Archive for the ‘Rehabilitation’ Category

Carpal Tunnel Syndrome: Are you suffering from it?

Tuesday, April 23rd, 2013 by admin

Today’s advances in technology have proven to be a wonderful thing for many of us. However, with the boom of this computer age many people have been developing different types of injuries to their wrists and hands.  One of the most common repetitive stress injuries affecting our society is Carpal Tunnel Syndrome (CTS). 

CTS may start with some tingling and/ or pain at the wrist which can eventually radiate to the hand and forearm.  Usually those with this condition also experience decreased sensitivity of the thumb, index finger (pointer), middle finger, and half of the ring finger of the palm side of the hand.  This condition is caused by compression of the median nerve which is located in the carpal tunnel of the wrist.  It can even lead to muscle damage to the affected hand.  The prevalence of this condition has increased considerably, currently affecting 50 cases in 1000 subjects (5%) in the general population.

Many of the people suffering from this condition:

  • usually work on the computer all day (due to poor wrist posture and shape while working, table height, the angle of the elbows, and repetitive motion)
  • are woman that are pregnant (due to swelling and inflammation)
  • are individuals with rheumatoid arthritis and other medical conditions that cause swelling and inflammation
  • are those that had a wrist fracture
  • are people that are constantly working with vibrating tools
  • and those that perform repetitive bending/ twisting movements of the hand/ wrist

Treatment approaches may vary from conservative modalities to surgical interventions.  Treatment can focus on decreasing pain and paresthesias (tingling/ numbness/ pain); increasing or maintaining muscle strength; maintaining function of the hand; use of a splint; anti-inflammatory medications; and patient education (preventative measures).  If this condition is not treated, it can lead to permanent nerve damage and severe loss of hand function.  If these signs and symptoms are affecting or interfering with how you are performing your day to day activities, you should seek medical attention and/ or treatment from an occupational therapist.


Esther Gonzalez M.S. OTR/L, Bil TSHH

Senior Partner

Adapting Spaces, LLC


Visual-Perceptual Difficulties In Children

Saturday, February 23rd, 2013 by admin

“I can’t do my homework! It’s too hard!!”  Many of you have heard this complaint countless times.  Some children use this as an excuse not to do their work; however, others actually mean it.  Often, children have trouble with reading, writing, or math because they have difficulty understanding what they see.  Visual perceptual or visual processing difficulties affect how the brain perceives and processes visual information.  If we can’t make sense of what we are reading or writing, how are we expected to learn and acquire new information being taught to us?  Unfortunately, many of the children that experience these difficulties go undiagnosed for years. As a result, they may become frustrated or bored while in class and act out because they can’t see (understand) what’s on the board or read with relative ease.  It is usually the case that children with problems seeing are often considered the “behavioral child”.

Living with visual perceptual difficulties can be very confusing and disconcerting.  Therefore, if you believe that your child is experiencing difficulty in school because of a visual perceptual difficulty, seek the help of an occupational therapist or vision specialist.  Through the implementation of adaptations and/ or strategies your child can have greater success while in the school environment.  Just because he or she may have visual perceptual difficulties, doesn’t mean that they can not learn and overcome this challenge.  Occupational therapists and vision specialists have the training needed to help your child succeed.  Below are a list of possible warning signs that your child may be suffering from a visual perceptual deficit:

  • Letter reversals
  • Difficulty learning the alphabet
  • Difficulty recognizing words
  • Understanding basic math concepts
  • Maintaining letters on lines and within page margins
  • Organizing written information on paper
  • Holds paper close to face
  • Excessive rubbing of the eyes
  • Constant squinting/ blinking
  • Watery eyes or swollen eyelids

After meeting with a professional to discuss your child’s concerns, it is important to develop a plan that you can incorporate while at home.  Here is a free website that can be useful which contains exercises to help your child improve his/ her visual perceptual skills in a fun and interactive way.

By: Esther Gonzalez M.S. OTR/L Bil TSHH

Senior Partner

Adapting Spaces, LLC


Helping Children with Handwriting Difficulties

Tuesday, January 22nd, 2013 by admin

As the state standards increase, so do the demands placed on our children.  Many children have trouble completing classroom assignments due to handwriting difficulties. Handwriting concerns have become more prominent since handwriting is no longer taught as part of the school curriculum.  Nowadays, children are expected to know how to identify and write upper case letters, lower case letters, and numbers while in Kindergarten.  This poses a serious problem for many children especially those facing difficulties with fine motor skills, sensory processing/ modulation, low/ high muscle tone, decreased hand/ body strength, visual- perceptual skills, amongst other conditions.

