Disabled 2 Abled

Dr. Reji Mathew is a psychotherapist and clinical instructor at New York University. She is also a polio survivor and  freelance writer. She is a strong advocate for raising awareness among the media, health care providers, and the public about the long- term care needs of individuals with polio and other neurological conditions.

Her article on Energy Conservation was published in the October 27 issues of  OT Advance, a national magazine for occupational therapists throughout the country. The article can be read at the following link:

Energy Conservation
http://occupational-therapy.advanceweb.com/Article/Energy-Conservation-1.aspx

Dr. Mathew’s ongoing efforts to educate the media, health care providers, and the public can be read at the following link:

Health Care Advocacy/ Post-Polio International/OT Advance Magazine
http://www.post-polio.org/adv/iss-hlthcareadv.html

Thank you to Dr. Mathew for your efforts to assist all of us who have long-term care needs which are often not recognized by the medical establishment.

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Filed under: disability, energy conservation, occupational therapy

The ultimate in energy conservation is when someone else does whatever needs to be done.  That someone can be a service dog.  Just feed them and love them.  No worries about stealing your money, not showing up on time or quitting without notice.  In other words, the perfect caregiver.

A service dog gives you security and independence.  They open doors for you,  literally and figuratively.  Dogs are conversation starters and in public
become the focal point of attention instead of your wheelchair or scooter.  They can help you dress, make the bed, open and close low cupboards, do laundry, retrieve objects, turn off the alarm clock.

Large dogs can help pull the wheelchair, open doors, carry heavy objects, even help pull a person to standing.  One lady, who lacks the upper body strength to get up and down from her wheelchair, relies on her service dog to lift her from a seated position while she holds onto the dog’s leash

Numerous stories tell of lives saved by dogs who alerted their owners to life-threatening situations.

Service animals travel free of charge and are permitted to accompany their owner/trainer in the cabin of the aircraft.  A service animal must occupy the
floor space where the person sits and cannot obstruct an aisle or other areas that must remain clear for emergency evacuation.

Some countries have restrictions on animals transiting through or destined for their country, including service animals.  Ask your airline to check with the
countries on your itinerary for any restrictions that may apply.

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Filed under: Accessibility, disability, lifestyle modification, travel

Whatever difficulties you are grappling with - visual or hearing impairment, mobility challenges, invisible disabilities and chronic conditions - there is a way to access cyberspace. Computers bring the world to you and enable you to enter the world. Communication, education, entertainment, shopping, employment - it’s all available thanks to ongoing technological advances.

It isn’t possible for this chapter to cover the huge range of adaptive devices that are available - there are numerous web sites and publications dedicated to that - and computer accessibility is changing so fast that whatever is written now may be surpassed by new inventions in the near future. The purpose of this chapter is to increase your comfort and enjoyment and ensure that you don’t develop new problems from using your computer.

Between surfing the internet, corresponding with friends and family, participating in chat rooms, ordering products on-line, where does the time go? Hours can pass before you realize that you’re really uncomfortable and hurting. This can put you at risk for problems such as carpal tunnel syndrome, tendonitis, bursitis, neck and back pain - all resulting from chronic, continuous overuse of the hands and arms.  Headaches, eyestrain, tension and fatigue also come with the territory.

People didn’t develop these conditions before computers came along, even if typing was their full-time job.  What has changed?  For one thing, we type much faster on a computer keyboard: thousands of keystrokes per hour.  And there are no breaks - we don’t have to shift at the end of each line or stop at the bottom of each page to insert fresh paper.  And typewriters didn’t require staring at a monitor endlessly.

The problems are compounded if your computer workstation doesn’t fit you.  Here, then, are some recommendations to help you arrange and adjust your work environment to fit you and your body.  They won’t all apply to everyone - just utilize whatever fits your situation.

Make your desk user-friendly.
Start by establishing a comfort zone on your desk. This is the area you can reach easily without having to stretch.  Determine your comfort zone by making a semicircle with each arm and then place the things you use frequently within that zone.  The lighting - preferably indirect lighting to reduce glare - should be on your left side if you are right handed and right side if you are left handed.

Use energy-saving equipment
Use a telephone head set to eliminate gripping and take the strain off your arm and neck. Invest in an electric stapler, electric pencil sharpener, electric scissors.

