One of the things J is working on in Physical Therapy is assisted walking. Here is a look at some AT J’s PT built to help facilitate bench walking around the house.
The second stone in the AT Arms Race from the AT Skunk Works labs. Last week I showed you a switch adapted squirt gun, now let me introduce how that became the AT Battle Tank.
A beautiful summer day at the AT household inspired me to share a little summer Assistive Tech on a shoestring budget.
Assistive technology (AT) isn’t always for the individual who happens to have a disability. AT can also be something utilized by caregivers to make life easier as well. This weeks DIY AT entry is one of those helpful life hacks for the caregiver.
Part of J’s life includes a G-tube. Due to various issues, J receives a continuous drip feed through that G-tube using an enteral pump. That means a carefully measured amount of food is pumped directly into J’s stomach at a predetermined rate over a prolonged period of time. That also means that the carefully measured amount of food must be made every day. This is where today’s low-tech AT project comes in.
As I wrote earlier, J started playing Challenger League Baseball this year. AT Mom and I may have been more excited than J with the approaching first game. The last practice before the game J received a uniform – a Blue Jays jersey and ball cap.
The day of the game arrived! We got dressed, packed up, and headed out for the ballpark. We arrived for warm up with the team. AT Mom and I had the biggest smiles on our faces watching all of the kids arrive in their uniforms complete with huge smiles on their faces, ready to “play ball!” It was a very sunny day, perfect for a baseball game. AT Mom whipped out the sunscreen and started protecting J’s exposed skin. (I was too excited for the game to start, after all J and I were about to play baseball!)
After AT Mom finished applying sunscreen I moved to complete the uniform by adding J’s ball cap. I took a step back to admire “J the baseball player.” J’s head turned to look at a friend and J’s ball cap fell forward. I stepped up and fixed the ball cap and took another step back. Again, J’s head turned towards the crack of a bat from one of J’s friends taking batting practice. Again, the ball cap fell forward.
For then next couple of minutes there was this sort of dance going on, J’s ball cap falling forward and AT Dad stepping in to readjust the ball cap. The problem was that whenever J’s head moved the ball cap would rub against J’s headrest. After a few minutes I realized why some of J’s teammates simply did not wear their ball caps, and we went capless ourselves.
The first couple of games involved the same dance each time. I would try to help J wear the ball cap, constantly fixing it, then give up and go without. J was happy to not wear the cap and focus on playing baseball. I think it helped that J could feel more wind through J’s hair as we ran the bases without the ball cap.
Then one game I got to talking with one of the other parents about possible adaptations for the ball cap. I thought about building a sort of halo that could suspend the ball cap above J’s head. AT Mom thought that would just be visually distracting. (She was right.) Then I hit on an idea that I thought would work great.
Side view of my ball cap to show before adaptation.
Back view of my ball cap to show before adaptation.
The problem was that J’s headrest would rub against the back of J’s ball cap and spin the cap of J’s head. What if J’s ball cap did not have a back to rub against the headrest?
Side view of J’s ball cap after my adaptation.
Back view of J’s ball cap after my adaptation.
I cut out the back three panels of J’s ball cap and used barrettes to attach the front of the cap to J’s hair. This allowed J’s head to turn against the headrest without rubbing the ball cap. The first time I tried the new ball cap it stayed in place for nearly the entire game. That includes running the bases.
J wearing the adapted ball cap.
The next couple of games did not fair as well. The cap stayed on better than before, but J’s fine hair made it difficult to get the barrettes to hold well. Thinking about the design a bit more, next season I will cut out the back three panels but this time I will leave the Velcro strap across the bottom used to adjust the size of the ball cap. When next season comes around I’ll have to remember to write an update to how well the new design works.
A couple of years ago AT Mom and I were invited to bring J to watch a friend play Challenger League Baseball. J was absolutely hooked. From the moment we arrived and even before we were fully settled into the bleachers, J was glued to the fence watching all of these kids playing baseball. J had already been exposed to MLB on television (that’s another story for another time), but this was the first time J got to see other kids, including kids with similar challenges, playing the game. I think the kids who happened to be wheelchair users captured J’s imagination the most. One of our favorite pictures of J is one that AT Mom captured of J standing in a gait trainer that is pressed up against the fence. J’s head is beautifully upright watching the play on the other side of the fence.
