Occupational Therapy facilitates meaningful activities!

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A lot of people don’t know what occupational therapy is. That’s because we do so much! One thing we do is facilitate individuals to participate in meaningful activities. Here’s one example.

This is Christine: a passionate advocate for augmentative communication devices with a big heart. She loves the 3e love heart wheelchair logo, as their mission is to change the perception of disability.

Christine also loves RAD camp, a week long summer camp for adults and children with disabilities. They have a variety of classes and activities throughout the day, including art class. Some of the art projects are personalizing projects and adding that bit of individual flair.

Even though I was not participating in camp as an occupational therapist, my brain has a difficult time looking at the world through any other lens. As an OT, I look at the activity and break down the requirements needed in order to be successful. I assess the person’s abilities and find compensatory strategies or assistive devices that can help achieve the goal of creating a meaningful camp artifact that reflects her personality and highlights her ability.

Christine and I worked together to design a stencil that she could use for multiple projects. I took a piece of construction paper, covered it in clear packing tape for stability and washability, and made a wheelchair heart logo stencil. We problem-solved the rest of the task together, so that she would be the one creating the art. We used the stencil all week long to decorate art and journal projects.

I love occupational therapy because we create solutions for everyday life!

Experimenting with custom splint design

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This family wanted the support of thermoplastic splint with the comfort of neoprene, so I combined both. 

I made the custom splint in a traditional manner by tracing her hand, melting aquaplast, and forming it to her hand. I left the forearm trough as a plastic stay to keep the wrist straight. 

I measured her forearm for the neoprene and sewed straps and d-rings to it. I attached the neoprene to the aquaplast with rivets because I thought it would be the most secure option. I lined the inside with padding to make it nice and comfortable.

I used 1/16″ aquaplast and there is a little give to them. I find a slight dynamic component is so important. The client tolerates them well and is maintaining her range of motion.

Dressing Aids

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Commercially available adaptive aids rarely work for pediatrics. I made these 3 tools to help with the difficult task of buttoning pants. Two of them are modifications to existing aids available: the button hook and the zipper pull. The third one (to my knowledge) is my own design, for these purposes I will call it the loop hook.

Primary task limitations: unable to reach button, difficulty pinching/grasping, and decreased upper extremity/grasp strength

Initially, I wanted to combine all tools into one, but it worked better for this client to use all 3 separately. I formed a triangle handle, a T-handle, and another handle that looked like an anchor. The T-handle worked the best for her. I was also trying to make it as compact as possible. I formed all of them out of Aquaplast pellets, but continually had to reheat them to make them longer. I used binder clips and heavy duty paper clips to form the metal parts. I used pliers to bend them.

For the button hook, I kept the shape of the large heavy duty paper clip because it seemed to work better with jean buttons. 

For the zipper hook, I added a straight piece of metal to help with pushing the zipper down. This piece needed to be bent on the inside of the plastic or it fell out. 

The loop hook was formed by bending a binder clip and was used for 3 purposes. When the client was zipping the zipper up, they used the loop hook to stabilize the pants at the bottom as they were unable to reach that far down. They also used it simultaneously with the buttonhook. For unbuttoning, the loop hook would hook onto the button hole and would help pull the button hole away from the button, as the button hook pulled in the opposite direction. When buttoning, the button hook would go through the button hole first, attach to the button, then the loop hook would hook onto the button hole, both tools would be pulled in opposite directions, and “voila!” pants are buttoned. Sounds confusing, but the client picked up on it right away. :)

Future implications: 3D printing could make some of these individualized adaptations quick and easy. Contact me if you’re interested in collaborating.

Dining Aids

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I’m trying to work on utensil grasp patterns with a kiddo. My intention with these aids is not for them to use always, but to use them as tactile and visual cues on how to place their hands on the fork and knife in a more effective way. 

I made a triangle handle for a knife using Aquaplast. I formed the triangle using a cast cutting strip, which was just the right width I was looking for. I always try to find objects which can facilitate the form that I’m shaping. In this case I wrapped the knife in place using athletic tape to form a triangle. I formed the Aquaplast around it. Before it completely hardened again I removed it and massaged out any bumps. I placed 3/8″ open cell blue padding on the inside back wall and closed off the end of it to allow the knife to slide in and out.

