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The Arthritis Self-Management Program: (ASMP)
The program was an immediate success in the States and began as a pilot project in B.C. in 1989,then
went nationwide in 1992,thanks in large part to a half-million-dollar Seniors Independance Program grant to the Arthritis
Society (corporate donors have been underwriting it since then).
The six-week course is open to people with all forms of arthritis,their spouses and families,and anyone
else who may be interested. (Participants are charged a nominal fee to cover the price of a book and other incidental costs.)
The ASMP acts as a complement to traditional treatment, helping people to better understand their arthritis,cope
more effectively with chronic pain and depression,and take a more responsible role in their arthritic care.
People with arthritis are trained as group leaders,and group work is emphasized, because peer pressure
has been showen to enhance efficacy.
Another factor people learn to deal with is "learned helplessness",the erosion of confidence a chronic
disease can impose. If you learn that climbing stairs is always a painful experience,i.e.,you may stop dropping in on a basement-level
shop or visiting a friend who lives in a walk-up.
You'll learn to be not helpless in the face of those challenges.
And,if every time you experience a change in symptoms you feel you have to consult a doctor,you become
dependent.
The ASMP teaches people how to avoid or avoid such hurdles. It also "injects" them with a healthy dose
of self-efficacy,by giving them a take-charge attitude about every aspect of their arthritis.
To date,taking part in ASMP has taught thousands of people to "take charge" of their arthritis. They're
more informed about their disease and better able to cope with it on a day-to-day basis than they were.
Because,they are better informed,they're also prepared and confident in their dealings with medical
professionals.
They know what questions to ask,and they invitably come away with more information about medications
and their side effects,potential prognoses for their condition, and exercises than someone without their training.
Knowledge is power. The more you know,the more able you're to cope-and the better you're able to live
with arthritis. The big step is to learn about your medications. They're about to become a part of every patient's life.
You can do a ASMP of your own in your own home-if you like-with some-guidence-help, correct information,strong-will-power
and determination to succeed.
It's your decision,body and future well-being at stake,no one else but you.
Protecting Your Joints:
The most recent Centre for Disease Control and Prevention suggest that 30 minutes of moderate-intensity activity for
most days of the week. Depending upon your baseline,those 30 minutes can be spread out,so if one spends walking 15 minutes
in the morning then perhaps 15 minutes doing another activity in the afternoon,that amounts to the daily quota .
We have to be careful of the differential effects of exercise for losing weight and for RA patients whose joints are
aching all over or even for just overwell fitness for good well-being. There is a difference to consider. It has to do with
intensity for one. i.e., If one schedules walking for 30 minutes and if your body says 5 minutes then it is better than doing
nothing.
People need to look at what the factors are,that are contributing to fatigue, pain,depression or inflammation (common
in RA). Is there another medical condition present? When one is able to isolate what these few things may be,then we apply
treatment strategies based on the cause
People with arthritis are frustrated. They don't like or want to be feeling ill. Some patients try a variety of trials.
Some turn to herbs and supplements without understanding the dangers involved or the treatment itself. Others may follow
a strict dietary avenue.
Rheumatoligists are RA experts and they really don't have any scientific proof that diet,as a single agent without anything
else,does anything to stop arthritis. They wish it did,but it doesn't.
A good well-balanced diet in addition to medical care is important,but as a sole therapy they don't hve any proof that
it helps except in perhaps the smallest minority. Medication will be tapered or discontinued,depending upon the medication,
when a person is in remission or feeling better. Some medications may be continued as a maintainence therapy.
The hallmark of a safe exercise program is a gradual progression in exercise intensity,complexity of movements,and duration.
Often,patients with arthritis have lower levels of fitness due to pain,stiffness or biomechanical abnormalities.
Too much exercise during a flare or the wrong type may result in increased pain,inflammation and damage to the
joints. Thus,beginning with a few minutes of activity,and alternating activity with rest should be the initial goals.
Special emphasis should be placed on joint protection strategies and avoidance of activities that require rapid repititions
of a movement or those that are highly percussive in nature. Because faster walking speeds increase joint stress, walking speed
should be matched to biomechanical status.
