Running head: ASSISTIVE DEVICE REVIEW

Assistive Device Review Yara Bezgina Touro University Nevada OCCT 649

ASSISTIVE DEVICE REVIEW

Assistive Device Review Introduction It is a common knowledge that the ability to partake in occupations efficiently and independently is very important to ones feeling of self-worth and well-being. Engagement in self-care tasks, hygiene routines, toileting and dressing are the most basic and most private occupations that one participates in, and loss of independence in these areas may cause an individual a great deal of stress, anxiety or feelings of shamefulness. Unfortunately, due to physical or cognitive impairment or decline in physical status many clients can lose their independence in these tasks and will require retraining, adaptations, or modifications to their home environment in order to safely and efficiently complete their Activities of Daily Living (ADLs). Occupational therapist can educate and instruct the client on number of adaptive devices or technology that will help to improve performance during toileting, bathing, and self-grooming routines thus helping the client to regain their independence. In the study conducted by Seeger and Fisher (1982), occupational therapy was provided to the patients recovering from Total Hip Arthroplasty (THA) with the purpose of providing increase in functional independence through education and instruction on use of adaptive equipment in activities of daily living. The study found that by the end of occupational therapy the clients were independent in their ADLs and the use of adaptive equipment was high. Adaptive equipment such as high toilet seat, long handle sponges and reachers were used to improve clients reach and compensate for limited range of motion related to surgery. Patients found that reachers, sock aids, and most of the long-handle devices were very useful and were most often used items to complete grooming, dressing and bathing routines. In addition, a patient survey was administered to 160 participants three years after the initial start of the program, and inclusions for diagnoses ranged from degenerative joint disease, rheumatoid arthritis to osteonecrosis and other related

ASSISTIVE DEVICE REVIEW

orthopedic disorders. The results of this survey revealed that specific items for dressing, bathing, grooming ranged from 88 to 99 percent use. The study indicated that even though some of the participants discontinued use of equipment as their functional levels improved at 3 months postsurgery, 7 to 14 percent still utilized various pieces of equipment 7 months post discharge. In conclusion, the study confirmed that majority of the patients used adaptive equipment after discharge, and that equipment was appropriate and met clients needs, and was used to perform daily tasks (Seeger and Fisher, 1982). It is evident from this study that most of THA patients found their chosen adaptive equipment items to be highly useful, and applicable to use at home, and helped clients to perform their daily ADL routines safely and with dignity. Another study conducted by Neville-Jan, Piersol, Kielhofner, & Davis (1993), investigated the rate of use of self-care adaptive equipment at home. The study revealed a high rate of 85% utilization of equipment, and indicated that the more customizable and individualized equipment was to the clients environment and personal needs the more application of the equipment by the client has occurred. Another study by Wielandt, McKenna, Tooth, & Strong (2006), confirmed that use of assistive equipment is higher when clients concerns, opinions, and perceptions regarding the device are recognized, and the device is then selected based on clients individual needs and goals. Therefore, drawing from previous research, I wanted to create a long handle adaptive device that would address self-care task such as lower extremity shaving, but will be also applicable to my client, and customizable to fit various needs required for shaving. Client and Related Diagnosis My client is a young female who has suffered from leukemia and was able to defeat cancer two years ago. However, the client has recently undergone total hip arthroplasty due to bone thinning and bone loss, which are thought to relate to intense chemotherapy treatments. My

ASSISTIVE DEVICE REVIEW

client is a very independent female who lives with her significant other, but is very private about her bathing, grooming and self-care routines. The client would not allow her significant other to assist her in any of her self care routines, even though she takes longer and struggles with some of the tasks because of decreased range of motion and total hip precautions. Total hip precautions rules dictate that client should avoid: 1) bending over, 2) lifting the operated leg over 90 degrees, 3) crossing over the legs, and 4) turning the toes inward. These restrictions impair clients quality of life as she has to adapt to dressing, bathing, and some of the self-grooming tasks. The client was able to learn how to use hip kit, but her biggest concern in her inability to shave her legs without asking for assistance or breaking hip precautions. She has asked her mother to complete her lower leg shaving routine, but the client does not want to cause any more inconvenience to her mother, and is self-conscious about her legs being unshaved for more than couple days. Thus, my client will benefit from an adaptive device that has an extended shaver with a number of extra attachments such as mirror, and lotion sponge. The client will benefit from using this equipment as she will be able to efficiently shave, apply lotion, and check the areas shaved, therefore completing her self-care routine privately and without assistance from others. The diversity of this device will help the client to regain her independence in the specific area of self-care, thus reducing clients feelings of self-consciousness, and improving clients quality of life. Alternative Populations Populations that will benefit from this type of device are female or male clients that underwent total hip replacement surgery or have limited range of motion. These conditions will affect their ability to bend at waist, or lift leg over the hip, thus making it difficult for them to reach and shave their lower legs. In addition, clients suffering from osteoarthritis and stiffness of joints may benefit from this device as it will allow them easier and quicker access to shave their

