full use of both hands, however, doesn’t mean you can’t be a whiz in the kitchen. It may take a bit more time to get the job done but with patience, ingenuity, help from a friend or family member on occasion, and the proper equipment, there will always be a place for you in the kitchen.

While there are probably many more creative hacks to make time in the kitchen more efficient and enjoyable take a look at some of the options found below!

**IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Utensils:

Rocker knife: The T-Grip Rocker Knife allows the user to grasp the handle and rock the blade back and forth across the food, eliminating the need to saw back and forth.

T-Grip Rocker Knife

Built Up Utensils: the handles on these utensils have a larger circumference which makes it easier to grip and hold them. You can purchase a set of utensils pre-made with larger handles such as these: Vive Adaptive Utensil Set or you can purchase tubing such as Foam Tubing Grips to Make Built Up Utensils Handles and add it to any slender tool or utensil in your home.

Curved Silverware: for those with limited hand/wrist range of motion or spasticity this type of utensil can direct the food into your mouth more easily and comfortably. Note: these come in left- and right-handed styles to pay attention when ordering.

Parsons ADL Comfort Grip Curved Utensils, Soup Spoon, Left

Universal Cuff: great for anyone with hand weakness or limited dexterity, the universal cuff straps around the hand and on the palm side allows for any long household item such as a fork or knife, comb or toothbrush to be held into place for use. If more support at the wrist is needed to keep it extended consider a universal cuff/wrist orthosis combo like this Standard Wrist Orthosis with Universal Cuff. If the user has some stability in the wrist already the smaller version that fits just around the hand such as Norco Universal Quad Cuff may be more appropriate

Liftware Tremor Utensils: these devices were designed to adjust to the amplitude of a hand tremor to try and stabilize the surface of the spoon or fork to allow for easier transfer of food from plate to mouth. Some people are better candidates than others and with a hefty price tag research into the device is a good idea before purchasing

Liftware Steady Starter Kit for Hand Tremor

Cooking tools

Single-handed cutting board: The Single Handed Cutting Board is designed with a barrier in one corner of the board against which items like a sandwich can be stabilized. They also include a number of spikes onto which items like fruits or vegetables can be applied so they don’t move while you cut them.

Adaptive Kitchen Workstation: this multifaceted device suctions to the countertop to prevent slipping. It allows you to stabilize a variety of items for slicing, grating or chopping and provides a nonslip place for bowl to sit while mixing. The Cutting Boards For Kitchen And Meal Prep, Adaptive Wood And Plastic Cutting Board, Kid-Safe Chopping Board comes with good reviews of its efficacy.

Jar openers: These come in various sizes and shapes and can help open stubborn jar tops. Whether you lack the strength to grasp it tightly or the use of second hand to stabilize the jar these tools can be a lifesaver. Here are a few examples: The Grip Jar Opener: The Original Under Cabinet Lid Opener, Electric Jar Opener, Kitchen Gadget Strong Tough Automatic Jar Opener , Jar Opener Can Opener Bottle Opener

Cut Resistant Gloves: These can be a lifesaver, or finger saver in this case. Cut resistant gloves are made with specialized materials to protect the skin against the sharp edge of a knife blade, grater or mandoline slicer. If you don’t feel like you have the steadiest of hands or greatest coordination these gloves can bring confidence in the kitchen.

NoCry Cut Resistant Gloves

Herb mincer/food chopper: can chop small herbs or food like garlic into small pieces using one hand. You can purchase rolling options like this one: Simposh Mini Chopper or cylindrical ones that you press down on like this one: ZYLISS FastCut Herb Mincer

Other Helpful Items:

Lap Desk for Wheelchair Users: A simple LapGear Mydesk Lap Desk can be a perfect workstation for prepping food from your wheelchair. Consider the material it is made of to ensure you can clean an sanitize it easily between uses.

