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August/September 2003

By Laura A. Ryan, OTR/L, and Maria H. Cole, OTR/L

Maria H. Cole, OTR/L, (right) assists a client using a sock aid, a popular dressing tool.

Low-tech patient aids can make all the difference in performing daily activities.

Joan Wallace* is a 56-year-old woman diagnosed with mitochondrial myopathy, a progressive neurological condition that affects the muscles. She was struggling to comb her hair, brush her teeth, and even feed herself. When an occupational therapist gave her cylindrical foam—a simple adaptation—she was then able to complete those tasks with a minimum of physical effort. She described her first occupational therapy appointment as “enlightening.”

Many people like Joan are unaware of the role low-tech adaptive equipment can play in maintaining independence. Being offered this equipment can potentially make the difference between staying at home independently or paying for a costly home health aide.

A Wealth of Adaptive Uses
Adaptive equipment is defined as pieces of equipment that are purchased, customized, or adapted to assist the user in maintaining or enhancing his or her ability to function in everyday life.¹ The terms adaptive equipment, assistive devices, and assistive technology are often used interchangeably. For the purpose of this article, the term adaptive equipment will be used only to describe low-technology equipment for activities of daily living.

Any person struggling with decreased range of motion, increased weakness, profound fatigue, and limitations in mobility is a candidate for adaptive equipment. It is common to give adaptive equipment to individuals who undergo a total hip or knee replacement to assist them with lower body care.

However, adaptive equipment can also be used for persons with weak hands and an ineffective grasp stemming from general osteoarthritis, a stroke, or a high-level spinal cord injury. It can be helpful to people with poor sitting balance, such as someone with multiple sclerosis or a paraplegic. A woman in her last trimester of pregnancy may be unable to reach her feet to don her socks or tie her shoes. Those who are morbidly obese may also find adaptive equipment for their personal care easier to use and more thorough. Persons with restrictive lung disease are often unable to bend over without becoming short of breath and may find using adaptive equipment helpful in lower body dressing.

Conversely, adaptive equipment is not appropriate for everyone. Suitability and the necessary training play an important role when prescribing equipment. For example, an individual with even minor memory problems common to the aging population may find learning a new routine with an unfamiliar tool too challenging. Attention to the person’s attitude toward adaptive equipment is imperative.

If use of adaptive equipment is necessary, it should be approached with tact and empathy. Studies on the use of adaptive aids suggest psychosocial and cultural influences can play a role.² Having to use a sock aid or long-handled sponge to complete a task once performed without a thought may be difficult to accept for some, as it could be seen as a tangible example of one’s advancing age or level of limitation. In these instances, adaptive equipment may not be the best choice.

Reachers and Grabbers
There is a plethora of adaptive equipment available today, ranging from long-handled reachers to the one-handed bracelet clasper. Adaptive equipment is available from specialty catalogs, home improvement centers, gadget stores, and medical supply stores/professional pharmacies. The Internet offers a wide selection of adaptive equipment that can be found in minutes. Having the necessary equipment readily available makes the transition to using it within the daily routine easier and smoother. Often, leafing through an adaptive equipment catalog facilitates a worthwhile discussion of the client’s self-care routines and allows the therapist to address shortcomings in an effective manner.

Perhaps the most versatile item of adaptive equipment is the long-handled reacher. It can be used to pick things up from the floor as well as pluck lightweight objects off high shelves or assist with donning pants or skirts. The long-handled reacher comes in several lengths and styles. An extralong reacher measuring 30 inches is ideal for the client who is more than 6 feet tall or one with strict hip flexion precautions while a shorter reacher is best for one who is frail or weak or petite in size. Pincher-type reachers are very popular and do an excellent job of picking small objects such as a coin off the floor; however, they can be fragile and easily overused. A reacher with suction cups on the ends of two arms that open and close can be sturdier. Some reachers have a bolt-type attachment opposite the pincher, which can be used for more vigorous tasks such as slipping off socks or shoes. There are reachers that are lightweight and have adjustable length, forearm supports, and a lever action trigger. Prescribing the most appropriate reacher can ensure continued use of the equipment. One study found that 22% of elders who owned reachers were dissatisfied with at least one of the reachers they owned.³

Randy Troy* is a 55-year-old polio survivor with both upper extremity and lower extremity weakness. His primary complaint was his lack of ability to reach items on the table from his wheelchair. Troy reported he had a reacher but did not use it because it was too long. The occupational therapist suggested he try a shorter version used for the pediatric population and he was instantly happy with the length. It is important to determine the exact needs of your client, then fit those needs to the tools you prescribe.

Dressing and Grooming Aids
Another popular lower body dressing tool is the sock aid. This tool is often met with skepticism; however, it really does work. For those with strong hands, the hard sock aid may work well. The challenge with the hard sock aid is getting the sock actually on the tool. Once the sock is slipped over the end, the sock aid does a beautiful job of pulling the sock over the toes and up the heel. The sock aid with the two separate cords on which to pull is easier to maneuver than the sock aid with the loop, as it can be tricky to untangle the foot from the tool especially for postsurg-ical patients. There are also sock aids that offer a loop at the end of the cord, which allows clients to slip their hands through and use more bicep strength to pull the sock on versus pure grasp.