Special attention must be paid to joints that are misaligned or unstable. Control of pronation and shock absorption through
shoe selection or use of orthotics may be indicated.
Affected joints may be unstable and restricted in range of motion by pain, stiffness, swelling,bone changes or fibrosis.
These joints are at high risk for injury and care must be taken to ensure that appropiate joint protection measures are in
place. Activity during a flare is encouraged,concentrate on other unaffected joints,or try a different type of activity with
least strain.
Beginning exercisers should be encouraged to identify the type of physical activity they feel most comfortable with,and
then begin this activity in short sessions. If people have had a positive experience with a particular mode of exercise in
the past,they are likely to have higher exercise self-efficiency. e.g.,Among those who have enjoyed swimming in the past,water
aerobics may be an ideal method to increase physical activity.
On the other hand,if individuals are not fond of swimming,encouraging them to get into a pool regularly is less likely
to be successful then to get into a pool regularily is less likely to be successful than encouraging them to begin a walking
program.
Unfortunately,most people without arthritis begin a exercise program,and despite the best intentions,discontinue within
the first six months. This is not an option that rheumatoid arthritis patients can afford to follow.
Physical activity is essential to optimizing both physical and mental health and can play a vital role in the management
of arthritis. Regular physical activity can keep the muscles around affected joints strong,decrease bone loss,help control
joint swelling,and pain in most patients.
Regular activity replinishes lubrication to the cartilage of the joint ,reduces stiffness and pain. Exercise also enhances
energy and stamina,decreasing fatigue and improvin sleep.
The goals of an exercise program for individuals with arthritis are to:
1) preserve or restore range of motion and flexibility around aaffected joints.
2) increase muscle strength and endurance.
3) to increase aerobic condition to improve mood and decrease health risks associated with a sedetary life.
Mind and body are very closely connected,and for this reason cognitive behavioral therapy (CBT) employs two basic strategies
to produce significant improvements in stress,anxiety,and pain. Patients are taught to adjust their behaviour to minimize
physical stress and fatigue,and they are trained to ignore negative thoughts and emphasize positive ones.
At first,many patients dismiss the idea that "positive thinking" can limit pain,but research has proved it to be amazingly
effective. Several studies at Duke university and man others have found that CBT works very well,especially when spouses or
others emotionally close to patients accompany them to therapy sessions. Many physicians and mental health professionals,trained
in pain management can help patients with CBT. Relaxation lessens stress,and less stress usually means less pain.
Physiatrist are medical doctors,who specialize in musculoskeletal rehabilitation. They can design a tailored program
of exercises to strengthen joints and know hoe to alleviate neuromuscular pain in tense,painful ischemic (oxygen-derived )
muscles.
Occupational therapists can show you how to adjust your approach to tasks and how to use tools and movement aids,(assistive
devices ),to ease stress on joints. Most can also design and construdt assistive devices to fit your needs.
Physical therapists can improve physical functioning and limit pain by strengthening and stabilizing joints. Most licensed
physical therapists are well equipped to evaluate your condition and prescribe a customized schedule of exercises,treatments
and changes to daily routines.
There are specialized nurses trained in the management and care of rheumatic diseases,but unfortunately outside of a
hospital setting,or you are fortunate to access one,they are scarce. Some general nurses will not have the experience or training
to cope with the differences in rheumatoid arthritis and other rheumatic diseases, like osteoarthritis.
Some patients have dietary needs,but if you are one of them,make sure they are licensed,and come from a accreditted institution
of learning. Any one can call themselves a "dietician"
Most physicians,as they are necessary and valuable to our general well-being,do not take special training in diets,exercise,or
pain control. Some do not even take the basic option offered at medical school in rheumatology,and unfortunately or
not some internists are in the same category. They are not trained in basics like "bone-count"("feeling" the number of inflamed
joints involved). A rheumatologist is trained in most aspects of all rheumatic diseases.
The Cox-2 inhibitors have less stomach troubles then the older NSAIDs like Ibuprofen,Naproxen or Feldene. The Coxibs
include Vioxx and Celebrex. They improve inflammation in arthritis in patients with RA.