Kitchen Roll About: The Kitchen Roll About is a wheeled trivet that allows you to move heavy and hot pots or dishes along the countertop without having to lift them

Nonslip Mats: stabilize plates, bowls, cutting boards or other items

gasare, Extra Large, Thicker, Silicone Mats,

Suction cup plate: The Ableware Scooper Plate with Suction Cup Base for example, adheres to the table to prevent spilling or slippage of the plate during meals

Photo by RODNAE Productions on Pexels.com

Hittin’ the Gym: Adaptive Exercise Equipment

November 25, 2020November 25, 2020NMccantsPTLeave a comment

It is no surprise that health and fitness remain top priorities for persons with movement impairments. As mobility declines, one’s risk for developing chronic conditions such as heart disease, diabetes or hypertension increases which can add another layer of disability and further impair quality of life. Physical impairments such as difficulty or inability to walk, difficulty using the hands or upper extremities, impairments in balance and so forth can pose a challenge when it comes to going to the gym or participating in an exercise routine.

The good news is that with a little creativity there are almost always ways to participate in physical exercise that meet your individual needs and abilities.

According to the Physical Activity Guidelines for Amercians 2nd edition, adults with disabilities or chronic conditions should be getting 2.5 to 5 hours of moderate intensity or 75-150 minutes of high intensity activities throughout each week (or a combination of both). Additionally, those that are able to do so should aim to complete at least 2 bouts of strengthening exercises involving major muscles each week (Physical Activity Guidelines for Americans, 2018). In these cases it is important to first get clearance from your doctor that it is safe to begin an exercise plan and then consult with an exercise specialist or physical therapist to attain an individualized exercise program.

If you are ready to begin exercising many states have adaptive fitness centers outfitted with equipment that might be tailored to your needs. If you are looking to use your local gym facility or stock your own home gym these are examples of equipment that can be used to get you on the path to health and fitness.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Aerobic Conditioning

Recumbent bike/ seated elliptical: a great option for cardiovascular training for those who aren’t confident or able to walk for exercise but can move their legs well enough to use the bike. The Vanswe Recumbent Exercise Bike is a great option for those looking for a reasonable price and good adjustability. The recumbent seat fully supports the back to limit challenges to balance or core strength. Pro tip: if transferring into and out of the seat poses a challenge, look for a model like the HCI Fitness PhysioStep Recumbent Elliptical with Swivel Seat that has a swivel seat that will turn 90 deg to the side to allow for easier access. While certainly pricier, it is likely a better investment than a cheaper model that will end up sitting in the corner collecting dust because it’s too difficult to get in and out of it.

Ski ergometer: this upper body exerciser that can be used in sitting or standing, focuses on building strength in the posterior shoulder and trunk muscle which is important for healthy shoulders and neck especially for wheelchair users. The Concept2 SkiErg is a common model found in some fitness centers but with its narrow design could easily be used in the home too.

Concept2 SkiErg

Vita glide: seated upper body exerciser targets the chest muscles, the shoulder muscles and upper back. The Vita Glide consists of alternating push/pull with the upper extremities and can be used while sitting in a chair.

Upper Body Ergometer (UBE): think of a bicycle for your arms. This device sits on the tabletop and you use your arms to move the pedals forward and back while you sit or stand. These devices range in price and adjustability such as the more basic Vaunn Medical Folding Pedal Exerciser which is fully powered by your arms (or legs) and in comparison the Exerpeutic 2000M Motorized Electric Legs and Arms Pedal Exerciser which actually has a motorized assist program which helps you to move through the full cycle

Exerpeutic 2000M Motorized Electric Legs and Arms Pedal Exerciser

FES bike: FES stands for functional electrical stimulation. While this device comes at a hefty price and is most often seen within rehabilitation clinics some home options are available. This device uses electrical stimulation delivered to the muscles timed with the cycling of the bike to help re-educate muscles through an external stimulus. This device requires training to learn the proper set up and dosing and you should talk with your doctor or therapist to determine if you are a good candidate as any electrical stimulation can carry risks for certain people. The Christopher & Dana Reeve Foundation has a great resource on FES bikes for home use.

