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Getting to grips with independence

How Active Hands is transforming rehabilitation for people with reduced hand function.

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Every person has the right to lead an active, fulfilling, independent life; but the complex array of disabilities that affect one’s grip can severely challenge this right.

Active Hands founder Rob Smith certainly discovered this to be the case, after a cliff fall left him partially paralysed in all four limbs.

Frustrated at his inability to grip the various gym apparatus and weights, he set about creating a glove that could fasten his hands to whatever was needed; and so the General Purpose Gripping Aid was born! Fast forward to present day and The Active Hands Company now carefully designs and stocks a wide range of high-quality gripping aids that cater to anyone with reduced hand function and are perfect for use in rehabilitation, sporting and gym activities, home and hobbies, and so much more.

Case Study 1: Rehabilitation and Physiotherapy

NeuAbility, Denver (previously SCI Recovery Program) makes full use of the gripping aids that Active Hands has created in its comprehensive rehabilitation programme.

Its clients have a wide range of paralysis related conditions such as spinal injuries, spina bifida, multiple sclerosis, amputation, stroke, cerebral palsy, brain injuries and auto-immune diseases.

These disabilities often affect hand function, and physiotherapy and rehabilitation would be impossible without some way of fixing their clients hands to the apparatus.

This is exactly why NeuAbility considers it essential to include multiple pairs of Active Hands gripping aids in its facility; so its clients can slip the aids on quickly and easily, giving them a firm, comfortable and reliable grip that enables them to achieve a full, comprehensive workout. The thoughtful design allows the clients to put on the gripping aids independently, allowing them to be used at home too.

“Active Hands gripping aids allow our clients to access gym equipment fully and maximise the benefits of our fitness program.”

George Whitten, Clinical Director SCI Recovery Program

Whether they are using apparatus such as cable/pulley machines, battle ropes, handbikes, walkers or just basic free weights – all are used in conjunction with Active Hands gripping aids, and the clients absolutely love them!

Without these it would be infinitely more challenging for them to progress in their rehabilitation, restricting the opportunity to fully exercise the muscles in their arms, shoulders and upper torso.

But rehabilitation and the battle for independence don’t just end once you go home, with many people finding that the struggle to do simple day to day tasks can be the biggest frustration of them all. Brenda Besos was one of these people.

Case Study 2: Home and Hobbies

Brenda, a quadriplegic with limited arm function and zero grip, had struggled for many years with basic, everyday tasks that most people take for granted.

Things such as holding a pen, using cooking utensils/cutlery, holding toothbrushes, and applying make-up and other beauty essentials were all a constant struggle for Brenda due to her lack of hand function.

Over the years she had experimented with a variety of splints, cuffs and gloves, all of which she had found very limiting and unable to give her a firm enough grip or the ability to hold the items at the optimal angle required for use. However, once she discovered Active Hands’ Small Item Gripping Aid all that changed.

The unique design, whereby items are secured via clamps to a Velcro pad that is then attached to a gloved aid, means that you can choose to hold them at whatever angle you wish.

Not only that, but the pads are interchangeable; meaning that with extra Palm Pads you can keep your items permanently clamped in, allowing you to quickly and easily switch between them.

Brenda did exactly this and in no time she was able to write, brush her teeth, cook and hold cutlery, as well as apply eyeliner, mascara and lipstick – all with a newfound confidence and independence thanks to the firm, versatile grip that the Small Item Gripping Aid gave her.

On top of all this, Brenda was thrilled to find that she was now able to rediscover some of her favourite hobbies, one of which was painting. Hobbies such as this can be great ways of relaxing and expressing yourself, so finding that you are suddenly once again able to take part in these activities can be a huge confidence booster.

This was certainly the case with Brenda, and by having extra Palm Pads for different brushes it means that she is able to switch between them and create her art without requiring assistance!

“The possibility of the things I can do has definitely expanded. I no longer have to worry about objects slipping out of my grasp in the middle of activities. Pretty much anything can be placed in the palm piece and will trustingly stay on.”
Brenda Besos

Active Hands products are now stocked in hospitals, rehabilitation units and homes across the world; being used by both professionals and individuals alike as the universal solution when it comes to gripping issues.

By solving these issues, they are opening doors that once seemed permanently closed; giving people of differing disabilities back their right to independence which they are able to take with them through rehabilitation and out into the world!

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Repeated head injuries linked to depression – study

Repeated head impacts may be associated with depression symptoms and worse cognitive function later in life, new research suggests.

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It’s well established that a traumatic brain injury (TBI) can cause memory and cognitive problems, as well as depression, but now, researchers have looked at the consequences of repetitive head impacts.

They found that people exposed to repetitive head impacts may be more likely to experience difficulties with cognitive functioning and depression years later.

The researchers analysed data from the Brain health Registry on 13,000 adults, five per cent of whom reported having had repetitive head impacts through contact sports, abuse or military service.

They were asked about depressive symptoms and completed cognitive tests.

The paper, by researchers at Boston University and the University of California, San Francisco, reveals that participants who’d had repetitive head impacts and TBI reported greater depression symptoms than those who hadn’t.

Repetitive head injuries were a stronger predictor of depression than TBI, and those who had a history of repetitive head impacts and TBI with loss of consciousness reported the most depressive symptoms.

“The findings underscore that repetitive hits to the head, such as those from contact sport participation or physical abuse, might be associated with later-life symptoms of depression.

