Dressing for the person with...

1.Paraplegia - en.wikipedia.org/wiki/Paraplegia

Procedure for Donning Shirt
- position client on the bed to avoid balance problem
- balance body by putting palms of hands on mattress on either side of body
- if balance is poor, one / two pillows may be used to support back
- open garment on lap with collar towards chest
- put arm into sleeves and pull up over elbow
- hold on to shirt tail / back of dress, pull garment over head, adjust and button.

Procedure for Removing Shirt
- sitting in wheelchair / bed and open fastener
- remove garment in usual manner
- if usual manner is not feasible, grasp collar with one hand while balancing with other hand
- gather material up from collar to hem
- lean forward, duck head and pull shirt over head

Procedure for Donning Trousers
- position client on the bed to avoid balance problem
- use side rail / a trapeze to pull up to sitting position, back support with pillows / overboard of the bed
- sit on the bed and reach forward toward feet, or sit on the bed and pull knee into flexed position (and cross the legs)
- holding top of trousers, flip pants down to feet
- work pants leg over feet and pull up to hips.
- in semi reclining position, roll from hip to hip and pull up garment (pull body to side using bed rail)
** for donning trousers, reverse the steps.

Procedure for Donning Stockings
- put on stockings while seated on the bed
- pull one leg into flexion with one hand and cross over the other hand
- use other hand to slip stocking over foot
- pull stocking on

Procedure for Removing Stockings
- position client on the chair / bed to avoid balance problem
- pull one leg into flexion with one hand and cross over the other leg
- pushing stocking down over heel
- dressing sticks may be needed to push stocking off heel and toe and retrieve stocking

Proceure for Donning Shoe
- in sitting position on bed
- pull one knee at a time into flexed position with hands
- support affected leg in flexed position with one hand
- use free hand to put on shoe

Procedure for Removing Shoe
- in sitting position on bed
- pull one knee at a time into flexed position with hands
- use free hand to remove shoe


2. Quadriplegia / Tetraplegia - en.wikipedia.org/wiki/Tetraplegia

Procedure for Donning Cardigans / Pullover Garment
- position client in wheelchair and garment across tight with back pacing up and neck towards knee
- place both arms under back of the garment and in armholes
- push sleeve up onto arms, past elbow and onto shoulder
- to pass garment over head, duck head forward and pull the garment
- to work garment down over body, shrug shoulder, lean forward and use elbow flexion and wrist extension
- garment can be buttoned from bottom to top with aid of hook button

Procedure for Removing Cardigans / Pullover Garment
- sit in wheelchair and unfasten button by using button hook
- for pullover garment, hook thumb in back of neckline, extend wrist and pull over head while turning head toward side of raise arm
- for removing cardigan garment, hook thumb in opposite armhole and push sleeve down arm
- elevate and depression of shoulder with trunk rotation can be used to get garment to slip down arm as far as possible
- hold one cuff with opposite thumb while elbow is flexed to pull arm out of sleeve

Procedure for Donning Trousers
- sit on the bed wit rail up. trousers are positioned at foot of the bed with trousers leg over end or bed and front side up.
- sit up and lift one knee at a time by hooking right hand under right knee to pull leg into flexion, and then put trousers over right foot
- return the leg to extension or semi extend position while repeating procedures with left hand and left knee
- while still sitting, with pants or trousers to mid calf height, insert dressing stick in front of belt loop
- dressing stick is gripping by slipping its loop over wrist
- pull on dressing stick while extending trunk, returning to supine position and work with trousers until up to tight level
- using palms of the hand in pushing and smoothing motions, straightens the trousers legs
- in supine position, fasten trouser placket by hooking thumb in loop on zipper pull or platting Velcro close.

Procedure for Removing Trousers
- lying supine on bed with bed rail up, unfasten belt placket fasteners
- placing thumb in belt loop, waistband or pocket, work trousers past hips by stabilizing arms in shoulder extension and scooting body towards head of bed
- used arm as describe in previous step and roll from side to side to get trousers past buttock
- coming to sitting position and alternately pulling legs into flexion, push trousers down leg
- trousers can be push off over feet with dressing stick or by hooking thumb in waistband.

Bridging Technique

• lying on the back with both knees bent
• the person lift the hips up and balances in this position
• with you left hand help her in raising the hip
• with your other hand, give sensory reminder such as tapping
• you also may use above technique where push the knee while she lifting her hips up.

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This technique used to increase the leg muscle power and to neutralize muscle spasms on trunk.

Presurre Garrment......

Before starting, you must know your sewing machine...

During this session, we using Singer 974...

• using electric power or manual?
• top and bottom thread?
• type of suture...?

..My 1st sewing..

Making Sleeve

1.Make line marking on the pape
r for measurement

2.Mark every 5cm affected area.
 (where PG be worn)

3. Measure circumference each marked area.

4. Write down every measurement.

5. Multiple the measurement with 0.4cm

6. Draw the plan of the measurement
 on the paper.

7. On the paper, write down client's name,
 date measured
and  location of the affected area.

8. Cut the garment according the trace
paper trace .

9. Make sure the garment be cut exactly
 the same size of the trace  .

10. Sew the proximal and distal
edges first.

11. Sew and combine both side.

We using zig-zag pattern no.3

12. Mark two dots in 1.6cm distance.

13. and  every 5cm on the garment.

14. Wear the garment and measure
the dots distance.
Make sure the distance
 increase to 2cm.

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Done...... hehehee

Perfect 10!

Splinting.....