For the fork, I melted Aquaplast pellets to form a place for the index finger to rest and attached a built up foam handle. 

I’m hoping that these tools will assist visually, tactilely and facilitate the development of the arches of the hand.

Work With What You Got!

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I work with a 7-year old girl who was born with bilateral absent radiuses (bones of the forearm). She was having difficulty pushing her pants down to use the bathroom. We practiced using a dressing stick, which facilitated her independence well. I didn’t want her to have this long contraption to take to school. I’m pretty sure they make something similar commercially, but I only had access to this one. So, I sawed it in half, drilled small holes in each end of the stick, and threaded an elastic string through it. I used Aquaplast to form the neck, being careful it permanently adhered to only one end of the sticks. She is now able to take it to school in her backpack.

Dynamic Elbow Extension Splint

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I’m not going to lie, I was kind of proud of myself with this one. I had no idea how I was going to pull this off, even as I was making it. This is an elbow extension splint that I made for a 12 year old girl with Cerebral Palsy: hemiplegia. She was lacking 40 degrees of elbow extension. I had tried to teach her stretches to do on her own, but her understanding of the task was limited and there was not great follow through with the family. I could have done a static elbow extension splint, but I really wanted to be able to give a progressive stretch. We don’t have the funding to buy something like this out of a catalogue, so I decided to try to make it myself.

I used 1/8” Aquaplast for the upper arm and forearm. I folded the Aquaplast on top of itself for extra stability to make the bars. I used socket screws for rivets and covered up the back of the flat bolt with Sugru (a self-curing rubber/silicone) in order to avoid any rough edges near the arm. Additionally, she postures her arm in shoulder internal rotation. I was concerned about possible pressure points and/or rubbing that could cause redness. I cut that side down as much as I could without hindering the integrity of it, and then I covered it in Sugru. I attached the bars by punching holes through the bars and the base and forming a rivet out of Aquaplast pellets. I then formed two cylinders out of the Aquaplast. One of them I formed around a long screw, the other one I left open. I used a heat gun to attach each cylinder to the upper arm and forearm pieces. The end of the screw is inserted into the hole of the cylinder on the forearm. As she stretches, the wing nut can be twisted to push the elbow into further extension, and voila!

Sew Easy

I made this a long time ago. As an occupational therapist, it is helpful to know how to sew. Problem was, I never learned. We had a sewing machine at work, so I combined a work project with self-learning. I figured out how to use the machine and then created a helpful guide that could easily be accessed while sewing.

I made this a long time ago. As an occupational therapist, it is helpful to know how to sew. Problem was, I never learned. We had a sewing machine at work, so I combined a work project with self-learning. I figured out how to use the machine and then created a helpful guide that could easily be accessed while sewing.

Baby Toy

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This is not my design, but it’s a favorite of mine when working with babies. I used Aquaplast and formed it around a thin dowel with the edges extremely close, but not touching. Once the Aquaplast has set in form, but is not hardened entirely, I removed the dowel. I then cut beads into strips and slid the top bead of each strip through the space between the edges of the Aquaplast. Then to keep the beads from falling out and to give it a clean finish, I heated the sides up and used curved scissors to create a smooth edge.

DIY pocket button hook/zipper aid

This is a modified button hook that I made for a child whose fingers are contracted in extension. He is able to grasp items using a lateral pinch, but buttons on pants were difficult. Because of this he always wore elastic waste pants to school. He was able to button/unbutton using a standard button hook, but who wants to carry that giant thing around to school? I fabricated this out of a large paper clip and Aquaplast pellets. I made the hole slightly bigger than normal to accommodate a jean button. I curved the other side of the paper clip into a zipper hook, so that he can slip the hook into the hole of the zipper and slide his finger through the button hook to pull up. Now he can wear jeans to school just like his friends!

This is a modified button hook that I made for a child whose fingers are contracted in extension. He is able to grasp items using a lateral pinch, but buttons on pants were difficult. Because of this he always wore elastic waste pants to school. He was able to button/unbutton using a standard button hook, but who wants to carry that giant thing around to school? I fabricated this out of a large paper clip and Aquaplast pellets. I made the hole slightly bigger than normal to accommodate a jean button. I curved the other side of the paper clip into a zipper hook, so that he can slip the hook into the hole of the zipper and slide his finger through the button hook to pull up. Now he can wear jeans to school just like his friends!

