Adapted Makeup Brush

The photo in this post is a re-creation of a makeup brush, extended by a tongue depressor, held on with white cloth medical tape, that my friend, Delynne, used to use. For whatever reason, she no longer needs this simple but effective adaptation that allows her to independently perform an important part of her grooming.

A lot of people with a disability have perfect grooming lower on the list of priorities, following those list items necessary to live life in a healthy way. Somehow, Delynne has managed to do both and always looks great when you see her. I respect that.

It was good to have a subject to photograph and include that is outside the realm of understanding to a guy like me. She has given me additional subjects to shoot, one of which involves a large space outside, an air compressor, coffee creamer, lasers and a bit of trial and error. You'll know it when you see it this summer.

Source: Doctor's office or order a pack online.

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.

Velcro

Without Velcro The Gloves could not be tightened enough to provide me the dexterity that they do and many of the tasks I am able to complete successfully, would either be much more difficult, or simply impossible to complete. Getting a grip on certain exercise equipment, to help with Strengthening our functioning muscles, is made easier with Velcro. It enables the design simplicity of a Universal Cuff and Razor Cuff, an alternative to the difficulty of tying Shoelaces and so many other daily applications where a tight, but adjustable, fit is needed to be possible with limited dexterity.

By no means is this list exhaustive. In many cases Velcro can be creatively added to an existing device, article of clothing or tool to make it friendlier for us to use. Many stores now carry cinch straps made entirely out of Velcro. These are useful for places that something such as a rubber band or a bungee strap is just too difficult for us to use. If you have a great example of Velcro use let me hear from you.

Next week we will look at a Sport Cuff that enables a reasonable grip on almost anything with a handle such as a fishing rod, tennis racket or even a pool cue.

Source: Department stores, dollar stores, hardware stores and sewing stores.

Shoelaces

When your dexterity is limited tying anything is difficult. I have had my experience with weaving different knots, bracelets, lanyards and keychains using paracord but that is so much different than tying shoes. With paracord I typically have plenty of extra slack to work with, the knot or lanyard is in front of me at the ideal height on a desk or table, and they are typically knots tied tight enough that they will never come undone.

Shoelaces do not have the slack, are not in an ideal position to work on when they're on your floppy and uncooperative feet, and are knotted with the intention of being easily untied for removal or re-tying to snug them up.

Why do we need our shoes tied tight? Because often leg spasms can kick our foot right out of the shoe, properly fitting and tied shoes can assist in reducing foot drop caused by a tightening Achilles tendon, and it can help reduce edema. For these reasons I prefer footwear with a fairly high rise to them. However, hightop sneakers are more of an 80s to mid-90s thing. Hiking boots are usually what I go for when the long search for the right new footwear, that won't bother my feet or cause pressure sores, begins.

I have been fortunate enough to have someone available on a regular enough basis to tie my shoes when they need it. I do not suffer from edema like many people do, and because my feet are well stretched out each day I do not fear foot drop. Because of this I simply slip my shoes on and off each day but have not actively sought out a reliable method for independently tying shoes.

If you have a solution for this I would very much welcome your feedback!

Next week we will look at Velcro which goes far, far beyond a method of securing shoes in its usefulness and helpfulness in strengthening our independence.

Solution: Other than practice and patience, I have none that I can recommend as reliable and adequate.

Krulick's Soap Grippers

Last week's post discussed bath seats and how they have been ineffective for me. This week is another one of those adaptations that just didn't perform as indicated. Very simply, Krulick's Soap Gripper is a split ring, above a suction cup which has a cylindrical stud in it, intended to be pressed into the bar of soap to add to the suction cup's holding ability.

The problem is that the suction cup stops holding as soon as the soap dries and the stud that is intended to press into the bar of soap is too wide across, hollow and flat making it incredibly difficult to press into the bar. If it weren't hollow it could be carved into a point to help get it started into the bar of soap, but as it is I'm not sure an able-bodied person would get it secured to the bar without a struggle. While trying to apply the gripper properly for this photo I dropped it more than a few times, as seen by the flat spot on the soap facing the camera. It wouldn't be so bad to receive assistance affixing the gripper to a bar of soap every so often, but there is another problem.

