DME

Blog posts of '2015' 'October'

Tremors can affect those living with Parkinson’s, Multiple Sclerosis, Strokes and Traumatic Brain Injuries.  Some tremors are slight and have little impact on day-to-day living. But others are more pronounced, and can affect every day activities, such as eating, dressing, shaving, writing etc.

Living with a persistent tremor can be difficult and it can also be exhausting, as these continuous movements use energy in the same way as voluntary actions do. Severe tremor’s can have a significant impact on your independence.

Here are some simple tips and some equipment that can help you with everyday tasks.

Dressing
to make dressing easier avoid clothes with buttons or fiddly zips.

Make up
If your tremor makes applying mascara too difficult consider an eyelash tint.

Kitchen
Boil veges in a wire basket so you don’t have to lift a heavy pan full of hot water.
Use a food preparation board to hold food steady.
Use pre-chopped or frozen vege to reduce the amount of food preparation.
Use a “perching Stool” so you can sit/perch rather than stand to do daily tasks.

Eating /Drinking
If your tremor affects holding or reaching swap spaghetti or soup for a sandwich which may be easier to manage.
Use an independent feeding aid such as the “Neater Eater”.
Use a two handed or weighted cup.
Use weighted cutlery.
If you find it difficult to hold a drink without spilling it consider using a straw so you don’t have to lift it.

Computer
Consider using voice recognition technology if typing is difficult.
You can also get a reduced sensitivity mouse.

Writing
Use a weighted pen (fatigue can be an issue though).

Dynamic Movement Orthosis
Utilising a custom made lycra orthoses can help stabilise and control movement.

Remember to talk to your healthcare professionals, your Occupational Therapist and Physiotherapist will be able to assist you with many more helpful tips and suggestions to make living with tremor more manageable.

The shoulder is the most common site of pain reported by the wheelchair population. More than half of all people with weight bearing shoulder  develop shoulder pain. 

The length of weight bearing and wheelchair use correlates with the development of shoulder pain (that is, the longer you have been using a wheelchair the more likely you are to develop pain).

Weight bearing shoulders are more prone to injury as a result of:

  1.        the repetitive nature of wheelchair propulsion
  2.        the high-strength requirements placed on the shoulder muscles
  3.        loading of the joints at extremes of motion
  4.        muscular weakness or imbalance
  5.        high internal joint forces and abnormal stresses applied to the subacromial area during weight bearing through the shoulder, wheelchair propulsion and transfers.

 

57-65% of manual wheelchair users have Rotator Cuff Tears  as shown on MRI

Up to 75% of wheelchair users have radiographic changes in the shoulder joint

30-75% of wheelchair users develop upper extremity pain at some time

 

 

You can decrease your risk for injury by ensuring  you reduce the amount of loading or resistance to the stroke for wheelchair propulsion. One simple way is to minimize the weight that has to be overcome with each stroke. With regard to the wheelchair, simply choose the lightest chair possible.

 

Other considerations in the weight of the wheelchair are the accessories and seating. There are many different considerations with regard to this. Keep in mind that the lightest option may not be the most appropriate due to other factors, such as capability and transportation issues.

 

Some easy ways to keep the weight of the mobility system down is to use spoked wheels rather than Mag wheels, and use a rigid frame rather than a folding frame. Rigid frames are lighter because they do not have the cross frame and hardware utilized by folding chairs. (The one consideration is transportation – how will you transport your chair in the car/van.)  You may want to consider a power assist wheel or other power assistance device to reduce the amount of wear and tear on the shoulder joint.

 

DO use  a cushion. Most wheelchair users may have a higher risk for skin breakdown due to lack of sensation or ineffective pressure relief if they are a higher level of injury without full use of the triceps. Choose the lightest cushion that provides the right level of skin protection for you.

 

The wheelchair setup will influence the propulsion technique and ultimately the amount of resistance or reactive force/stress that is translated back to the shoulder joint.

 

The more rearward the seat position is in relation to the wheel, the less rolling resistance and the more efficiency with propulsion the wheelchair will have. A more rearward seat positioning will promote a long and smooth stroke that limits high forces and the rate of loading on the pushrim that you will see with a short and abrupt “pumping”-style stroke. This is, of course, true only if the wheelchair user has adequate range of motion in his or her shoulder joint.

 

 A rearward seat position basically has less drag because you are not loading the front casters as much, therefore not allowing a “ploughing” effect. The tradeoff is stability. The more rearward the seat position is, the less stable the wheelchair will be and the more likely it will tip backward.

 

For experienced users with a very low level of injury, this is not typically a problem; however, more inexperienced users or those with a higher level of injury may not have the seat set back as much or may need to use anti tippers.

 

Muscle imbalances. Most rotator cuff injuries are due to muscle imbalances of the shoulder. Shoulder strength and muscle length/range-of-motion imbalance can cause impingement of the soft-tissue structures of the acromiohumeral space.

 

Wheelchair users are even more susceptible to muscle imbalances. Nearly every motion and all repetitive motions are anterior, working such areas as the pecs, shoulder internal rotators, and anterior deltoid. These anterior muscles become tight and shortened, while the upper back muscles become weak and elongated. You can see these imbalances in the postures of chronic wheelchair users. A typical posture is rounded shoulders with mild thoracic kyphosis and forward head. This posture is even more accentuated by a non supportive wheelchair back that is stretched out, accommodating this poor posture.

 

 It is important that we stretch the anterior musculature while strengthening the upper back, posterior shoulder, and scapular muscles.   Check out http://www.thera-bandacademy.com/exercise/ for specific Rotator Cuff exercises.

Preventative maintenance with specific exercises is the key to longevity.

“Train before the Pain”

Protect your joints during everyday activities to minimise pain and deformity by:

* Using the largest, strongest joints.
* Avoiding stress on the small joints in the fingers and thumb.
* Reducing stress on painful joints.

 

#Arthritis

 

Opening and Turning Jars

A jar opener helps reduce stress on the fingers making the task easier. Some allow the effort to be distributed between two hands rather than one.

Taps 
A tap turner is a portable lever device that allows a push/pull movement to operate the tap rather than twisting, reducing strain on the fingers. A lever tap with a half or quarter turn mechanism further decreases the effort required to operate a tap.

Keys 
A key turner reduces the strain on the fingers and thumb.

Grasping and Holding
Building up the handle on a spoon, pen or toothbrush makes these objects easier to hold.   Foam tubing fits over small handles to make them larger.
You can buy products already made with built-up handles.

Reaching
A long-handled reacher makes it easier to pick things up from the floor.
A long-handled shoe horn or sock aid makes it easier to dress your feet.
Toe washers can assist to wash or dry between the toes.
Reaching your back or combing your hair is less stressful on painful shoulders if you use a long handled bath sponge or brush.

Sitting
A chair can be height adjustable or made-to-measure to ensure it is the right height for your needs.   A chair that allows your hips to be level with or higher than your knees makes it much easier to stand. Armrests give further support to help you rise out of a chair.
Pushing down on the armrests with your palms will protect your finger joints.
Sitting down instead of standing for activities such as showering or preparing a meal can relieve painful joints and save your energy. A shower chair or kitchen stool will enable you to do this.

Walking
A walking stick or frame gives support to painful hips and knees when you are mobile. A frame with a seat provides somewhere to rest when tired. Some walking aids have specially moulded handles to distribute the pressure more evenly across the hand.

Dressing
Elastic shoe laces are available to avoid tying shoelaces.

 

 

Stroke