Nursing Pillow

My apologies for the length of time between posts. As you can see, I've been a little busy. :)

I've always had a hesitation to hold babies. There are a few factors such as shyness, inexperience, uncertainty and fear of not holding them safely or securely. Most of those still exist for me but my experience and confidence are growing, shyness is gone because it's our child and securely holding them is greatly improved thanks to the nursing pillow pictured above.

Many nursing pillows, like the one I use to hold our baby, are U-shaped so that it wraps around my waist. A form of that shape helps it stay in place and allows me an arm or two free if I need to maneuver a bit. The biggest improvement I learned about from the ever problem solving Heather. She told me of how she modified her pillow to tie in the back so that she could feel safe about having her baby on her lap while completing the tasks necessary to keep her family running well.

I don't feel the need for those ties and am fortunate that my time with our daughter is for enjoyment. I never need to hold her and try to complete the essential tasks at the same time. Though I do find my available time to do what I need to do, and what I want to do, quite stretched thin and I don't have the work load my wife does. More quality sleep would help in getting things done more easily, and I truly don't need to be told it will get better. We know it will, but that doesn't help on the days following a bad night.

Until she's climbing all over me I will appreciate this pillow that allows me to hold our bundle closer.

Source: Most baby supply stores and some department stores.

The Root of All Our Troubles

Spinal cord injuries can be caused by trauma, disease, infection, a tumor or a number of other things. They can be complete or incomplete injuries, incomplete injuries leaving varying degrees of sensation or even movement below the level of the injury. My injury was incomplete, but the residual below-level function is limited to barely perceptible sensation in my kneecaps and soles of my feet, along with the tiniest flicker of inutile movement in my right ring finger.

Most traumatic injuries, where broken bones were the cause of the injury, requires surgical repair. Mine was performed after a week of traction that was increased to 55 pounds over that period of time. The crushing motion of my injury required the traction to stretch my neck out so the vertebrae would realign in preparation to be fused with the assistance of harvested bone fragments, two titanium plates, seven screws and about three feet of wire.

One of the worst parts of the recovery was the first few days after the surgery. The neck muscle spasms were fighting the realigned spine. Not so different than the discomfort faced by a person with bad posture sitting or walking straight after a long time of living the way that caused the poor posture, initially. Surprisingly, neither the surgical pain nor the installation of a halo in my skull without anesthetic were not as painful as those spasms. Those first days after surgery are one of the few memories I retain from my stay in neurology. It must have been intense.























Without question, it was not pleasant. However, to preserve my remaining function, and restore strength to my neck, it was a necessary surgery and a critical early step in my recovery.

One last note, from a photography perspective, out of focus x-rays can only have so much made out of them. Making a photo out of a two dimensional image was not the easiest thing I've done and wish I would've had a better creative spark for these but at least you got a glimpse of the inside of many of our necks.

Deadly Curb Cuts

In the past we have looked at what a proper, well-maintained, curb cut looks like and how it can make crossing the street simple and uneventful. However, there are exceptions to the rules that are beyond ridiculous. Last week we looked at the consequences of using a combined variety of construction materials, such as concrete, asphalt and paving stones, to build a sidewalk and what one winter in our climate can do to the usefulness of those sidewalks.

This week we look at the consequences of some of the extreme, but far too common, examples of when those materials shift over a few winters.

I know that scale is often difficult to perceive in a photograph so let me give you a hard number. The lip you see in the photo above is located just down the street from our house and is nearly 10 cm or 4 inches tall. This is dangerous on its own to come down off the road to a drop that significant but it's more than that. You're coming down into a gutter that immediately begins sloping upward, making the perfect grove for the front wheels of a wheelchair to dig in and jolt the user with more than enough force to compromise balance which could easily send them out of their chair, or tip the chair over.

Traveling the opposite direction, you're coming down a rutted slope (I understand the importance of those ruts for the visually impaired) which introduces vibrations to begin with just before slamming into a solid wall of asphalt. The perfect example of this is downtown by Citizen Café. Descending the concrete sidewalk, the roadway has crumbled with numerous holes in the asphalt at the bottom of a very steep curb cut. Seeing what I was about to run into, I was able to stop my chair, after a bit of uncontrolled sliding down the steep curb cut, and climb back up. Thankfully the driveway to an automotive shop was close by and the street was quiet enough that I did not feel in danger jaywalking to get across to the café. This was downtown, just a few blocks away from the ideal curb cut shown in the post linked to above.

Under ideal circumstances I could, as a C5-C6 quadriplegic, very slowly navigate this lip to descend with a degree of safety but to climb up that lip would be a challenge because of the difficulty of popping a wheelie while rolling down a hill. Because of that it would need to be done by climbing it from a nearly stopped position, eliminating the much needed momentum to make the climb doable. In this instance I had not only a camera bag but some lighting equipment with me in order to make the photo. I had to find far less dangerous transitions to safely get to the location, make the photo and get home safely.

