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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
Image by: http://www.access-ability.com/grab.html
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
Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2161&pid=2945
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
Image by: http://www.access-ability.com/bath3.html
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
Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=184&pid=10446
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
Image by: http://www.dynamic-living.com/bath-appliques.htm
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
Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2627&pid=5551
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
Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2022&pid=34670