ASSISTIVE DEVICE REVIEW

lower leg. Alternatively, female clients who are pregnant and cannot reach down or bend in the shower will benefit from this type of device, as it will provide them a way to complete their selfgrooming safely and with less energy expidenture. Clients that have to follow abdominal precautions and cannot put strain on their abdominal area can benefit from the extended shaver as it will prevent client from bending and twisting at the belly. Also clients with Spinal Cord Injury below T5 level who have weaker trunk control, but good upper extremity function can utilize this piece of assistive device to complete their self-care routine. Precautions and Contradictions It is important to know the safety measures when using this device, as it is a device that uses sharp shaver, and can potentially cause cuts and tear skin if used incorrectly or without caution. The clients should be cognitively competent, and know basic precautions when shaving such as direction in which shaver should applied against skin, the smooth movements against the skin to avoid cuts, applying enough soap or shaving cream, and also cleaning and changing the razor in order to avoid skin infections, and irritation. The client is also responsible for washing the device, changing the sponge when needed, and using caution when attaching the mirror, as it has a potential of falling and breaking, thus causing safety risk of client cutting themselves. About the Device My device is three in one extended shaving kit that comes with three detachable pieces: 1) an adjustable mirror 2) spray bottle 3) a lotion sponge. All of the pieces except for the attached razor body are removable, and can be used by the client depending on their need and goal. The attached razor body is a standard Venus razor, but it allows a client to purchase separate razor cartridges, and exchange them as often as needed. This is an important feature as the client can maintain and change razor cartridges at their own convenience, and is not required to purchase a new razor body every time. An adjustable three inch mirror has a leg that is

ASSISTIVE DEVICE REVIEW

twistable and bendable and allows a client to adjust to position that is the most optimal for viewing the results of their shaving job. Spray bottle allows a client to change the soap or spay liquid whenever needed and is easy to open and fill. The lotion sponge is detachable from the base and also allows a client to change the old sponge to a new one. The sponge base has a Velcro strip that makes it easy to purchase different type or brand of sponges and attach it to the base. This device allows a client to customize the supplies they want to use at their own convenience. Fabrication I started the process of fabrication my device by obtaining a long handled stick that served my need. The Swiffer that I obtained had a base that was a mop which I have detached. I have constructed my device by making each separate piece first, and then designed and adjusted the stick width and Velcro straps accordingly. Making the Lotion Sponge The rectangular mop was made of thin plastic and I have down the rectangle to a small circular piece with my garden scissors. The cutout circular piece that used to be a mop served as my lotion sponge carcass. I have used splinting material to create a stencil for a shape of sponge I wanted to use. I have cut and made my sponge base out of green splinting material, and attached a thick strip of Velcro in the middle so that a soft sponge can easily attach and detach from it. Because the carcass of the sponge used to be a mop it snaps right on the stick without any Velcro needed. Making the Mirror I used my old flexible tripod to create a leg for a mirror, and I attached a mirror to it by using strips of splinting material and molding it around the back of the mirror. The flexible tripod is adjustable and bendable, and you can also add extra length or shorten the leg by

ASSISTIVE DEVICE REVIEW

snapping the pieces out. It is very easy to do and does not require any other tools, just grip strength and good grasp. I then made another attachment that would secure the mirror on a stick out of small strip of splint material. All I had to do is mold and hold the hot splinting material around the stick to conform to its shape. I then cut a vertical space in the middle of the mold to make the mirror detachable. In order for a mirror base to sit without sliding and turning on the metal base of the stick I used tape to thicken three areas of attachment on the stick so that the mirror can snap on and sit tightly. Tape also provides more resistance against the splint material and I added tiny bits of Velcro leftover pieces to those areas to increase resistance. Making the Spray Bottle Making the spray bottle was the most complicated part of the process. It took me a few trials to figure out how to attach the bottle to the stick. I had to figure out the angle at which to make adjustments to the spay mechanisms, so that it sprays when the strings are pulled from above, at an angle at which the client will be holding the long handle stick. I used remaining splint materials to mold around the spay neck, and looped the wire in front, and then tied it in a back of a bottle creating a pulley at which the spay button would be activated. After that, I taped around the bottle to cover the brand name and also used Velcro piece in the middle to create a point of attachment for my bottle. The bottle would attach at the belly by the Velcro piece, and the spray release system would be pointing down facing clients lower leg. The strings would come in the back and would loop all the way up the handle, that way the client can grasp and pull on the strings, and mist would be released on the desired area. I created an additional Velcro strap that would tape around the bottle to prevent the bottle from wobbling around. Making the Razor Attachment The last part that I made was my razor attachment and razor lock. I tool Venus Razor and detached the cartridge used for shaving. I then proceeded and broke the razor body part at the

