One handed OT bandit

The tale of the one handed OT bandit:
a.k.a. my life as an Occupational Therapist with a flexor tendon injury...


At the end of August, just as my work was getting crazy, I had an accident in my kitchen. I was making a salad and after cutting other vegetables, I chose to take the pit out of an avocado with a knife I would not normally use, a paring knife (the super sharp ones from Costco). No towel, no cutting board.

I remember thinking to myself, "I should get the chef's knife and a cutting board... Nah, I'll be fine". Yeah, I was wrong. The paring knife slipped on the avocado pit and I stabbed my left pointer finger all the way through with the knife. I severed my two flexor tendons, an artery and a nerve.

My finger wrapped up in the ER.

I had surgery the next day. I had never broken a bone before so technically this was my very first cast.

My very first cast. At age 40.
I was so tempted to draw on eyes and a mustache like a sock puppet.
I totally should have.

Then I spent the first 6 weeks in a long splint, full time. Day and night. Only taking it off for exercises.

My Dad called me the one-handed bandit. I liked the nick-name.

long splint

Then after 6 weeks they cut my splint down to a little one, mostly because my wrist was killing me, all pressed up against that plastic. In fact, that long splint made my poor pinky finger numb. It was nice to move a little more!

short splint

I was going to blog about the experience as I went along, but I couldn't bring myself to do it. I was too close to the injury and I could still easily remember exactly how the injury felt. Plus I felt like all my free time was spent doing exercises! 

Now I am 14 weeks post surgery. Finally, I am ready to share what a flexor tendon injury is like from a patient + OT's perspective, what one-handed techniques I used and how I fit in rehabilitation into a life of a busy working mom who has too many hobbies.

Now I am an Assistive Technology Specialist for a Special Education collaborative. I also do school based Occupational Therapy (OT) after school/during the summer. I spend most of my day either training teachers how to use special education software and iPads or facilitating consultation meetings. After school/during the summer I am helping children with fine motor skills that relate to school...like handwriting, shoe tying and opening lunch containers. So even though I have the same fundamental training as my hand therapists (Anatomy, Neurology, Rehabilitation). It had been years since I stepped foot in a clinic. Traditional rehabilitation and hand therapy are completely out of my realm. It was like going back to graduate school! 

I learned a lot. Mostly that...

Flexor Tendon repairs are tricky!

• Your hand is broken up into several zones. I had what they called a zone 2 injury. They are known for the worst outcomes because of all the tendon gliding and pulleys.
• Since repairs are tricky and the outcomes vary, hand therapy is crucial to recovery. You can't blow it off. 
• For hand therapists, tendon injuries are like the big boss in a role playing multi-player video game. They are really difficult and in fact, I met several hand therapists who said they were scared of flexor tendons! The good news is you will probably get the best therapist at the clinic!
• Your tendons can rupture. Meaning they can tear apart, even with all those stitches in there. You have to be careful not to push yourself too hard. However, if you baby your hand too much, your in trouble too.
• Scar tissue is both your friend and your enemy. You want enough to hold your tendons together, but not too much or you won't have good range of motion.
• Like a woman's body after pregnancy....your finger won't be the same. If you are diligent and do everything you are supposed to do AND your body systems cooperate, you might get decent outcomes. Might. (I was the crazy and paranoid type of patient...um...I mean compliant patient and I still have had a lot of problems.)

Anyway, here are my tips and experiences. I pulled the good ones from my therapists and the rest are from my own experience. They may or may not apply to you, as each injury, repair and recovery is unique.

Tips for other one handed bandits on the go:

Keeping your splint dry:

• Surgery bag: I could only take a shower if I bagged my splinted hand. I tried suran wrapping my hand (time consuming), I tried grocery bags (too short) and I tried kitchen bags (Too big and smelly. No no! Not smelly from garbage! I get the Febreeze kitchen bags.) What worked? The plastic draw string bag that I put my clothing/shoes in during my surgery. It was the perfect length. I just put a hair band around my bicep. Easy.

• Flower bag: Keeping that splint dry can be challenging at times. One time I was at Trader Joe's and it started to down pour. I had a small umbrella but the wind was bad and I knew my splint would still get wet as I walked to my car. I asked for a flower bag at the check out. It actually fit great! Like at home I used a hair band to keep it on my arm (I have long hair, so I keep hair bands in my purse).



Trader Joe's flower-cast bag!

 Desensitization (for nerve repairs):

• Stick it: My hand therapist gave me a popsicle stick with different splinting material on it (foam, mole skin foam, fuzzy side of velcro and rough part of velcro) to use to desensitize my finger.  You can make your own if your therapist didn't make you one.
• Nerve puzzler: With nerve injury my finger was super sensitive to any texture. But that's only four textures. Since I work with kids, I have puzzles. One puzzle by Lights, Camera, Interaction that has different textured shapes. I popped the pieces in a plastic bag and put it in my purse.