As an Occupational Therapist, I work with children facing this struggle on a daily basis. Many of you may be wondering, how can an Occupational Therapist help my child learn how to write?  After all, they are not teachers! Don’t they work in hospitals or clinics? Yes, it is true that we are not teachers and we usually work at other sites.  However, many occupational therapists specialize in the area of handwriting since it affects how children function within their school environment.  Our job as occupational therapists is to help individuals become more independent in their day to day activities.  In this case, since a child’s main occupation is to go to school and learn we help them access their education.  One way to help them access their education is by working on their handwriting skills.  Giving them the opportunity to improve upon their handwriting skills will in turn allow them to produce written work so that they can demonstrate understanding of what they have learned within the classroom.

Many teachers and parents are recognizing the growing need for children to receive help with their handwriting skills.  A recent New York Times article also made reference to this major concern. Children may have trouble holding their pencils properly as well as identifying letters and numbers (visual memory) or producing them correctly.  Other components of handwriting addressed in occupational therapy are: sequencing (formulating numbers or letters with the correct sequence/steps); line regard (keeping them on the line); orientation (no number or letter reversals); and letter and word spacing (proper distance between letters and words).  For older children, we tend to work more on observing the page margins, punctuation marks and writing speed (so that they can keep up with the rest of the class).

Since the demands of classroom work continues to increase with each year that passes, we see more and more that children can benefit from our services.  If your child is having difficulty performing written tasks and keeping up with the classroom demands due to handwriting concerns, seek the help of an occupational therapist.  We are specialized in this area and want to help your child access their education so that they can be successful in their learning environment.

By: Esther Gonzalez  Bil T.S.H.H. M.S. OTR/L

Senior Partner

Adapting Spaces, LLC


Improving The Well-Being of Dialysis Patients, an OT Approach

Monday, December 10th, 2012 by admin

It is possible that you may know someone that was diagnosed with Chronic Kidney Disease (CKD). It is also very likely that you or someone you know is suffering from Diabetes, High Blood pressure, or both. These two chronic conditions are among the leading causes of kidney disease.  Another cause is frequent urinary tract infections. According to the U.S Department of Health and Human Services, 1 in 10 American adults (more than 20 million people) have some form of Chronic Kidney Disease.  End Stage Renal Disease, (ESRD) is when there is total damage to the kidney and the patient needs to undergo dialysis treatment. According to the U.S Department of Health and Human Services, the prevalence of ESRD between 1980 and 2009 has increased by almost 600 percent from 290 to 1,738 clients for every million cases.

George Washington University conducted a study examining the quality of life and psychosocial issues affecting dialysis patients. They found that depression is the most prevalent psychological symptom affecting dialysis patients. Researchers believe that dialysis patients may feel depressed due to their heightened awareness of the possibility of death.  Other reasons were linked to the feeling of loss of independence, increased family burden, and decreased physical level of function.

Occupational therapy can help individuals undergoing dialysis treatment live a more fulfilling and healthy life by helping them modify or adapt the activities they perform. Occupational therapists have been uniquely trained to break down tasks into individual components to better understand the performance demands it has on the individual. The occupational therapist uses a client- centered approach to find out what are the most important daily activities to the client. Then they establish a parallel between the demands of each specific task and how much effort is required by the patient to perform it.  Once this parallel has been drawn, the occupational therapist formulates a work plan which may include ways to improve the patient’s ability to maintain an adequate level of function that would allow the patient to continue performing the task. If the patient is no longer able to perform the task the way he or she is accustomed to do so, the occupational therapist will develop a list of alternate ways to perform the task successfully.