Rounded curbs with reasonable gutters would be safer than these curb cuts with terrible transitions. What I cannot understand is why the annual pothole repair crews cannot be instructed to either fill in these transitions with asphalt or cold mix when they are in the area or to smooth them out out with the equipment they have for preparing potholes for repair. I understand that either option has its problems but how can this not be a priority?

The problem with filling it in is that it could affect drainage and curb cuts like these are already notorious for filling up with sand and debris, carried to them by rain and other water draining as it should in the gutters of the street. The problem with shaving down the asphalt is that the integrity of the road in those places may be compromised. My argument to that is if it is an annual task appropriate small repairs should be able to be made easily, regularly, and without long-term damage to the road.

I know that it's difficult to predict how land will settle over time, and the soil in our neighborhood is very sandy, but when this happens it simply should be the city's duty to fix these shiftings. I would expect the amount of taxes we pay in these new areas of the city to at least provide us a safe place to go for a stroll.

I still insist that the CPA wheelchair relay take place outside in places like this. Get our Mayor and other "celebrities" wheeling across this, falling face first in the concrete and maybe that would bring a little bit of action in our city's accessibility instead of just the lip service we receive every year from them.

Solution: I'm thinking that we should be reporting these as potholes but I do not feel we are a large enough proportion of the population to garner any action from those who have the power and the money.

Sidewalk Construction Material Transitions

In approximately 1990 the city of Swift Current replaced their concrete sidewalks downtown with paving stones. Before the end of one short winter those paving stones had shifted, heaved and cracked. This resulted in difficulty shoveling, tripping hazards, weed growth, and years of regular maintenance to maintain sidewalks that were about as safe as the cobblestone streets of old Montréal.

Moving forward in time there are numerous examples of mixed construction materials being placed side-by-side in designs planned by someone who obviously has no idea what our climate does to surfaces each yearly cycle of the weather. Above you can see an example of paving stone mixed with concrete at the Preston Crossing Shopping Centre in Saskatoon, Saskatchewan.

Yes, there is just enough room for my model to wheel on the concrete between the paving stones but those paving stones do cross the entire sidewalk in places with 4-6 cm ridges which require a slow crossing or to pop a wheelie over top as you roll, if you are physically capable of doing so. Should you be traveling beside someone, why should we always be expected to switch sides or interrupt our flow because of poor design? What if I want to wheel on the road side of the sidewalk to protect my wife, who is on my right, from oncoming traffic in a most chivalrous manner? The inward slope to the grating containing a tree, weeds, and sand is not too much of a problem now. However, when this centre was built those grates were hollow below the metal and wide enough to swallow a wheel from a wheelchair or a cart. This is dangerous and, as always my common argument is applicable, here as well, what about someone pushing a stroller?

This is an example of poor design that is mostly an inconvenience. It can be seen anywhere that concrete, paving stones or asphalt meet. The gaps, heaves and ridges after one or two winters take away most of the smooth function of surface transitions like these. All of the aesthetic qualities are removed, if not worse than if one material were used, and I question how many shovels, plow blades or snowblowers have been damaged trying to clear the snow on the above sidewalks.

Next week we will look at something that is outright dangerous. I've shared about the helpfulness of properly made, maintained and implemented curb cuts. This time we will look at a failed design and failed maintenance that exceeds the inconvenience shown in this post and moves to an unexpected hazard.

Solution: Those organizations charged with the duty of informing designer and planners need to get the information in the right hands, including city officials who can prevent exclusionary designs like this from ever being made in the first place. Stamped concrete is a more costly material but has much greater longevity than paving stones, if aesthetics are insisted upon.

Ramps - Erindale Pond

Continuing the series on ramps, we will take a look at one of the urban ramps I have encountered multiple times. The one pictured above leads up from the Erindale pond in Saskatoon, Saskatchewan. The path around the pond is quality asphalt, reasonably level with only a few instances of lips where the building materials transition between concrete, paving stones or asphalt. The tricky part comes when you need to climb up from the shoreline to get back to your vehicle or where you came from.

Often a photo does not accurately represent the grade of a ramp and I fear that this photo is one of those, despite my best efforts. This ramp is reasonably steep for an urban setting but it is very long and without any level portions where a rest might be appropriate. Other techniques, such as allowing a wheel to back into the landscape tie at the side of the ramp, can work when a rest is needed, however, often there are no options like this and the only alternative is to turn your wheelchair sideways to lessen the effort needed to prevent rolling back down the ramp. The biggest problem with this sideways parking technique is the energy it takes to get straightened out and resume climbing.

