The Pathways Toward Recovery with Jessica Miller - Episode 10

Hello everyone and welcome to another episode of the No Plateau Podcast. I'm your host Henry Hoffman and I'm happy to be here with you. I am excited to have back Jessica Miller, who is a fellow OT and the owner of Pathways and Neurorehabilitation Education. Welcome Jessica.

Podcast Transcript

Jessica Miller (00:19.126):

Thank you so much, Henry. It's good to be back.

Henry Hoffman (00:21.838):

Yeah, good to have you too. You were on season one, episode 10. So if no one has seen that episode yet, check it out where you can learn about some awesome things that Jessica is doing in the OT mentoring world. And so that was a wonderful time chatting with you and all the things you're doing, the amazing things you're doing. And is it Indianapolis? Is that where you are?

Jessica Miller (00:43.298):
Yes, that's right.

Henry Hoffman (00:44.926):
All right, how's the weather right now?

Jessica Miller (00:48.598):
It's decent. It's been kind of a tepid winter, so our morning walks to school are still really doable. We'll see if the morning walks continue in the next month or so when we get to those freezing temps. I don't know.

Henry Hoffman (01:00.734):
I remember those days growing up in Buffalo, New York. So I don't miss them, but it's fun for the couple. We're filming, we're editing this right now and doing this right before Christmas. So it is fun for those first couple of weeks before Christmas, but then by January, you're probably like, okay, time to move on, right?

Jessica Miller (01:04.502):
BOO!

Jessica Miller (01:19.03):
Right, it's fun the first time you get the shovel out, you do all the snowmen and igloos, and then after that you're like, can I pay someone to do this please?

Henry Hoffman (01:26.766):
Yeah, exactly, exactly. Well, today's gonna be fun. And what we're gonna do, it's a continuation of what I did in season one, where I did a let's go shopping for stroke survivors, where we did neuro recovery tools. We used Amazon as the platform. We wanted to really look at what is, and for caregivers, what makes sense? What do people need? What should people avoid purchasing? Cause it's really a waste of money and it's just false advertisement. And...you know, as they transition through their different stages of recovery, what might be helpful? Well, today's part two, and I'm happy you agreed to join me on part two, and we're going to focus on ADLs, which is also known as activities of daily living and, or DME, durable medical equipment. And we're going to really talk about not so much the neuro recovery tools. We're going to talk about the return to home safely and what equipment may a caregiver or patient be thinking about that they don't really know. I guess before we start, when would a, you know, you've been doing OT for a long time too. When do patients typically, for the caregivers that are listening, the patients that are listening right now, when do they typically get educated on, hey, gee, Joe's leaving soon, here are some things they may need? Is that something that happens in their inpatient rehab stay during the whole process, or they kind of crammed it in the last week?

Jessica Miller (02:49.39):
That's a really good question. And Henry, that's changed over the course over the couple of decades that I've been in practice where a person used to be after a stroke, maybe they were in rehab for a good six weeks or more. And so you had a lot of time for education. You could gather that equipment, but stays are so short these now, it can be maybe just two weeks that a person's in, they had a stroke and then two weeks later, they're going home. And there's just this like of information that the caregivers are trying to take in.

So they usually, the hospital will, inpatient rehab will help them get a wheelchair and maybe if they need a hospital bed or something like that. But all these other things that we're gonna be talking about today are just, they might get touched on in like a discharge recommendations list on the day they leave. Or in one OT session before that. But they don't really have enough time. So I'm glad that we're doing this.

Henry Hoffman (03:35.646):
Gotcha.

Henry Hoffman (03:42.126):
No, yeah, this will be a real helpful resource. And last time we did the Amazon as the platform to search for tools, but today, this time I'm gonna use the very popular rehabmart.com. A lot of people may not know Rehab Mart from a patient caregiver standpoint, but I know a ton of therapists do. Did you happen to know that it was started by two OTs?

Jessica Miller (04:04.918):
I love that. And you told me their story that it kind of came out of their own need that they were didn't one of them also have a child with a disability. Is that something you mentioned?

Henry Hoffman (04:13.71):
Yeah, so there's Hewlett-Smith and Mike Price, and actually both families have a child with disabilities. And when I was talking to Hewlett at one point, getting to know RehabMart a little bit more a while back, he also mentioned that how the company started in the mid-90s was, you all remember, everyone remembers the old Fred Sammons catalog back in the day, Fred Sammons, the founder of Sammons, which has changed over. Then it...

Now it's at Performance Health, I believe it is. They had like a 400 page catalog, right? Everyone had this thick catalog in the OT department. Well, Hewlett was saying in the mid 90s, man, is anyone trying to figure out how to get this catalog online? And that's basically the, as I remember and recall, that was the birth of RehabMart. So it's a wonderful platform. I use it a lot, looking for products. I know a lot of therapists do. So I figured today what we can do is we'll share the screen.

Jessica Miller (04:45.998):
Mm-hmm.

Jessica Miller (04:58.094):
I'm gonna go.

