1. Adapting the Disabling Environment: Hemiplegia Stephanie Hayes March 21, 2005 OT 5162

2. Hemiplegia  Partial or complete paralysis on one side of the body Can cause limitations in balance, coordination, and fine motor abilitiesCan cause limitations in balance, coordination, and fine motor abilities  Tingling, numbness, or loss of sensation can also occur on that side of the body  Occurs due to a disruption of blood flow to the brain  Requires intensive therapy for a strong recovery

3. Possible Causes of Hemiplegia  The most common cause is a cerebrovascular accident (CVA) or stroke  However, 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 encephalitisan infection, such as meningitis or encephalitis vasculitis (an inflammation of the blood vessels in the brain)vasculitis (an inflammation of the blood vessels in the brain) cerebral palsycerebral palsy

4. Task Analysis  Occupation: Taking a shower An activity of daily livingAn activity of daily living Highly important for self esteem, body image, and social interactionsHighly important for self esteem, body image, and social interactions Steps:Steps: being able to enter being able to enter turn on the water turn on the water wash both body and hair wash both body and hair turn off the water turn off the water exit the shower exit the shower

5. Necessary Performance Skills  Physical CoordinationCoordination PosturePosture StrengthStrength EnduranceEndurance Intact SensationIntact Sensation Pain Pain Proprioception Proprioception Vision Vision Pressure Pressure Temperature Temperature  Cognitive processing Attention Adaptation Concentration Judgment Organization Knowledge

6. Necessary Performance Skills  Psychosocial PerceptionPerception AppropriatenessAppropriateness

7. Performance Contexts  Features Enclosed spaceEnclosed space Hot and humidHot and humid Private and personalPrivate and personal Socially necessarySocially necessary  Barriers Slippery, smooth surfaces Heat accumulation Rushing hot water Soap dish placement

8. Barrier: High Bathtub Wall  Weak side has trouble lifting into tub/shower combination  Possibility for tripping  Safety hazard Image by: Stephanie Hayes

9. Solution 1: Walk in Shower  No large step to negotiate  Easy access for all people  Sliding door allows for easy entrance Image by: http://www.access-ability.com/bath.html

10. Solution 2: Grab Bars  Provide a secure holding surface when stepping over bathtub wall  Can be used with either hand  Available in a variety of sizes and materials Image by: http://www.access-ability.com/grab.html

11. Barrier: Slick Shower Floor  Problematic for a person with coordination and balance difficulties  Possibility for slipping and/or falling  Safety concern

12. Solution 1: No Slip Shower Flooring  Offers a stable standing surface  Provides “rapid discharge of soapy water”  Available in many shapes, sizes, and colors to fit all showers Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2161&pid=2945

13. Solution 2: Bath or Shower Non-Slip Mat  Helps prevent falls  Stays non-slip when wet  Soft foam provides cushioning for feet  Useful for the entire family Image by: http://www.dynamic-living.com/bath-mat.htm

14. Barrier: Shower Layout Requires Standing  The socially “appropriate” way to shower  Takes a significant amount of endurance, coordination and balance  Bending down and manipulation of soap and shampoo is required while showering

15. Solution: Shower Seat  Conserve strength and energy while showering  Able to shower while sitting  Decreases movements needed during shower Image by: http://www.access-ability.com/bath3.html

16. Barrier: Lack of Temperature Display  Deficits in sensation can occur on the weak side  Limited temperature sensation can lead to burns

17. Solution 1: Water Heater Control Valve  Limits the maximum temperature water can reach  Controls all water faucets  No fear of getting burned when taking shower, washing dishes, or using the bathroom sink  Best solution for client who lives alone Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=184&pid=10446

18. Solution 2: Bath Appliqués  Provide visual temperature reading  Change color with the changing temperature of the water  Also act as anti-slip pads  Fun shapes for children Image by: http://www.dynamic-living.com/bath-appliques.htm

19. Solution 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

20. Barrier: Small Duel Control Handles  Weak hand might have difficulty with fine motor control  Shaking or tone decreases accuracy of turn  Must control two knobs independently Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2627&pid=5551

21. Solution: Single Rotating Handle  Hot and cold are controlled simultaneously  Easier to turn  Can be controlled with a closed fist Image by: http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2022&pid=34670