Fitting in exercises during your day:

• Red light therapy: I work two jobs (one that requires driving) and have two elementary school aged children. I spend a lot of time driving! You hit a red light and you can get in 5-10 reps of whatever exercise, go through desensitization protocol, or do some scar massage.
• Park and putty: While in a parking lot before an appointment or waiting in carpool, I brought a cookie sheet/metal tray into my car. I would use it for my putty exercises on the go.

In the kitchen and dining room:

• Creative cut up: I used a pizza cutter to cut meat or snipped with kitchen scissors.
• Contortionist cutting: I used my elbow on the injury side to stabilize food and then cut *carefully* with my good hand. Mostly I was cutting simple stuff like cucumbers and tomatoes. If you are scared to do this: buy stuff pre-cut or buy a cutting board with spikes that will hold the food. Link: Single handed cutting board
• Sticky mat: Don't even try to stir that fruit on the bottom yogurt without a sticky mat (Dycem). I also had a piece for work just so I didn't have to give up my yogurt for breakfast. Link: dycem disks or roll of dycem
• Prepare to...have someone else make your dinner: Cooking one handed is time consuming and can be exhausting. I relied heavily on friends, family, my spouse, take out and delivery. "Take out" was a pretty loose term. It included Trader Joe's, Whole foods and my local grocery stores. There is also this place in my city where you can cook dinners ahead of time to put in the freezer, sort of an assembly line thing. Except you are making calzones and chili. They also stock some already made by the staff for you to pick up if you can't take a night off to bag stuff yourself. 
• Dish rug: When I couldn't get someone else to do dishes for me. I put a towel on the bottom of my sink so I the pans wouldn't slip around while I was scrubbing them or I would stabilize with my involved side's elbow. Everything else went into the dishwasher. We also used a lot of paper plates.
• Twist away: I used either chip clips or those clips that snap together from IKEA instead of twist ties. Link: IKEA Bevara sealing clip
• Thigh high jars: I would use rubber jar openers to open jars on the table or dycem or I would hold a jar or water bottle between my thighs and then twist with the good hand. You can sit during this trick so you don't spill the contents. This does not work for very full jars. No one wants spaghetti sauce on their pants.

Self care:

• Clean shoulder: The suggestions I read for washing your hair was to pour shampoo in another container and scoop out what you need or squirt shampoo directly on top of your head (hoping that I didn't give myself too much). Instead...I squirted shampoo and conditioner on my involved side's shoulder, in that indentation from your collar bone and then swiped up the perfect amount for my long hair. I had a very clean and conditioned shoulder.
• Backwards Bra: Instead of running out and buying front closure bras, I used the elbow of my involved arm to hold one side of my bra closure, putting it on backwards and around my waist. I would flip the other side of the closure to fasten, spin the whole thing to my back and scoot it up my chest. Ta-da!
• One handed shoe-tying: I admit, I figured out my own method, just winging it. I would search Youtube for a technique. If I get time/feel like procrastinating I will post mine. Caveat: It takes me 15 minutes to tie my shoes one handed and it's not very tight. I considered going to Dick's sporting goods and buying elastic laces for my sneakers. I sucked it up instead.
• Pants problem: Same deal. Use your involved elbow to hold one side of the waistband and then fasten with your good hand. I hurt my hand in the summer, so I could wear skirts with elastic waistbands or wear maxi-dresses for work. I avoided button down shirts and panty hose/tights. (Not that I like panty hose anyways.)

Driving:

• Elbow driving: You shouldn't drive until your doctor says its okay. Due to my job, my doctor was sympathetic and let me drive early on. I used my elbow or forearm while I turned the wheel, otherwise I drove one handed. Honestly, I was a better driver one handed. I was never tempted to glance at my phone or eat!
• Park away: Parking is more difficult one handed. Just park far away so you can give yourself plenty of room to turn wide and slow.

Wrangling children and animals:

• My kids are 8 and 11 so I didn't have to try to change diapers or give squirmy babies a bath. My kids helped me as much as they could. They actually were proud to help their mom! So I am providing a link for you with younger ones: Through the Looking Glass
• Looped Leash: I didn't walk my dog until I was 4 weeks after surgery. She is part beagle and pulls on the leash at every squirrel and rabbit. Even after 6 weeks (when I was only wearing a splint at night), I still would wear my splint just in case. I loop the leash around my waist instead of holding it (run the leash through the hand loop).
• Dog poop twist: Normally I use those bio-degradable poop bags on a roll that attaches to the leash for our walks. Those bags are just too small to tie a knot in one handed. So instead I used grocery bags. I was able to twist them, hold them against my belly with my elbow and tie a knot in them one handed.
• Claw conundrum: The dog went to the groomer and got her claws clipped there. I would bring my cats to the vet to have the technician clip their claws for me. Normally they charge for this, but they did it for me for free while I was injured. I was at the vet's office buying "please don't barf on my rug" cat food or "don't get disgusting worms in your poop" medicine for the dog, so it's not like they weren't getting money from me. 