For instance, I had a patient not too long ago that has been receiving dialysis for over 10 years.  In the recent years, she has been experiencing increased pain in her legs due to peripheral neuropathy which makes it difficult for her to enjoy one of her favorite past-times- window shopping. I understood that 10 years of dialysis and the effects of Diabetes had taken a toll on this patient’s body, but not on her mind.  Although she was not feeling optimistic about her future prognosis because of her medical condition, she still wanted to feel alive and do the things she enjoyed. So I worked with her and her case manager to develop a plan that included: an exercise regimen; proper footwear selection; implementation of energy conservation techniques; training on fall and safety precautions; appropriate and convenient means of transportation; amongst other things. We were also able to modify the way the patient performed the activity of window shopping, so that she could continue to do so successfully. Through the implementation of strategies and adapting the task, she is currently able to window shop and is happy to do so.


Miller Calberto, MS, OTR/L , CAPS

Senior Partner

Adapting Spaces, LLC


Preventing Repetitive Stress Injuries- Work Ergonomics

Wednesday, November 14th, 2012 by admin

Over the years, technology has become such an integral part of our lives. We can easily spend a few hours on the computer doing work, searching on the internet, and/or socializing with family/ friends through social networks.  As we spend more and more time at the computer, we become more susceptible to neck, back, wrist, and hand injuries.  “According to the U.S. Bureau of Labor Statistics, nearly two-thirds of all occupational illnesses reported, were caused by exposure to repeated trauma to workers’ upper body (the wrist, elbow or shoulder).”   As a result, many of these individuals require rehabilitative services in order to remediate or alleviate the symptoms of these repetitive stress injuries.  Some common repetitive stress injuries are carpal tunnel syndrome, tenosynovitis, and tendinitis. Work Ergonomics is the study of how people interact with their physical environment while at work in order to minimize injuries. The use of workplace ergonomics can help reduce the incidence of repetitive stress injuries at work. Here are a few tips to consider when setting up your computer workspace:

  •  Computer Monitor- Try to make sure that the monitor is at eye level or just below it
  • Good Posture- Try to maintain the head and neck in-line with the torso
  • Maintain shoulders relaxed while typing (avoid hiking up your shoulders- it will increase the tension around your shoulders, neck, and back)
  • Keep your elbows close to your body and supported (you can rest your elbows on the chair’s armrest for support)
  • Keep your lower back supported (you can use a pillow or a backrest for lumbar support)
  • While typing your wrists and hands should be in-line with your forearms (you can use a wrist rest/ cushion to maintain the alignment)
  • Maintain adequate room between the keyboard and mouse while typing to maximize ease and comfort
  • Always maintain your feet flat on the floor; if this is not possible adjust the seat height or use a stool to prop your feet on

 The list above, listed a few simple ways to reduce the likelihood of incurring a repetitive stress injury. If you already have one, seeking therapeutic services can help you: strategize to prevent further injury as well as remediate and/ or alleviate the symptoms of them.

 By: Esther Gonzalez, M.S. OTR/L Bil TSHH

Senior Partner

Adapting Spaces, LLC.



Monday, September 24th, 2012 by admin

Fall prevention is an enormous topic that, as an Occupational Therapist, I get asked about all the time.  No one wants to or anticipates falling in their home, but it happens.  People always want to know how to not fall while at home.  If you work in healthcare in any way, you are aware of the prevalence of falls across the country.  Being able to advise clients and family members in proper home modifications is vital.  Keep in mind that you cannot prevent falls all together, but with the proper home modifications you can prevent falls as much as possible. 

According to The National Safety Council and Centers for Disease Control (CDC) in 2007, more than 21,700 Americans died as a result of falls; more than 7.9 million people were injured by a fall; and over 1.8 million older adults that had a fall-related injury resulted in an emergency room visit.  Falls are the leading cause of injury-related deaths among older adults 73 and older and the second leading cause of death from ages 60-72 (”  In addition, a new CDC study published in the Morbidity and Mortality Weekly Report (MMWR), “ an estimated 234,000 people ages 15 and older were treated in U.S. emergency departments (ED) in 2008 for injuries that occurred in bathrooms.  Four out of 5 of these injuries were caused by falls” (

When I recommend home modifications, I do my best to keep it simple and save costs as much as possible.  This is usually a very overwhelming time for the people I am working with and by sticking to a few basic principles and recommendations I feel that I am generally able to accomplish what I need.  Here are my basic recommendations to decrease the risk of falls and increase safety throughout the home:

1)      To enter the home, be sure that there are handrails on both sides of the stairs.  Ideally, there should be a landing so that the door can swing open all the way to allow for easy entry.  Also be sure to provide/have proper assistance just in case.

