Coping with hemiplegia and hemiparesis
July 10, 2013
Hemiplegia (paralysis of one side of the body) can often occur following brain injuries, particularly strokes. These conditions can make everyday tasks extremely difficult. Here are strategies for coping with common problems due to hemiplegia and hemiparesis.
Paralysis of arms or hands
If an arm or hand is paralysed, it is important to try to improve its function by treating it as normally as possible and not neglecting it. Place the limb in positions that were typically used before the stroke, and place it where it can be seen. This is particularly important if the person lacks awareness of the affected limb.
One approach is to open the hand our flat and rest it, palm down, on the lap or table. Ask the physiotherapist if the hand or arm would benefit from lots of sensory stimulation, such as massaging the skin, rubbing briskly with a wet flannel, rubbing the hands together, kneading and rolling dough etc.
Conventional wheelchairs can be very difficult to use one-handed and many people use powered wheelchairs instead. However, these are expensive, heavy and lack portability. One arm drive manual wheelchairs can overcome these problems. You could ask an OT or other healthcare professionals about availability.
Sensory problems
If there is a sensory problem, such as inability to feel heat, cold, pain etc this area of the body will be particularly vulnerable and will need special attention. Care should be taken to ensure the affected area does not get too hot or cold, and to prevent the skin from coming into contact with things that could burn, scald, or cause another injury, such as sharp objects or rough surfaces.
Personal hygiene
Teeth: Experiment with different toothpaste dispensers. If using only one hand, lay the toothbrush on its back and squeeze the toothpaste over the bristles. Alternatively hands free toothpaste dispensers are available.
Dentures: A suction denture brush is available, working in a similar way to the suction nailbrush.
Nails: A suction nailbrush is available that can be stuck onto the sink, so that it does not need to be held. The unaffected side can use this easily, and then the affected side can be held in position by the ‘good’ hand, and the nails rubbed back and forth, across the brush. A suction nail file also works in a similar way.
Toileting: Interleaved toilet tissue (as often used in pub and restaurant toilets) is easier to use, as tearing off tissue is difficult using one hand.
Shaving: Use an electric shaver, preferably a rechargeable one which does not need to be plugged in during use.
Coping in the Kitchen
Snap on aprons: These have a bendy plastic waist band with a snap-fastener, avoiding the need for tying a bow behind the back.
Opening cans: Adapted can openers are available with handles that click together with a single squeeze, and so do not need a constant strong grip to hold them together. Electric can openers, suitable for one-handed operation, are also available.
Slicing: Cutting guides are available for slicing bread and meat. These have upright pillars to hold the knife steady and make cutting safe and simple. The width of the slice can often be adjusted a necessary.
Spreading: Spreading boards are available, with two slightly raised edges at right angles to each other. The slice of bread is laid next to these edges to stop it from moving during spreading.
Cutting: Easy-grip scissors can be helpful if you need to use the opposite hand from the one that you would normally use. These open with a spring action, so very little strength is required.
Peeling: ‘Rex” peelers have broader handles than traditional peelers and require less movement at the wrist. You could also try a battery operated peeler with a contoured handle for easier grip. There are even electric peelers available, with spikes to hold food for conventional peeling and a separate scraper section. Vegetables are rubbed against the scraper to remove the peel. The scraper can also be used as a fine grater.
Boiling: Metal handle guards can be fastened onto the side of a cooker to hold pan handles steady while their contents are being stirred. When cooking vegetables in a saucepan, it can help to place a wire chip basket, or sieve, inside the saucepan before adding vegetables. Once cooked, the vegetables can easily be drained by lifting up the basket or sieve. This prevents the problem of needing one hand to hold the pan, and another to hold the lid, or strainer, while pouring off the excess water. The water can then be left to cool before attempting to empty the saucepan.
Avoiding burns: Heatproof mats can be placed on the work surface, or adjacent to the oven, so that hot cookware can be placed onto them before being moved.
Chopping, grating and mixing: Food processors, blenders and juicers can be invaluable for chopping, grating mixing, etc. Choose a design that is easy to operate, take apart and clean. Simple mechanical choppers or electric mixers are also available which only require one handed operation. Try a hand-held ‘stick blender’ to mix the contents of a bowl or saucepan with the press of a button.
