Saturday, November 2nd, 2019
When a stroke patient returns home, the home environment can impact a person’s recovery. The home includes the social and cultural environment such as the people who live there, as well as the physical aspects of the home such as steps and layout. It is important that the home environment be one that supports continuing recovery and safety for the patient. This article is intended to provide basic information to stroke survivors and their families about potential problems with the physical aspects of the kitchen.
The effects of a stroke are different for everyone, depending on the part of the brain injured, how bad the injury is, and the person’s general health. Effects such as weakness, paralysis, problems with balance or coordination, pain or numbness, problems with memory or thinking, and tiredness can all change the way a person functions in the kitchen. Since each person is unique, changes to the kitchen are most effective when they meet one’s specific needs. A professional occupational therapist, available through most hospitals, medical centers, and community clinics, can help to determine the best home modifications to suit your situation. The suggestions and options presented here are very general and are intended to guide you in seeking professional assistance.
The kitchen can be a dangerous place for stroke survivors with movement limitations or decreased sensation. Kitchens are often small spaces with counters and appliances that are difficult to access from a seated position. Hot or sharp objects as well as any type of object that is difficult to reach can pose serious safety hazards for anyone, but often more serious for people with disabilities.
In order to prevent accidents, it is important to consider every aspect of the kitchen that you will come into contact with on a daily basis. With some thoughtful planning, you may be able to feel safe enough to prepare your own food or at least be able to do things in the kitchen with some help. Some of the suggestions below involve major construction changes; others are simple organizational ideas that may make kitchen activities more feasible.
When stove controls are placed at the front of the stove, one does not have to reach over the burners to adjust the temperature. Push button controls eliminate the need to turn the hand or wrist if this movement is difficult for the person, but, on the other hand, these controls may be more cognitively demanding. Controls arranged in the same location as burners simplify the thought processes needed to turn on the correct burner. Automatic shut off controls can be installed to stoves to increase the safety for people who may forget to turn of the stove.
An over-the-stove mirror can be used to reflect the contents inside of pots and pans on the stovetop so that someone in a seated position can see despite the height of the stove. A person with decreased mobility will most likely encounter obstacles when trying to use a stove—obstacles that could be safety hazards if not addressed. Just as one may turn their bath-room sink into a roll-under sink, one can create a roll-under stove by removing cupboards or moving the oven so the stove can be accessed from a wheelchair or other chair.
People with reduced sensation or less ability to detect temperature change are at a greater risk for burning themselves. Oven mittens or hot pads should have a place near the oven and stove for easy access. Although oven mitts and hot pads can protect the skin from burns, they may also make it more difficult to hold a pot or pan.
A clear space near the stove or oven also needs to be available to place the dish quickly to prevent spills, which could lead to burns. A nearby cart with a heat resistant cutting board or a heat resistant cutting board to hold in one’s lap are possible solutions. A fire extinguisher should be within easy reach.
The height and depth of normal kitchen sinks often prove to be obstacles for stroke survivors with limited movement. A roll-under sink allows a person in a wheelchair to approach the sink with the chair facing the sink, as it provides room for one’s knees to fit underneath. Covered or insulated pipes are needed to prevent leg burns. Lowering the height of the sink can also increase the accessibility of the sink for a person in a wheelchair, but must be high enough for the person’s knees to fit under the sink. In addition, a shallow sink can be helpful for a person in a wheelchair, as it does not require the person to reach down too far. If the sink has a roll-under space, the shallow sink may also allow for more legroom underneath the sink. Lever handles allow a person to turn water on and off with the use of a fist or arm movement rather than finger movements or grasping.
The height of countertops can be modified for a person in a wheelchair as well, since the standard countertop height of 36 inches is usually too high for a person to reach from a seated position. Counters of different heights may provide spaces for all household members to use in the kitchen. Roll-under countertops, like roll-under sinks, allow a person in a wheelchair or standard chair to more easily work at the countertop in a seated position.
When it comes to food storage and access, organization is the key. A side-by-side refrigerator, which has the freezer on one side and the refrigerator on the other, allows a person in a seated position the ability to access both the freezer and the refrigerator. When the freezer is stacked on top of the refrigerator, frozen foods can be difficult to reach and may even fall on a person’s head as they are pulling down items.
A person with impaired vision may be unable to read some of the labels on food and spice containers. Labeling containers with black bold letters in all caps on a white background may help to make identifying foods easier. Plenty of spacing between bottles makes for easy identification and removal from the shelf or rack. Switching some foods or spices to containers with larger-sized lids may help to make the containers easier to open.
Cutting food can be dangerous if the stroke survivor has trouble using their hands. Purchasing pre-sliced foods may be the safest solution to this problem. Weighted handles or built up handles make utensils and cooking tools easier to handle. A spiked cutting board or a non-skid surface holding the cutting board can also decrease the chance of being cut.
To avoid outdated or spoiled food, leftover food should be dated and perishable foods should be disposed when expired.
Being unable to enjoy activities that you once did because of recent disabilities can be extremely frustrating. For many stroke survivors, dining is one such activity. Using utensils, sitting up to the table, and swallowing are often difficult following a stroke. In addition to help from health professionals such as a speech therapist and a nutritionist, specialized utensils and dishes are available that may make dining less frustrating and more enjoyable. Whatever the obstacle, patience plays a key role in improving your dining experience.
A plate guard or scooped plate can be used to scoop food onto a utensil. The guard attaches to most plates and is commonly used by people who have controlled movement with only one hand. Food can be pushed by a utensil against this wall-like device that curves along the edge of one side of the plate. A damp washcloth or rubber product can be used to stabilize the dish to make dining easier as well.
Stroke survivors often find it difficult to control their food. This can be made easier by using utensils with built-up, bendable, or weighted handles. Built up handles increase the surface area of the utensils to reduce the need for a fine pinch to hold the utensil, instead only requiring a gross motor grasp. Rubberized handles prevent the grip from slipping. Weighted handles are useful for a person who has tremors or uncontrolled movements that cause spilling. The heavy weight of the handle can reduce the amount of movement in a shaking hand.
Swivel forks or spoons keep food in the same position while the handle of the utensil moves. This is useful for a person with unwanted hand movements to decrease spilling food before it reaches her mouth. People who have difficulty holding utensils can also use universal cuff utensils. The cuff fits around the hand and the utensils are attached to the cuff, requiring only arm movements to control the food. It is often necessary for people with limited or compromised hand movements, such as being unable to pinch or grasp, to use these utensils.
Drinking can be made easier by using a cup with a lid and straw. This replaces sipping from the side of a cup, which is important for a person with reduced muscle control at the mouth. This reduces the risk of spilling or dribbling. A weighted cup is similar to weighted handles on utensils. This weighs down a hand with tremors or uncontrolled movement, reducing spills.
For a person who is not in a wheelchair but has trouble controlling their body posture, it is important for them to have a chair that supports their posture while at the dining room table. It is also important for them to have adequate cushioning that properly fits the chair. To make dining as comfortable as possible, a person in a wheelchair should have access to a table that is of a proper height for the wheelchair.
In addition to using specialized utensils and tools, survivors of severe strokes may need to have their food chopped, ground, or pureed. Sometimes, liquids need to be thickened. A speech therapist can give advice on how to avoid swallowing or choking problems. The patient’s physician or a nutritionist can help to develop a specialized diet and fluid intake amount to lessen the chance of additional strokes.
Reference : Internent Stroke Center