2)      Upon entering the home one of the first things I look at is the type of flooring used.  I look for smooth transitions between rooms.  This allows for easy maneuverability of wheels (either on a walker or wheelchair) and reduces a trip hazard of having to step over a threshold.

3)      There should be no throw rugs.  If there are throw rugs that cannot be parted with, use of a non-skid mat under the rug is essential to reduce the possibility of wrinkling and sliding.  Another common suggestion is to tape the edges of the throw rug down to avoid the edge rolling up or getting caught.  Of course always use extra caution when rolling over the edges (of rugs/ thresholds) to avoid a trip hazard.

4)      Keep walkways free of clutter to avoid the need to step over or move things with your feet or equipment while ambulating.  Most standard/basic walkers are ~18” wide so keep this in mind for clearance.  This can be especially difficult in smaller homes with narrow halls and doorways.  If this is the case for you, do the best you can and if possible ask for or get assistance. 

5)      In the bathroom install a grab bar in the shower to assist with standing tasks.  In the instance of a tub/shower combo use a tub transfer bench for easier and safer transfers.   In the instance of a shower stall use a shower chair.  In either case I always err on the side of caution in the case that balance could be an issue.   This way there is a place to sit if needed in a pinch.   Non-skid matting or stickers on the floor can be used to decrease slippage on wet tile.  For ease of toilet transfers, at the very least use a raised toilet seat either with armrests attached or a grab bar on the wall depending on the space available. 

6)      If there are stairs present in/out of the home be sure to use contrast as a marker for the edge of each step.  This can be done simply with electric tape or paint.  People with visual impairments can have difficulty judging where the edge of the step is without contrast.   

7)      In the kitchen be sure that commonly used items are kept within easy reach.  This means to use the bottom shelf of the upper cabinets and the top shelf of lower cabinets as much as possible.   One other tip I love to give is to keep dishes used daily in the dish rack.  This way they are literally within arm’s reach at a moment’s notice.

8)      In the bedroom, as in the kitchen, use top drawers or the easy to reach middle portion of the closet to make clothes retrieval easier.  This way there will be minimal bending and over- reaching for needed items.  Be sure to keep bed linens off the floor to avoid getting feet/walker caught and tangled causing a trip hazard.  

9)      Lighting is key!  Be sure that lighting is kept natural whenever possible.  Avoid glare off shiny objects such as the television or floor.   To achieve this you may only need to change your bulbs to a different wattage or change the position of a lamp to provide less direct light. 

I always remind clients that safety is key!  Each person and each home is different, but with the right foundation you can easily build or change these recommendations to suit your needs. 

Contributed by

Elizabeth R.K. Tomoso, OTR
Occupational Therapist
Independent Life Solutions


Tuesday, August 14th, 2012 by admin

As an occupational therapist, I often work with clients that have suffered a stroke.  The effects of a stroke, otherwise known as a cerebrovascular accident, can manifest in a number of ways.  It can range from slight weakness of the muscles to total paralysis of one side of the body.  The side of the body that is affected is the one opposite to the area of the brain that was injured.  This blog post will focus on those individuals who have completely lost use of one side of their body. 

In the past, rehabilitation facilities had therapists’ assess the client’s home prior to discharge.  This was done in order to make the discharge as efficient and effective as possible.  However, due to the overwhelming emphasis on work productivity, budget cuts, and cutting back on staff more and more rehab centers have abandoned this practice. Clients suffering from a stroke are being sent home with just the basic skills they have learned while at the rehab centers.

Individuals with a hemiparesis (paralysis of one side of the body) can present with many difficulties.  One of the areas mainly affected is the ability to perform Basic Activities of Daily Living (BADL’s).  This includes: bathing, grooming, feeding, dressing, and toileting.  They can also present with poor coordination, diminished sensation, speech difficulties, problems with swallowing, and cognitive impairments.  As a result, we will explore some ways to help these clients live more comfortable while at home.