Unfortunately, J was too young to play at that time. A couple of years later though, J got to play baseball for the Blue Jays. The first couple of games made it apparent that J’s favorite part of the game was batting. J’s favorite position was Designated Hitter – I guess it was a good thing we were on an American League team.
Fielding was a difficult part of the game for J. Being a chair user added some challenges to fielding the ball, but those could be overcome with a fielding aide (AT Dad had to dust of my old baseball skills). However, more than that was the impact of J’s Cerebral Palsy on wearing a glove. The nature of J’s tone made wearing a typical baseball glove inappropriate. I took my lead from some of the other parents and help J put a baseball glove on one of the armrests of J’s wheelchair. I knew there had to be a better way so during one of the games I started talking with some of those other parents about ways to adapt a baseball glove for our kids.
The solution that I came up with was based on an adaptation done by J’s OT I wrote about earlier (AT <3s Velcro). The simple idea was to attach some hook Velcro to the inside of the heel of the glove. J could then wear the left Velcro sensitive splint when fielding. The hook Velcro sticks to the splint and J does not need to hold the glove on.
J’s adapted glove. You can see a bit of the white hook Velcro pad.
I happened to choose some industrial hook Velcro. I was hoping that the “industrial” nature would include a strong adhesive that would help keep the Velcro attached to the glove. Also, the hook side of the Velcro is made up of what appears to be a lot of tiny pyramids – so it is not as abrasive against bare skin.
Opening up the glove for a better view of the white hook Velcro pad.
I cut a patch wide enough to cover most of the inside of the heel of the glove. This would increase the surface area of the Velcro touching the Velcro sensitive splint. As an added benefit it has meant I have to be less precise when helping J put on the glove during those days that J’s tone is less cooperative.
A better picture of the hook Velcro pad attached to the inside of the heel of the glove.
The glove I had purchased for J at the beginning of the season was a tee ball glove that had a wrist strap that was fastened by Velcro itself. That meant I could open up the wrist strap completely when helping J put on the glove, exposing my Velcro adaptation for easy use.
Helping J put on the glove before taking the field.
Now during inning changes instead of putting J’s fielding glove on an armrest of J’s wheelchair I help J put it on. I start by helping J put on the left Velcro sensitive hand splint. Then I open the wrist strap of the baseball glove and help J place J’s palm centered on the hook Velcro pad inside the baseball glove. I then help J tuck J’s thumb inside the glove. Finally, I close the wrist strap of the baseball glove and help J tuck fingers inside the baseball glove. J seems to like keeping that pointer finger outside the glove like the pros do.
J wearing the glove and ready to take the field. Note the pointer finger outside the glove just like the pros!
We then wheel out to the field and take our position (usually around second base). During the inning it is not uncommon for J’s fingers to come out of the glove. That would have resulted in the glove falling off in the past; however, thanks to the Velcro adaptation the glove stays on J’s hand.
J ready to field any grounders towards second base.
Now when we are in the field, J and I charge every ball put into play towards second base. We cover second base and back up first base on just about every other play. With all that running we no longer spend any time going back to pick up a dropped glove. Fielding has become a bit more exciting for J with all the running and activity; however, J still prefers to bat. I guess I know where J falls on the age old Designated Hitter debate. It looks like the AT household will be an American League household.
J taking a break between batters.
Today I want to share a particular piece of Assistive Technology that is the foundation of a number of adaptations in our house. First, let me give you a little background on J’s disability. J happens to have athetoid Cerebral Palsy. J’s particular picture means that all limbs are affected, muscle tone is variable, and often there are extra or involuntary movements. One half of J’s body tends to be higher tone, and the other side tends to be more variable.
The different tone pictures make grabbing and holding things particularly challenging. The higher tone half of J’s body has an easier time grabbing and holding something. However, when the muscles in the hand contract to grasp an object all of the muscles in the arm contract as well. This results in J holding the object close to J’s chest. Also, that side of the body has a harder time letting go. J often needs help releasing objects on that side. The more variable tone half of J’s body has an easier time releasing objects; however, that side has a much harder time maintaining a grasp on something. When J tries to gab something with this side it often times results in accidentally dropping or “throwing” the object.