Keep your wrists in a neutral position.
The keyboard should be at a level that keeps your wrists straight. If your wrists are bent upward or downward while you’re typing you’ll be at risk for carpal tunnel syndrome. Some desks have a pull-out drawer in front that lowers the keyboard. Placing the keyboard on a lap desk has worked well for some people. You can also change the height of your chair, but if you need to raise the chair make sure your feet don’t dangle. Ways to support the feet include a commercial foot rest, a stack of telephone books or a large 3-ring notebook binder.

Choosing a chair
Sit down and check the depth of the seat from front to back. Too shallow and your thighs won’t be supported; too deep and your back won’t be supported. See if the seat height can be adjusted so your hips are slightly higher than your knees to allow better blood flow to the legs. Check out whether the armrests can be adjusted for proper support. I’ve found that sitting on a wedge-shaped cushion with the high part at the back is not only very comfortable but facilitates  better sitting posture.

Supporting the low back is important for everyone and if your neck muscles are weak you might also need neck support.  You can purchase lumbar and cervical pillows filled with buckwheat husks which can be adjusted to your own contours. You can also make your own cushions by putting fiberfill (used for stuffed toys) into a piece of stockinette tubing.  Leave the ends of the tubing long enough to tie around the chair.

Mouse matters
To decrease repetitive motion, vary the type of mouse you use. An alternative mouse functions like a regular mouse but is designed to accommodate different needs. Try changing between a traditional mouse and one of the many alternatives: track balls, touch pads, optical mouse, head pointers, voice recognition systems, and keyboards with different layouts to accommodate various hand positions. There is a mouse to fit every type of demand; no need to overwork your hands..

Monitor matters

The monitor should be easy on the eyes. Reduce the contrast on the screen as much as possible and position the screen about18-25 inches from your eyes. The top of the screen should be at eye level but if you wear bifocal or trifocal glasses a slightly lower screen will keep your head in the proper position.

When you need to copy from a document, place it in a document holder attached to the side of the monitor so it is the same height and distance as the screen. Copying from a document right in front of you is much easier than swiveling your head back and forth.

Take frequent breaks and stretches.
Blink often and look around the room every few minutes. Optometric studies have shown that people tend to blink less and open their eyes wider when looking at a computer screen. This causes dryness that can lead to fatigue, a burning sensation, difficulty focusing, and headaches.

Stretch your joints every few minutes while you’re sitting. Move your wrists back and forth. Make a fist, then stretch the fingers outward. Lean backwards and forwards, then bend side to side. Stretch your arms sideways, then touch your fingertips to your shoulders and circle your shoulders backwards and forwards.

I recommend “Yoga for Computer Users” (from Amazon).  Many of the exercises recommended in this book can be done sitting in your chair in front of your computer.

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Filed under: Accessibility, Arthritis, Multiple sclerosis, Parkinson's, accessible, adaptive equipment, chronic condition, disability, energy conservation, fibromyalgia, lifestyle modification, lupus, postpolio, stroke

Have you thought about using a cane but dismissed the  idea because you’d be self-conscious? Think you’ll look “disabled”? Figure that you’ve gotten along okay without walking aids so far, why start now?

Good question. But ask yourself if you’re really getting along okay. Do you tire quickly when you walk? Is your gait unsteady? Does it take effort to keep your balance? Are you afraid of falling or do you fall easily?  Do you cut outings short because walking takes too much effort? Do you reach out to hold onto stable objects as you walk?

If the answer is yes to any of these, you have good reason to try a walking aid. The experiment  won’t cost much and you might be able to borrow one for a trial run. Go to a full length mirror and watch yourself walking with and without the aid. Don’t be surprised if the added support makes you look less disabled.

When muscles are weak, we compensate any way we can. This may include bending forward, leaning to one side, walking asymetrically, or distorting the body in various ways. These compensations squander energy and can make you look more conspicuous. Canes or crutches can help you walk more normally and the extra bonus is having more energy to enjoy the fun stuff of life. When considering a walking aid, a cane may be adequate if you only need minimal support.

PICK THE RIGHT STICK
First determine the correct length of the cane. If it is too long and your elbow stays bent when you lean on the cane, the triceps muscle at the back of the elbow has to stay contracted.  This can lead to muscle fatigue and shoulder pain.  To prevent overworking the triceps, the cane handle should be at the height of the wrist when your arm is hanging at your side.  This allows your elbow to straighten and “lock”itself in the straight position when you lean on the cane. Too short a cane isn’t good either - you don’t want to lean to the side.