Aceteminophen works in different ways. It's really more of a pure analgesic or pain medicine,and its not a NSAID. It
can be taken along side a NSAID. Two NSAIDs shouldn't be taken at the same time. But one can take,say,Vioxx or Celebrex with
Acetaminophen and receive extra pain relief.
If some patient's who doesn't respond to the standard NSAIDs or the coxibs and acetaminophen was added to that without
noticeable results,physicians might add a combination of acetminophen with a mild narcotic analfesic such as codiene (Tylonol).
Tylonol comes in different strength,the stronger ones have a codiene additive.
Vicodin,Lortab,Lorcet are common drugs that can be mixed. Patients need to know that there is a risk of bleeding ulcers,and
stomach problems,when they start a new NSAID such as the coxibs,that there's still a slight chance that it might raise the
blood pressure ( Vioxx ) or affect the kidneys in certain patients.
Patients need to know that acetaminophen has been shown,recently,through clinical trials that in higher doses of 2 to
4 grams per day,it can cause bleeding ulcers and stomach problems,which is a new finding. Before it was considered perfectly
safe on the stomach.
Physicians and patients worry about habituation with narcotics where patients feel like,they must take them. They can
cause light headiness or make them feel a little fuzzy,and it can cause constipation,especially,in older persons.
Oxy Contin is in the national news,where people abuse it recreationally and some states ban sale of the product. Drug
outlets have been broken into to get access to the product. If patients have long-standing,delibilitating RA-which,now is
not common as in the past. Our newer therapies,specifically,our DMARDs such as Enbrel,MTX,and Arava,have slowed the disease
process down,and most patient's don't have significant enough arthritis to require something like Oxy Contin and wheel chairs.(wheel
chairs were once common to RA patients)
Darvon is a mild analgesic. We can mix it,with the NSAIDs. We can mix it with the newer coxibs. And,there are Davon compounds.
Darvon can be taken with acetaminophen at the pharmacy and its an analgesic.
Ultran or Tramadol,which is the genetric name,and now a newer version of it,called ULtracet,which was approved in the
summer of 2002,which is a combination of Tramador or Ultram,plus acetaminophen,again,have been effective,its a non-narcotic
analgesic,foud effective for pain relief,less constipation problems,less central nervous problems in older patients who have
problems with their heads,and feeling like they can't think quite as well. The good news it can mix with DMARDs and NSAIDs.
All of these medications work,some of them better than others,for different people,in different situations. But,again,they
can have some side effects. The patient and physician must decide on the individual situation and come up what is best for
the patient.
As far as I am concerned,number one is a good night's sleep and rest because if you're not getting adequate sleep,you're
going to have more pain. You're going to have more fatigue. It has been proven that the average North American gets about
4 to 5 hours of RESTFUL sleep. And many times when one has RA you'll roll over on one side and your hips hurts when you come
out of a deep slep and you're fatigued-you have more pain. Often people pin their wrists or arms under their body during sleep
and that results in pain all day,at times.
Scientific studies may show that any food,any diet does nothing for arthritis but many people with RA don't get get a
wholesome,all-around-nutritious diet because they don't feel well and a result nibble at that and this. Good health,regardless
of condition contributes to overall good health,so why not RA patients ?
We are supposed to drink 8 glasses of water a day. The average person only drink 2 glasses of pure water and when we
don't drink a lot of water the probability of side effects with all that medication is greater.
Stress management is very important. If it isn't controlled properly the result is more pain and fatigue.
Many times with arthritis we get atrophy of the muscles;decondition. The more deconditioned you get the more pain and
fatigue. Patients have to get involved with exercise because the weaker muscles and ligaments around joints become,the more
pain you're going to have.
Start by trying to find out where the individual who has rheumatoid arthritis is with the particular illness. Different
things affect people in different ways. Some people may be very anxious about the future and be coping with the present very
well. Others may have difficulty even thinking about how to get up in the morning and proceed with their day. Often start
with where the patient is.