A couple of years ago J’s Occupational Therapist focused on developing a strategy to provide J with a functional grasp. More to the point, J’s OT wanted to help J participate in activities like coloring that require maintaining a grasp for a period of time. That brings me to the star of today’s post: J’s Velcro sensitive gloves.
AT Dad’s hand next to J’s left glove.
J’s OT worked with the folks at Benik who make neoprene braces of different types. The OT decided on a custom splint for both hands (I am only showing the left one in pictures here). Most of J’s fingers are exposed so J can grasp with those fingers. Each glove partially covers J’s pointer finger and thumb to help encourage a pincher grasp, and/or pointing when appropriate.
J modeling the left Benik glove.
The outside of the glove is a Velcro sensitive material. This means that J can now grasp anything we can attach hook Velcro (the rough side): crayons, drum sticks, markers, paint brushes, and baseball gloves are just a few of the items we have adapted so far.
Another angle of J’s left hand in the glove.
The gloves do have a metal stay on the underside that helps keep J’s wrist at a functional angle. The only down side is that they are made of neoprene and can get a little hot. After wearing the glove for five minutes, J’s hand can get very hot and sweaty.
The bottom of a Velcro adapted crayon.
I can’t say how J feels about the gloves because we don’t focus on the gloves. Whenever I put the gloves on J is more interested in the actual activity. I guess that makes the gloves a very successful piece of AT, the kind that fades into background and does not become the activity itself.
J “holding” the crayon. J’s fingers are grasping the crayon, but it is really held on to the glove with the Velcro.
Awhile back J took an interest in science and, specifically, “star gazing”. AT Mom responded with this amazing art project. While it may not technically be Assistive Tech, it is pretty darn cool. Sometimes it really is just about discovering our children’s interests and making those things accessible to their imagination. Planting a seed, or a spark, of creativity. This is one of those projects.
Back to J’s interest in “star gazing”. J’s school was currently working on a theme that involved “star gazing” and J was really interested in the activities at school. Also, late at night we would allow J to watch some quiet time television as part of our bedtime routine. The channel we watched (PBS Sprout) was running a particular commercial pretty regularly for “Dream Lites”. Every time the song came on, J would quiet down and pay special attention to the commercial.
For those that do not know Dream Lites, they are a series of stuffed animals that have colored LEDs inside and a hard shell on top that has stars cut out of it. When you turn them on, the LEDs turn on in a changing color pattern (yellow, green, blue – I think) and project stars onto the ceiling. This gave AT Mom an idea. What if we put glow-in-the-dark stars on the ceiling for J to sleep under?
I chuckled and thought it was a great idea (little did I know what would happen next). AT Mom was not finished. A couple of days later some packages arrived. They included a couple of glow-in-the-dark star sets as well as a 3D glow-in-the-dark solar system pack.
Now I knew I was in a little bit of trouble.
AT Mom described her idea to me. Using a tri-fold poster board (think science fair display), we would draw out (by hand) the constellations in the Northern Hemisphere’s summer night sky. We would put glow-in-the-dark stars in place on the constellations, and add a few extra to fill the sky. We would then attach the planets in the correct order, and somewhat proportional distance from the center of the board as if they were orbiting the center. (For those detail oriented and perfectionists out there, we would use one distance scale for the inner planets and another for the outer planets.)
It was a great project and J loved it. The solar system came with diagrams of the night sky of the two hemispheres in summer and winter. This is what gave AT Mom the idea of being so accurate.
Getting started on the project. The Northern Hemisphere Summer diagram came with the solar system set. The big star is the center and represents the sun.
Of course I took the accuracy a bit further. I asked AT Mom to be sure and label the four corners with the cardinal directions from the diagram. That allowed me to mount the project to the ceiling with the proper compass alignment. (Have we lost you yet?) AT Mom did all of the drawing of the constellations and some of the glow-in-the-dark star application. I followed her drawing attaching the stars. J kept us in line with smiles and encouragement.
