Weakness or paralysis (one-sided)

Hemiplegia (paralysis of one side of the body) or hemiparesis (weakness of one side of the body) can often occur following a brain injury, particularly after stroke. Both conditions can make everyday tasks extremely difficult.

The information below describes some of the everyday difficulties that hemiplegia and hemiparesis can cause, as well as providing tips for coping with these.

Paralysis of arms or hands

If an arm or hand is paralysed, it is important to try to improve its function by treating it as normally as possible and not neglecting it. Place the affected limb in positions that were typically used before sustaining the brain injury and place it where it can be seen. This is particularly important if the person lacks awareness of the affected limb.

One approach is to open the hand out flat and rest it, palm down, on the lap or on a table. Ask your physiotherapist if your hand or arm would benefit from sensory stimulation, such as massaging the skin, rubbing briskly with a wet flannel, rubbing the hands together, kneading and rolling dough, etc.

In addition, it is important to remember that conventional wheelchairs can be very difficult to use one-handed and for this reason, many people use powered wheelchairs instead. However, these are expensive, heavy and lack portability. There are one arm drive manual wheelchairs available, which can overcome these problems. You could ask an occupational therapist or other healthcare professional about the availability of these systems.

Sensory problems

If there are sensory problems, such as an inability to feel heat, cold or pain, this area of the body will be particularly vulnerable and require special attention. Care should be taken to Ensure the affected area does not get too hot or cold, and to prevent the skin from coming into contact with things that could burn, scald, or cause other injury, such as sharp objects or rough surfaces.

Personal hygiene

Teeth: Experiment with different toothpaste dispensers. If using only one hand, lay the toothbrush on its back and squeeze the toothpaste over the bristles. Alternatively, hands free toothpaste dispensers are available.

Nails: Suction nail brushes are available, which can be struck onto the sink so that they do not need to be held. The unaffected side can use the brush easily, and then the affected hand can be held in position by the ‘good’ hand, and the nails rubbed back and forth, across the brush. Suction nail files are available, which work in a similar way.

Dentures: Suction denture brushes are available, which work in a similar way to the suction nailbrushes.

Toileting: Interleaved toilet tissue, which is often used in pub and restaurant toilets, can be easier to use, as tearing off tissue is difficult using one hand.

Shaving: Use an electric shaver, preferably a rechargeable one which does not need to be plugged in during use.

Dressing

Fastenings: Choose clothes without fastenings, such as t-shirts, polo shirts, or trousers and skirts with elasticated waistbands. Zip fastenings are often extremely difficult to manage with one hand. When dressing, it is much easier to dress the affected side first and undress it last.

Buttons: It is possible to do up a button one-handed, however, this takes practice. A latch hook may be useful instead. To use, insert the hook through the buttonhole, latch it onto the shank of the button and pull the button back through the hole. For buttoned shirt cuffs, it is useful to stitch elastic loops next to the buttonhole, and fasten the button through the elastic, rather than the hole. This allows for the hand to pass through the cuff without needing to unfasten the buttons. You could also replace the buttons with velcro. Remove the buttons and stitch them back on over the buttonholes. Stitch Velcro circles behind the buttonholes and onto the material where the buttons used to be.

Shoes: Choose shoes with velcro fastenings, or slip-on styles. Buckles may be manageable, but check that both shoes can be fastened up. Elastic shoelaces are inexpensive, and can help to convert lace-up shoes into slip-ons by allowing extra ‘give’ across the top of the foot.

Bras: Choose a bra with as few hooks as possible. Try ones that fasten at the front, or bras with no fastenings, which slip on over the head. Alternatively, you can adapt the rear fastening of a bra by attaching a piece of velcro in place of the hooks.

Coping in the kitchen

Snap-on aprons: These aprons have a bendy plastic waistband with a snap-fastener, avoiding the need to tie a bow behind the back.

Opening cans: Adapted can openers are available with handles that lock together with a single squeeze. These do not require a constant strong grip to hold them together. Electric can openers, suitable for one-handed operation, are also available.

Slicing: Cutting guides are available for slicing bread and meat. These have upright pillars to hold the knife steady, which makes cutting safe and simple. The width of the slice can often be adjusted as necessary.

Spreading: Spreading boards are available, with two slightly raised edges at right angles to each other. The slice of bread is placed beside these edges to stop it from moving around whilst spreading.

Opening jars and bottles: There are a variety of grips available to help you with this. Some gadgets grip the lid whilst you turn the container, and others grip the container whilst you turn the lid.

Cutting: Easy-grip scissors can be helpful if you need to use the opposite hand from the one that you would normally use. These open with a spring action, so very little strength is required.