I mention that this ramp is a reasonable grade for an urban setting. Far too often when new strip malls or other buildings have their parking lots paved the grade of the slope leading to either a concrete curb cut or the ramp leading into the building is ridiculously steep. For whatever reason, our home builder told us that they legally could not build my ramp in the garage because it would be a grade of 1:10, 1:12 being legal for a public building. This was our own private dwelling. The number of parking lots I see with ridiculously steep slopes before you actually reach the curb cut, sidewalk, or ramp to the building's front door are ridiculous. Situations like this display thoughtless guideline compliance without any common sense.

Thankfully, regardless of a slope's grade, devices such as hill climber brakes exist and can be used to grab your wheels so you cannot roll backwards. Those will be examined in the future.

We are thankful that these ramps exist, as opposed to simply being stairs, but improper implementation makes them less effective in building a barrier free community.

Source: Urban settings and do not be afraid to contact your city counselor if there are blatant problems with a local ramp, be it the condition of the building materials, the grade or transitions from level ground to the ramp or the ramp to the surface at the top.

Ramps - Switchback

Through the winding tunnels under the University of Saskatchewan, which connect the buildings that vary in age, elevation and repair, a person will encounter many ramps of multiple different characteristics. Some are steep enough that I would not feel safe climbing or descending them independently in a manual or power wheelchair. Others are properly and reasonably gradual, with many ramps falling between those two extremes.

The ramp pictured above is one of the better ramps in the tunnel system underground. The switchback halfway up gives a person an opportunity to rest, regain strength for the next climb, and can be a place to wait for a clear path to the next plateau. This ramp would be one example of one that is too narrow for multiple people at once and when the masses are moving through here it can become intrusive to be the guy in a wheelchair blocking everyone else's way.

Unfortunately, depending on the time of day and year, some of the access points in these tunnels are often closed or locked which necessitates venturing outside to find a suitable detour. Often choosing to take the tunnels is a longer distance than going outside but it can save exposing oneself to the elements. When you hit one of these dead ends, only to have to go outside to find a detour, it results in much wasted time and energy in backtracking. Far from a perfect system when time between classes is short, transportation arrival and departure times have short windows, and when accessible washrooms are less frequent than they should be.

Thoughts: If attendance at a post secondary education institution is in your future minimize those first stressful days by having a good explore to determine the best routes for yourself. Don't be afraid to mention to the appropriate counselor the problem areas that need addressing. It may not be fixed by the time you have completed your stay but, hopefully, you will be making it better for the next person who needs proper access.

Ramps - My Van

After a fairly worry free ownership of a Dodge Grand Caravan, modified to have pneumatic suspension by Van Action, it was good to upgrade to a mass produced product that is the Braun Rampvan. Because they manufacture tens of thousands of these each year, with dealership and repair support in most major centers, it gave me much greater confidence in the ability to have a problem diagnosed and fixed quickly, should one arise. When the pneumatic suspension system on my Grand Caravan developed a leak finding it was incredibly difficult and when it was thought to be found and repaired it was not long before the problem resurfaced.

It was an excessive source of anxiety for me because that van could not be driven without that pneumatic suspension. It functioned by inflating the suspension every time the van was to be used. If the compressor that inflated the suspension were to fail it would be mere minutes before the van would be unsafe to drive. I was never stranded anywhere but with the compressor cutting in every 60 seconds my concerns over it having excessive wear or overheating and failing completely were not without merit. With a Braun Rampvan the rear suspension is compressed each time the user wants to enter or exit the van. If this system were to fail the ramp may be a bit steep but the vehicle would be perfectly drivable.

The ramp on these vans can vary in steepness from a grade of 1:7 to a grade of 1:9, when parked on a flat surface. This depends on the distance the floor is dropped and the style of ramp. In the case of mine, a Toyota Sienna, the floor had to be dropped 12 inches, which resulted in a slightly more gradual incline than in my friend Paul's Honda Odessy which has a 10 inch drop floor, but a different style ramp that is steeper for the first third, then more gradual for the top two thirds. One good push will get you over the steeper bottom half of his ramp then the rest of your climb is easy. The ramp on my van has only a slightly steeper bottom half and requires just a little more than one full push to get over that hump. You cannot always count on being able to, but when the opportunity to park next to a curb or sidewalk comes, take it. Your ramp will be virtually flat.

These differences between vehicles and ramps can be difficult to determine which will work the best based on your physical ability. An authorized dealer should be able to provide you with demonstration models to try. Other technology, such as hill climber brakes, are available to assist in the process. They will be covered in the future and I hope to complete compiling a video we recorded the raw footage for to demonstrate the difficulty of climbing each ramp on each van by two quadriplegics of slightly different levels of neurological function.

If there's one thing I have learned about vehicles it is that necessity truly is the mother of invention. When I had a ramp I needed to be able to climb my determination made it possible in a short amount of time. The same could be said for difficult transfers and many other physical things I needed to be able to accomplish independently. Determination and practice go a long way.

