Using a Cane With a Vestibular Disorder Can Be Dangerous to Your Health…

With my background in Occupational Therapy, I should have realized using a traditional cane to aid in my balance was a poor choice. I think I just chose to ignore this fact. It seemed the least obvious, to others, of my choices. As compared to walking sticks,  a walker, a wheelchair, or a scooter. I would gladly use a scooter these days if they weren’t so cumbersome to load and unload. Some of you may be able to use a cane with great success, not me though. I was recently forced into using my cane while visiting my dad in the hospital, but while attempting to stop a spinning spell by leaning on the cane, I almost fell! When I put most of my weight on it, it failed me, or maybe I just failed. The cane didn’t support me as I anticipated. Instead,  I began a wobbly stagger in a circle…That red-hot flush of embarrassment hit my cheeks as I managed a feeble smile at whoever happened to see me. I thought I was over caring what people thought, obviously,  I’m not. I had to re-evaluate how I was going to tackle this…

There are so many options, but I was ill prepared. It was up to me, myself, and I. With each visit (2x daily most days for two weeks), I discovered some coping mechanisms that helped me and I wanted to share. Maybe someone can learn from my errors, I hope so!

  • Use a backpack instead of a purse. The first day, I left the house with my mug of coffee, my usual large tote, 2 newspapers still in their wrappers, and my cane. Not until exiting the car, did I realize I had more stuff than hands! The tote is cumbersome anyway (my life is in there!) and when worn on one shoulder, it throws off my balance. Then, I grabbed my coffee and cane. Oh, and the two newspapers. Off I go, quickly having to readjust myself, over and over and over again…Using a backpack frees up your hands and shifts your balance upright. It also held my tote, coffee, and anything else he requested! I ‘graduated’ to using a small crossbody purse after a number of days, which is a great option also.
  • Wear sunglasses. I’ve always had sensitive eyes and they not only protect our eyes from the sun, I find them helpful when maneuvering the sometimes overly bright, white hallways. White floor and walls are very disorienting to me. I used the colored lines on the floors (meant for patients) to help me.
  •  Fluorescent lighting is an irritating stimulus for most of us. Wearing sunglasses indoors can cause stares from people wondering, “Who do you think you are? A movie star”? I just tell them, “Why, yes I am and I’m incognito. Please don’t tell anyone”… Bad Margaret!
  • I found out (at the end of the stay), they offered wheelchair loans while visiting. No, I didn’t utilize them. Darn false pride! When the next time comes around, I will call the hospital and inquire what they offer, before going.
  • I did have a few people (mostly elderly) ask me why I needed a cane (as I’m such a youngster at 61 years!). I took the opportunity to briefly explain my Vestibular Disorder. All of them could identify with dizziness and one had Tinnitus. Never miss an opportunity to educate, you never know!
  • Ask for help if needed! It is a hospital after all.
  • Take care of yourself! Caregivers need care, too. I tend to put on the bravest face possible, so it’s difficult for others to understand when I’m crashing because I ‘look just fine’…Don’t we ALL since it’s invisible? I did crash a few days…Maybe I need to take my own advice!

Still Working On Team OT…

For the past few months, I’ve worked diligently on VRT, but using  Occupational Therapy philosophy this go around. There’s no ‘miracle’ to report, but what has changed is my activity level and that can’t be ‘bad’. I’m also, using a mindfulness approach, which simply put I am forcing myself into really thinking how I go about my day. I’m working on my posture. I’ve talked a bit about how OT looks at every area of our lives and how we do it. I’ve made simple modifications at home. Also important is energy conservation, considering how much energy it takes for say, showering or running errands. Do you really have enough energy on this particular day, to do both tasks? Showering and washing my hair are very exhausting tasks for me, I know, it seems so simple, right?  I’ve done all these things. I consider these things now, throughout my day.

Yet, I still can’t invert my head without dizziness. Think through your day. How many times do you bend over without a thought? “What IS that under my bed”? “Do I really want to know”? Bend over to wrap a towel around your wet hair? Bend down to dry your lower half? Doing a somersault? Okay, I’m joking with that last one, but the list goes on. Just take a count of how many times you bend over in your daily life? It’s probably many more times than you think. How might you handle it?  One reason I’m working on my posture is due to an accommodation I’ve picked up from the beginning of my Vertigo. Accommodation is something we do without consciously thinking about it. We do it in order to complete the task. An example of accommodation: In a seated position, you need to reach for something above your head, just out of reach. As you reach, your hip (on the same side) raises off the seat.Try it yourself, you’ll see. Besides, I kinda like my 5′ 10′ self!