To begin, it is important to assess the environment and remove anything that would hinder the performance of a daily routine.  This can be done by adapting the environment to include things that would make the setting more user-friendly.  For instance, two of the main areas that need to be looked at when assessing the environment are the bathroom and bedroom.  Sometimes remodeling is not an option; therefore, it is necessary to adapt the existing space.  Occupational therapists with their vast knowledge of assistive technology can help in selecting the right assistive devices and durable medical equipment to facilitate this task.

Currently, there are a number of items on the market that occupational therapists can recommend to assist in performing activities of daily living.  We often suggest that all self-care items be placed in an easy to access area.  It is also important to make sure that there is good lighting and ventilation in these areas.  In the bathroom, water temperature should be regulated to avoid getting burned.  When it comes to dressing, utilizing one- handed techniques has proven to be just as beneficial as using assistive devices to complete the task.  One- handed techniques allow the client with a stroke to use their unaffected side to aide in performing various tasks.  Consult with an occupational therapist to learn more about one- handed techniques.  In the meantime items such as elastic shoelaces, pants with a velcro fastener, and shirts with snaps or larger buttons can facilitate dressing activities.  As a rule of thumb, it is important that the individual performing the activity be seated on a firm surface with both feet placed on the floor to provide ideal support and optimal posture.

Mealtime is another difficult task to perform after a stroke.  It requires stabilizing the plate; gathering and/or placing food onto a spoon/fork; and stabilizing food while cutting. In order to help the individual successfully perform the task, it may be necessary to use assistive devices.  As a rule of thumb, during mealtime an upright sitting posture is essential.  It not only facilitates the activity, but also decreases the likelihood of aspiration (choking).  Thus, it is necessary to ensure that dining chairs provide proper support to maintain a good posture and that the table be at a comfortable height for the individual.  Currently, there is a vast amount of assistive devices that can help individuals with a stroke become more independent during mealtime.  Some frequently used items are a scoop dish/ plate, ergo plate, and rocker knife.  These items can help turn this experience from a frustrating one into a rewarding one.

Suffering from a stroke can be a life changing experience.  Even more so for those individuals with complete paralysis of one side of the body.  Hospitals and rehab facility programs are designed to make life after a stroke easier.  However, when the client goes home it tends to be a different story.  A combination of one- handed techniques coupled with assistive devices can help the client with a stroke live at home more comfortable and independent.  An occupational therapist can assist in training and selecting appropriate assistive devices. 


Miller Calberto, MS, OTR/L, CAPS
Senior partner
Adapting Spaces, LLC

Edited by Ester Gonzalez, MS, OTR/L, Bil TSHH 

Wounded Soldiers Regaining their Independence

Wednesday, May 30th, 2012 by admin

Memorial Day is a day of remembrance!  This is the day that we honor all of the brave soldiers that lost their lives in war and those that continue to sacrifice themselves for our country.  Many of these men and women not only lost their partners and close friends to war, but some have experienced other personal loses as well.  Daily, countless soldiers are injured and have to cope with living the rest of their lives with a physical disability such as an amputation or severe burns.  Others have to face the devastating effects of a traumatic brain injury.  Whatever effect the war may have had on them, they are now forced to face life with a different perspective.  What was once automatic and relatively easy has now become a challenge.  These life altering experiences make it difficult for soldiers returning home to resume their lives with the same level of ease and independence.  As a result, they often require rehabilitative services to increase their level of functioning and regain their lost independence.  

 Since World War I, occupational therapists have helped injured soldiers to heal mentally and physically. They have trained soldiers with disabilities to regain skills they need in order to function on a daily basis, as depicted on the TIME Magazine’s article “America’s Next War”. As occupational therapists, our goal is to help individuals with disabilities become more independent in performing day to day activities.  These may include activities that are meaningful and/ or purposeful such as bathing, dressing, grooming, moving around the home independently, preparing a meal, or returning to work after an injury.  As well as, those activities considered enjoyable such as leisure ones. Home modification is an emerging area of practice in the field of occupational therapy and one that is helping soldiers with disabilities adjust to civilian life.  Occupational therapists are uniquely positioned to provide this specialized service thanks to their in-depth knowledge of human function, task analysis, and the effect of the physical environment on human capabilities.   An adaptation or modification can consist of something as simple as installing a grab bar in the bathroom for support; lowering kitchen cabinets for those who are in a wheelchair; or installing a chair lift for accessibility purposes.  Through the implementation of home modifications, injured soldiers can regain their independence and engage in those activities that are important to them.  As occupational therapists, it is rewarding to know that we are able to provide such a unique service to those soldiers who have so graciously given so much. 