Henry Hoffman (05:10.958):

So the caregivers and patients can kind of see what we would normally do with our patients, which is literally have the laptop in front of the client and say, okay, let's talk about what are some of your needs and then really type in some of those products. And so the patient can actually see, gee, this makes sense. Maybe I should think about getting that. But before we do that, you know, you kind of touched on it. It's gotta be a confusing time for a caregiver and a patient. I mean, obviously the patient has their stroke, the hospital does their job keeping them alive.

The caregiver is still trying to figure out, what am I doing? How do I move on? How do I get my loved one home safely? So they're still struggling, they're Googling things. So it's gotta be a confusing time, a fragile time, you know, a scary time for a lot of these folks. And you know, a lot of them are coming home, they're desperate for knowledge. They may have physical needs, cognitive needs, visual needs, and they're stuck on their own. A lot of them are stuck on their own with no support. So we're hoping, for the purpose of today, is this is gonna be some type of initial educational webinar, if you will, to teach them on, hey, it's not gonna go over all aspects of activities of daily living, which is ADLs, the things, you know, the dressing, the bathing, the grooming. We'll touch on a few just to kind of wet their palate, then hopefully they can take that, use this tool that we're gonna provide, and then pass it on to their therapist or doctor and they can help educate them more on their, and personalize what specifically they may need. So I think that's something to kind of keep in mind. Now, what we ended up doing is before the call, we kind of talked about, gee, what do we want to, what do we really want to share today that's not overwhelming just to kind of skim the surface? And we came up with five categories and we were thinking about the timeline of a patient or caregiver. And we thought, okay, what's the very first thing that has to happen? They have to get in the home safely, right? Step number one, they pull into their house, they're happy they're home.

You gotta get into their home safely. Step number two, we both agreed. The thing we're gonna do next is take a shower and get rid of that hospital funk, right? That smell from the hospital. And then step three is, of course, you gotta get dressed. Clearly, we just went over three steps that require special equipment for a lot of people. And then step four, some of us wanna take a nap and just relax in our own bed for once since it's been a couple of weeks. I'm sure that's gonna be a natural next step for some.

Jessica Miller (07:16.846):
See you later.

Henry Hoffman (07:36.638):
And then finally, get some real food. I mean, everyone is sick of the hospital food at this point. They're hoping something's in the fridge. So there's some things we can do to get in the bed safely, to take that nap, and eventually eat, whether it's one-handed or adapted, so you can incorporate that effect at hand. So we're gonna tackle those five categories. I promise it won't take long for the listeners. And so what I figure we'll do is I'm gonna go ahead now and share the screen. So bear with me for one second.

Jessica Miller (08:06.266):
Henry, I love, you know, it's kind of like when you're on vacation and you just can't wait to get back to your own bed and your own shower and eat your own food. And this is, you know, this is a, you've been away from home but you've not even for a fun thing, for a horrible thing. And so those things people cannot wait to get in their own shower, their own bed and eat some food. So these are really great topics.

Henry Hoffman (08:18.846):
100%.

Henry Hoffman (08:28.546):
Absolutely. All right. So can you see my screen?

Jessica Miller (08:33.898):
Yes.

Henry Hoffman (08:35.078):
Okay, so for the folks that are watching, hopefully the ones that are listening, you're not gonna be able to take advantage of seeing the video, but you can go to our YouTube channel to watch this. But if you happen to be watching on our YouTube channel in the video there, you'll see that there's Rehab Mart's website, and there's a search bar right at the top. Okay? And so I'm just gonna go right in, that's what I love about Rehab Mart, is they have that search bar right there, ready to go. So we set the first category is just getting the home safely. So what term should we type in for getting to home safely. What should we start with?

Jessica Miller (09:08.398):
Why don't we try a ramp?

Henry Hoffman (09:10.19):
Okay, so I'm gonna put in ramp. And so imagine you're working, if you're a therapist, you're working with your patient, you type in ramp. And for the patients and caregivers looking, you can kind of see right off the bat, we see I type in ramp, and here's some of the things we see. SoJessica, I also noticed there's something, there's ramps, and I also noticed something called, I've never heard of a threshold ramp. So maybe you can spend a few minutes explaining some of the things that patients and caregivers should think about for ramps and thresholds, or if you have any stories to share.

Jessica Miller (09:42.258):
I'm so excited when we were looking at this that they have that threshold ramp. We'll talk about that one in a second. But let's first start with if the person has stairs, you know, it might seem like an obvious thing that they need a ramp. And I think the one tip that is often overlooked is so, you know, you're a caregiver, you're loved one just had a stroke. I know I need a ramp. Boom. The first one you see you click on it. But really you want to go out and measure first.

How tall that step is. And so the American, the ADA would say if you have a four-inch tall step, then you want your ramp to ideally be four feet long. And that's going to provide you this nice kind of low-grade ramp that you can safely get a wheelchair or walker up and down. So if it's a six-inch tall rise, then you'd want a six-foot long ramps. However many inches tall you want that many feet long for a ramp. So that's just going to be a general guide to help you safely get in. And they do have some of these nice portable ramps. A lot of people think that they have to get a wooden one installed, but from Rehab Mart, you can just get these portable ramps and those are really nice.