Microwaving: A microwave can be a very helpful as it reduces cooking time and cooking requires minimal handling. Proper microwave cookware, which is designed to absorb less of the cooking heat, will be cooler to handle.
Eating and drinking
Moving food and objects: Trolleys are useful for transporting hot objects from one work surface, or from room, to another. One-handed trays are also available, with a handle that rises over the centre of the tray so that it can be balanced safely with one hand. These also come with an anti-slip surface.
Plates: Plates with anti-spill raised edges are available. Alternatively plate guards can be clipped onto most plates.
Cutlery: A wide variety of adapted cutlery is available to make eating easier, eg specialist knives which enable food to be cut without requiring a fork to hold it steady.
Egg cups: Try egg cups with a suction base.
Non-slip matting: Special rubber matting is widely available which prevents plates, cups and other items from slipping around during use. Alternatively, a damp tea towel folded and placed underneath can also prevent hard objects from slipping on a smooth surface.
Housework
Washing-up: Brushes which attach by suction onto the draining board are available, which allow you to clean pots one handed. Alternatively, and automatic dishwasher can make life easier.
Vacuuming: Heavy vacuum cleaners are very awkward to use with one hand. Choose a light machine with a swivel-head which can be easily manoeuvred around furniture. It is helpful to clear space before beginning the job. Hand-held ‘Dustbuster” vacuum cleaners which are rechargeable, are very handing for stairs and small areas of carpet.
Laundry: Automatic washing machines are preferable, as washing by hand is obviously very difficult one-handed. For drying, it is easier to hang each garment on an indoor during rack. Once the washing is dry, place the items on a flat surface to fold them. Buy socks that are all the same so any two will make a pair rather than having to pair items after washing.
Ironing: Again, this can be difficult using one hand. Extra care needs to be taken so as to avoid burns particularly if there is any loss of sensation in either hand. It may be easier to turn the ironing board around if using a different hand from the one previously used. A tumble dryer and fabric conditioner, as well as careful choice of fabric, can help to reduce the need for ironing. Large items that need folding after ironing are best laid on a table.
Tips for dressing
Fastenings: Ideally, choose clothes without fastenings, such as t-shirts, polo shirts, casual tops, and trousers or skirts with elasticated waste bands. Zips are extremely difficult to manage with one hand and are best avoided. When dressing, it is much easier to dress the affected side first, and undress last.
Buttons: It is possible to do up a button one-handed, but it takes practice. A latch hook maybe useful: insert the hook through the buttonhole, latch it into the shank of the button, and pull the button back through the hole. For buttoned shirt cuffs, stitch elastic hoops next to the button hole, and fasten the button through the elastic rather than the hole. This allows for the hand to pass through the cuff without needing to unfasten the buttons. You could also replace buttons with Velcro. Remove the buttons and stitch then back on over the buttonholes. Stitch Velcro circles behind the button holes and onto the material where the buttons used to be.
Shoes: Choose shoes with Velcro fastenings, or slip on styles. Buckles may be manageable, but check that both shoes can be fasted up. Elastic shoes are inexpensive, and can help to convert lace up shoes into slip-ons by allowing extra ‘give’ across the top of the foot.
Bras: Choose a bra with as few hooks as possible. Try bras with front fastening, or bras with no fastenings, which slip on over the head. Alternatively, the rear fasting of the bra could be adapted by fastening a piece of Velcro.
Conclusion
Although life with hemiplegia or hemiparesis is inevitably difficult, there are many ways to manage the everyday practical issues. We hope these tips provide you with some useful ideas for yourself, a friend or relative. Remember, always ensure that the techniques you are using are safe, and if you have any questions, problems or concerns, consult an occupational therapist.
If possible, try items out before making expensive purchases, as some things will work better for some people and not others. Also, some companies can charge a lot of items when something equally effective can often be found very cheaply. Always be wary of buying expensive equipment, especially on impulse.
If possible, it is advisable to consult an OT about equipment that would be most suitable for you. They may also be able to help you obtain any items which you find difficult to locate.