Easy Stand Glider: The Easy Stand Glider is a mix between an elliptical and a standing frame. The user can transfer into the seat easily and then through a variety of straps and supports the device will help them into a supported standing position at which point arms and legs can be moved as though standing on an elliptical. This device gives all the benefits of standing with the addition of exercise!

Pedal exercisers: lower extremity exercisers that look like either bike or elliptical pedals. The device can be placed in front of any chair or wheelchair and allow for cardiovascular and leg training. See the links in the Upper Body Ergometer section to see examples of the cycling style and check out this link to see the under desk elliptical style Sunny Health & Fitness Under Desk Elliptical

Wheelchair roller trainer: think of this as a treadmill for a wheelchair. Set up like an indoor trainer for a bicycle, this device allows a manual wheelchair user to simulate forward or backwards motion while remaining stationary. Some models even allow for modification of resistance to allow for greater challenges. These are available for standard manual wheelchair and for some sport or racing chairs. The McLain Wheelchair Trainer is an excellent example of this equipment.

Strengthening

Active Hands: This is an awesome company that creates gripping aids for persons with weak or insufficient grasp or hand strength. The General purpose gripping aid, Looped Exercise aids and Hook aids can be used with most handles, barbells, dumbbells and other strengthening equipment in a commercial or home gym to secure your grasp.

General Purpose gripping aid

Cuff weights: these weights can take the place of a traditional dumbbell and provide resistance to arms and legs without worrying about having to hold onto the weight. You can buy them in a set of various weights such as the The Deluxe Cuff Ankle and Wrist Weight – 7 Piece Set or individually depending on what you need (BalanceFrom GoFit Fully Adjustable Ankle Wrist Arm Leg Weights)

Medicine ball with strap handles: hands can be inserted into the handles and the straps can be fastened tightly to compensate for weakened grip

FitBALL MedBalls with Straps – 6 lb –

Resistance bands: these bands come in different resistances and provide variable resistance to strengthen muscles throughout the body. Loops can be tied into the ends of the band if grasp is difficult. Bands can be secured to a door or other areas of the home as well to allow for different muscles to be targeted. Bands such as these AZURELIFE Resistance Bands, are a good example.

Rickshaw: The CanDo Rickshaw Rehab Exerciser strengthens arms and shoulders from a seated position. Weight plates can be loaded on the opposite side to increase or decrease resistance.

CanDo Rickshaw Rehab Exerciser

Other Accessories

Push gloves: often used by individuals with high level spinal cord injuries but also useful for other wheelchair users, push gloves provide additional grip to decrease effort and increase efficiency of pushing the rims of the chair. Useful for everyday use and athletic endeavors. Prime Wheelchair Gloves Protective Gear Mobility Quad-Push Gloves

Elastic straps: For those with weakness in their abdominals or trunk, elastic straps such as these placed around the upper trunk and the back of the chair can better enable the exerciser to lift weights and move their upper body against resistance.

Bodypoint Universal Elastic Strap for Wheelchair

Bibliography

Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, Compiler; 2nd ed.). (2018). U.S. Department of Health and Human Services. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

On the Road Again Part 2: Equipment and accessories for driving

November 5, 2020November 5, 2020NMccantsPT1 Comment

If you haven’t read Part 1 of this segment I recommend starting there. In this segment I am going to discuss examples of accessories and modifications that can be made to a vehicle to make it more accessible and to compensate for impairments such as difficulty transferring, needing to remain in a wheelchair or bring it with you, hand or leg weakness and more.