Since I’m unable to hang my head down when bending over, I began hyperextending my neck, which is not good for us. It pinches Cranial Nerves causing numbness, tingling and more in my arm. I recently discovered I have two Cervical Vertebrae that are so offset, the Neuro-Surgeon thinks I likely ‘broke my neck as a child and don’t remember it’. Really? Yes, I still live in the same place as my misdiagnosis of a Vestibular Disorder. No, I’m not having anything done at this time for my neck as he wanted to use surgery to repair my ‘broken neck that I don’t remember’. What happens when I hyperextend my neck is distressing. My left arm goes completely numb. I can still move it, use it, but without feeling what I’m holding, accidents can/will happen. I began using neck exercises from an early round of PT, no improvement. I’ve seen my MRI pictures and there are two vertebrae that, at some point, will likely require surgery. It won’t be done here, though!

Some of the modifications I’ve made to my home:

  • a shower chair is essential! I use it in the shower and when my husband colors my hair (don’t be a hater!)
  • my furniture is arranged for both tactile cues and a place to plop should I become dizzy
  • food prep: I sit at my kitchen table
  • laundry: I sort clothes with my feet. Then, in kind of a football stance (bending at my waist with neck extended, which is not good for us! I load/unload washer/dryer.  I’m working to get my husband to build platforms for the washer/dryer set, then hardly any bending would be required
  • I’ve recently begun using a cane (VERY reluctantly!), after a recent situation I couldn’t get out of, my husband’s medical testing. I had to maneuver some very difficult solid white hallways. White ceiling, floor, and walls. I had to take 2 breaks and had non-medical employees ask if needed help, very nice! I am using one from our daughter’s accident. It’s functional, which translates to ugly. If I’m going to start doing this regularly, I want a ‘pimp cane’!

These are just of few of the modifications I put into place, making my home safer, as I do believe seven broken bones is enough for me.

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I’m Team OT this Time Around…

I’m not sure if it’s because VEDA has their upcoming Balance Awareness Week (September12-18), or if I am making an experiment of myself, but I’m going to whole-heartedly do VRT, again! Yes, again, after these many years! This time, though, I’m applying what I knew best, Occupational Therapy Based VRT. I’ve pulled out resources and this is my plan (do not do this yourself!), I look at my ADL’S or Activities of Daily Living, which simply put means, what do I do in my daily living (showering, housework, cooking, etc.). A great example would be the loading/unloading of my dishwasher. I have to visual scan what is in there and Motor Plan where and how to complete this task. I know I’ll get dizzy if my head inverts (upside-down), so I incorporate a squat to keep my head in a more neutral position. Raise up, turn body in the direction needed (still having trouble with quick head turns). I have to tilt and turn my head in putting away my dishes. It’s all done very ‘mindfully’, I really need to concentrate on the activity. I’m lucky, my kitchen is a Galley style (two sides facing each other), so there’s not much area to take a fall. I always think about my fall risks, as I’ve broken seven bones. Below, I’ve listed the areas an Occupational Therapist evaluates. As you can see, it does involve every area of one’s life, even Sexuality and Spirituality! At my worst, sexuality was the last thing on my mind, but on a good day…I continue with amazement with all Occupational Therapy entails. I’m giving you some insight, there are options with VRT.

*This is NOT for you to ‘treat’ yourself, it’s simply for a look at another side of VRT.

 

Appendix 3. Examples of Impact on Activities of Daily Living

*Eating: leaning across a table to pass something

*Bathing: bending to reach the legs, feet, perineal area, closing eyes to wash hair

*Toileting: bending to wipe, bending to pull garments up or down, maintaining balance      while standing to urinate (males), twisting to reach toilet paper if behind toilet

*Transferring: sit-to-stand transfers from toilet, other seats

*Grooming and hygiene: bending the head forward to groom hair or brush teeth

*Taking medication: bending the head back to swallow medication

*Sexual activity: being in the superior position and weight shifting or moving the head rapidly; stability on water bed or other positioning furniture

*Sleep: head movements during sleep, changing sleeping positions, or maintaining the head in certain positions during sleep will elicit vertigo and cause waking, possibly nausea, and disequilibrium while groggy

*Instrumental Activities of Daily Living
Meal preparation, cleaning, other home management skills: Bending down, looking into  high or low cabinets or shelves, and tasks that require repetitive head movements may all  elicit symptoms. Task performance may be compromised or the task may be abandoned  altogether.