Other adaptations to the vehicle will be covered in future posts.

Source: Authorized adapted vehicle reseller and modifiers.

Ramps - Our Deck

The time has come to begin my series on elevated access. By that I mean ramps and lifts that enable us to access those places not on ground level. I say that the time has come because until now I have focused on subjects whose consequences have the greatest impact upon quadriplegics. Ramps and lifts affect such a broad range of disabilities it would be difficult to list them all.

This ramp is the one in our backyard that allows me access down to our patio, flower boxes and lawn. Our deck supports are made of treated lumber but the surface materials are made from Trex composite material that does not require staining or care of any kind. That, combined with the aluminum railings, was undoubtedly more costly initially but over the life of the deck the savings in stain and labor to maintain it will easily pay for the additional cost. At some point I will discuss the invisible costs of living with a disability. Paying for labor to do something as simple as stain a deck is one example of those less visible costs.

Though it does not look very steep because of my choice of ultra-wide-angle lens, the ramp is the building code standard of 1:12, which I find a very easy climb, unless my push rims happen to be wet from watering flowers or chasing the dog with the hose. Times like those I am grateful for my hill-climbers which, when engaged, prevent me from rolling backwards. On occasion the flat landing halfway up the ramp has been a great benefit to either have a different view of our backyard or to be a place to turn around and chase the dog back down.

One final note for anyone looking to build or modify a home to be barrier free: Be aware of your space limitations on each side of the house. On one side we have crushed rock, which I cannot access nor cross. On the other side, by the patio as pictured above, is a sidewalk that leads to her front gate with the inconvenient exception that the air conditioner blocks my path. Had we known, or had our home builder being more mindful of the situation, we would have either relocated the air conditioner or had it installed higher up so that getting past my wheelchair, or with the lawnmower, would be possible.

Source: Custom-built by our home builder to suit the size we wanted and the space available.

Zip Ties, Split Rings, and Paracord

When it comes to dexterity few things are as challenging as zippers. Tiny little tabs designed to be pulled with a pinch between the index finger and thumb. Not quadriplegic friendly.

My simple solution for a lot of years was split rings. I think every keychain in my parents' home was scavenged for this purpose. The fact that my dad had a small collection of keychains help my inventory of split rings to grow quickly. It's remarkable how many zippers there are to benefit from a permanent ring on them. Zippers are everywhere.

The one place that I most wanted my adaptation to be less visible was on the fly of my pants. For that location I chose to use a small black zip tie, as barely visible on the pair of jeans in the photo above. Zip ties like that do wear out in time and a few did break on me, leaving me with a bit of a struggle to do up my pants until it could be replaced with a new zip tie. Thankfully that zipper does not need to be started like on a full-length jacket zipper. I have no secret method to assist in starting a zipper on a jacket. That is simply a matter of trial, error and patience.

Though I still use split rings for a lot of purposes, I have transitioned to using paracord for most of my zipper pulls. There are a myriad of colours to choose from and their flexibility can provide minor advantages over split rings in certain circumstances. I have even begun transitioning away from bungee cord and toward paracord for my pant hooks. The snaps that connect two ends of paracord together to make a pullable tab and loop, like those attached to the yellow and black paracord in the photo above, are cheap and abundant on places like eBay. However, I found the ones I chose to not hold nearly as well as they should. I made certain to make my selection based on the size of paracord I was using, prepare the ends by cutting and melting them and made certain the snap was applied properly, but often it would let go at inopportune times.

The alternative is to simply thread your length of paracord through the zipper eyelet then tie the two lengths in a half hitch, as I have done for the zipper laying immediately to the left of the pouch, the second one to the right of the pink lanyard. A more interesting alternative is to tie an interesting knot in the end and use it as a lanyard, essentially a simplified version of the lanyard I tied to be my keychain. As frequently as we are forced to compromise form for the purposes of function, this is one of those simple places that I appreciate the more decorative look of a diamond knot lanyard over a simple half hitch. I decided to get extra fancy and do a double diamond knot for the longer zipper pull on my camera bag.

Hit me in the comments with your zipper adaptations, if you have any unique methods.

Source: paracord and snaps – eBay. Split rings – dollar store or craft supply store.

Nail Clippers and Nail Files

Ingrown nails are unpleasant for anyone but an undetected ingrown toenail can be a source of Autonomic Dysreflexia and, if untreated, infection for those of us without sensation in our toes or fingers. Healing in the feet and legs of we quadriplegics is reduced because of our diminished circulation so preventative care is much better and easier than treating a problem after it begins. Standard nail clippers usually take care of the majority of the work, that is, when a person is able to effectively use them. I cannot.

For years post injury I would chew my fingernails off when they needed it. This had all sorts of implications from damage to the nail, peeling back further than it should at the edges, as well as sanitary concerns. As well as I could wash my hands, sometimes the underside of the nails just didn't come as clean they could. Thankfully, I found a solution.