“It should be made clear that this association is likely to be dependent on the dose or duration of repetitive head impacts and this information was not available for this study,” said Michael Alosco, associate professor of neurology at BU School of Medicine (BUSM).

Those who’d experienced repetitive head impacts or TBI also performed worse in some of the cognitive tests.

“It should be noted that not all people with a history of repetitive hits to the head will develop later-life problems with cognitive functioning and depression,” says Study author Robert Stern, professor of neurology, neurosurgery and anatomy & neurobiology at BUSM.

“However, results from this study provide further evidence that exposure to repetitive head impacts, such as through the routine play of tackle football, plays an important role in the development in these later-life cognitive and emotional problems.”

The researchers point out, however, that one limitation of the research is that researchers didn’t have data on the extent of participants’ injuries.

Last year, BUSM researchers found that longer someone was exposed to tackle football, the higher the risk of developing the degenerative brain disease chronic traumatic encephalopathy.

For every year of exposure to the sport, footballers had a 30 per cent increased chance of having the disease.

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City dwellers “more likely to die in hospital” after stroke – US study

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Compared to those living in urban areas, stroke patients treated at rural hospitals were one third less likely to undergo a procedure to remove a blood clot that caused the stroke and were more likely to die of stroke before leaving the hospital.

Researchers examined national data on almost 800,000 adults hospitalised after a stroke between 2012 and 2017.

In their paper, published in the American Stroke Association’s Stroke journal, the researchers warn that this urban-rural divide may be getting worse. This gap, the paper states, could be caused by the slower take-up of newer treatments and technologies, and because rural hospitals are less well-resourced and have poorer access to specialist care. Rural hospitals may also be more likely to lack specialised clinical support, such as dedicated stroke units.

Other causes for poorer stroke care could be a lack of clinical expertise in urban areas, due to difficulties attracting and retaining experienced staff, and poorer access to emergency services and longer responses to emergency calls due to distance.

“The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications,” said Gmerice Hammond, author of the study and a cardiology fellow at Washington University School of Medicine.

“Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities.”

The study had some limitations, including a lack of data on the severity of patients’ strokes, or factors that would determine whether a patient received advanced therapies, sich as the size of the clot and where it is located.

Karen Joynt Maddox, senior author of the study and assistant professor of medicine at Washington University School of Medicine, calls the differences in care, and the lack of improvement over the five-year period, ‘striking’.

“Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren’t receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren’t eligible by the time they arrived?

“Those questions can’t be answered with administrative data, but they’re very important to look into so that we can develop effective solutions.”

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One charity’s challenging move to online group sessions

Since lockdown began in March, many people recovering from brain injuries have had to adapt to remote sessions with health workers.

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But it’s not just outpatients that have seen a change. One neuropsychologist in York is trying to sustain momentum with her support group, but navigating the new online world with patients has brought its challenges.

Just before lockdown, Diana Toseland, consultant clinical neuropsychologist, was celebrating. Her charity, Café Neuro York, became officially registered. Café Neuro is a social support network that allows people with long term neurological conditions in York to learn new skills, help others and learning to be mindful, after they’re discharged from health services.

Group members were meeting face-to-face for morning and evening meetings, and once a month on Thursday evenings there was an interactive presentation for members to enjoy. When lockdown began, Toseland wanted to continue her twice-weekly sessions online.

But adjusting hasn’t been easy – Toseland had built up a loyal user base, but sessions were very much based offline. Adjusting hasn’t been easy.

“People need this in York. People with a neurological condition need ongoing support,” Toseland says. “People with brain injuries found it helpful to come along to meet people without having to explain – they can just be who they are. It’s about what people can do, not about their condition or disability.

Since lockdown, Toseland has been struggling to know how to support people.

“I’ve got up to speed with Zoom. This week we had six people call in, but their difficulties are quite profound and they’re finding it hard to get onto Zoom. Some call in late because they forget or find it difficult, others call in with help from families.”

Toseland has found there are many technical difficulties to overcome before the sessions can begin.

“You need so many things – good internet connection, distraction-free environment, working microphones and speakers.

“One woman managed to set it up herself, her career before the injury was IT, but then she didn’t have sound. Then she tried headphones, which worked, but then she took them off and couldn’t get the microphone on the computer to work without the headphones – she was the most successful in that meeting.

“Another has poor signal so she has to sit under a tree in her garden, which means she can only do it when the weather’s good.”

Once the call is up and running, Toseland says some members find it difficult to navigate the conversation, which has entirely different unspoken social rules than offline conversations.

“They’ve found it difficult because you can’t have two people having a conversation, it’s got to be one person at a time, which requires intense concentration. People can’t sustain that level of attention long enough to fully participate in the conversation.

“Some go quiet, it leaves people with headaches, it’s fraught with disaster. They might dominate the conversation and not pick up on cues; one finds it’s too much stimulation, so she closes her eyes.”

But Toseland hopes to continue the groups, as when it does work, it works well.

“On the other hand, for those who have joined it, they’ve used it as a bit of a lifeline.”

But Toseland is looking forward to getting meetings back into the real world. She’s been runnin Café Neuro for over a year and a half, and she’s seen more progress in some members than they ever made coming to her clinical practice.

“It’s made a difference in ways I couldn’t have predicted, and an impact wider and quicker than I could’ve possibly hoped for,” she says.

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