The split in the ring makes it loose so it falls off my finger very easily, before the soap even gets wet. I know the intent is to fit fingers of all sizes, but falling off that easily makes it little to no help at all. Had I needed to come up with an adaptation for a bar of soap it would involve drilling a hole through the bar and running a bolt through the hole, a washer on each side to make up for any shrinkage due to use. to that I would secure a paracord lanyard to hold it on my wrist or around my neck. That would be all with nylon hardware. You won't get clean with rusty soap.

Of course, liquid soap, maybe with a sponge on a rope, is a whole lot easier than either of these options.

Source: Occupational therapy device catalogues, seniors' supply stores.

Bath Seat

The bath seat pictured here is not the standard removable seat that is just placed in the tub for use when needed. It was built right into the house with the intention that I would be able to use it to gently lower myself into the tub and lift myself out to dry off and get dressed on. This never happened. To this day I do not think I would be strong enough to use it and it was soon supplemented with a hydro-powered bath lift. Unfortunately, the difficulty transferring unclothed, combined with the rubberized shelf liner-style rubber material covering the lift to prevent slippage, did just that. It was too difficult to transfer from my chair to the bath lift without causing damage to my skin.

The two times I did use it I greatly enjoyed being mostly immersed in water and enjoying the benefits of the water jets on my body. But, after being that relaxed and the heat tiring me the transfer out was very difficult and negated almost all benefits of using a tub. I know this is not the case for many stronger quadriplegics and many paraplegics, but for me showering is quicker, easier and my bathing method of choice. I reserve my full immersion in water for hot summer days at the lake or nice hot pools, such as the Temple Gardens Mineral Spa in Moose Jaw.

A less costly and less permanent option for anyone wishing to try using a bathtub might be the removable bath seat that actually sits in and over the edge of the tub. It's more secure than the smallest standard bath seat you might see but both of them still don't allow you to get much more than your legs wet. I realize that they could also be used as a seat for showering but I am grateful to have had a roll in shower over the years.

As much as this bath seat did not work for me to assist with bathing, next week I will show you the Krulick's Soap Grippers that were completely useless to me.

Source: The built-in bath seat was included in the renovation. Portable, removable tub seats are available from most adaptive equipment supply stores or discuss with an occupational therapist what would be best for you. They may even have some available for you to try some before buying.

Arm Garters

It was only recently that I discovered the effectiveness of arm garters. I finally started looking for a solution to the problem of the sleeves of longsleeved shirts sliding down over the wheeling surface of either my hand or the palm of my glove. When they would it would almost completely remove my grip on the push rims and make it very difficult to go anywhere with any sort of efficiency. As with most quadriplegics, it is more difficult for me to feel warm and I was tired of feeling cold or having to turn up the heat so high that it made everyone else uncomfortable. I've always been about function over form but the aesthetics of longsleeved shirts can be desirable, as well.

I do not know exactly when I realized that an effective product may be out there but once the concept struck me I realized I had known about them since the very first Matrix movie. Near the beginning, when Neo first meets Morpheus, Morpheus is wearing arm garters on his retro style longsleeved shirt. It is not often that I place much value on pop culture but in this case remembering that costume served me well.

After checking a few secondhand stores and coming up only with some cheap beaded bracelets that were reasonably inconspicuous, I took to the Internet and found the solution you see in the photo above. The first pair I bought was approximately $35 with shipping, the second two pairs, exactly the same as the first, I found from a different seller for about seven dollars per pair including shipping. They are available in black, silver and gold.

Now just about any time I need a jacket I prefer the additional warmth and comfort that a longsleeved shirt adds. They are just one more item that gets added to my person, along with my pouch containing my phone, wallet and change, hat and keys before going out.

Source: eBay, high-end clothing stores (but their prices are ridiculous and their quality is not necessarily superior).

Dental Care

I'll be the first to admit that I use my teeth, lips and tongue for more things than I probably should, but so many times the dexterity and strength required to get something done is simply not in our hands. The only alternative is our mouths. All the more reason to care for them properly, even if the transfer in and out of the dentist's chair is one of my most dreaded transfers of the year.

Electric Toothbrush

Most dentists recommend a good electric toothbrush for everyone, but when your dexterity is impaired an electric toothbrush can shave a few minutes off of an already lengthened bedtime and morning routine.

I have seen peers who have added a lengthened and enlarged handle to a manual toothbrush, even pairing it with a universal cuff not unlike my former Razor Cuff. The problem with universal cuffs, anything that easily slides into a pocket easily slides out, means that a motion like brushing teeth results in the toothbrush sliding back out frequently during the brushing. When I use a manual toothbrush I weave it between my fingers and add a second hand to firm up the grip.