The initial thing is try to find out is whether they have support from their husband, wife, or other family members.
If they're employed, does their boss understand what's going on with them? People need a sense that this illness is not going
to isolate them. They need to be understood and have a feeling that other people care about them.
Getting support from family members and employers is very important. Oftentimes, feeling understood gratifies people
so much - they feel like other people care about them. It's often very important that they discuss the frustration and the
depression with their primary physician. The doctor may suggest a referral, so they can have an opportunity to really pour
their heart out about what's troubling them and what they're frightened of.
A psychiatrist,may suggest the use of antidepressant medication, though not necessarily right away. This often can be
quite helpful in lifting someone's mood and also can be helpful in terms of pain control even though it doesn't necessarily
do anything for the underlying arthritis process.
Not everyone needs a antidepressent,it depends on their coping skills. It depends on what their previous history
has been. If you have someone who has never been ill and all of a sudden has this diagnosis mentioned to them, the way that
they react to it will often reflect how they've dealt with other traumas in their life. If there is someone who has had multiple
illnesses, this additional illness can often give them an overwhelming sense of "What's going to happen to me?" and a complete
loss of control.
People like to feel like they're in control of themselves and in control of their health. When this starts to be preyed
upon, everyone feels a little bit of loss of self and somewhat of a loss of self-esteem. But we're talking about degrees here.
Depression and anger go hand-in-hand, as we all know. What do you tell a person who's living with rheumatoid arthritis
and who's frustrated with their inability to do the simple things that they used to be able to do?
Number one,try and empathize with them about how difficult that must be. Number two,tell them express themselves, how
angry they're feeling, even if they tell the therapist they're not angry. The therapist try to get to the point where they
understand that it's very normal to be angry, and they don't need to be afraid of their anger or feel guilty about their anger.
The therapist then work with them on how they're going to begin to get some of their expectations met and how they're
going to go on in life with a more positive focus rather than being so consumed with the idea that this disease is going to
take everything away from them. "It's very normal to be angry. Patient's are encouraged to get involved in learning
about their illness and in learning about good health in general."
As somebody coping with diabetes, which is another long-term chronic condition, sometimes it's not the disease that’s
the problem, it's the stress of coping with the disease. It always depends on the degree of involvement and how much
rheumatoid arthritis takes away from a person's everyday functioning. It is helpful is to get people involved with other rheumatoid
arthritis patients so that they hear that their complaints are similar to other patients struggling with the illness. Try
to encourage patients to do as many things as possible that they like to do and things that they used to do.
Patients need encouragement to get involved in learning about their illness and in learning about good health in general.
There are a lot of things like exercise and proper diet which we hear a lot about today that really do make some sense for
people who don't have a particular illness. But especially if you have a chronic illness, that's something that you have to
watch. The more you can help a person focus on the positive things about their life, the better they're going to be able to
tolerate having this particular illness
Some positions and movements can put extra stress on involved joints. Even when these joints are not hot, swollen, and
painful, they need to be used in their most stable positions.
Avoid activities that involve a tight grip. If your hands are affected by arthritis, holding an object tightly can harm
the weakened joints. You can buy items with enlarged handles to lessen the strain on your hands. You can also build up the
handles on pens, eating utensils, tools, or brushes by taping a layer or two of thin foam rubber around the handles (or by
using a foam rubber hair curler or pipe insulation).
Avoid activities that put too much direct pressure on your fingers or thumbs. Pushing down on your dinner knife with
your finger when cutting meat is an example of direct pressure. Instead, try holding the knife like a dagger or using a pizza
cutter. Use a knife to open a milk carton or a box, instead of pushing with your thumb. To avoid opening push-button car doors
with your thumb, use a door opener aid with a lever handle.
Avoid tight pinching, squeezing, or twisting motions. Spread your hand flat over a sponge or rag, instead of squeezing.
To open a screw-top jar, lean on the jar lid with the palm of your hand and turn the lid with a shoulder motion to reduce
stress to your fingers. Use a rubber gripper, or use a drawer to hold the jar while you twist the cap. You can also purchase
a jar opener that allows you to hold the jar with two hands while turning it. Remind the family not to close jar lids so tightly
the next time! Use push type ratchet or power screwdrivers, instead of twisting the standard type handles.