The 15 cm x 2 cm nail file pictured above is my simple solution. When tucked in between the palm of my hand and my gloves it is sturdy enough for me to effectively file down my fingernails. I have to get creative with pinning down the finger containing the nail being filed, but that is another challenge solved by finding the right surface or technique to hold the digit steady. I have been fortunate to have someone care for my toenails but I do feel confident in my ability to file them while in bed, should the need arise. I have learned to do my nail filing before laundry day because the pile of dust produced by it inevitably gets on my clothing and skin. Often the irritation it causes on my face makes me itchy for a period of time unless I really scrub it clean.

Before I found the nail files I use now, I used to use a smaller crystal nail file secured to a butter knife with hockey tape. The knife simply served as a longer handle to make it easier to hold in my gloves. These larger files have eliminated that need.

Source: Department stores, drugstores, eBay.

Tongs

When a squeezing action is required to operate a tool such as scissors or, in this case, tongs it requires we quadriplegics to use two hands if we hope to have any type of strength or efficiency with a tool of that nature. When much of your actions at the table or preparation surface require an elbow or arm to be down for balance, and two hands are required to operate tool like this, I feel more like an excavator with a very limited pivotal range for my scoop. It's not that it can't be done, it's just that there are often better tools for the job for us.

In the case of a bowl of salad I find a nice large serving spoon to be more effective for both tossing and serving than tongs could ever be. Still, when that sizzling steak on the barbecue is ready to be flipped I feel bad about giving it a gentle stab with my fork, potentially releasing a few juices, rather than a gentle turning with a pair of tongs.

UPDATE: It was brought to my attention, by dear Heather, that these tongs can be the difference between reaching something or being unable to get at it. Of course, her being a paraplegic, her hands are able to use tongs with the ease of anyone, and that's why she has four pairs. Thank you for informing us, Heather!

Source: Really, finding the right substitute for you most likely available at a department or kitchen store.

Lanyard

You've already seen this lanyard in my post regarding door bumpers to assist in pressing remote buttons. These little well tied loops of rope or cord can be so helpful in so many other ways. Keeping keys attached to something easy to grab a hold of, and easy on the teeth for those times you need to hold on to them with your mouth, is a big deal because the alternative is dropping them. For many quadriplegics, or any wheelchair users for that matter, picking things off the floor can be very difficult. Especially if you already have something on your lap or are in the middle of a snow-covered parking lot.

A lanyard can be homemade, bought cheaply from any discount store, and be almost any length you need to fit your intended purpose. As attractive as the Solomon bar weave is on the upper part of this lanyard, it is the diamond knot that I am most grateful to be able to tie successfully. That knot makes for not just a loop to hold onto but a nicely sized ball of cord to incorporate into a zipper pull, making the challenge of operating a zipper a little bit easier. Here are my thoughts on zippers. While the white part of the cord is illuminated by a camera flash, the green part is because of the glow-in-the-dark material used to make this lanyard. It's a little more expensive than standard paracord but for those times I wanted to be able to find my keys in the dark I'm glad I chose it for this keychain.

The reason I like paracord so much is that when used to secure keys, as shown in the door bumpers post linked to above, is that it is quite easy to detach the keys for those times when you need to separate your vehicle keys from your house keys, such as when leaving a vehicle for service. I prefer this over the quick clasp lanyards that you can purchase in stores because often those clasps are spring-loaded and pivot which makes operating them very difficult, and a danger to a person's lip should you choose to use your teeth and have the clasp snap shut.

In the future we will take a look at other lanyards of the smaller size used to keep smooth and difficult cell phones closer to us and less likely to be dropped on the floor if they slip out of our hands. Because I did not want to be tied down by a lanyard hanging off my phone I chose a very rubbery case and the larger design of the Samsung Galaxy Note 2 for my current phone, which I talk about in the post regarding touch screens and styluses.

Source: Webbed lanyards - Department or DollarStores
Paracord and Premade Paracord Lanyards - EBay and Etsy

The Island

I stand by the importance of having the right tools for the job, regardless of where that might be. Utensils for cooking effectively, such as the right flipper or knives, are crucial as much as the right hacksaw or rotary tool are for the first steps of building something. In the future I will show you my workbench and carefully chosen tools, but today the focus is on the surface essential to safely cook.

The top level of the island pictured above is a standard countertop height. It still has a significant degree of functionality for me but is primarily my wife's surface for her kitchen needs. The lower surface is a mirror image of the top level of the island with the two essential aspects. Firstly, the fact that I can roll under it anywhere along the front or sides. Secondly, the lowered height of it, which was chosen based off of other surfaces that have worked well for me. Having this large surface available to me has given me almost complete freedom in the kitchen to cook as effectively as I do.