If you have any questions about adaptive equipment please call StrokeLine 1800 STROKE (787 653)
This story was first seen in the Synapse bridge magazine www.synapse.org.au. It was reproduced from www.headway.org.uk with the permission of Headway – the brain association.
Paralysis of arms or hands
If an arm or hand is paralysed, it is important to try to improve its function by treating it as normally as possible and not neglecting it. Place the limb in positions that were typically used before the stroke, and place it where it can be seen. This is particularly important if the person lacks awareness of the affected limb.
One approach is to open the hand our flat and rest it, palm down, on the lap or table. Ask the physiotherapist if the hand or arm would benefit from lots of sensory stimulation, such as massaging the skin, rubbing briskly with a wet flannel, rubbing the hands together, kneading and rolling dough etc.
Conventional wheelchairs can be very difficult to use one-handed and many people use powered wheelchairs instead. However, these are expensive, heavy and lack portability. One arm drive manual wheelchairs can overcome these problems. You could ask an OT or other healthcare professionals about availability.
Sensory problems
If there is a sensory problem, such as inability to feel heat, cold, pain etc this area of the body will be particularly vulnerable and will need special attention. Care should be taken to ensure the affected area does not get too hot or cold, and to prevent the skin from coming into contact with things that could burn, scald, or cause another injury, such as sharp objects or rough surfaces.
Personal hygiene
Teeth: Experiment with different toothpaste dispensers. If using only one hand, lay the toothbrush on its back and squeeze the toothpaste over the bristles. Alternatively hands free toothpaste dispensers are available.
Dentures: A suction denture brush is available, working in a similar way to the suction nailbrush.
Nails: A suction nailbrush is available that can be stuck onto the sink, so that it does not need to be held. The unaffected side can use this easily, and then the affected side can be held in position by the ‘good’ hand, and the nails rubbed back and forth, across the brush. A suction nail file also works in a similar way.
Toileting: Interleaved toilet tissue (as often used in pub and restaurant toilets) is easier to use, as tearing off tissue is difficult using one hand.
Shaving: Use an electric shaver, preferably a rechargeable one which does not need to be plugged in during use.
Coping in the Kitchen
Snap on aprons: These have a bendy plastic waist band with a snap-fastener, avoiding the need for tying a bow behind the back.
Opening cans: Adapted can openers are available with handles that click together with a single squeeze, and so do not need a constant strong grip to hold them together. Electric can openers, suitable for one-handed operation, are also available.
Slicing: Cutting guides are available for slicing bread and meat. These have upright pillars to hold the knife steady and make cutting safe and simple. The width of the slice can often be adjusted a necessary.
Spreading: Spreading boards are available, with two slightly raised edges at right angles to each other. The slice of bread is laid next to these edges to stop it from moving during spreading.
Cutting: Easy-grip scissors can be helpful if you need to use the opposite hand from the one that you would normally use. These open with a spring action, so very little strength is required.
Peeling: ‘Rex” peelers have broader handles than traditional peelers and require less movement at the wrist. You could also try a battery operated peeler with a contoured handle for easier grip. There are even electric peelers available, with spikes to hold food for conventional peeling and a separate scraper section. Vegetables are rubbed against the scraper to remove the peel. The scraper can also be used as a fine grater.
Boiling: Metal handle guards can be fastened onto the side of a cooker to hold pan handles steady while their contents are being stirred. When cooking vegetables in a saucepan, it can help to place a wire chip basket, or sieve, inside the saucepan before adding vegetables. Once cooked, the vegetables can easily be drained by lifting up the basket or sieve. This prevents the problem of needing one hand to hold the pan, and another to hold the lid, or strainer, while pouring off the excess water. The water can then be left to cool before attempting to empty the saucepan.
Avoiding burns: Heatproof mats can be placed on the work surface, or adjacent to the oven, so that hot cookware can be placed onto them before being moved.
Chopping, grating and mixing: Food processors, blenders and juicers can be invaluable for chopping, grating mixing, etc. Choose a design that is easy to operate, take apart and clean. Simple mechanical choppers or electric mixers are also available which only require one handed operation. Try a hand-held ‘stick blender’ to mix the contents of a bowl or saucepan with the press of a button.