Table 1. Popular adaptive equipment.

Another type of sock aid, which operates similarly to the hard sock aid, is the soft/flexible aid. The advantages of the flexible aid over the hard one are that the sock is pulled onto the tool with ease and that the sock is stretched out less. There are a number of sock aids that have been designed specifically for compression stockings. These aids have a sturdy metal frame that will not bend with the pressure from the stockings. One needs to bend from the waist more when using a compression sock aid, as they do not have cords on which to pull.

The dressing stick is another excellent lower extremity dressing tool. It is inexpensive and very sturdy. It requires a bit more maneuvering than the long-handled reacher, thus it is more appropriate for someone with good spatial and problem-solving skills. This tool can assist with doffing socks and shoes, can hook the waistband of slacks, which will then allow them to be slipped over the feet easier, and can obtain any large out-of-reach items.

A long-handled shoehorn is a handy tool no closet should be without. This allows the user to slip on both tie and loafer-style shoes easier and with less bending. The standard size is 18 inches; however, there are extralong shoehorns, which would be appropriate for those who are tall. There are metal and plastic styles available. The metal shoehorns are sturdier but less comfortable to use than the plastic ones.

Individuals who wear an ankle foot orthosis (AFO) often find a metal shoehorn helpful in encouraging the AFO to slide into the shoe. Using elastic laces in tie shoes eliminates the need for bending to repeatedly tie the shoes. A helpful hint when adapting shoes with elastic laces is to be sure to thread the lace through the fabric tab on the tongue of the shoe. This will ensure the tongue of the shoe does not fall to the floor and makes donning the shoe much easier.

Long-handled sponges are invaluable for completing thorough foot care. Round sponges on the end of a long plastic handle are the most popular choice, but there are many other styles, even some available commercially. When choosing the round sponge, one must be aware of the pliability of the handle. Warming the plastic under warm water will allow one to bend the handle to a good angle in order to also reach the back as well as the feet. This simple trick makes the sponge much more effective. There are sticks with narrow sponges and soft brushes at the end, which do a better job of getting between the toes. Many bath stores now carry the shower nets (“poufs”) also on a long stick. There are bath mats with “fingers” that scrub the foot. If one has a weak grasp versus difficulty bending, using a shower pouf with a looped string that can be put around the wrist, or a bath mitt that is a washcloth sewn into a mitten, can be effective.

One of the most common complaints from women is the inability to don their jewelry. There are many items available to assist them. A commercial catalog offers a bracelet assist where one end of the bracelet is held stationary, allowing it to be clasped with just one hand. For earrings, there are wide, circular earring backs that are slightly bigger than the diameter of a pencil eraser and are easier to manipulate and grasp. For bracelets and necklaces, replacing the clasps with magnetic closures makes fastening a breeze.

Do-everything Tools
A favorite item in our clinic is cylindrical foam. It is inexpensive and can be used to build up utensils, tools, toothbrushes, and even pens. A therapist simply cuts a piece and the client can then take it home and use it instantly. If the hand and wrist are weak, the universal cuff can make the difference between independence with self-feeding versus being fed. Joan Wallace reported the universal cuff was her favorite piece of equipment, since it allowed her to feed herself.

Ergonomics and adaptive equipment have now merged and there is a wide variety of equipment available. All of these items are helpful not only for those with weakness but also anyone with repetitive or overuse problems. There are ergo-nomic choppers, can openers, cookware, silverware, and gardening tools. The equipment is available not only in catalogs but also at large department stores and specialty linen stores.

President Franklin Delano Roosevelt once said, “The only limit to our realization of tomorrow will be our doubts of today.” This is especially true given the physical limitations FDR faced on a daily basis from polio. He made the necessary adaptations to his routine, including use of two canes for ambulation, and carried on to become one of our nation’s most revered presidents.

We are all capable of greatness but we must be able to put our socks on and face the world in a presentable manner to do so. How the mundane tasks of life are accomplished is not as important as getting them done and moving on to bigger and better things. Utilizing adaptive equipment can offer one a level of independence not able to be achieved in any other manner. N *Names have been changed.

References

Kraskowsky LH, Finlayson M. Factors affecting older adults’ use of adaptive equipment: review of the literature. Am J Occup Ther. 2001;55(3):303-10.
Louise-Bender, Kim J, Weiner B. The shaping of individual meanings assigned to assistive technology: a review of personal factors. Disabil Rehabil. 2002;24(1-3):5-20.
Chen LK, Mann WC, Tomita MR, Buford TE. An evaluation of reachers for use by older persons with disabilities. Assist Technol. 1998;10(2):113-25.

Laura A. Ryan, OTR/L, is a staff occupational therapist and Maria H. Cole, OTR/L, is a senior staff occupational therapist at Spaulding Rehabilitation Hospital Outpatient Center, Framingham, Mass.

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August/September 2003