Use good posture to protect your neck, back, hips, and knees. When you have pain or stiffness in any of these areas,
you need to pay special attention. Use a book rack, so you don't have to strain your neck looking down.
Whether you sit or stand to work surfaces should be at a correct height. Your elbows should be at right angles and your
shoulders should be relaxed when you work. To make it easier to get out of a chair, use pillows to make a seat higher. Learn
proper body mechanics for lifting, bending, reaching, and rising from a chair.
Control your weight Extra pounds put more stress on weight-bearing joints (hips, knees, back, and feet). This extra
stress can lead to further joint pain and damage. Losing weight will be helpful to your joints. Check with your doctor to
find the best weight-loss program for you. You'll also look better, probably have more energy, and feel healthier, too!
Avoid staying in one position for a long time When joints or muscles are kept in the same position for a long time,
pain and stiffness may increase. For example, writing a long letter or doing needlework keeps your hand in the same position
for a long time. Do a quick body check of your jaw, neck, shoulders, arms, hips, legs, and ankles. It's a good idea to frequently
relax and stretch these areas, especially any area that feels tight or stiff. Shrug or rotate your shoulders in big circles
to reduce the tension that collects there.
Use your strongest joints and muscles Remember to use the strongest joints and muscles whenever possible. By using
larger joints or your whole body, you can reduce the stress on smaller joints.
Here are some examples:
Carry a purse with a shoulder strap, rather than holding it in your hand, or use a backpack or fanny pack. Push open
a heavy door with the side of your arm, not with your hand, or lean into it using your body or hip. Add cloth loops to drawer
pulls and the refrigerator door handle so they can be opened using your forearm.When using stairs, go up with your stronger
leg first and go down using your weaker leg first. Always use a hand rail if available.
Pay attention to body mechanics
When lifting something that is low or on the ground, bend your knees and lift by straightening your legs. Try to keep
your back straight. Use reachers instead of bending to get something from the floor or cupboards. If you have to bend,
try to keep your back straight. To get up from a chair, slide forward to the edge of the chair. Keep your feet
flat on the floor. Lean forward, then push down with your palms-not your fingers-on the arms or seat of the chair. If you
have wrist pain, you can push off with your forearms against the top of your thighs. Stand up by straightening your hips and
knees.
Distribute weight Spread the weight of an object over many joints to reduce the stress placed on any one joint. For
example, use the palms of both hands to lift and hold cups, plates, pots, or pans, rather than gripping them with your fingers
or one hand only. Use padded oven mitts for hot dishes. Carry heavy loads in your arms close to your body, instead of gripping
them with your fingers or hands.
Balance rest and activity Both work and leisure activities are important for people with arthritis, but you can overdo
them. It is wise to take short breaks and alternate heavy and light activities throughout the day. Learn to balance periods
of work with rest breaks, so you don't place too much stress on your joints or get too tired. You may need to take longer
and perhaps more frequent rest breaks when your disease is more active.
Part of this balancing includes pacing yourself during the day, and also from day to day. Allow plenty of time to finish
the things you start, so you won't feel rushed. Don't try to do too much at one time. Pacing also includes doing the hardest
things when you're feeling your best.
Plan ahead You can make your life easier by planning ahead. Perhaps each night you could prepare a written schedule
of the next day's tasks. Think about what the tasks involve--the amount of time they require and how tiring they are. Remember
to build in rest periods, and to alternate heavier with lighter tasks.
Be realistic. Look at all of the activities you do in a normal day and week, and eliminate the ones that are not necessary.
Delegate some of the others. Set priorities for the remaining tasks, but remember that you can change your priorities if needed.
Organize your tasks. Combine steps and find shortcuts. For example, you can save time and energy by fixing simple meals
that require little preparation. If you want to serve more complex dishes, choose a day when you have more time. Cook extra
portions and freeze them to use on days when you don't feel like cooking.