Esther Gonzalez, M.S. OTR/L Bil TSHH
Adapting Spaces, LLC

Autism: Making “Sense” of the World

Wednesday, May 9th, 2012 by admin

Every day, thousands of people are affected by Autism.  Autism is a disorder that can affect an individual’s ability to interact with others and engage in their environment.  Many children with Autism have difficulty perceiving and interpreting sensory input around them.  From the moment we wake up until we go to sleep, we receive information through our senses.  The way our brain makes sense of this information effects the way we respond to certain experiences.  If we perceive something to be harmful, we avoid it.  If we perceive it as being enjoyable, we are more likely to engage in it.  For children with Autism, this can be a big problem.  This inability to make sense of their world interferes with their ability to interact with others and engage in their environment appropriately.  As a result, they may exhibit adverse behaviors such as tantrums, outbursts, avoidance, and ultimately seclusion.  This can limit the opportunities the family has to bond with their child.  There is a way to help these children cope with these environmental stressors and decrease the occurrences of these adverse reactions.  Modifying one’s home to include a “sensory room” is one effective way.  The sensory room is tailored to the individuals needs and can be used to relieve and/or help the person cope with these involuntary responses to certain stimuli.  It contains various stations with specific sensory equipment and activities that are “less threatening” to the child.  The room is inviting and relaxing; it helps soothe and calm the person.  Some examples of things found in a sensory room are: bean bags; fiber optic/ led lights; bubble tubes; vibration/ massage chairs; ball pit; swing; sensory stations with various textures; calming wall colors; music station; and child- friendly padded floors and/ or walls.  We as Occupational Therapists specialize in and are knowledgeable in this area.  We evaluate the child and their living environment; as well as, provide helpful suggestions to keep your child safe and independent while at home.  Adapting the environment to include a sensory room would give you and your child the opportunity to bond more and enable your child to interact more freely in his environment. 

 April was National Autism Awareness month.  In light of that, we decided to take the opportunity to educate the public on how home modifications can be used to help make your home more user- friendly for your autistic child by including a sensory room.  If you have any questions about how to cope with the adverse effects of sensory processing or modifying your home to include a sensory room, feel free to give us a call.


Esther Gonzalez, M.S. OTR/L Bil TSHH
Adapting Spaces, LLC


Monday, January 23rd, 2012 by admin

Blindness or low vision affects approximately 1 in 28 Americans older than 40 years (Eye Disease Prevalence Research Group, 2004). It is important for these individuals to have the best lighting conditions wherever they are in order to maximize their vision.  Proper lighting is essential if you experience vision loss.  A good light source can make a dramatic effect on how you perform various activities of daily living such as reading, writing, and food preparation.  It can help you improve your independence and maintain your personal safety while at home.  When considering lighting, it is important to be able to manage or control the quality and quantity of light in your environment.  There are 5 different types of light with distinct characteristics.  Each one has advantages and disadvantages for individuals with vision loss.

1)      Sunlight:

  • The most natural source of light.
  • Can be used while performing any activity.
  • May create a glare problem or shadows.

2)      Incandescent:

  • Light bulbs used primarily for lamps and ceiling fixtures.
  • It is constant light that does not flicker.
  • Can be used for close work activities such as reading, knitting, sewing, etc.
  • May create a shadow or glare spot and uses more heat/ energy.

3)      Fluorescent:

  • Used primarily for ceiling fixtures.
  • Provides better lighting for a wider surface area.
  • Does not create a shadow effect and uses less energy.
  • Light can flicker and can not be dimmed as easily as a incandescent light.

4)      Combination:

  • Incandescent and fluorescent light.
  • Can be used for both illuminating a wide area of space and for close work tasks.
  • May require specialized lighting fixtures which can be expensive.

5)      Halogen:

  • More concentrated than the incandescent light bulbs and is usually used in lamps and recessed ceiling fixtures.
  • Gives good illumination and is more energy efficient than incandescent light bulbs.
  • It is not recommended for prolonged close work because the light is hotter.


Miller Calberto, MS, OTR/L, CAPS
Senior partner
Adapting Spaces, LLC