Headsupport for Tumbleform

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I was working with a baby that had Torticollis, and he needed a little more head support in this Tumbleform chair to keep his head in midline. I used scraps of material and pool noodles to create support on each side. I sewed seams all around the material, measured the material over the noodles and sewed that. In retrospect, I could have done a better job with hiding the inner seam, but it works.

DIY Sippy Cup Handles For Limited Grasp

This is an adaptive handle that I made to put on a sippy cup, in order to facilitate holding the cup or working on bringing cup to mouth. I used Velcro Easystrap around the base, as it is easily adjustable and could be used on various sized cups. The “handles” are made of Neoloop, which is essentially a neoprene material. It has a stretch to it, which allows the hands to slide in and remain secure against the cup. None of it is sewn together to allow adjustability.

This is an adaptive handle that I made to put on a sippy cup, in order to facilitate holding the cup or working on bringing cup to mouth. I used Velcro Easystrap around the base, as it is easily adjustable and could be used on various sized cups. The “handles” are made of Neoloop, which is essentially a neoprene material. It has a stretch to it, which allows the hands to slide in and remain secure against the cup. None of it is sewn together to allow adjustability.

Sensory Wall

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I read an article in Advance for OT about an OT who created a sensory wall. I had the opportunity to make a similar wall in 2006. I used different textures for each character. I used AstroTurf for grass & corrugated cardboard for the tree. Winnie the pooh was soft and Sponge Bob was made of sponges. I also incorporated dressing tasks: the stem of a flower was a zipper, the petals were snaps, and Dora’s Velcro shoes were real Velcro. Hello Kitty had a dress that you could change.

DIY Shoehorn

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This is an adaptive shoe aid I made for a client who was unable to bend their knee. We tried a long handled shoe horn and a foot funnel, but neither worked. I used Aquaplast to make a combination of the two. I’ve used it with several of my clients since. This is a picture of a Polaroid, which explains why the quality of the photo is so bad.

Dynamic Wrist Extension Splint

I had a client with juvenile rheumatoid arthritis who was limited in wrist extension. Her doctor had requested I make a splint to increase range of motion in wrist extension. I could have made a static splint and remolded it as she progressed, but it didn’t seem like the best option. I did a little research online, and found a dynamic design. I’ve never made a dynamic splint before, but I was willing to try it. 
 On this splint, there is a piece that fits on the dorsal side of the forearm and the fingers slide into the oval shape and rest at the MCP joints. There are two small hooks. One at the far side of the forearm and one at the fingers. A rubber band is secured around the hooks and provides a consistent stretch into wrist extension. The hinge at the wrist allows her to flex her wrist and use her hand functionally. As she progressed, I used tighter rubber bands and eventually twisted them around several times to provide a greater stretch. She went from neutral wrist extension to 70 degrees.

I had a client with juvenile rheumatoid arthritis who was limited in wrist extension. Her doctor had requested I make a splint to increase range of motion in wrist extension. I could have made a static splint and remolded it as she progressed, but it didn’t seem like the best option. I did a little research online, and found a dynamic design. I’ve never made a dynamic splint before, but I was willing to try it.

On this splint, there is a piece that fits on the dorsal side of the forearm and the fingers slide into the oval shape and rest at the MCP joints. There are two small hooks. One at the far side of the forearm and one at the fingers. A rubber band is secured around the hooks and provides a consistent stretch into wrist extension. The hinge at the wrist allows her to flex her wrist and use her hand functionally. As she progressed, I used tighter rubber bands and eventually twisted them around several times to provide a greater stretch. She went from neutral wrist extension to 70 degrees.

Pencil Grasp Assist for Muscular Dystrophy

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This is an adaptive device I made that is used with clients who have difficulty grasping a pencil. It maintains the fingers in a pinch. It is typically used for people with muscular dystrophy.

*Disclaimer: this is not my original design

Elbow Flexion Assist Harness

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I made this for a client who was unable to bend their elbows. There was some bony limitations, but they were also lacking bicep muscles. There is a harness that fits over the trunk and rests on the shoulders, then there are two wrist splints. A piece of Theraband is attached to the shoulder and to the wrist, which allows them to extend their arm, but also stretch it back into flexion. It also allows the person to bring something to their mouth for self-feeding.