Assistive Devices for Arthritis

Environmental Modifications

• Assistive devices, alternative methods, and environmental modifications can increase clients' independence, ease, and safety in completing meaningful occupations with less pain and stress on their joints.

Assistive Devices

• Extended-handle devices (e.g., dressing sticks, sock aids, shoe horns, bath sponges, hairbrushes, toilet aids) are used to compensate for loss of proximal ROM and strength.
• Devices with built-up handles (e.g., eating utensils, button aids, writing implements) are used to compensate for limited hand function.
• The therapist should consider the client's goals, factors, activity demands, and contexts when suggesting assistive devices.
• Important factors to consider when selecting an assistive device include:
  • Is the client receptive to using the device?
  • Will the device reduce pain, joint stress, energy demands, or time expenditure?
  • Is the device easy to use?
  • Is the device acceptable to the client in terms of appearance, cost, and maintenance needs?
  • Is the device likely to cause any negative effects?

Client and Family Education

• Client education is essential for empowering clients and leading to positive changes in pain reduction, psychological status, disease management, self-efficacy, and overall health promotion.
• Important educational aspects include:
  • Disease process
  • Symptom management
  • Joint protection and fatigue management
• Disease process education should cover:
  • Type of arthritis
  • Basic underlying pathology
  • Medications and medication side effects
  • Risks of prolonged synovitis in RA (e.g., irreversible joint damage and potential disability)
• Symptom management education should cover:
  • Monitoring for signs and symptoms of inflammation
  • Recognizing pain as a signal to modify activities
  • Integrating rest, exercise, splinting, and PAMs into daily routine
  • Family members' understanding of the client's abilities and when to assist
• Joint protection and fatigue management education should cover:
  • General principles of joint protection and fatigue management
  • Reducing internal and external joint stress, pain, and inflammation
  • Preserving joint integrity during ADL performance
  • Saving and expending energy wisely

Joint Protection and Fatigue Management

• Respect pain as a signal from the body that something is wrong
• Avoid activities that cause pain and inflammation
• Gradually progress repetitions or resistance
• Engage in community-based exercise classes specifically designed for people with arthritis
• Organize the environment, pace activities, and rest to moderate fatigue

Therapeutic Activity

• Performance of therapeutic activities offers physical and psychological benefits
• Discussing current and past hobbies or completing an interest survey can help determine appropriate activities
• A carefully chosen and graded activity can encourage ROM and strength
• Activities should be nonresistive, avoid patterns of deformity, and not overstress joints

Splinting

• Splinting is an integral component of arthritis treatment
• The goal of splinting is to maximize function
• Important factors to consider when deciding on a splinting plan include:
  • Primary goals for splinting
  • Benefits of splinting
  • Limitations of splinting
  • Joints involved in the splint design
  • Effect of splinting on unsplinted joints
  • Previous splints tried or worn
  • When to wear the splint