As an Occupational Therapist, there is a running joke that you can get any patient to do just about anything if you have the right adaptive equipment. There actually IS a real, multi-part joke about it:

How many Physical Therapists does it take to change a light bulb?
Just one – the PT holds the light bulb and the world revolves around him/her.

How many Speech Therapists does it take to change a light bulb?
ST’s don’t change light bulbs – they might break a nail and it’s too dangerous to do while they’re wearing their high heels.

How many Occupational Therapists does it take to change a light bulb?
Just one – But he/she will need about $5,000 worth of adaptive equipment to do it.

There are some pieces of adaptive equipment that are frequent “tools of the trade” for me; ones that I recommend for my patients almost all the time – a commode to put over the toilet so it’s a higher seat that is easier for sick senior citizens to get on and off. A chair in the shower so the patient is safer when bathing. A reacher so they can obtain items on the floor without bending down.

But sometimes you have to think out of that box and be creative enough to re-invent one item to act as another. As Alton Brown would say, death to the uni-tasker!

Depending on the size of the chair, shower and person, a plastic lawn chair might work for sitting in the shower if the patient can’t afford a real shower chair.

A shopping bag attached to a walker in a certain way is a good temporary solution for not being able to carry items because your hands are both holding the walker.

A thick rubber band placed around a lid may help weak hands open a jar when a jar opener isn’t readily available.

A back scratcher or even a hanger can help you pull items closer to you so they’re easier to reach.

Canned goods from the pantry can be used as decent substitutes for dumbbell-style weights.

In a pinch, I can take a gallon jug that once held water or milk and turn it into an item to help people put their socks on. No really, I can! What’s more, I went to college for this! 😉

I’ll occasionally get patients who have problems cleaning themselves after they’ve had a BM. They might have arm or hand weakness from injury or illness, or perhaps they’re in pain from bad arthritis or they are too stiff and shaky from Parkinson’s disease. Whatever the case, it’s an important part of self-care so it’s in the realm of what I have been known to work on with patients (welcome to my world!). Anyway, they do make several versions of an item called a “toilet aid” that can help with this problem but it can cost somewhere in the field of $50, insurance doesn’t pay for it, it doesn’t work for everybody and it’s non-returnable. The vast majority of my patients are on limited budgets and $50 is a lot to spend on a “maybe” so sometimes you have to see what you can use instead.

Once again using the philosophy of multi-tasking a household item, I’ve discovered that spaghetti tongs sometimes work just as well. $1-$2 at a Dollar Store and they’re ready to go – and to clean up after themselves after they’ve went ;-). And if it doesn’t work, oh well, it’s only a few dollars down the toilet. Of course, knowing that I sometimes recommend spaghetti tongs my patients for this task, my friends being who they are, have made it their business to follow a hard and fast rule – don’t ever eat spaghetti at Sharon’s house!

Well, I’m proud to say that I finally figured out another reason to use spaghetti tongs as an adaptive tool. May I introduce one of my current patients, “Mike.”

Mike is in his late 40’s and was involved in a motor vehicle accident back in August – he was driving his car and was broadsided by a semi truck. Yep, a semi – the fact that he’s still here with us is pretty amazing. Anyway, he sustained multiple injuries, including broken ribs, bleeding on his brain (he was in a coma for a while), fractures of several of the bones on the left side of his face, as well as a broken left shoulder, elbow and pointer finger.

He’s out of the coma and although I didn’t know him before the accident to be able to compare, just from conversation, his brain seems to be doing fine. The index finger is OK. The ribs and face are healing. He’s getting more and more shoulder movement with every OT visit. Slowly but surely, his elbow is able to straighten out more but the doctor thinks he has some bony overgrowth because he can still only bend it halfway. They’re currently looking at some alternate ways to help get the elbow to bend more, running the gamut from a brace/machine to passively try to bend it more, to the possibility another operation to chip away at the bony overgrowth. Meanwhile, my job is to look at the worst case scenario and figure out adaptations so he can be as independent as possible in light of how he is now, in case it doesn’t get better (he’s a young guy and isn’t on Medicare. Who knows if his health insurance will approve the machine or the surgery, y’know? I always have to play devil’s advocate).

Anyway, he’s a restaurant manager by trade and plans to go back to work as soon as possible, so I wanted to make sure that he could do everything for himself before I was done with him. He has done pretty darn well – he can shower by himself, open and close buttons one-handed and has even finally gotten enough strength to open most bottles and jars by himself (even without a rubber band!). But he still couldn’t tie a neck tie and he needed to do that for his job. Of course the easy way would be to buy a bunch of clip-ons or have someone pre-tie a bunch of ties that he could then just put over his head, but it’s always best if you can do things as close to “the old way” as possible.

The problem was that although he was right-handed, he couldn’t bend his left elbow enough to hold the tie where he needed to. Enter the spaghetti tongs! Look at this:

 

Picture taken with Mike's permission. He said it was OK to use his face in the picture too but I told him that with today's privacy laws I'd probably go to OT jail if I did, LOL! re: the design on the tie is "modern art" - he got it from his staff a few Christmases ago, when they all signed it. He said it's his favorite tie

It worked like a charm and Mike was able to tie his neck tie for the first time since his accident.

Y’know, I love my job because there are warm fuzzies involved in being able to help people become the best they can be. And I love working with my senior citizens because they’re cute and I often learn a lot from them – the history and lifestyles of John and Jane Q. Public from years past has always been interesting to me. But there’s something just a little more satisfying about being able to help someone who has been a current member of the work force and you’ve been able to do your part to get him back there.

The “Occupational” in “Occupational Therapist” came from World War I, when therapists were keeping injured soldiers “occupied”.  However we slowly evolved into (re)teaching “daily living skills,” which only sometimes includes true “work skills.” And especially for me, with all the seniors I work with, it RARELY has to do with someone’s job. But this time it did. I hadn’t felt like such an “occupation” OT in a long, long time.

Mike is going to start going to Outpatient Rehab tomorrow, so I had to discharge him today (it’s a natural progression, it’s one or the other and you can’t do both at the same time – either you’re homebound, during which time you receive Home Health services, or you’re not). As is often the case, it’s bittersweet – I enjoy working with him but I know he can continue to get better with the machines and equipment they have at Outpatient that I, as a Home Health OT, can’t carry in my car. However he’s definitely going to be a success story and I look forward to possibly bumping into him at his job one of these days – wearing a tie. 😉

 

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