As mentioned in Part 1, there are several websites that can help you get connected with a mobility equipment provider in your area and a Certified Driver Rehabilitation Specialist (CDRS). The CDRS will not only test your fitness for driving but will also make recommendations for adaptive equipment, provide opportunities to train and practice with the equipment and connect you with a local vendor.

adaptive driving — Photo by Lu00ea Minh on Pexels.com

Keep in mind, the photos and links below are meant to provide an example of what is available to you but is not promoting any specific brand or manufacturer. Additionally you should always consult a licensed mobility dealer to install, train and select appropriate adaptive equipment for your vehicle.

Wheelchair Van/SUV/Truck

A wheelchair van or vehicle is a vehicle purchased from a dealer that is converted to be wheelchair accessible. These vehicles may provide side entry or rear entry and typically involve a lift or ramp to access the vehicle. In this instance the wheelchair is meant to stay inside the vehicle during transportation either in the passenger or driver position.

Scooter/Wheelchair Lift

These are mechanical lifts that raise your wheelchair or scooter off of the ground for either storage inside or outside of the vehicle during driving. Several options are available to transport the vehicle just behind the trunk to allow for full use of the interior space while others will actually transfer the chair inside the vehicle. There are even lifts that will hoist a chair into the back of a pickup for transport.

Check out the Mobility Works website for visuals and in depth information about these different types of lifts

Wheelchair Ramps

Wheelchair ramps extend out from the back or side of the vehicle to allow the driver to enter the vehicle in their chair or for someone to assist by pushing the chair, sans passenger, into the vehicle for transport.

Tie Downs

The main purpose of tie downs is to secure a wheelchair in place inside the vehicle and allow an occupant to safely ride as a passenger or drive the vehicle from inside their chair. There are 3 main types of tie downs: manual, retractable or automatic and should be installed by a certified mobility dealer. The manual and retractable tie downs consist of a 4 point strapping system (2 in front, 2 in back). These two options require the wheelchair user to have a companion or assistant present to attach the tie downs to the proper position on the chair and then ensure that the straps are tight and secure. The automatic tie downs consist of an attachment on the bottom of the chair that allows the user to simply drive their chair into a channel locking system installed in the floor of the car which locks it into place. A button is then pressed later on to allow the user to disengage. Not every chair can be utilized with this type of system. Because of the dangers of serious injury in the case of a car accident or unexpected movement of the car it is vitally important that proper training by a certified professional be undertaken for anyone who will be involved in using these or installing these devices.

Mobility blogger Katie Cummings writes an informative piece comparing different tie down systems in this blog.

Hand Controls

Hand controls allow a driver to accelerate and brake using their hands instead of their feet and are available in left and right hand controls. These devices are great for anyone who has fair to good dexterity in their hands and arms but poor sensation, coordination or strength in their lower body.

Extension Controls

Extension controls allow the driver to better reach foot pedals, turn signals, gear shifters, parking breaks or any other levers needed to operate the car. If you think about where in your car these levers are typically located you can imagine it would be difficult if you could not use the hand on that side to operate the lever or could not reach far enough to access it easily. These accessories can provide better access to each of these mechanisms

Mobility Innovations is one company supplying a variety of extension controls to adapt your vehicle.

Left Foot Accelerator

As a physical therapist in a neurologic rehabilitation setting I have come across many people who have had a stroke or brain injury, for example, that affects their right leg making it difficult or impossible to access the accelerator and break. Sometimes these folks take it upon themselves to switch to using the left foot. If you’ve ever tried to hit even the break with your left foot while driving you will quickly realize, if you have been driving for some time, that your left side often is not nearly as coordinated for this task until you have had a lot of practice. Additionally, reaching across to the accelerator on the right side is difficult and frankly, unsafe. So in this case the left foot accelerator may be the hero of the day. With the accelerator on the left side one can easily use their left foot in place of their right. The good news with this is that is does not eliminate the right foot accelerator and a toggle or other mechanism can be utilized to switch back and forth which allows another driver to use the car in its traditional set up.