Work, office style (normally this blog is for low-tech solutions, but I need go high tech on ya for a bit, my apologies):

• Speak up:  I tried Siri on my iPhone and iPad and the speech recognition that comes with Mac 10.9. Honestly, it drove me nuts, but it was good for personal use, just not work. If you don't have built in access to speech recognition, I recommend Dragon Naturally Speaking (Windows) or Dragon Dictate (Mac) for your computer. If you have an older mobile device, Dragon Dictation for your iPad or iPhone. Andriod users vary frequently by device, so I would check that out individually by your phone provider.
• Sticky typing: I typed one handed and used the sticky keys feature (Mac and Windows) that you can find in your Accessibility features of your computer. To one handed type, you place your hand in the center of the keyboard (where your first finger-pinky covers the f and j keys.) and move around from the middle. If you need more instruction or practice on one handed typing, I suggest going to www.typingstar.com and download a free trial of GS Typing Tutor for Windows or look into Five Finger Typist for Mac.
• Hunt and predict: If you are a hunt and peck typist, one handed typing may not be your preference. You can also use word prediction software. That's when you begin typing and software gives you the rest of the word. You can type with one finger this way and still get stuff done. I personally use Co:writer with my students which is useable on a computer, chromebooks and the iPad. You can also use Spell Better on the iPad, which is free.
• Wheelies: I used a wheeled crate to drag all my stuff around so I could easily just park the crate and do something with my good hand (like open car doors). This strategy does not work when it is raining, unless you can cover the crate effectively and don't mind wearing a jacket with a hood (you won't have an extra arm for an umbrella).   

Old school Occupational Therapy:
This means using functional and leisure activities as rehabilitation. I'm sure there was some fancy word for it that I learned in OT school, but honestly I just think of it as old school OT. In a nutshell, once my surgeon released me for all activities, my hand therapist encouraged me to incorporate using the muscle that bent that last digit of my finger (Flexor Digitorum Profundus or FDP for short) in everyday activities. Below are examples of what to do with your INJURED HAND. Yep...after all those weeks of living like a one-handed bandit, you are to use the gimpy one. 

*DISCLAIMER: Now some of these activities may not apply you because you may have injured a different finger (I got that pointer finger, which I actually use besides pointing) or have different therapy plan in general. Please make sure your surgeon has given you the go-ahead for activities as tolerated and also talk to your hand therapist before you do any of these ideas:

• Carrying a "heavy as you can deal with" bag with a thick handle (my briefcase, cloth grocery bag)
• Driving your car (making sure you wrap those last digit around as far as it goes.)
• Pushing a grocery cart (again, wrap those little digits!)
• Carrying boxes
• Opening Jars and water bottles 
• Opening a tab on a can of soda/mineral water
• Bowling (Okay, I haven't tried it yet, but it's on the to do list)
• Opening cartons (I was trying to open a box of theater candy is when I noticed this good one)
• Peeling stickers off a paper (stamps, price tags off of items)
• Picking up coins and transferring them to your palm
• Kneading bread
• Rainbow loom (pick up the bands and stretch them on the posts with your affected hand)

The number one activity you MUST try is Rock Climbing. I'm serious. My finger's range of motion actually improved a little after climbing a little kid rock wall 3 times. See me below. I'm the big person next to the 5 year old.

Last tip: Be patient with yourself. After those long and short splints, I kept having issues.  Not only was I unable to fully flex my finger (or even get close), my finger would curl up on me. It's normal to be frustrated.

This is it. My best attempt at flexing my index finger. Sigh.

There's my finger, curling up.

I had three more splints to manage my scar tissue problem.

blocking splint

Dynamic finger splint

I'm number 1! Oh wait. It's just an extension splint.

Best wishes to my fellow bandits!

*This blog does not replace medical advice or treatment protocols. Mostly it's to give you some tips and interesting questions to ask your medical professional.

Winter Themed Heavy Work: Hole punch snowflakes

 

This is a twist to paper snowflakes that incorporates hand strength and providing resistive input to your fine motor muscles (i.e. heavy work).

Stuff:
Squares of white paper/scrap paper
Hole punch
Scissors

How to:
1. Cut a 8 X 11 inch paper and cut in half
2. Cut off excess to make a square.
3. Fold twice to make a smaller square or alternatively, a triangle.

4. Use the hole punch to create a snowflake.

Ta-Da! Perhaps you can put them all over the windows and do a snow dance. Who doesn't want a snow day?