Henry Hoffman (11:01.158):
Very cool, very cool. So the take home there is one inch of height equals 12 inches of ramp. Is that what I did my quick math?

Jessica Miller (11:01.598):

And then you're scrolling.

Jessica Miller (11:12.418):

Yes, you got it. Good job.

Henry Hoffman (11:13.542):
OK, good, good tip, good tip. What about these thresholds? What are they all about?

Jessica Miller (11:20.938):
Okay, so I had a gentleman who needed help to get inside of his house, or so he thought. And he'd been at home for a good six months and he learned how to get himself dressed and he could cook breakfast. He could even take a shower, use the restroom, all of these things by himself. But he couldn't be left alone because he couldn't get in and out of his house. And it wasn't until we opened up talking about that old Stamins Preston catalog, and we're looking through it trying to find some of these solutions, and he was like oh, and he points to the threshold ramp. He said because really the problem is I thought he had steps. He does not have steps. He has about a two and a half three-inch, what do you want to call that threshold to get over to get outside of his patio doors and he just simply couldn't get his wheelchair over it and he purchased one of these.

And that was literally the key to now being safe, that he could get in and out of his house and he could go on this back patio. He's really an outdoor person. So he could watch the birds and enjoy some, he has some pots that he would plant out there. This really changed the quality of his life. And then his loved ones felt like they could safely leave him home alone. So that's an amazing tool, that threshold ramp.

Henry Hoffman (12:35.174):
Oh yeah, absolutely. Well, that's really helpful. I'm sure a ton of people are thinking about that. Even if you're listening to this right now and you're in the hospital trying to transition home, how are you gonna get in the house? So clearly you're gonna need a ramp. Clearly a threshold helps as well. I'm sure for some, it's gonna be a wheelchair, and I know at your hospital you'll probably have wheelchair specialists working with you as well. So excellent. So now that we're in the house safely, I'm gonna go back to the search bar.

And we said the next step after getting in the home safely would be taking a shower. So how about we put in the term, search term shower first and see what happens.

Jessica Miller (13:10.423):
Yes.

Henry Hoffman (13:15.806):
And when you see shower, I am scrolling down and I do see some shower chairs. I do see some benches. You know, sometimes I look for what's called a transfer tub bench. So what I'm gonna do is I'm gonna go back up to the top because I specifically want to get your comments on a transfer tub bench as well. So let me type in the word transfer tub bench.

Let's see what pops up. All right, so these are the ones that most therapists recommend, most patients might be familiar with. What are your thoughts about, and I see one here where it's kind of sticking in and out of the tub. Do you see that one?

Jessica Miller (13:58.798):
Mm-hmm. Yes, those are great.

Henry Hoffman (14:00.178):
Yeah, what are your thoughts about transfer tub mentions?

Jessica Miller (14:05.27):
I love them so much. So they can look a little awkward when your sometimes loved ones will, it's just this, it's a very long bench, and they say, it's not gonna fit into my tub. And that's actually kind of the way it's made to be. And so you'll see in this, if you can't see it, I'll describe it. There are four legs to this bench, of course, and there are two legs that fit inside the tub and then two legs that fit outside the tub.

And there's just that long seat. And what this enables a person to do is to transfer or just sit down on the edge of that bench that's sticking outside of the tub. They can transfer from their wheelchair or walk or they're just basically sit down. And then while they're sitting they or you can help them slide one leg, kind of lift one leg over the bathtub and then the other leg, and they can just slide down. They don't ever have to stand and pick up a leg and try to put it over the bathtub because that can be really risky.

They have a nice back, and they have an armrest. And once they're in there, you're good to go.

Henry Hoffman (15:04.675):
Oh, yeah.

Jessica Miller (15:10.946):
Yeah, no doubt. I mean, even talking to patients who go, oh, sorry for interrupting, there's a little bit of a delay. Go ahead.

Jessica Miller (15:12.019):
I will say.

Jessica Miller (15:19.771):
Okay. Just that there is one common problem that happens with these. So once you're sitting in there and then you pull the curtain, now the curtain is kind of wrapped around that part that's sticking out of the tub. And when you turn the shower on, the water just can pour out onto the bathroom floor and you get the great flood as the therapists know it. So there is a trick that I wanted to share. Henry, have you heard this trick, the shower curtain trick?

Henry Hoffman (15:40.679):
Ha ha.

Henry Hoffman (15:48.194):
Now, indulge.

Jessica Miller (15:50.77):
Okay, okay. So I'm going to describe it, and then I'll also I'll give you a YouTube link that you can see this in action. But if you have on your shower, if you have that kind of two curtains, kind of the pretty one on the outside and that plastic one on the inside. If you don't have a plastic one on the inside, you can pick one up from even the dollar store, and then you want to, once the bench is in the spot, you're going to need it, which just means there's room for those.