If you have a basement laundry area, bag your laundry and drop or drag it down the steps to avoid carrying heavy loads
and making several trips. Plan to stay there until the laundry is finished. Have a place to relax while waiting, or use the
time to catch up on reading or letter writing.
Organize work and storage areas: Keep all the equipment necessary for any task together in one area, within easy reach.
For example: Keep your baking equipment in one place. Keep pots by the stove. Keep the same cleaning supplies in several places:
kitchen and bathrooms, both upstairs and downstairs.
Store heavy jars and boxes at elbow level. If you must store objects up high, be sure they are lightweight. Use a long-handled
reacher or tongs to get them down. Keep appliances that you use most often (such as a toaster) out on the counter. Keep shelves
shallow (preferably only one row deep), or use space savers, such as Lazy Susans and pullout shelves. Use a pegboard at the
workbench for easy access to tools. Sit to work
If possible, sit at a comfortable height to work. Many of the tasks you usually do standing can be done seated, and
this will take the weight off your hips, knees, and ankles. For example, sit to cook, iron, wash dishes, work at your tool
bench, and even to dress. A high stool may be useful for some of these tasks. Use good posture to avoid straining your shoulders
and neck.
Use labor-saving devices Many different devices have been developed to make tasks easier and more efficient. You can
find these in local hardware and variety stores, pharmacies, and medical supply shops. Check with an occupational therapist
who can answer your questions and help you choose the best device for you. It can be costly to order from catalogues and find
the item doesn't work for you.
Use devices that can: provide leverage to give you more force,keep joints in the best position for functionm extend
your reach when range of motion is limited, help you avoid strain on joints
Ask for help While it may be hard to admit that some things are more difficult to do than before, it is important
to get help when needed, especially for activities that are particularly stressful to your joints. Your family and friends
will understand you better if you share your feelings with them and let them know how they can best help you. You might try
telling them on a scale of one to ten (with "ten" being the worst}, how much pain or fatigue you're having.
You may even find that your family and friends have some of the same emotional reactions to your arthritis as you do.
They may feel shut out or frustrated when they aren't able to help. Tell them that the amount of pain and stiffness you feel
varies throughout the day and from day to day. Try to involve your family in decisions about sharing chores and making new
arrangements of shelves and furniture. Ask your friends for their understanding if you have to change or postpone plans you've
made.
Respect pain: Try to avoid or modify activities that cause pain. If you have painful hands but must work at a computer,
try to rest your hands frequently or talk to your supervisor about making changes. These might include adjusting the level
of your keyboard or using a wrist support at the edge of the keyboard.
Avoid activities that involve a tight grip or squeezing. Use tools with built-up handles. Build up pens and pencils with
foam rubber. Use scissors that spring open. Use good posture. Use work surfaces that allow you to keep your back straight
and your shoulders relaxed. If you work at a desk, you can use a slanted top, a drafting table, or a document holder to reduce
the strain on your neck and upper back.
Avoid staying in one position: Change your body position and move your neck, shoulders, arms, hips, and legs often to
avoid stiffness. If your job requires a lot of standing, shift your weight from one leg to the other by placing one foot on
a box, footrest, or stool in front of you. Wear comfortable, supportive shoes.
Use your strongest joints and muscles: Remember proper body mechanics. To lift something, bend with your knees, not your
back. Carry your briefcase with a shoulder strap.
Balance rest and activity: If your job requires a lot of standing or walking, take frequent rest periods. Try to lie
down for a while during your lunch break, or sit if lying down is not possible.
Organize work areas: If you use tools, place them at a convenient level. Use a Lazy Susan or desktop organizer to keep
items within easy reach. Sit to work, when possible: A well-designed chair for working should provide good back support, and
should swivel or be easily moved. It also should be adjustable to the proper height for any activity.
Use labor-saving items: Use specially designed tools such as pistol grip ratchets and ergonomic hammers that keep your
wrist in a stable position. Use a rolling cart or luggage tote instead of carrying heavy objects in your hands.
Ask for help: Have a talk with your supervisor (or the personnel director) about your needs. Most employers will want
to protect their investment in your training and experience. An occupational therapist may be able to help sort out your needs.