Peeling: ‘Rex’ peelers are available, which have broader handles than traditional peelers and require less movement from the wrist. You could also try a battery operated peeler with a contoured handle for easier grip. There are also electric peelers available, which do all the work and do not require holding. In addition, grater/ peeler units are available, with spikes to hold food for conventional peeling and a separate scraper section. Vegetables are rubbed against the scraper to remove the peel. The scraper can also be used as a fine grater.

Boiling: Metal handle guards can be fastened onto the side of a cooker to hold pan handles steady whilst their contents are being stirred. When cooking vegetables in a saucepan, it can help to place a wire chip basket, or sieve, inside the saucepan before adding the vegetables. Once cooked, the vegetables can easily be drained by lifting up the basket. This prevents the problem of needing one hand to hold the pan, and another to hold the lid or strainer, while pouring off the excess water. The water should be left to cool before attempting to empty the saucepan.

Avoiding burns: Heatproof mats can be placed on the work surface, or adjacent to the oven, so that hot cookware can be placed onto them before being moved.

Chopping, grating and mixing: Food processors, blenders and juicers can be invaluable for chopping, grating and mixing. Choose a design that is easy to operate, take apart and clean. Simple mechanical choppers or electric mixtures are also available, which only require one-handed operation. A hand-held ‘stick blender’ can be used to mix the contents of a bowl or saucepan with the press of a button.

Microwaving: A microwave can be helpful to use as it not only reduced cooking time, it also requires minimal handling. Microwave cookware, which is designed to absorb less of the cooking heat, will be cooler to handle.

Moving food and objects: Trolleys are useful for transporting hot objects from one work surface, or from one room, to another. This greatly reduces the risk of accidents. One-handed trays are also available, with a handle that rises over the centre of the tray so that it can be balanced safely with one hand. These also come with an anti-slip surface.

Eating and drinking

Plates: Plates with anti-spill raised edges are available. Alternatively, plate guards can be clipped onto most plates.

Cutlery: A wide variety of adapted cutlery is available to make eating easier. For example, specialist knives which enable food to be cut without requiring a fork to hold it steady.

Egg cups: Egg cups with a suction base are available.

Non-slip matting: Special rubber matting is widely available which prevents plates, cups and other items from slipping around during use. Alternatively, a damp tea towel folded and placed underneath can also prevent hard objects from slipping on a smooth surface.

Housework

Washing-up: Cleaning brushes which attach by suction onto the draining board are available, which will allow you to clean pots one-handed. Alternatively, an automatic dishwasher can make life easier.

Vacuuming: Heavy vacuum cleaners are awkward to use with one hand. Choose a light machine with a swivel-head which can be easily manoeuvred around furniture. It is helpful to clear space before beginning the job. Hand-held ‘dust buster’ vacuum cleaners, which are rechargeable, are also helpful to clean stairs and small areas of flooring.

Laundry: Automatic washing machines are preferable, as washing by hand is obviously very difficult one-handed. For drying, it is easier to hang each garment on an indoor drying rack. Once the washing is dry, place the items on a flat surface to fold them, such as a table for large items. It can also help to buy socks that are all the same so any two will make a pair, rather than having to pair matching items up after washing.

Ironing: Again, this can be difficult using one hand. Extra care should be taken to avoid burns, particularly if there is any loss of sensation in either hand. It may be easier to turn the ironing board around if using a different hand from that used previously. A tumble dryer and fabric conditioner, as well as a careful choice of fabric, can help to reduce the need for ironing.

Games and hobbies

Card games: Purpose-made holders are available, which can hold cards steady for you. A simple alternative is to hold the cards in the bristles of a new, upturned scrubbing brush.

Sports: Sports can be difficult but adaptations can often be made. Racket sports only require one hand and the use of a one arm drive wheelchair can help. Alternatively, table tennis can be played from a static position. Bowling is fun and pool or snooker can also be possible with some help to get the non-functioning arm in the right place. Games related to bowls can easily be played one-handed and there are playing areas in most towns and cities.

Video games: One-handed controllers are available for the Xbox, PlayStation and PC, while most games on the Nintendo Wii can be played using one hand. Joysticks are also suitable for many games and these can be attached to a table by suction pads for one-handed use.

Crafts: The biggest difficulty with most hobby activities is stabilising the components. Clamps, plasticine, non-slip matting and specialist frames can be used for needlework. A hoop that clamps onto the table is available for embroidery, as are simple threaders for sewing needles. A clamp is also available for holding a knitting needle to allow one-handed knitting.

Final considerations

Although life with hemiplegia or hemiparesis is inevitably difficult, there are many ways to manage everyday practical issues. We hope this publication has provided you with some useful ideas for yourself, a friend or relative. Remember, always ensure that the techniques you are using are safe, and if you have any questions, problems or concerns, consult an occupational therapist.

If possible, try items out before making expensive purchases, as some things will work better for some people than others. Also, some companies can charge a lot of money for items when something equally effective can often be found very cheaply. Always be wary of buying expensive equipment, especially on impulse.