Equipment in making splint:

• splint- splint should be kept in cold and closed place.
• splint pan and netting-
  water capacity must be 1/3 - 1/2 of the pan.
  water temperature depends on the splint type,
   (1 °C=1.8 °F).
  water must be regularly changes to prevent infection.
• spatula- to lift the splint from the pan
• shearing scissors- used to cut the splint before soaking the splint
• straight and curve scissors- to cut the splint after soaking

Making Resting Hand Splint:

1. Tracing -
Trace client hand on the trace paper.
Mark the anatomical mark on the paper.
Add the size of a finger from the trace line.
Cut the traced paper and trace again onto the splint using a gel pen (to prevent from scratching the surface of the splint).


2. Cutting - 
Cut the traced splint using the shearing scissor.
Keep a good technique of cutting the splint to prevent ergonomic hazard such as stress of the hand muscle.



3. Fabricate / Moulding - 
Soak the splint till the edges are transparent and cut the remaining line for the thumb then soak the splint again till all the splint become transparent.
Place the pattern on the temporarily supinated forearm.
Position the thumb and mould the material around it.
Make sure the wrist are about 25-30 degree extended and the CMP joint are about 25-30 degree flexed.
Trim any extra edges and round them.


4. Flaring - 
Flare any sharp or hard edges to prevent injury when used.
This can be done by soaking it to the splint pan for about 3 second and rub or smooth it with thumb and index finger or palm.


5. Strapping - 
Before placing the strap, make sure the splint dried.
Place the board strap:

• 1 over the wrist
• 1 over the PIP joint
• 1 around the thumb
• 1 at the proximal end

My first and finished resting hand splint : 

it haven't given mark yet, but the wrist extension quite low and need to be improve.. hehehe :P

Isometric Exercise

Examples of Isometric Exercises

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Plank: The plank targets the entire core while also strengthening the upper and lower body. Lie prone, with your stomach on the floor. Lift your chest and place your elbows in line with your shoulders and perpendicular to the floor, with your palms facing down and forearms out in front. With feet hip-width apart, raise your body up so it is parallel to the floor. Keep your eyes looking forward just past your hands, so you don't put extra strain on your neck, and hold. Start with 10-15 seconds and increase as you become stronger.

Side plank: The side plank is similar to the original plank, but focuses more on the oblique abdominal muscles, which are on the sides of your core. Lie on your side. Place your elbow directly underneath the shoulder with the forearm forward, perpendicular to your body and palm down. Keeping the legs in line, one stacked on the other, raise your body up so you are on the side of your bottom foot and your elbow and forearm. Keeping the hips in line with the body, hold for the desired time.

Wall squat: The wall squat focuses on the legs. Press your back against a wall. Slowly lower down until your quadriceps are parallel to the floor, with a 90-degree angle at the knee. Keep your weight in your heels and hold this position until you are fatigued. For added resistance, hold weights in both hands.

Occupational Profile

Content in an Occupational Profile includes:

• client's demographic data - who is the client?
• client's occupational history - the past experiences.
• reason of the referral - why is the client seeking for the service?
• client's priorities - goal to be achieve from the treatment
  (short and long term goal)
• area of occupation affected - main current problem(s)
•  context and environment - anything that support and inhibit occupational performance

Mr. Muhammad Akif, malay, 38 years old bus driver who works for 6 years for a public transport company. Mr Akif was married and had 2 children, both still in primary school. He lived at rented 2 storey house with his family which 20 minutes commuting by motorcycle. His monthly income was RM 1800++ and his wife didn’t work since they first child. Mr. Akif never been promoted since working with his company because his unfinished SPM education. Mr. Akif works for 10 hours in a working day and usually travel 2-5 hours before his break time. He started his duty on 6.30a.m until 4.30p.m on morning shift and 1p.m until 11p.m on evening shift. Mr. Akif was diagnosed with Symphysis pubis disruptions after motor vehicle accident during his way back home. He suffered pubic bone displacement greater than 2.5 cm, rupture of the anterior sacroiliac, the sacrospinous, and the sacrotuberous ligaments, rendering his pelvis rotationally unstable. He was referred to Occupational Therapy Department after 6 weeks wearing external fixation to receive treatment;

ü  Compression therapy – edema treatment

ü  Active hip, knee and ankle movements

ü  ADL training

ü  Return to work training

ü  crutches, or walker as assistive devices

ü  partial weight bearing on the affected limb (not earlier than 3 months post-operatively)

ü  The patients were followed up 6 weekly for the first 6 months, every 3 months after that until a year and thereafter once a year.

Mr. Akif was determining to return to works as soon as possible after the surgery. He desires to be able to driven in less than 6 months. While using the crutches, he hopes the adaptation in his bus will enable him to drive safely. On the first week of treatment with OT, therapist found out Mr. Akif having problem in his:-

ü  ADL: functional mobility, bowel and bladder management and personal hygiene and grooming.

ü  IADL: religious observance, community mobility.

ü  Works

ü  Leisure

ü  Social participation

As a working husband and father, Mr. Akif is unable to work for his family and house payment due to his condition. In addition, his wife had unemployed. However, his company is covered by insurance policy for workers.  He also is having trouble in transporting in his 2 storey house. Especially, when he needs to go out of his house such as going to the hospital. Mr. Akif’s wife was advised to move they bedroom to the ground level for the temporary. Mr. Akif also having problem in full filling his Friday prayers.

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This is only my version of occupational profile and haven't check by my lecturer yet. Thanks