Source: Any department store or dentist's office.

Flosser

Flossing can be enough of a challenge for anyone whose fingers are not paralyzed. For quadriplegics a proper flossing using our fingers is almost impossible. Thankfully there are ample commercially made tools to help anyone get it done.

The above photo is my tool of choice because of the amply long handle and easily replaced heads. However, there are picks, tiny brushes and even vibrating flossers with heads similar to the one I use. My hygienist and dentist thank me for it.

Source: Any department store or dentist's office.

A special thank you to Dr. Steve at Stonebridge Dental for lending me his practice teeth, from his university days, to make this photo.

Razor Cuff

Continuing with the morning routine theme of recent posts, finding a satisfactory independent method of shaving myself confirmed that necessity is the mother of invention.

Once the halo and vest came out of my skull and off of my chest it was time to resume shaving my own face. I had not developed the dexterity to wield the small handle of my razor and refused to use an electric razor because of the mediocre shave they provide. So, with the assistance of an occupational therapist, we adapted the handle of my current razor by adding material used the make splints, including those designed to improve a patient's wrist tenodesis, as spoken of previously in The Gloves post.

To that a modified universal cuff* with a wider than standard pocket was added for the enlarged razor handle and I, again, had a usable razor. Regaining that piece of independence and the satisfaction of a nice shave was a good day. I used that cuff and razor for years until the razor would no longer hold a new blade securely and the stitching on the cuff's pocket had begun to let go, repair attempts with tape being short-lived. It was then that a decision had to be made. Repair it, replace it, or find a way to eliminate the need for it.

I found a razor with a built in electric trimmer. The need to house batteries made for a larger diameter and longer handle and I have shaved with it for years after a short period of becoming accustomed to it.

The first cuff was made by the kindest and most creative of people who could work wonders with that sewing machine. Thank you, Beulah. You will see more of her work in the weeks to come.

Source: Talented Seamstress. Components for the cuff from a fabric and sewing store. Splint material from n occupational therapy catalog though you can buy plastic that melts together and becomes pliable in hot water, which would make a very suitable substitute.

*A universal cuff is simply a strap with a slot or pocket that secures around the hand with Velcro. Typically the slot is large enough for a utensil handle or toothbrush.

Roll Bar

With paralyzed trunk muscles rolling over in bed is not immediately done with ease. With time and strengthening is isn't as difficult but some days that small advantage is appreciated.

One side of the bed has my chair ready to be grabbed to help me roll over during the night, or while getting dressed, but there is nothing always readily available on the other side. Certain headboards have a nice ledge or overhang to help, most do not. In hotels, nightstands are often my handle on the other side of the bed.

At home it should be ideal. This simple handle makes it that way and makes my morning routine consume that much less energy. It is not long after waking up that I reach for this handle every morning.

Source: Hardware Store

The Gloves

One of the most significant moment to moment challenges of being a quadriplegic is the lack of hand and finger function. Being able to firmly grasp things with one hand, use tools and grip surfaces is not something to be taken for granted.

These rubber-palmed, leather, quad wheelchair gloves (quad because of their lack of fingers and wrap around style of donning) provide protection from the disproportionate amount of use our hands go through on a daily basis. They are, for me, shoes, brakes, warmth, a means to hold on to tools and utensils, a source of rigidity for my fingers, friction for countless applications and an item that spends more time on my body than off of it. This well-used pair is very near retirement.

Many of my peers use football receiver gloves or weightlifting gloves, both of which have full fingers and can be time consuming to get on curled, stiff digits. For me, these gloves provide a shape to my thumb and index finger which was, and now is, essential to my wrist tenodesis. Tenodesis will be a future post but, for now, let me explain it this way: When tendons tighten that tightening can be guided to be advantageous. As my newly paralyzed thumb tendons tightened they were guided so that as I pull my wrist back into extension my thumb pinches against my index finger, providing some functionality.

The advantage of my quad gloves is the tight band the Velcro creates around my first knuckles. Sliding tools between the glove and my palm is the key to my ability to cook, build things at my workbench and many other tasks where this can effectively simulate a grip. Many posts to come will make this very clear.

They may not be ideal for a Saskatchewan winter, but I'd rather get where I'm going with cold hands than be comfortably warm and stuck in the snow.

Source: Hatch - They can be difficult to have shipped to Canada, but resellers are available and the gloves are available on Amazon.com.