Spinner Knobs and Steering Wheel Accessories

If grasp is an issue for you there are ways to adapt and change the steering wheel to ensure a safe and secure grip. These accessories mount onto the steering wheel and provide alternate ways to secure the hand to the steering wheel. For example, an amputee driver ring provides a place for an amputee to secure a hook prosthetic onto the steering wheel while a Tri Pin consists of 3 pins in a triangle formation that one can slide their hand into allowing for stabilization of the hand and wrist onto the steering wheel. Once again, a certified mobility equipment provider or CRDS is the best person to help you decide which accessory is best for you.

Turning/Swivel Seats

Imagine if your car seat could turn 90 degrees out the door of the car and then simply lower down until your feet hit the floor. Picture being able to simply turn and sit right down onto it without having to try and scoot inside the vehicle. Helpful right? Well this convenience actually exists in the form of turning or swivel seats. These are car manufacturer specific and need to be installed by a trained professional but can make transfers into and out of the car exponentially easier.

Check out the Turny Evo by BraunAbility as a great example of this car modification.

Electronic Driving Aids

This is where the magnificence of modern technology meets the adaptive driving world. Electronic driving aids allow a user to perform tasks such as acceleration or brake, turn signal operation, gear shifting, operating wipers, fan controls, ignition and lights with the touch of a button. Gas, brake and steering can even be controlled with a joystick in some instances. As you can imagine, this specialized equipment can open up driving to almost anyone that has the cognition and desire to gain independence in driving.

Once again, Mobility Works has a great list of available Electronic Driving Aids for you to look through.

Photo by ThisIsEngineering on Pexels.com

On the Road Again: Options for driving adaptations

November 2, 2020November 5, 2020NMccantsPT1 Comment

For many, cars are their primary mode of transportation. Whether you are a driver or a passenger, being unable to access your vehicle can be a huge hit to your independence. Examples of issues that may prevent someone from driving easily or at all include having difficulty grasping and manipulating a traditional steering wheel, being unable to use the right foot on the gas/brake pedals; need for more trunk support than a traditional car seat provides or difficulties transferring into a car seat. As a passenger, being unable to transfer and to sit in the car are two possible roadblocks for using personal transportation versus an accessible ride service.

Whether you are a teenager learning to drive for the first time or a seasoned driver hoping to stay or get back behind the wheel, there are many options to adapting a vehicle to make it more accessible.

A great first start to this process is seeking out an Occupational Therapist or Certified Driver Rehabilitation Specialist (CDRS) that can assess your fit to drive. Vision, cognition and neuromotor control are some of the areas that will be assessed and the tests administered will give an indication if you are ready to hop behind the wheel in a regular car with no modifications, undergo training and assessment for appropriate vehicle adaptations or if remediation efforts such as additional therapies or other practice needs to be implemented first.

Options for driving adaptations — Photo by Claire Toribio on Pexels.com

To locate a Certified Driver Rehabilitation Specialist or mobility equipment dealer in the United States, The Association for Driver Specialists website (ADED.net) is a great resource.

Insurance does not often provide coverage for these items but some programs like Workman’s Comp, Vocational Rehabilitation or the VA may. Some car manufacturers offer Manufacturer Rebate Programs if you buy or lease a new car from them which will provide money to fund vehicle modifications to that car. Additionally, you may find small grants to be available through disease or injury-specific organizations and associations.

Below is a list of examples of different modifications and adaptations that can be made to your vehicle. Check out On the Road Again Part 2 for more details about the equipment.

Wheelchair lifts

Ramps

Tie downs and locking mechanisms to ride in or drive from wheelchair

Hand controls to operate the gas/break

Swivel seats for transferring into/out of car

Parking brake extension

Turn signal crossover

Spinner wheel

Left foot accelerator

Electronic driving aids

**The Adaptive Driving Alliance provides a list of consumer resources to assist you in your mobility product decisions.

***Bonus! Take a listen to the Rehabilitation Reimagined Episode 6 with Lea Bertoni, OTR/L, CDRS from Driving to Independence to learn more about working with a Certified Driving Rehabilitation Specialist!