Microwaving: A microwave can be a very helpful as it reduces cooking time and cooking requires minimal handling. Proper microwave cookware, which is designed to absorb less of the cooking heat, will be cooler to handle.
Eating and drinking
Moving food and objects: Trolleys are useful for transporting hot objects from one work surface, or from room, to another. One-handed trays are also available, with a handle that rises over the centre of the tray so that it can be balanced safely with one hand. These also come with an anti-slip surface.
Plates: Plates with anti-spill raised edges are available. Alternatively plate guards can be clipped onto most plates.
Cutlery: A wide variety of adapted cutlery is available to make eating easier, eg specialist knives which enable food to be cut without requiring a fork to hold it steady.
Egg cups: Try egg cups with a suction base.
Non-slip matting: Special rubber matting is widely available which prevents plates, cups and other items from slipping around during use. Alternatively, a damp tea towel folded and placed underneath can also prevent hard objects from slipping on a smooth surface.
Housework
Washing-up: Brushes which attach by suction onto the draining board are available, which allow you to clean pots one handed. Alternatively, and automatic dishwasher can make life easier.
Vacuuming: Heavy vacuum cleaners are very awkward to use with one hand. Choose a light machine with a swivel-head which can be easily manoeuvred around furniture. It is helpful to clear space before beginning the job. Hand-held ‘Dustbuster” vacuum cleaners which are rechargeable, are very handing for stairs and small areas of carpet.
Laundry: Automatic washing machines are preferable, as washing by hand is obviously very difficult one-handed. For drying, it is easier to hang each garment on an indoor during rack. Once the washing is dry, place the items on a flat surface to fold them. Buy socks that are all the same so any two will make a pair rather than having to pair items after washing.
Ironing: Again, this can be difficult using one hand. Extra care needs to be taken so as to avoid burns particularly if there is any loss of sensation in either hand. It may be easier to turn the ironing board around if using a different hand from the one previously used. A tumble dryer and fabric conditioner, as well as careful choice of fabric, can help to reduce the need for ironing. Large items that need folding after ironing are best laid on a table.
Tips for dressing
Fastenings: Ideally, choose clothes without fastenings, such as t-shirts, polo shirts, casual tops, and trousers or skirts with elasticated waste bands. Zips are extremely difficult to manage with one hand and are best avoided. When dressing, it is much easier to dress the affected side first, and undress last.
Buttons: It is possible to do up a button one-handed, but it takes practice. A latch hook maybe useful: insert the hook through the buttonhole, latch it into the shank of the button, and pull the button back through the hole. For buttoned shirt cuffs, stitch elastic hoops next to the button hole, and fasten the button through the elastic rather than the hole. This allows for the hand to pass through the cuff without needing to unfasten the buttons. You could also replace buttons with Velcro. Remove the buttons and stitch then back on over the buttonholes. Stitch Velcro circles behind the button holes and onto the material where the buttons used to be.
Shoes: Choose shoes with Velcro fastenings, or slip on styles. Buckles may be manageable, but check that both shoes can be fasted up. Elastic shoes are inexpensive, and can help to convert lace up shoes into slip-ons by allowing extra ‘give’ across the top of the foot.
Bras: Choose a bra with as few hooks as possible. Try bras with front fastening, or bras with no fastenings, which slip on over the head. Alternatively, the rear fasting of the bra could be adapted by fastening a piece of Velcro.
Conclusion
Although life with hemiplegia or hemiparesis is inevitably difficult, there are many ways to manage the everyday practical issues. We hope these tips provide you with some useful ideas for yourself, a friend or relative. Remember, always ensure that the techniques you are using are safe, and if you have any questions, problems or concerns, consult an occupational therapist.
If possible, try items out before making expensive purchases, as some things will work better for some people and not others. Also, some companies can charge a lot of items when something equally effective can often be found very cheaply. Always be wary of buying expensive equipment, especially on impulse.
If possible, it is advisable to consult an OT about equipment that would be most suitable for you. They may also be able to help you obtain any items which you find difficult to locate.
If you have any questions about adaptive equipment please call StrokeLine 1800 STROKE (787 653)
This story was first seen in the Synapse bridge magazine www.synapse.org.au. It was reproduced from www.headway.org.uk with the permission of Headway – the brain association.