Jessica Miller (16:20.254):
You're going to pull the shower curtains closed and once they're in that spot you're just going to take a pair of scissors and you're going to trim two slits that are the width of that bench so then you're going to take that you just made like a flap and you're going to take that flap and inside that bench, there's a little slit and you can just take what that flap that you just cut out and put it right down in that slit and then now it's on the inside of the tub.

And so that will prevent that water from pouring out and keep you safe when you get out of the tub.

Henry Hoffman (16:54.654):
That is an excellent idea because I do know exactly what you're talking about. That is one of the big pitfalls of having that type of transfer tub bench, but if you cut that slit that keeps that water, traps it from getting on the outside of the tub, so that's perfect. I like that. The other thing I wanted to mention is, you know, when you go to hotels, you know, typically these handicap accessible hotels don't have all that equipment that's needed. Thankfully, there's things like grab bars that do help. So I know, although we won't be showing grab bars for this episode, but you definitely want to get that bar that attaches to the wall. Maybe there's one on the opposite wall where you, when you go into the tub, because to your point, very high risk for falls if you try to step over the tub. So you want to make sure you're kind of loaded up with different grab bars to help you. So that's a really good tip. Before we transition to the next category, two other things I thought were helpful in the shower bathing category. One is those long-handled. I don't know if they have it. Let's try long-handled shower. Long arm shower head holder. Let's see what this is. So when you're living with hemiparesis, or you have weakness in one side of your body, you sure want these long arm or long-handled showers, that handles, that can really, you can grab with your unaffected side and get your legs, get your back, just to prevent falls and other potential injuries. So that's one I wanted to bring up. And then the other one, which is a lot of folks get, is let me put in bath mitt, see if it's there. That one's, or a washing mitt, there you go. So that one you can put on your affected hand.

Jessica Miller (18:43.511):
Oh, these are good.

Henry Hoffman (18:48.766):
And,there's probably a Velcro strap there or something similar and cinch it up. And then you can get it wet, put some, there's, you can put the soap inside. There's a soap pocket and you can incorporate your affected side. So, hey, let's rewire our brain while we're washing. Does that sound great and fantastic?

Jessica Miller (19:04.43):
Absolutely. And I would say that I love that.

Henry Hoffman (19:06.394):
All right, so those are my.

Jessica Miller (19:12.802):
Sorry, Henry, there's just a delay there, thank you. The other thing I love about the long-handled hose is since the person isn't maybe being able to stand up and turn around, that hose can get every part of your body and help you rinse off without having to stand. Again, it keeps you safe. So I really like that one a lot.

Henry Hoffman (19:13.458):

Go ahead, Jessica. Yep.

Henry Hoffman (19:34.158):
Absolutely. Wonderful. All right. So we got in the house safely Now we're all clean. We don't smell like a hospital room anymore Next step is we're gonna get dressed That's right. So there is when you think about getting dressed now Normally, there's a lot of adaptive equipment for dressing but there's a ton you don't really use for hemiparesis It's common for geriatric population. It's common for hips and knees meaning hip replacement or hip.

Jessica Miller (19:43.126):
Woo!

Henry Hoffman (20:03.298):
Injury or knee replacement because they can't bend down and they need the reacher or the sock aid. But when you're living a one-handed life or you're really struggling to use your affected hand, there's not a ton of dressing equipment that is beneficial. There's some, it just depends on the level of recovery, but the two we'll focus on today are going to be shoe related. And I think the first one we decided we were going to look up was.

Foot funnel, is that correct?

Jessica Miller (20:36.342):
Yes, the foot funnel is probably my all-time favorite piece of adaptive equipment. And I totally agree with you, Henry, that less is more when it comes to equipment, helping a person with hemiparesis get dressed. Because one, you have to remember always to have that item by you to get dressed. But two, some people ask me, is a sock aid going to be helpful? It's actually difficult to put a sock on to a sock aid with one hand. So it's actually much easier just to learn how to put your sock on with one hand or try to get the other one to help. So, but shoes are a tricky spot and a lot of therapists will suggest or the old school way of thinking was really the long handled shoehorn which is useful, but you still have to kind of hold the shoehorn, get the shoe in the right place and you have to really coordinate the two and they can be it can be frustrating with one strong hand. So the foot you if you can see the video but if not it's just this piece of plastic that you fit on the outside you know when you try to slide a shoe on and you accidentally crush the back heel of it?

Henry Hoffman (21:48.154):

Yes, my two daughters do that every time they leave for school.

Jessica Miller (21:52.394):

Right? And so some of these fancy shoes now prevent that, but this foot funnel can turn almost any shoe into a slip-on without crushing the back of it. So this piece of firm plastic you put right on top of that heel, it overlays on top of it, and then it creates this little slide and you just slide your shoe, your foot in the shoe and the heel slides down the foot funnel and the foot funnel protects the back of that so it doesn't get crushed and then it has a string and you just pull it out and it's incredibly simple. I love it so much.