A plug-in at each end of the island allows me to use multiple electrical appliances at the same time and the front 15 cm of the upper-level, where you see the coffee grinder, salt shaker and pepper grinder, is accessible to me to help keep my work surface as free as possible. If I had to do it all over again, given the space available to us, I would have rotated the island 90° and made it another 15-30 cm wider. Too often I am left with a slightly tighter preparation area than I would like when there is a hot pan or wok beside me. I am careful, but this has caused the occasional burn. Thankfully I have not, yet, spilled a vessel of hot food on the floor.

Though height is important, the most important thing is by far the fact that I can roll right under it and be facing forward while preparing. The same goes for being able to roll under a sink, be it in the kitchen or bathroom, or my workbench downstairs. Anytime I have been forced to pull up parallel to a vanity, and twist my body to try to use the sink, it results in a back ache and shoulder pain after an extended period of time. I can get by but I really appreciate having my work surfaces fully accessible.

Source: Custom made by the cabinet company who worked with our home builder. Easily done by any cabinet maker.

Rounded Versus Square Mattresses

Being adaptable is important for instances such as traveling or simply being away from home. I certainly notice when I am away from the very suitable circumstances of our home. I am very efficient in our kitchen with my island but put me in someone else's kitchen without a suitable surface for me to roll under, with a knife that is not easy for me to hold safely, and I do not look very efficient at what I am trying to do.

At times I grow complacent with the ease of my transfers at home in relation to other places and always find them especially easy when returning home after being away. The struggle of a more difficult transfer only serves to enhance my balance and strengthen muscles through the effort required.

One of the biggest challenges is sleeping and dressing in a bed that is not our own. Especially if that bed happens to have a queen size mattress with a rounded edge like the photo above. Ironically, that is the first mattress I used post injury and it was recommended by my occupational therapist because it uses an air bladder system which supposedly provides better pressure relief. In order to get that softer mattress it needs to be deflated a bit once in bed and re-inflated to be firm enough to complete my morning routine. The air pump is as loud as a vacuum cleaner which is not what I would call the first thing I want to hear in the morning after waking up.

Unfortunately, when the mattress is fully inflated it has a concave shape to it. This causes the edge to be far less usable at night or in the morning when it is time to sit up and it causes my hips to tend to want to slide off the bed. That means to safely sleep in the bed I need to have more than half to myself, which leaves my wife with far too little space for a comfortable night's sleep. When transferring in and getting undressed at night, and then getting back into my chair in the morning, it feels as though I am always fighting the tendency to slide off the bed. For these reasons it is a passable bed for the cabin and only needs to be endured a few times per year.

Below is our current bed. It is a combination of a firm bottom foam mattress and a medium density topper. The top portion of the mattress is about one third as thick as the bottom and is still quite firm. I have yet to have any problems with pressure areas, the sharp edge gives me a good sense of security for both sitting up at night and when transferring in and out. We ordered it from a custom mattress manufacturer who essentially makes each combination of mattresses on a customer to customer basis so it did not cost us a ridiculous amount of money. Coming home to this bed after being away reminds us that it was worth every penny.

As you can see above, I still use a sheepskin to keep my feet comfortable at night and prevent any pressure areas on my heels or ankles. It was time for the red one to be retired once I found this one at Costco around the middle to end of September, which is when they seem to carry these each year.

Source: Many mattress stores will help you find what fits your needs best, but I recommend going somewhere that they specialize so you are not getting the cookie-cutter sales pitch from a general furniture salesperson.

Barbecue Tools

Last week we looked at the Reaching Rod that I use for a number of tasks around the house. By far the most important is using it to safely lower the lid of our barbecue. By hooking the curved portion through the leftmost teardrop shaped hole near the handle I am able to gently pull the lid forward to begin lowering it. As it descends the handle of the barbecue rests against the neck of the rod, the hook remaining in the teardrop shaped hole, so that the lid does not slam shut. With our previous barbecue I was able to use the fork of our barbecue tool set to do lower the lid gently. The shape of the new barbecue lid's handle necessitated finding an alternate way. A prime example of one method not necessarily working for everyone or every circumstance. Base your own solution on this information.

Regarding the tools that I use to barbecue, there is nothing special about them except that when purchased we were very intentional about choosing tools that had a good rubber handle. This handle made for ease of inserting in The Gloves yet provided enough friction to safely flip a nice, big, juicy steak. More challenging than that are grilled vegetables because they can be floppy or more likely to roll or slide off of a tool, but I manage by being extra careful when cooking them. Unfortunately, the shafts of the tools we first chose were somewhat flimsy and they did tend to bend when put under any pressure, such as sterilizing the flipper by placing it under the lid between uses. The tools we bought recently have a nice rubber handle but sturdier shafts which we hope will make for less flex when dealing with something heavy such as a whole chicken.