A curved handle puts a lot of pressure in the middle of the palm, while a straight handle distributes the weight across the hand more evenly. Although a slight difference in diameter may seem trivial, a thicker cane does give more support than a thin one. Aluminum and carbon fiber canes are lighter than wood and have buttons for adjusting the height. The cane should be used on the side opposite the weaker leg to give a wider base of support. However, this may not work well if the opposite arm is weak. If both legs are equally weak you probably need more assistance than a cane provides. And if you’re leaning too heavily on canes or crutches, you may need to consider using a wheelchair or scooter at least part of the time, to relieve the stress on your shoulders and back.

Underarm crutches provide more support and stability than a cane, but can cause damage to nerves in the armpit if you lean on them too much. Thick crutch pads that slip over the arm rest offer comfort and added protection from too much pressure. Many other devices  - including padded hand grips and larger crutch tips - offer additional assistance for comfort and safety.

Forearm crutches, also called Lofstrand or Canadian crutches, have  a handle and a metal or plastic cuff just below the elbow which gives support without putting pressure in the armpit. Here again, the crutch handle should be at wrist height to enable you to straighten and “lock” your elbow when you bear weight on the device.

Okay, now that you’ve watched yourself walking in a mirror, do you still think the walking aid makes you look more disabled?

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Filed under: Accessibility, Arthritis, Multiple sclerosis, Parkinson's, adaptive equipment, chronic condition, disability, energy conservation, lifestyle modification, postpolio, stroke

Eliminate extra trips. After wearing yourself out at the supermarket, it doesn’t seem fair that your work isn’t done - you still have to put the groceries away. Well, try this. As you go up and down the aisles, mentally divide the grocery cart into four areas. Put frozen or need-to-be-frozen foods together; in another section put items that need refrigeration. Place canned goods and staples in the third section, and cleaning supplies, paper products, and personal care items in the fourth section. Keep the groups of items together when you’re checking out so they’ll be bagged that way but be sure the bags are packed lightly. When you get home put the bags into your collapsible grocery cart and make one trip each to the refrigerator, freezer, cupboard, etc. But pace yourself - first put away the freezer and refrigerator foods, then rest before you finish the job or wait till someone else can do it.

Minimize trips to the linen closet by storing linens in the rooms where they are used - towels in the bathroom, sheets and pillowcases in the bedrooms. If lack of space is a problem install pole shelves over the toilet and hang wire shelves in the closet. Then use your linen closet as a storage area for items you use less frequently.

Put duplicate supplies or small equipment in each area where they are used. Keep office supplies (paper, pens, tape, scissors, stapler) in each room of the house where you use them. Store cleanser and sponges under each sink. Keep a broom and dustpan or lightweight vacuum cleaner in more than one area. In a two-story house it is even more essential to have duplicate supplies on each level (but it’s better if your living space is all on one floor).

Clean out your closets. If your closets are packed so tightly that you can hardly hang or take down clothing, it’s time to be ruthless and weed them out. You may be attached to certain outfits but be objective - do they fit, are they outdated, are you tired of looking at them? If in doubt take them out. Think of how grateful some charity will be.

Then take the garments you wear frequently and put them in the most accessible areas of the closet. If you’re in a wheelchair hang shirts, blouses, and pants on a rod which is 40 to 48 inches from the floor. For longer items of clothing which need a higher rod, use a dressing stick or reacher to move the hangers on and off the rod. Put lesser-used items on the high shelves:you can use a reacher when you need to get them down. Keep shoes in a closet door shoe holder instead of on the floor.

Hook up your washer and dryer as close to the bedrooms as possible: most of the laundry is generated in this area. A front-loading washer allows the laundry to be handled easily from a seated position but a top loading washer works better for someone who works from a standing position. All dryers open at the front so you may want to put the dryer on a platform to eliminate bending. And use a reacher for those items that are hard to get to at the back of the dryer.

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Filed under: Accessibility, Arthritis, Multiple sclerosis, adaptive equipment, chronic condition, disability, energy conservation, fibromyalgia, lifestyle modification, lupus, postpolio, stroke