Henry Hoffman (22:28.446):
Yeah, that Seems like a winner right there for sure, especially trying to get that foot in one-handed. I can imagine how that could be beneficial. The second product under the foot category for getting dressed we were going to look at was elastic shoelaces. So let's just see what pops up if I put that in. And what do you think about this type of elastic shoelace and in general elastic shoelaces?

Jessica Miller (22:56.418):
So I like the one that Rehab Mart has here because sometimes if you look up elastic shoelaces, you're going to get those curly Q1s.

Jessica Miller (23:09.058):
Punky Brewster. I mean, I didn't even remember Punky Brewster, and she had those Curly Q shoelaces. So great for Punky but not so much for our stroke survivors. So I like these. And again, you put these shoelaces in one time and then you can have it on the stroke survivor's foot. And then you just tie it in the place that has the right amount of tension. And then you never have to tie it again. So you just slide your foot in and out. And one little hack or trick is, you do want to weave this through that spot that holds the tongue. You know, there's that little loop. You want to make sure you go through that because that's going to help keep the tongue up and out of the way when you now slip your shoes on. So I do love elastic shoelaces. You can learn one-handed techniques. Um, that's another option that your OT can help you with, but this is super simple, the elastic laces.

Henry Hoffman (24:03.514):
Yeah, and also, of course, you can do Velcro straps for shoes, although typically they're not as stylish. I know Nike has a whole adaptive equipment line, including these really cool clamshell closure sneakers, which looks really interesting. So thankfully, the textile and clothing industry is catching up with our times and offering awesome solutions for people with some of the challenges. So that's wonderful. All right.

Jessica Miller (24:08.907):
Right.

Jessica Miller (24:14.966):

Mm-hmm.

Henry Hoffman (24:33.51):

Got in the home safely, took a shower, got dressed, we're kind of pooped, it's day one, we're home. Who does not want to take a nap in their own bed, right? They've been in this awful hospital bed for a couple of weeks, maybe even longer. They just want to chill out and relax. So let's go back to the search bar. One that comes up for search term would be, I think it's called a bed cane, is that right?

Jessica Miller (24:44.427):
As police.

Jessica Miller (24:58.603):
Yes, those are great.

Henry Hoffman (25:01.226):

All right, so beautiful. So RehabMart has quite a selection here. So what are your thoughts on bed canes? Anything for patients or caregivers to confirm, check out, watch out for?

Jessica Miller (25:13.954):
Yes, so Henry, if you would want to click on the second or third one that's listed there, we will get to see how it's made because some people are concerned that this isn't very sturdy. But you can see in the picture, the more detailed pictures underneath this cane that acts as a handle next to the bed is actually this nice wooden platform that goes under the mattress, in between the mattress and the box spring. So there's that.

Henry Hoffman (25:19.966):
Okay.

Jessica Miller (25:42.13):
Wooden board and then there's also a strap, and that strap goes wraps around the mattress. So it's quite secure and then you can think when your body weight or your loved one's body weight is on it. Your body weight is then on top of that wooden platform and they're nice and stable. These have kind of multi-purpose so they can help you to get to get a loved one in and out of the bed, but this handle really gives the person some leverage. If they're having difficulty pulling that weaker leg into bed, they can use their strong arm and kind of really pull on this cane as a lever to get their legs up into the bed. It can also help once they're in bed being able to roll over so they can push on this bar to move away from it. They can pull on this bar to turn towards it and then it can also just a guess a little caveat I was going to say it can also help prevent a person from incidentally rolling out of bed. So if a person is a high fall risk they're going to want a longer bed rail but this can provide just a little support there to help them when they're sitting up out of bed and help prevent them from sliding down. So it's multi-faceted and it can getting helping a person get into bed it can be really challenging work for both the survivor and the caregiver. And so this can save your back, helping them get in and out.

Henry Hoffman (27:12.154):
Yeah, 100%. I mean, definitely the sit-to-stand alone, preventing them falling out of bed. I mean, I think we've all been there with some bad dreams from time to time that could have saved me a couple of times probably. And then of course, just the ease of transitioning while in bed. Easy investment to get if you're coming home and you're trying to think of your starter pack of what things you need. This would be at the top of the list. Another one that I wanted to look at.

Jessica Miller (27:23.82):
And we can't expect that.

Henry Hoffman (27:41.89):
In the bed category is the foam. Let's put in foam wedge, see if foam wedge pops up. You know, whether you have sleep apnea, whether it's a swallowing disorder, whether it's a bad back, you know, there's lots of reasons why folks may need a wedge. Now this one is, you're not going to be sleeping, you know, that vertical, that's more for reading, but you can see in this example, let's see if there's another example, here's one. You can see in this example it's elevated, right?

Any thoughts on wedges for sleeping and benefits? I mean, obviously getting from a supine to a long sit position is a little bit easier. And of course the whole breathing, sleep apnea, or swallowing issues, what's your thoughts on wedges if they're helpful?