ASSISTIVE DEVICE REVIEW

neck where it was thin enough to be attached to the bottom of my stick. I then used splinting material to attach the razor body to the stick right in the area where the mop used to attach. Because of the unique nature of the mop attachment site I was able to insert my razor right into that area and it was really easy to secure it in place. I also made a razor lock which is a bended piece of splinting material that goes right below the razor and clips on the stick to prevent the razor from wobbling and wiggling around during shaving. Other Adjustments I applied Velcro stickers around the area where the bottle would attach, and then I thickened certain areas on the sick by wrapping layers of tape around it in for other pieces to attach on securely and to provide extra resistance. There are no other modifications that I made to the stick. I also made sure to smooth out all the edges on the splinting material I used. Cost Effectiveness and Time The supplies to make my device were relatively cheap and easily found at any local store. My total came up to 49.60 dollars for all purchased materials, excluding the splint material that I used instead of using glue or tape. I was lucky to have an access to leftover splint material from my other project, and I have utilized it as my bonding agent. However, if the client was to use the razor in really hot water it would not be the best material for such purpose. Due to limited finances and limited access to alternative materials I used very little amount of splinting material to create a prototype of the device. I did not want to use glue, as it would come apart with cold or hot water as well. It took me about 5-6 hours to make all the pieces and decorate the device. Original Item Bought
Swiffer Mop Velcro Strips Soft Sponge packet of 4 Duct Tape set of 2 Green Speaker Wire Set of 4 (3 inch) mirrors Summer mist spray

Supply used for

Long handle stick Velcro straps, bottle attachment Sponge body Decoration/mounting Bottle strings One mirror attachment Spray bottle

Original Item Price

$9.99 at Walmart $7.97 at Walmart $5.55 on Amazon.com $3.97 at Walmart $4.47 at Walmart $1.99 at Michaels $3.99 at Target

ASSISTIVE DEVICE REVIEW

GiletteVenus Razor Flexible Camera Tripod I utilized strips and leftover pieces of splint material

Razor body attachment Mirror movable leg Used for razor mount, shaver lock, base of sponge, spray bottle kit

$5.97 at Wallmart $5.66 on Amazon Obtained for free at Touro University Nevada upon permission from professor

Possible Improvements If I had more resourced and access to other materials I would like to improve my device in the following ways 1) making the long handle stick length adjustable to clients height 2) making the stick out of the bendable material so the client reach other areas such as back of the legs 3) use other bonding material such as plastic to attach pieces 4) using a better quality razor 5) using a spray system where you can pour the soap inside the hollow stick core as it would contain a space within it, and then the mist would be activated and released through the perforations in the body of the stick. Similar Products When I conducted research I was able to find two comparable produces that addressed the same task. The first product is called Razor Holder Long Handle and is available for purchase through amazon website for 48 dollars. It is designed to hold regular or electric razor and looks like a long handled stick with Velcro straps to secure the different type of razor (Amazon, 2012). Another device is called Razor Reach and it is available for purchase through the razorrech.com website or sometimes can be found in local drug stores. Razor Reach is sold for 14 dollars and 99 cents, and is a simple device similar to the first one reviewed, where the razor is secured in place by razor clip (Razorreach, 2012). Both of these devices are simple, and do not offer addition items such as lotion sponge or mirror. I believe that three in one extended shaving kit will help the client to address all the shaving needs at once without spending money on additional devices.

ASSISTIVE DEVICE REVIEW

10

Appendix

Figure 1

The razor body attachment with cartilage and razor locker to secure tight positioning and prevent razor from wobbling during shaving procedure. Figure 2

Oval sponge head attaches to the stick, and can be used with different types of sponges.

ASSISTIVE DEVICE REVIEW

11

Figure 3

Spray bottle with string and spray mechanism attachments. The bottle comes with extra Velcro strap to secure tight attachment to the stick

Figure 4

Spray bottle attached to long handle stick and secured by Velcro strap

ASSISTIVE DEVICE REVIEW

12

Figure 5

Mirror attachment sitting on thickened area and lotion sponge Figure 6

Long handle stick with Velcro attachments and razor body

ASSISTIVE DEVICE REVIEW

13

References Amazon. (2012). Razor Holder Long Handle. Retrieved from http://www.amazon.com/Aids-to-Daily-LivingHolder/dp/B002HYITUA/ref=sr_1_5?s=hpc&ie=UTF8&qid=1370802200&sr=15&keywords=long+handle+razor Neville-Jan, A., Piersol, C., Kielhofner, G., & Davis, K. (1993). Adaptive equipment: a study of utilization after hospital discharge. Occupational Therapy In Health Care, 8(4), 3-18. Razor Reach. (2012). Shave Without Bending. Retrieved from
http://www.razorreach.com/eshop/pc//

Seeger, M., & Fisher, L. (1982). Adaptive equipment used in the rehabilitation of hip arthroplasty patients. The American Journal Of Occupational Therapy: Official Publication Of The American Occupational Therapy Association, 36(8), 503-508. Wielandt, T., McKenna, K., Tooth, L., & Strong, J. (2001). Post discharge use of bathing equipment prescribed by occupational therapists: what lessons to be learned?. Physical & Occupational Therapy In Geriatrics, 19(3), 47-63. Wielandt, T., McKenna, K., Tooth, L., & Strong, J. (2006). Factors that predict the postdischarge use of recommended assistive technology (AT). Disability & Rehabilitation: Assistive Technology, 1(1-2), 29-40.