Finished with the constellations and stars. Now to hang the planets.
When we finished with the constellations it was time to attach the planets. AT Mom again led the way by doing the distance scaling and putting dots where she wanted each planet to hang (labeling the dots reducing that chance that AT Dad would hang the planets in the wrong order). I cut 9 pieces of fishing line to the approximate same length I attached each of these lines to a planet on one end (each planet had a loop just for this purpose) and a toothpick on the other. I poked a hole at each dot AT Mom drew for me and pushed the toothpick attached to the right planet through each hole. I could adjust the hang length of each planet by winding the fishing line around the toothpick. When I had the hang lengths I liked, I used blue masking tape to fix the toothpicks flat in place (just in case).
Planets added. AT Mom took this photo from underneath while I held it up outside. Yes, there are nine planets. AT Mom and I still count Pluto – don’t be a Pluto Hater!
Then came hanging the project over J’s bed. I did that one afternoon as a surprise for J. I used the hangers commonly used to hang bathroom mirrors. I used a total of 11. The first 10 were because of the tri-fold presentation board. I used 4 on each long side (2 on each center fold side, 1 on every short fold side), and 1 on each short side. The eleventh was to reinforce a fold that had started to tear. It was a “simple” process of using my compass to find magnetic North, holding the project up to the ceiling with the correct cardinal orientation, having AT Mom trace the outside of the project onto the ceiling, taking down the project, and attaching the hangers to the ceiling using drywall anchors.
Here it is attached to the ceiling above J’s bed. I used mirror hangers.
I know that to many people this may seem like a little over the top for an art project. However, it only took J’s first reaction to staring up from bed at the stars and solar system overhead to make the effort worth it. When we turned out the lights so J could see it all glow… Pure joy!
The view from J’s pillow.
J now enjoys a view of the summer night sky every night. I have to admit that I get a kick of J’s joy every time I see it myself. Oh, and remember the “Dream Lites” that helped start this whole thing? The next time Nana and Papa came to visit, they brought J a little gift – a giraffe that projects even more stars on the ceiling. Thank you Nana and Papa!
I was hoping to get to my second post a bit quicker than this. Thankfully my delay in posting was due to a great visit from Nana and Papa and nothing medical in nature. For my second post I though I would keep to the low-tech theme.
When we (my wife, J’s team, and I) ordered J’s wheelchair we included a tray. We wanted J to have a surface both for activities and to help J prop into an upright position. Due to J’s big (and sometimes uncontrolled) movements padding of that tray is very important. The tray we choose had a clear hard plastic surface with a Velcro attachable pad.
J’s tray without the padded cover. Note the black lip around the edge.
J’s tray with the padded cover.
The problem with the tray was the lip around the outside. You can see the black lip in the above pictures around the sides and front of the tray. This lip’s purpose was to help contain activities onto the tray and reduce what would fall off onto the floor. A good intention; however, it is very hard and has a pretty abrupt edge. Combined with J’s movements and it resulted in bruises on J’s forearms. We absolutely needed a padding solution and fast!
A close up of the hard edge. Notice the abrupt shape of the top.
This is one of those solutions that is one of those AT Dad gambles that turned out to be a Grand Slam. While my wife, J’s PT, and I discussed different padding solutions versus various extensions to the tray to make it harder for J to strike the hard border, I proposed pipe wrap insulation as an easy (and inexpensive) solution. AT Mom was a little hesitant. I think she was concerned about how it would look. After all, J would have the tray on most of the time and this would be a very visible modification.
Two different types of pipe wrap insulation. The black (top) one is rubber, the gray (bottom) is polyethylene.
Here comes the gamble – while AT Mom was at work one day, I ran out to the local hardware store and obtained a few different 6 foot lengths of pipe wrap insulation. I measured out a piece, cut it to length, and attached it to J’s tray. Not only did it cover and soften that lip, but it provided and even higher lip to help keep activities contained on J’s tray. It looked good to me, but the Grand Slam came when AT Mom got home from work. She took one look at it and reacted … “That actually looks good!”
Close up of me attaching the pipe wrap insulation. The greenish plastic is the tape covering the adhesive.