Jessica Miller (28:30.55):
Yes, this can really help a person avoid a hospital bed. You know, if they have those swallow precautions where they have to keep the head of the bed up 30 degrees, then you can imagine that's pretty hard to sleep in. So if you're at home, you don you may not want to get a hospital bed just to comply with those swallow precautions. And so using a foam wedge can help to keep you in compliance with those precautions and yet still be able to sleep in your own bed. So that's one reason.

And then I really love the one that Rehab Mart has here because it's got this nice curve. And so it's going to fit right into that spot. When you sit in a chair, your bottom is lower than your knees. When you sit in your bed, your bottom is actually lower than your knees. So that curve there is going to really help to keep your bottom from slipping down, and you're going to be able to maintain that position. And of course, your husband is going to need one of these for his day bed so he can sleep in it.

Henry Hoffman (29:23.418):
Yep, I agree, I agree. All right, now we're at our last category from the five categories. Now that they've taken a nap, right? They're clean, they're dressed nice, they're in their home. I know they're hungry, I'd be hungry too. I mean, they're in their humble abode. So now when we think about eating, dining, there's tons of tools, tons of adaptive equipment that's gonna help not only orthopedic patients,

Jessica Miller (29:35.438):
They're hungry, Henry.

Henry Hoffman (29:54.082):

But neurological patients and specifically when we think about one-handed individuals, it gets a little tricky with what equipment to really recommend because You'll see things and we'll go over a few where they're, you know, cuffs where you can put your hand in a utensil, a built-up utensil, all these things that are used for arthritic patients that sometimes are recommended for stroke survivors, and you have to wonder which ones make the most sense now full disclaimer here

Our number one job as therapists is to continue to advocate for what's called forced use. Meaning, we want the neurological patient to use their affected side as much as possible. Because the more they use it, the better their chances for neuro recovery. You're making your brain very happy when you stimulate the affected side of the brain. And that's how you rewire, right?

We have something called learned non-use where you don't use your arm enough and then you start to deplete the, and literally prune away and neuronal cells just start disappearing, they die off. And then you have limited chance for recovery. But if we can force you to use your affected side as much as possible, we can rewire and we can have new cellular growth, new neuronal growth, and we can create new pathways which will lead to more function in the arm and the hand.

So having said all that, that's the physical part of stroke recovery. But there's also a mental health side of stroke recovery. Think about how frustrating it must be for a lot of folks that are listening when they don't have use of their affected side. And people like me are telling them, uh, use that affected side all day long. After a while, they're gonna say, you know what, Henry, go fly a kite, right? Because they still gotta get stuff done. They still want to have a sense of accomplishment. They still want to have a sense of independence.

So of course they're going to engage their healthy limb to take over. I would so I get it. I just know at the same time the more I do that the less chance for recovery. So it's going to be this ongoing balancing act. How much do I use my affected side to really help as a diving board to new neuronal recovery, right versus how much do I use my good arm because I just want to get stuff done.

Henry Hoffman (32:20.35):
And for sanity purposes, right? So when we get into this next category, you're gonna see a lot of tools, aids, utensils, where it's either, yeah, this is used for your healthy limb because let's pretend for a second the client is very low level. They call it dense hemiplegia, meaning no activity on the right side at all or the left side at all. Yeah, you're gonna have to have your good arm take over and do most of the...the feeding and a dining one-handed, right? And that's just, it is what it is. Then on the other spectrum, there's gonna be patients who are pretty high level stroke survivors that have some emerging finger extension, some ability to extend the wrist, some ability to extend their elbow. Well, as a therapist, I'm gonna say, look, Joan, I know your healthy arm can do this for you, but as part of therapy, let's have your affected side struggle a little to either scoop up the food, cut the food, manipulate different utensils, things like that to really challenge the affected side because we know the brain wants it to happen. So when we talk today about dining needs and utensils, and all these categories to be honest with you, there's going to be the severely impaired shoulder and elbow and hand and the mildly impaired.

We'll kind of separate the two. Does that sound good, Jessica? We'll do that.

Jessica Miller (33:52.75):
Yes, I think that's super smart to go that route.

Henry Hoffman (33:55.758):
All right. So having said that, let's type in, let's start off with what? Maybe I'll do utensil. Utensils, let's start with utensils. Let's see what happens.

Henry Hoffman (34:08.35):
All right, so as you can see, there's a lot of built-up handled utensils, and those are typically used for arthritic patients or people who have a weak grip. So they're trying to, you know, squeeze around a built-up handle. But for the purpose of what we wanted to do is, oh finally, okay here we go, I see you, I see these universal cuffs. So in general, thinking about utensils, we'll get into a rocker, I see a little rocker knife there and we'll show another one.

What do you think about universal cuffs and built-up utensils at this point for structural members?