*Gardening, yard work: Tasks may be performed less efficiently or abandoned; falls may  occur on uneven ground.

*Vehicle care: Car washing and changing oil and filters may be difficult or impossible.

*Child, elder, and pet care: tasks that involve picking up and carrying loads, bending  rapidly, performing or assisting in transfers, diaper changing, cleaning up messes on floor

*Community mobility: Driving will be more difficult, especially under conditions of reduced visibility, and may be abandoned or performed only for limited errands.

*Shopping: Navigating stores, carrying packages, bending to pick up items, scanning shelves for items will be more difficult and may be abandoned.

*Safety: ascending/descending fire escapes and stairs, dim areas with only emergency lighting

*Play, leisure, social participation, religious activities: Visual motion sensitivity, difficulty kneeling, navigating in crowds, vertigo elicited by repetitive head movements or bending the head down; activities and rituals may be severely restricted or abandoned.

*Work, either paid employment or volunteer jobs: Symptoms elicited by a wide range of tasks will cause reduced efficiency and sometimes total inability to per- form some jobs, depending on task demands.

Appendix 4. Examples of Performance Skills Affected by Vestibular Impairments

*Posture: Standing balance is impaired in most people with vestibular impairments. People may tilt the head and/or body off the vertical. They may have difficulty attaining and maintaining upright standing. This skill is particularly difficult when visual cues are absent or decreased. Static head and trunk posture while seated are sometimes impaired; dynamic sitting balance may also be impaired.

*Mobility: Mobility skills are manifested as veering toward one side while walking, ataxic gait, and falling or stumbling, particularly on uneven surfaces. Load compensation skills are impaired. Clients may need to use light touch to improve orientation and stability.

*Coordination: Dual-task performance skill is decreased.
*Energy: Routine tasks take more energy than usual, and endurance is decreased.

Appendix 5. Examples of Performance Patterns Affected by Vestibular Impairments
*Habits: Skill components of habits may be disrupted, and performance efficiency may be reduced, increasing the cognitive load and increasing the difficulty of performing habitual skills that were previously easy to perform (e.g., basic activities of daily living may have to be performed with modifications).

*Routines: Due to effects on performance skills, routines are less efficient and may need to be changed or abandoned altogether (e.g., hair washing may require supervision for safety and may take too long in the morning before work, so the client’s morning and evening routines may be changed).

*Roles: Some roles may be reduced or even abandoned, with consequent detrimental economic and psychosocial effects (e.g., clients with Ménierè’s disease may have to leave their jobs).

Appendix 6. Examples of Context Affected by Vestibular Impairments
*Physical: The physical environment may require modifications for safety (e.g., installing bathroom grab bars), or the home environment may require significant change (e.g., removing throw rugs, changing lighting patterns).

*Social: Misunderstanding of symptoms and problems by family, friends, and significant others may lead to hard feelings, reduced participation in socialization, changes in preferred social environments. These problems may occur due to decreased self-confidence, fear of falling, and a history of falls.

*Spiritual: Falls, vertigo, decreased concentration, and decreased ability in dual task performance, which all lead to decreased performance in vocational and vocational activities and decreased participation in the community, can cause decreased sense of self-worth, self-doubt, and decreased joy in life.

*Virtual: Visual motion sensitivity may lead to avoidance of virtual environments.

Appendix 7. Examples of Activity Demands Affected by Vestibular Impairments

*Timing: Tasks may take longer than before.

*Space demands: Lighting, flooring, and support surfaces may have to be changed.

*Social demands: Reduced social interaction per task may be required due to reduced tolerance for auditory and visual noise.

*Required bodily functions: Reduced function of vestibulo-ocular reflex, vestibulospinal reflex, and reduced spatial orientation skills all affect functional performance.

Appendix 8. Examples of Client Factors Affected by Vestibular Impairments

*Mental functions: reduced attention skills, reduced ability for dual task performance

*Sensory functions: reduced vestibular function, sometimes reduced auditory function

*Neuromuscular functions: reduced postural control, reduced dynamic visual acuity, impaired gait

*Vestibular labyrinth: In some instances, structural abnormalities in the physical labyrinth may be present, but these features cannot be observed; they may only be inferred.

*The American Journal of Occupational Therapy

Downloaded From: http://ajot.aota.org/ on 08/11/2016

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