In the kitchen Plan meals ahead to lessen last minute tasks. Use electric appliances such as can openers, mixers,
blenders, fry pans, crockpots, microwave ovens, knives, and dishwashers to get the job done with less time and energy. Place
a mixing bowl in the sink when stirring. A damp cloth underneath will help to keep it from slipping. Hammer rust-proof nails
through a cutting board to secure vegetables while cutting.
Use a French Chef's knife, which keeps hands in good position for cutting, slicing, and chopping. Use disposable aluminum
baking pans for easier cleanup. Spray a nonstick product on pans or line with foil before baking or frying. Let dishes drain
and dry in a rack. Use lightweight baking dishes, plates, pots, and pans, and serve from them. Use a wheeled cart to move
heavy items from place to place. Sit on a high stool while cooking or washing dishes. Use convenience foods such as precut
potatoes and onions.
Laundry and housecleaning Do only the tasks that are really necessary. For example, buy permanent-press items that don't
need ironing. Use separate laundry baskets to sort clothes before taking them to the laundry room. After the clothes come
out of the dryer, sort them into different baskets for each family member to put away. Sit to sort, fold, and iron clothes.
Put casters on furniture. Use a sponge mop with an easy squeezer, a "janitor's pail" with a wringer, or a pail on a wooden
dolly. Use a long-handled feather duster. Dust with a mitt, using circular motions with your hand extended. Wear an apron
with big pockets for carrying cleaning supplies. Store cleaning supplies everywhere they are used.
Use an automatic toilet bowl cleaner and spray-on mildew remover so you won't need to scrub. Alternate heavy tasks,
such as mopping floors, with light ones, such as dusting. Just do one major cleaning task a day, such as washing clothes or
cleaning the bathroom
.
In the bathroom Sit on a bath stool in the shower or tub. Wash with a bath mitt or a long handled brush. Extend or
build up handles on brushes and combs with rulers, foam rubber, or pipe insulation. Install lever-type faucets which can be
controlled with the palm, or build up faucet handles or use a non-skid pad. Put grab bars around the tub and toilet. Use
a rubber suction mat or nonskid strips in the tub or shower.
Squeeze a toothpaste tube between your palms or put a washcloth under the tube and lean on it. You can also buy toothpaste
in a pump dispenser. Use an electric toothbrush or one with a built-up handle. Use a raised toilet seat, if you have trouble
sitting or rising from the toilet. Use a free-standing mirror to put on makeup, so you don't have to lean over the sink and
strain your back.
In the bedroom Use long-handled shoe horns and sock aids. Wear shoes that fit and provide good support. Some shoes
have velcro closures or elastic shoelaces. Wear pre-tied neckties. If possible, replace buttons with velcro or use a button
hook. Use a zipper pull or add a loop, chain, or large paper clip to make a zipper easier to grasp. When making the bed, finish
one side at a time.
Leisure Use a card rack or holder or a brush to hold playing cards. Lay newspapers open on a table to read; use a
book stand. Use felt-tip pens, which require less pressure, or larger pens, which are easier to grip. Use a push-button phone
or a pen tip to dial. Get a headset so you don't have to hold the receiver.
Use specially-made, lightweight tools with built-up or extended handles for gardening and other yard work. Use a
gardening stool designed to reduce the stress on your back and legs. Break up long shopping trips into several shorter ones.
Use a fishing rod holder or camera strap to free your hands. Play golf for nine holes and then rest before starting the second
set. Ride a golf cart and use lightweight clubs. Use a three-wheeled bike for greater stability.
In the car Have power steering, brakes, windows, and seat controls. Build up tops of keys or use key holders to make
turning easier. Use a car door opener (self-help device) to reduce stress on your hands. Use a wide-angled mirror if you have
trouble turning your neck.
Although it is important that you use your affected joints wisely all the time, it may take a while before this seems
natural to you. If you continue to find things too hard or painful to do, talk to your doctor or therapist. There are many
techniques, aids, and devices other than the ones described here that might help solve your problems
Gov.: National Institute of Health
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