Jessica Miller (34:43.074):
So, Henry, you were talking about, you know, no two strokes are the same. So let's pick a person who has some shoulder movement. They can lift their arm and they can move their elbow, but they don't have any independent finger controls. So they can move their arm. We wanna use it, right? And eating is one of the most, you're talking about rewiring the brain. We need things to be motivating. Home-cooked food, I will say.

Whether you're putting a carrot in a person's hand, if they have spasticity and they're trying to get that or a pretzel rod or something like that, can be really powerful for neuroplasticity because eating is highly motivating. So a universal cuff is great from that perspective. So I would say a downgrade is no utensil and you've got like that carrot or pretzel rod or something like that. But then you can put a universal cuff which just wraps around the person's palm.

You can stick a utensil in it a spoon or a fork and I would suggest using a fork and you can play with where you're placing it you can have it kind of coming out of the palm side or you can have it coming out of the pinky side having that fork come out of the pinky side makes it easier so that they can stab something on the plate and if they have any supination or where their palm turns up then they can bring that to their mouth and I used this tool with um berry when he had just that amount of movement, he could lift his shoulder and he could bring his arm in, but that was about it. And we cut up, one of his favorite things to eat was a Cosmic Brownie. And so we cut up that Cosmic Brownie and put the universal cuff in with that fork and he could just stab the brownie. He was so motivated to get that brownie into his mouth and he could bring it up and then take that bite off. And he was successful doing this. So then we talked about, okay, he had to work so hard. And I was like, very...you can do that and I understand you want to enjoy your food. So what can we do at each meal just to get a little practice in and he agreed that he would do three bites of every meal with that universal cuff and a fork and then after those three bites I agreed he could take it off and still use that affected limb to stabilize the plate but then he could use a stronger arm and finish enjoying that meal and so we can we can

Jessica Miller (37:04.93):
Have find a happy medium there.

Henry Hoffman (37:08.282):

I love that. I love how we're still incorporating the arm. He's doing it on his own. He doesn't have hand function, so he needs a universal cuff, but it's still the affected side. Awesome. Love that. Let's type in a rocker knife. Some people may be thinking, well, how the heck am I gonna cut anything? You brought up cutting. These are rocker knives. You can see from the photo, you can grab it, and then you can rock back and forth to slice it because you may not have the motion needed or the joint.

Jessica Miller (37:09.518):
I love that.

Henry Hoffman (37:36.474):
Motion of what's called ulnar deviation when you're holding onto a knife. You can, a, you may not be able to grab a knife correctly. B, you won't be able to do the motion of slicing back and forth. It might be a little bit more dangerous. This one's easy because you can rock back and forth. So I could see how that could be effective as well. Let me put in cutting board and then I'll see what you think for any other comments on that. So cutting board because what are you going to cut on? Because you got to be able to hold it. Obviously if, if you are using your left hand. Let's say it's your healthy hand and your right hand can't stabilize the food. You're gonna need something like a cutting board. Jessica, are there any tips or strategies that you have regarding cutting boards or thoughts on that?

Jessica Miller (38:25.178):
Yes, I do love that cutting board right there that you're showing that has, it looks like those nails coming up through it is the one function of it. And then you'll see on the corner of the board, there are two little walls. And so we'll talk about each of those and then the rocker knife. So you can use a rocker knife with this cutting board and you can use it without. It's misleading to look at, but that rocker knife will even work to cut a pork chop or a steak.

The nice thing about that let's say you're using your strong hand to do the cutting because you're holding the knife and you're doing a downward pressure and you're rocking the piece of meat isn't or whatever you're cutting isn't running around on your plate as if you were doing the traditional kind of sawing and that meat's going to move back and forth but there's just something about this rocker knife the downward pressure and then they're rocking back and forth. I had one gentleman who would have his wife it came with a little carrying case and he would put that in his wife's purse to go to a steakhouse because it felt really good to him that he could cut his own steak. He just had to take his own special knife. So I love those. I wish I could give every stroke survivor a rocker knife and a foot funnel. Those are the two that I love. Yes, tis the season. Yes, yes, yes. So this one, the cutting board doesn't necessarily fit into a stocking, but if your loved one is a person that enjoys cooking,

Henry Hoffman (39:39.71):
Stocking stuffers, right?

Jessica Miller (39:53.046):
This is a must-have. So on the bottom also, it comes with these little suction foot, suction cup feet to keep the board stabilized. And then let's say I have a lot of people that want to make potatoes, so they want to make a potato soup or a potato salad. So you can take this potato and just put it on those two nails and that's going to hold it in place. And then you can take your peeler then peel the potato. You might have to pick up that potato and turn it over and put it back down, but you can definitely do this whole task with your strong arm and then you keep the potato stabilized on those nails and then you can grab a knife. This could be the rocker knife, but it can also be just your typical chef's knife because the potato is already stable and you can just chop the potato in small pieces and this works beautifully.

And the other component to this, the corner that has the two walls, sometimes people overlook this, but what you can do there is you're going to turn the cutting board so that corner is towards your body, towards the person's body, and then you can slide in a piece of bread and it's going to be much easier to put your peanut butter and jelly or your butter and mustard, whatever condiments you want on your sandwich because you can, when you're pulling the knife towards you,

Henry Hoffman (40:46.802):
Very cool.

