Adapting the Disabling Adapting the Disabling Environment:Environment:HemiplegiaHemiplegia

Stephanie HayesStephanie Hayes

March 21, 2005March 21, 2005

OT 5162OT 5162

HemiplegiaHemiplegia

Partial or complete paralysis on one side Partial or complete paralysis on one side of the bodyof the body• Can cause limitations in balance, Can cause limitations in balance,

coordination, and fine motor abilitiescoordination, and fine motor abilities Tingling, numbness, or loss of sensation Tingling, numbness, or loss of sensation

can also occur on that side of the bodycan also occur on that side of the body Occurs due to a disruption of blood flow to Occurs due to a disruption of blood flow to

the brainthe brain Requires intensive therapy for a strong Requires intensive therapy for a strong

recoveryrecovery

Possible Causes of HemiplegiaPossible Causes of Hemiplegia The most common cause is a The most common cause is a

cerebrovascular accident (CVA) or strokecerebrovascular accident (CVA) or stroke However, it can also be caused byHowever, it can also be caused by

• a brain injurya brain injury• blood clot in the brainblood clot in the brain• an infection, such as meningitis or an infection, such as meningitis or

encephalitis encephalitis • vasculitis (an inflammation of the blood vasculitis (an inflammation of the blood

vessels in the brain)vessels in the brain)• cerebral palsycerebral palsy

Task AnalysisTask Analysis

Occupation: Taking a showerOccupation: Taking a shower• An activity of daily livingAn activity of daily living• Highly important for self esteem, body image, Highly important for self esteem, body image,

and social interactionsand social interactions• Steps:Steps:

• being able to enterbeing able to enter• turn on the waterturn on the water• wash both body and hairwash both body and hair• turn off the waterturn off the water• exit the showerexit the shower

Necessary Performance SkillsNecessary Performance Skills PhysicalPhysical

• CoordinationCoordination• PosturePosture• StrengthStrength• EnduranceEndurance• Intact SensationIntact Sensation

• PainPain• ProprioceptionProprioception• VisionVision• PressurePressure• TemperatureTemperature

Cognitive processingCognitive processing• AttentionAttention• AdaptationAdaptation• ConcentrationConcentration• JudgmentJudgment• OrganizationOrganization• KnowledgeKnowledge

Necessary Performance SkillsNecessary Performance Skills

PsychosocialPsychosocial• PerceptionPerception• AppropriatenessAppropriateness

Performance ContextsPerformance Contexts

FeaturesFeatures• Enclosed spaceEnclosed space• Hot and humidHot and humid• Private and personalPrivate and personal• Socially necessarySocially necessary

BarriersBarriers• Slippery, smooth Slippery, smooth

surfacessurfaces• Heat accumulationHeat accumulation• Rushing hot waterRushing hot water• Soap dish placementSoap dish placement

Barrier: High Bathtub WallBarrier: High Bathtub Wall

Weak side has Weak side has trouble lifting trouble lifting into tub/shower into tub/shower combinationcombination

Possibility for Possibility for trippingtripping

Safety hazardSafety hazard

Image by: Stephanie Hayes

Solution 1: Walk in ShowerSolution 1: Walk in Shower

No large step to No large step to negotiatenegotiate

Easy access for all Easy access for all peoplepeople

Sliding door allows Sliding door allows for easy entrancefor easy entrance

Image by: http://www.access-ability.com/bath.html

Solution 2: Grab BarsSolution 2: Grab Bars

Provide a secure Provide a secure holding surface holding surface when stepping when stepping over bathtub wallover bathtub wall

Can be used with Can be used with either handeither hand

Available in a Available in a variety of sizes and variety of sizes and materialsmaterials

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Barrier: Slick Shower FloorBarrier: Slick Shower Floor

Problematic for a person with coordination Problematic for a person with coordination and balance difficultiesand balance difficulties

Possibility for slipping and/or fallingPossibility for slipping and/or falling Safety concernSafety concern

Solution 1: No Slip Shower Solution 1: No Slip Shower FlooringFlooring

Offers a stable Offers a stable standing surfacestanding surface

Provides “rapid Provides “rapid discharge of discharge of soapy water”soapy water”

Available in many Available in many shapes, sizes, shapes, sizes, and colors to fit all and colors to fit all showersshowers

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Solution 2: Bath or Shower Solution 2: Bath or Shower Non-Slip MatNon-Slip Mat

Helps prevent fallsHelps prevent falls Stays non-slip Stays non-slip

when wetwhen wet Soft foam provides Soft foam provides

cushioning for feetcushioning for feet Useful for the Useful for the

entire familyentire family

Image by: http://www.dynamic-living.com/bath-mat.htm

Barrier: Shower Layout Requires Barrier: Shower Layout Requires StandingStanding

The socially “appropriate” way to showerThe socially “appropriate” way to shower Takes a significant amount of Takes a significant amount of

endurance, coordination and balanceendurance, coordination and balance Bending down and manipulation of soap Bending down and manipulation of soap

and shampoo is required while and shampoo is required while showeringshowering

Solution: Shower SeatSolution: Shower Seat Conserve strength Conserve strength

and energy while and energy while showeringshowering

Able to shower Able to shower while sittingwhile sitting

Decreases Decreases movements movements needed during needed during showershower

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Barrier: Lack of Temperature Barrier: Lack of Temperature DisplayDisplay

Deficits in sensation can occur on the Deficits in sensation can occur on the weak sideweak side

Limited temperature sensation can Limited temperature sensation can lead to burnslead to burns

Solution 1: Water Heater Control Solution 1: Water Heater Control ValveValve

Limits the maximum Limits the maximum temperature water can temperature water can reach reach

Controls all water faucetsControls all water faucets No fear of getting burned No fear of getting burned

when taking shower, when taking shower, washing dishes, or using washing dishes, or using the bathroom sinkthe bathroom sink

Best solution for client Best solution for client who lives alonewho lives alone

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Solution 2: Bath AppliquésSolution 2: Bath Appliqués

Provide visual Provide visual temperature readingtemperature reading

Change color with the Change color with the changing temperature changing temperature of the waterof the water

Also act as anti-slip Also act as anti-slip padspads

Fun shapes for Fun shapes for childrenchildren

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Solution 3: Anti-Scald ValveSolution 3: Anti-Scald Valve

Image by: http://www.access-ability.com/bath5.html

Easy installation Can be installed into

any existing shower Can keep other

showers in the house at maximum heat for able-bodied persons

Barrier: Small Duel Control Barrier: Small Duel Control HandlesHandles

Weak hand might Weak hand might have difficulty with have difficulty with fine motor controlfine motor control

Shaking or tone Shaking or tone decreases accuracy decreases accuracy of turnof turn

Must control two Must control two knobs independentlyknobs independently

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Solution: Single Rotating HandleSolution: Single Rotating Handle

Hot and cold are Hot and cold are controlled controlled simultaneouslysimultaneously

Easier to turnEasier to turn Can be controlled Can be controlled

with a closed fistwith a closed fist

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