Professional Practice

  • AIDS AND ADAPTATIONS

Leather thumb support

A client with a C6 quadriplegia was developing extensor tightness at the first metacarpal. He was unable to tolerate a traditional thermoplastic opponens splint so a soft leather brace was made to reposition the thumb.

Writing and Typing Aids

A university student with C6 quadriplegia was unable to hold a pen to take notes. None of the commercially available writing aids met his needs for stability and ease of donning and doffing.

A finger cuff was made of Taylor Splint and custom molded to the desired finger angle. Cable wire clips were trimmed and affixed to the cuff to hold the pen—one clip faced upwards and the other faced downwards to counteract lever forces. 

Similar cuffs were made without the clips for keyboarding.

 

 


The Lidia Collar

A woman with muscular dystrophy had muscle weakness of her neck extensors. She wore a Philadelphia Collar to hold her head up but its rigidity prevented her from performing ADLs such as walking unaided, reading a book, and preparing a meal.

When none of the commercial collars met her need for dynamic support, the Lidia Collar was borne. Made of a latex party balloon, it supported her chin sufficiently to take the strain off her neck but compressed on active neck flexion to allow her to look down. On the upside, the balloons are inexpensive and come in a variety of colors to coordinate with a wardrobe. On the downside, they can be hot and they deflate after 2-3 days.

PILLOW SLEEVE

A client with a C1-2 AIS D spinal cord injury needed to alternate his sleep positions from supine to side lying to maintain skin health as well as for comfort. On discharge, client would not have help in the night to place and remove the supporting pillow for turns.

Goal:
Independent with pillow placement for night turns


Barriers:

  1. generalized body stiffness 
  2. weak gross grasp
  3. altered sensation

Solution:    
A pillow sleeve was made with the following characteristics:
1.  fabric was of a different texture from the pillow case so that the client could feel when he was reaching the target area of the pillow.
2.  a large loop of 1” wide Dacron strapping was sewn on the front to give easy access for his arm to slip through.
3.  the loop could be pulled with one hand or two.

Outcome:
Client became independent with pillow placement and removal.

  • Poems

ASIA PLUS

Hey you, don’t be afraid
When you’re thinking about the ASIA.
Spinal injuries are very diverse,
After this verse, you’ll know it better.

C4       Lift your shoulders from the floor.
C5       Elbow flexors are alive.
C6       Extend at the wrist.
C7       The elbow goes to heaven.
C8       A big fist you can make.
T1       Spread your fingers; bend your thumb.
T6       Breathe deep to cough and spit.
T12     You’re sitting very well.
L2        Hip flexion you can do.
L3        Kick out the knee.
L4        Pick your feet off the floor.
L5        Toe extensors have survived.
S1       Push-off to walk or run.
S4-5    Bowel and bladder (the sphincters) have arrived!

Dianna Mah-Jones
2013

SAVE THE SHOULDER

Yo Big Daddy, listen to my story.
Got some things to tell you so you won’t be sorry.
Your body’s healing up so you gotta take care
Here’s a tip that you should be aware.

When you’re lying around and you don’t move
Your range of motion you can lose.
Joints get stiff, capsules get tight.
You’ll get some pain that you won’t like.

If you ain’t got the range, ADLs are tough.
You try really hard but you can’t get close enough.
Fight to put your shirt on, stretch to comb your hair,
Want to wash your back? Nope, can’t reach there.

So what can you do when you’re lying in bed?
Good positioning will keep you ahead.
Do it on your side; do it on your back.
Use pillows or a bolster to hold where you just can’t.

When lying in supine (by that we mean face-up),
Avoid keeping elbows in and hands on your stomach.
The shoulders need to abduct and externally rotate.
Don’t forget the forearms – try to supinate.

So, protract, palms up, hands away from feet,
Bend that elbow. Do it at rest and sleep.
Ten minutes or an hour; three times every day.
The sooner you get started, loose joints will stay that way.

In side lying, start by reaching out.
Palm up, arm bent, that’s what it’s about.
Top arm should cuddle a big fat pillow
Do these things to keep your shoulders mellow.

You know your body best; you know what feels just right.
Work it hard through the day, don’t lose it through the night.
Your body learns by what it feels; it is forever changing.
So keep those shoulder joints free and fully ranging!

Start self-directing cause staff are always changing.
Do your part to keep your joints free and fully ranging.

Dianna Mah-Jones July 2012

Skinny on Skin

ITs, coccyx,
Sacrum, bum.
Gotta stop the pressure sores
Before they’ve begun.

Eighteen on the Braden Scale
Gives early warning,
Reduce the risks to
Stop a sore from forming.

One, Two, Three, Four
The stages do reveal
How deep the wound is
And how much there is to heal.

Therapeutic surfaces
Interface with skin
To redistribute pressure
And let the blood flow in.

Gel, foam, air,
Static or with power,
Pick the right mattress
To sleep away the hours.

Turn to the left,
Turn to the right.
Every two to four hours
Through the whole night.

Sitting up in bed
Must watch for shear.
Gatch at the knees first
To stop a sliding rear.

Then raise the head up
But not past 30 (degrees)
Pressure on the tail bone
Can be really “hurty”.

Mobile in the wheelchair
Weight shifts are the rule,
30 (seconds) every 15 (minutes)
That’s what’s cool.

Maintain the cushions,
Now let’s rehearse:
Squoosh it, moosh it,
Or immerse.

Sit well back,
Ride ‘em high,
Neutral pelvis,
Weight bear through the thighs.

When the skin’s in danger,
Nutrition is a key
Eat well, drink lots
And pee, pee, pee.

Don’t sit in puddles
Of urine or of stool.
Macerated skin
Makes one feel like a fool.

Watch for wrinkled clothing,
Pockets, keys and belts.
When the skin’s insensate
The pressure can’t be felt.

If there’s a risk of pressure sores,
Be as cautious as can be.
Learn these lessons well
To keep the skin healthy.

 

Dianna Mah-Jones, BScOT, MSA
February 2013