Jessica Miller (41:16.522):
A lot of times you need your other hand to stabilize. If you can, definitely get that hand involved. If it has spasticity and it just won't stay there holding your bread down, this wall will hold that bread while you're spreading that condiment on. And then lastly, you'll see in between those two walls in that corner is an open spot, and that's there by design because you can then take your knife and cut a diagonal, cut your bread or your sandwich into a diagonal. And it's of that force is pulling the bread into those two walls. So it's simple and it works perfectly.

Henry Hoffman (41:52.518):
Yeah, absolutely, that's probably one of the hot ones that most OTs recommend. And then finally, let's put in one last one under dining the scoop plate. So I know that's another one that's pretty popular for patients and caregivers. This is called a scoop dish, if you will. Thoughts on that one, Jessica, as we wrap up?

Jessica Miller (42:13.518):
So this helps decrease a lot of frustration. Because if you're trying with one hand to chase something, you know, you've got your vegetable that you're trying to chase around your plate, and it just keeps falling off the plate. So this just has, it's almost like half of it is half of a bowl. And so you can just scoop right into that wall, and it helps the food get onto your utensil.

And I will say once again, because Henry Hoffman, you're so good about making sure we're not killing off those brain cells. You want to one more trick whenever you're helping your loved one at the table. So you've got this scoop plate in front of you and we want to help that weaker arm stabilize the plate. Well, or the bowl, you're, they're going to try to bring that arm onto the table, and it's going to slide off. They're going to bring it onto the table. It's just gravity is going to pull it off, and they're going to stop trying to put it onto the table and they're going to learn to not use it.

But a trick is when you pull up to the table, you don't want to pull up square face on like you think we do. But let's say they are the right side affected. So that right side is the weaker arm. You actually want to turn their chair so that their right hip is closer to the table. And that way, when they bring their right arm onto the table, the whole arm is supported onto the table, and it's less likely to slide off.

And that's going to be much less frustrating, and they're going to be more successful.

Henry Hoffman (43:42.778):
Yeah, 100% there. All right, let me stop sharing so we can get back to full screen here. Hold on one sec.

Henry Hoffman (43:52.882):
All right, so that was real helpful. I think the take-home there with that last one, the dining is, you know, I always tell the client, yeah, definitely put your arm on always. Try to, instead of trying to lift the arm with the other hand, try to activate the deltoid, activate your shoulder and get your hand on the table. Did you do that before the stroke? Yes, then why aren't you doing it now? So it's that constant reminder to have them do that. The other thing is finger foods.

A lot of them have their hand curled because of the tone, but they have enough bicep and enough shoulder to get the hand to the mouth. So like you said earlier, take that carrot, take that bread, take the cracker, put it between thumb and index finger with your healthy side, and then force them to bring it to their mouth so they have to actually work on that hand-to-mouth activity. So I think that's important too. So yeah, so fun shopping with Jessica Miller on ADL, popular ADL equipment, DME equipment for patients.

I mentioned earlier, it's a double-edged sword. We want to get you as independent as possible, but at the same time, we don't want you to forget about your heavy product or your weak side. So it's a constant give-take relationship. I know a lot of you are just transitioning to home that are listening. And so hopefully these tips are helpful. This is something we're definitely gonna want to do again. There's other episodes we can do to share other equipment needs. Jessica, any final thoughts as we wrap out the going shopping part two with you today?

Jessica Miller (45:22.846):
I have seen so many loved ones purchase so many items because they just, they want to help in any way they can and so they see this infomercial or they see something on Amazon and so they just, they purchase all these items hoping that something will help, and I know it comes from a place of love and I just want you to have support in that. So if you aren't sure if something could be helpful I would say take it to your friendly OT, whether you're, you know, they're at home health or you're an outpatient.

But ask them, hey, I was wondering if this could be helpful getting in and out of bed, or, and then that's going to prompt that conversation. You're going to open Rehab Mart or open up that catalog and look at your options because your OT can probably go, oh, that actually isn't going to help, and that's going to cause more frustration. But this could help. And so don't hesitate to ask. And I would encourage you to ask before just spending a lot of money on the equipment. So, Henry, I love that you did this because it's just helping them pick the things that are important without buying everything on Amazon.

Henry Hoffman (46:22.266):
Yeah, 100%. Thank you. And we'll put your contact details also back in the show notes and link rehabmart.com as well. Well, it was a pleasure shopping with you today, Jessica. I hope you have a fantastic rest of December with your family and loved ones. And until next time, enjoy the rest of your year.

Jessica Miller (46:28.462):
Perfect.

Jessica Miller (46:36.674):
Thank you. Thank you.

Jessica Miller (46:43.382):
Thank you, Henry. Happy holidays.

Henry Hoffman (46:45.562):

Yep, happy holidays.