August 29, 2011

Occupational Therapy On A Shoestring Budget

In the Chicago area, Pamela Cox, OT, has been nicknamed “MacGyver” by her colleagues, after the resourceful 1980s TV character who solved a wide range of problems with everyday materials, such as duct tape and a Swiss Army knife.

Cox, who has had a long career in nursing homes, acute care and rehabilitation units, realized some of her patients were paying for costly items when she could develop homemade versions from materials at the hardware store. “I roam the aisles of Home Depot looking for simple and cheap items to use in my sessions,” she said.

For the past 11 years as a home health occupational therapist, Cox’s new patients often have given her a skeptical look when she walks in with a hula hoop adorned with plastic shower curtain rings. Cox uses the hoop to assist patients in improving shoulder ROM, by having them push the shower rings around the hula hoop as she holds it. “It’s the poor man’s version of the shoulder arc, which can run over $150,” she said.

Upon seeing the hula hoop, one of her patients, Mason Martle, asked her: “Do you really expect me to stand up and use that?”

Martle, who suffers from central system peripheral neuropathy, proprioception issues with his left arm, and weakness on his left side because of extensive nerve damage and temporary paralysis from surgery, since has become a believer in Cox’s gadgets. “Pam has a lot of creative ideas that have really worked for me and have helped my recovery,” Martle said.

Cost-cutting measures

With cutbacks in reimbursement for home healthcare, many home health OTs have been forced to find ways to shrink their equipment budgets. Home health agencies have added further economic pressure by providing fewer and fewer supplies to OTs. The economic climate also has negatively affected Americans’ household incomes, straining patients’ abilities to pay out of pocket for equipment and supplies.

Shannon Johnson, OT, also likes the challenge of coming up with practical but cost-effective rehab tools. Johnson mainly treats patients diagnosed with amyotrophic lateral sclerosis or Lou Gehrig’s disease. While the majority of patients with ALS are cared for at inpatient clinics, Johnson works for a home care services program in Minnesota that provides free visits to patients.

Johnson is specially trained in communication devices and keyboard programming. One of her favorite devices is a pencil with a nice eraser. Johnson usually builds up the pencil with foam tubing to make it easier to hold and then it can be used to help press bed controls, TV remotes, computer keyboards and phone keypads, and even to turn pages of books or magazines. “One thing after another is taken away from these patients, so it’s nice to find simple things like pencils with erasers to help patients continue to communicate with others,” Johnson said.

Foam tubing is a particularly helpful and versatile material to make handles thicker, she said. Not only is it useful with erasers, but also with pens, utensils, drinking straws and toothbrushes. Velcro is another handy item. “We use Velcro for everything to hold things in place on tables, wheelchairs or computers so someone can use it with one hand without it moving,” Johnson said.

Creativity factor

Before she became an OT, Cox was an art major in college, so she has creative instincts. “My feeling is that I have to be creative because my patients don’t have gyms and oftentimes can’t get to an outpatient department, so the more tools I can offer them the better,” Cox said.

She has developed several unusual alternatives to catalog items. Take, for instance, the standard sock aid. Even though they are not very expensive, Cox developed one out of a detergent bottle. She cuts the bottle open and then puts clothesline between two holes and duct tapes the edges to avoid sharp parts. “I recently had an appointment with a patient who I had seen seven years before, and she was still using the same sock aid that I had created for her,” Cox said.

To help assist with ROM and strength training, Cox has developed a homemade pulley system made from socks and soup cans. She uses clothesline tied at the top of a door, with one end tied to socks containing the soup cans and the other end rigged with a piece of PVC pipe on which the patient can pull. More soup cans are added to the socks to increase the weight.

Martle recalls graduating from Campbell’s Condensed to Progresso cans. “When we did this exercise, Cox would mark the rope and ask me to do it a certain number of times, and then the next time she would ask me to go past the mark.”

Many of the geriatric patients seen by Katie Bushala, OT, with The Comprehensive Group in Glenview, Ill., are resistant to buying rehab equipment. “They don’t want to spend a lot of money, so it’s forced me to become very resourceful,” she said.

Bushala regularly uses some low-cost methods to make things easier for her geriatric patients. When bathing or showering, she suggests patients place a bar of soap inside a tube sock so it’s easier to grasp. She also recommends putting rubber bands around grab bars in the shower to prevent them from being too slippery. For patients who have deficits in stereognosis, she uses an old tissue box and fills it with keys, paper clips, coins, marbles and other items with interesting textures rather than buying a kit.

Another added benefit of using everyday items is that patients may be more likely to continue exercises on their own, Bushala said. “For patients to follow through with a home exercise program, I want them to use things that they are going to have in their home and be able to use,” she said. “If I come in with arm skates and other fancy equipment, they won’t continue on their own.”

What’s the alternative?

Before purchasing your next expensive rehab tool, check this list to determine whether you have the everyday items to make one.


• Arm skate/Beach ball, furniture dolly

• Dressing stick, sock aid/Detergent bottle, clothesline and duct tape

• Incline board/Panel board, telephone book, weights

• Jux-a-cisor arm exerciser/Coat hanger, piece of PVC pipe and duct tape

• Over-the-door pulley/Rope, socks, soup cans, PVC pipe

• Pointer/Pencil with eraser, foam tubing

• Shoulder arc/Hula hoop with plastic shower curtain rings

• Shower mitt/Tube sock

• Stereognosis kit/Tissue box, old keys, paper clips, coins

• Therapy clay/Play-Doh


1 comment:

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Occupational Therapy Equipment

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