At first I thought that the triangular hangers at the end of the tools would be helpful. They ended up getting in my way so I removed them. Otherwise, it was just a matter of trying a few tools until we found the ones that suited best. This is definitely not something terribly unique, just a matter of purchasing what works best for you.

Source: Hardware and Department Stores

Reaching Rod

My friend, a fellow quadriplegic, and I often jokingly express our envy of paraplegics and their functioning hands. I've heard it said that quadriplegics just want to be paraplegics, paraplegics just want the able-bodied, and able-bodied people want to be Superman. True or not, it would still be nice to have proper dexterity and even be able to use the common gripper-extension arm with a pistol style handle that can be squeezed to close the pinchers at the end to aid in picking things up off the floor. Even those are mostly unusable by us as they require us to use two hands to squeeze the trigger and typically that needs to be done directly in front of our chest using stronger arm or pectoral muscles which negates the reach advantage it is supposed to provide.

With a bit of creative designing and a few imperfect results, my dad and I came up with the above product. By slipping the T-shaped end into The Gloves I have a very helpful extension to my arm to aid in many tasks. My primary uses are reaching certain light switches in our home, assisting in opening the kitchen blinds whose pull cords are just out of reach and, most importantly, gently closing our barbecue when enjoying the pleasures of cooking with it.

The only modification made over time was the addition of a few wraps of hockey tape to increase the friction of the surfaces it comes in contact with. The rubber hose that covered the T and hook ends had deteriorated so I improvised with hockey tape. Without it the plane, smooth, painted steel would occasionally slip off of the surface I was using it on.

Regarding the photo, as previously mentioned and in the interest of full disclosure, I do very little digital manipulation of my photos. This one was one exception where the fishing line used to suspend the rod was removed digitally.

Source: Any beginner welder should be able to fabricate something like this for you and a similar device probably could be manufactured just by heating and bending a single piece of steel rod.

USB Flash Drives

USB ports can be frustrating for anyone - lining up the plug with the port, making certain it's facing the correct direction (help us, if it's a vertical port!) - but with paralyzed hands it's even more difficult. A streamlined design, like that of a laptop, makes for a minimal distance between the drive and the desk or table, providing even less surface area available on the drive to grasp. Thankfully, many USB flash drives have a suitable place to attach a lanyard or split ring. Of course, the split ring attached to my monkey's fist self-defense paracord creation is an exaggeration, but made for a more interesting photo.

Either a lanyard or a split ring will assist in easing the removal, but I find the split ring to give me a more solid place to insert my thumb which also helps in sticking the drive in the port. Many USB peripherals do not have ways to make them more convenient for us. But many do. There are a myriad of interesting and unique designs for flash drives and often something as simple as a binder clip can provide a larger handle on almost any USB device.

Source: Split rings are available from any department or hardware stores.
Interesting USB Drives are abundant at online retailers like Deal Extreme, Amazon or eBay.

Coughing

Last week's post on Incentive Spirometers is an integral part of health for quadriplegics. The diaphragm strengthening encouraged by an incentive spirometer is an important part of keeping our breathing strong and healthy. Usually inhaling is not the difficult part of breathing for someone who still retains the capacity to breathe without a respirator. The difficulty comes in exhaling with force. This limitation makes it difficult to have a good cough or sneeze, and forget about easily inflating a balloon or blowing your nose.

Being able to properly fill and empty our lungs is important to keeping them clear of phlegm and getting rid of it when sickness does set in. Having a cold is so much more difficult as a quadriplegic. It's never a pretty sight to be sick but the time spent clearing passages seems to be so much more significant when it takes that much more effort to get the job done. Before my injury I was never able to properly hock-a-lugie, that is, inhale my nasal mucus and expel it through my mouth. Necessity is the mother of invention.

More immediate is the danger when we are choking and have difficulty expelling what air is in our lungs to try to clear the passageway. I am notorious for accidentally inhaling sharply and getting some of my own saliva partway down my trachea. I believe it was only one time that I actually needed assistance in the form of abdominal thrusts to clear my airway when that happened.

As I mentioned in my post on Autonomic Dysreflexia, I was again disappointed by the rehabilitation staff as they were almost entirely unable to assist me in learning to cough properly. My education came from a fellow patient who, after two years of being discharged from rehab, returned to increase his independence. To this point he had relied on his wife's help for many, many of his daily needs but wanted greater independence. One of the things he had learned to do, and was kind enough to teach me, was to cough strongly.