This is one of those modifications where the actual results far out performed my expectations. In fact, I think that this performed so well that AT Mom gave me a little more latitude in attempting a few of my more “interesting” ideas since then (yes, I will be adding some of those in future posts too).
J grabbing onto the softer, gentler edge of the tray.
Not only does J have a softer edge to protect against those forearm bruises, but it is actually a softer edge to grab onto. The tray’s lip is now bigger and better prevents activities from being accidentally swiped onto the ground. According to AT Mom, it does not look half bad either!
Close up of how the pipe wrap insulation covers the tray’s original abrupt edge.
For those readers interested in replicating this at their home, here are some details. I recommend using the self sealing type of pipe wrap. This type is split down the middle and has adhesive on the split edges. You attach it by removing the plastic tape covering the adhesive and simply press it in place.
J’s tray with the new pipe wrap insulation and padded cover.
Using the search term “self seal pipe wrap insulation” on HomeDepot.com returns a price range of $1.64 – $7.25 per 6 foot length (the results you see that cost more than $100.00 are per carton, not per 6 foot length). The price difference depends on the pipe diameter (1/2 inch, 3/4 inch, 1 inch) and the material (polyethylene or rubber). The pictures on this post are using the 1/2 inch rubber pipe wrap. I am actually replacing the 1/2 inch polyethylene wrap. Both work very well to pad the edges. The rubber has a bit more give to it and looks cleaner (smooth black finish instead of rough gray finish). My wife’s first reaction to the new rubber wrap was “I like that one more.”
One more final shot of the end result.
I thought for my first AT project post I would start with something easy, and something that many people may not consider Assistive Technology, since it is a Low Tech solution. For this one I have to give credit to my Mother-In-Law, thanks Nana!
We are constantly looking for ways that J can help around the house. J’s disability includes physical challenges that impact both J’s gross and fine motor control. This often leads to a number of explorations into the world of AT around our house. This particular exploration focused on trying to find a routine task that J could do with minimal assistance. In a flash of brilliance my Mother-In-Law decided to look at how J could help with turning on and off the lights. (Again, way to go Nana!)
The problem is that our house has the traditional light switches. J’s motor challenges made these difficult to use. These switches are too small for J to grab, and require an amount of force to flip that would result in J’s hand slipping off the switch instead of throwing the switch.
I cannot speak for the order of events that lead to the solution. My wife and Mother-In-Law called me into the living room to show me something. What they showed me was a simple solution that we have been using ever since.
Nana had repurposed the tubing that came with J’s suction machine. After cleaning it (of course), she cut the two blue ends off the tube. She cut one right at the end of the blue tip and the second she cut about 3/4 to 1 inch up the clear tubing (so it was a bit longer). Here is a picture of the suction tubing still in the package with the bottle and filter.
Suction bottle, filter, elbow, and tubing package. This is the tubing we used. Note the blue tips on either end of the tubing.
Nana then took these blue tips and pushed them right over the light switches. The were tight enough that they stayed on. They extended the light switch to a length that J could hit and operate the lights. J could run a hand up or down the wall until it contacted the new and improved light switch, then continue to sweep that hand to turn the light on or off.
Here is a set of pictures of one of the light switches. This happens to be the shorter original adaptation that Nana made. We only adapted one of these switches since the second is for decorative (versus functional) lighting. It also gives you an idea of the before at the same time.
One of the light switches we adapted. The blue tip is also a soft rubber that makes it gentler on “big swipes”.
A second view of the same light switch. Notice just how much extra length that is added to the switch with this adaptation.
J now participates in our regular routines and is responsible for turning on and off our adapted lights. Daddy holds J up next to the wall and J very intentionally and carefully reaches out a hand, slowly grabs the adaptation, and flips the switch. Daddy then struggles with all his strength to keep a hold of J as a happy dance with huge laughter follows.
Here are a couple of action shots of J turning off the lights before heading to bed.
J using a soft hand and the wall to “spider walk” a hand to the light switch.
Lights out and its time to go to bed!
This is a quick and easy (assuming you have the suction tubing) adaptation that makes light switches much more accessible. If you do not have suction tubing I would look at trying things like pen caps, etc..