The photo, indicating the motion used, demonstrates how we can compensate for the lack of abdominal muscles normally used to give the diaphragm a firm wall to press against when coughing, sneezing, blowing your nose or any other task requiring strong exhaling. By bending over quickly, either by gravity or by pulling on the frame of my wheelchair, timed with my exhale, I can cough just as hard as anyone. Unfortunately, I am not able to cover my mouth as I would like when doing this, but at least my cough is directed at my feet and not the people around me. Sneezing is much more difficult to time because it is involuntary. Often I can assist it simply by being in a slightly bent over position which adds some pressure to my abdomen, but it's still never a full, satisfying, sneeze. As for blowing my nose, I can use this technique to a degree in the shower. Otherwise, just like coughing, what comes out has to go somewhere and my hands are currently occupied and unable to hold a tissue in front of my nose.

This same technique can be used with less efficiency while in bed. When sitting up I can bend over quickly to add pressure to my abdomen but not as much pressure as when sitting in my chair, with my knees to my chest. If I am able to keep my legs straight while sitting up in bed using this technique it does add more pressure than if my legs are bent out to the side. The problem with this technique when I have a cold is that it requires me to sit up every time I need to cough. When sick this can be very often. The alternative is not pretty, but it works. By timing my exhale while pushing, almost striking, just below my ribs I can add enough pressure to cough strong enough to expel the irritant. It might look like I am beating on my stomach but when you need rest to get better, but cannot get that rest because of incessant coughing, it's better than nothing.

One final technique is a shallower throat clearing method that I am not certain I can explain well. Using your vocal cords, with your mouth closed, allowing the air and sound to exit your nasal passages, you can make a "erh-erh-erh-erhm" sound and vibrations that can very effectively clear blockages near the top of the trachea.

I hope this helps to prevent a few cases of pneumonia and to help a few people endure a chest cold a little bit easier.

Source: Respiratory therapists taught me much and could probably teach you techniques based on your physical ability.

Incentive Spirometer

More than a few times in the months following a spinal cord injury in which the ability to breathe normally is affected there are problems relating to the reduced lung capacity and significantly reduced ability to inhale and exhale. Our breathing depends on our trunk muscles, diaphragm, and to a small degree our shoulders. With a spinal cord injury in the neck one of the two diaphragm innervation locations is cut off as well as the muscles in the trunk. That is a lot of lost function in a critical area. The worst time after and injury is immediately following, when breathing function instantly goes from using your diaphragm and trunk muscles to just part of the diaphragm. I clearly remember the distress I was in and the offer of nearby friends to perform some mouth-to-mouth assistance which I refused, being a foolish teenager not wanting his friend placing his mouth on my own.

This reduced capacity resulted in multiple initial pneumonias, the regular need for a suction hose to extract phlegm, and a general inability to expel air with adequate force. Thankfully, I never needed deep suction, as in when the hose needs to be inserted much deeper into the throat by a trained individual, but simply the same as they give you at the dentist's office. Though I still may be considered more susceptible to pneumonia it has never been a problem for me, personally.

I still cannot cough properly while sitting up or laying on my back without a learned technique, and the satisfaction of a good sneeze only graces me about one out of 20 times that the tickle and urge causes me to inhale in preparation. If I time it just right I can apply pressure to my abdomen to execute a proper sneeze. The critical act of coughing will be addressed next week.

Thankfully, there are tools to assist in building lung capacity and strength. Pictured above is an incentive spirometer, which is designed to do just that. The hose can be attached to either side of the body of the device. One side allows you to suck air in and the other side allows you to blow air out. The idea is to increase the resistance as your strength increases so that keeping the ball at the top while the air moves through it is just difficult enough. It's no different than any other strength training.

An incentive spirometer can also be helpful to encourage very deep breathing and complete exhaling which is a very good practice in clearing congestion and preventing sickness. For we who find it very difficult to get our heart rate and respiration high enough to naturally perform this deep breathing this can be a lifesaver when dealing with any kind of respiratory illness. Regardless of illness, I try to do some deep breathing a few times each day in the interest of prevention.

Source: Respiratory therapists, occupational therapists and many medical professionals. They are very affordable and can be ordered online.

Sport Cuff

I misplaced my sport cuff many years ago because I always just use a new pair of The Gloves with strong new Velcro as my tool of choice to hold on to any sporting device with a straight handle. When I wear The Gloves I do not diminish my ability to wheel nearly as much as when I tried using the above pictured sport cuff. I also found the sport cuff to limit my wrist function which is so essential to so many sports, especially those such as badminton or icefishing where wrist movement is really essential to the technique. However, for someone who's muscles that control the wrist are paralyzed this cuff makes some sport possible where it would not have been, otherwise.

For sports such as tennis or fishing with a large rod, where the movement involves more control by the larger arm muscle groups, a sport cuff has great advantages. This one was borrowed from my friend, and former model, Paul. Though he and I have virtually the same level of function, there are a few muscles of mine that provide me just a little more function than him. Where every little bit of function counts, especially where wrist flexion and triceps come in, a sport cuff like this can mean the difference between being able to successfully participate in an activity or not being able to.

Source: Occupational therapy product catalogues, online, or custom made.