WORK & EXERCISE FOR HIGH-LEVEL QUADS
By Arthur Heyer
This is a condensed & updated copy of a paper
presented at the Sixth Annual CSUN Conference "Technology and Persons with
Disabilities",
Los Angeles, Calif., March/1991, pp. 399-407 of the Proceedings.
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THE CONTENTS:
ABSTRACT
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Combining function with exercise without sacrificing efficiency is the
goal. A mouthstick and equipment designed around the use of the mouthstick
are presented as probably the best means for work and exercise for many high-level
quads.
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INTRODUCTION
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So far, attention to exercise has been given to people
who can use their limbs. For example, paraplegics are strongly encouraged
to use their functional limbs to combine exercise with mobility. But little
or no attention in the area of exercise has been given to high-level quads
who have functional neck and shoulder muscles. Actually, the physical capabilities
of high-level quads have often been severely underestimated. The use of
some electric or electronic devices, which were initially designed for very
immobile persons, has been wrongly extrapolated to less immobile persons,
such as C-3 or C-4 quads.
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ELECTRIC PAGE TURNER
VS. A MOUTHSTICK
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For example, some counselors recommend the purchase of
a $500 electric page turner for their quad patients who could very well use
a mouthstick. A mouthstick, that is, a well designed mouthstick with a sturdy
"Y"-shaped mouthpiece and tubular body, is the best page turner; one that
can turn one or 100 pages at a time, back and forth. An electric page turner
can turn only one page at a time. It would be terribly impractical to use
any dictionary or reference book with a page turner that can only turn one
page at a time. Additionally, a mouthstick is useful for many other tasks,
such as typing, dialing the telephone, operating a calculator, remote controls,
etc. It can also be used for handling papers, filing and retrieving them,
etc. Additionally, a mouthstick costs a fraction of what an electric page
turner costs, and it promotes exercise!
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EXERCISE
IS IMPORTANT FOR EVERYBODY back to The Contents
Exercise is as important for high-level quads, as it is for
anybody else. And, because exercise is only possible with the use of functional
muscles, the rehabilitation of high-level quads should be directed towards
the use, as intense as possible, of all residual functional muscles.
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WORK
& EXERCISE WITH A MOUTHSTICK back to The Contents
Quite unintentionally, the use of a mouthstick and the
equipment designed around it has resulted in an advantageous combination
of efficient work with exercise. My own experience of 32 years as a heavy
mouthstick user, plus the experience of those who are also using one, makes
me state as a fact that a sturdy and well designed mouthstick is the best
tool available for use by persons who have no functional arms or legs, but
who have functional neck and shoulder muscles.
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MOVING &
STRETCHING back to The Contents
My work-station is designed around a range of neck motion
I have in all directions. During my work, where I do typing, telephoning,
reading, filing, etc., I reach up and sideways frequently. For example,
the muscles of my neck stretch much when I am tuning my radio, which I have
conveniently placed on a second level of my workstation.
| When this paper was first published in 1991, I still had the need
to regularly place a diskette into the upper disk drive of my TRS-80 computer.
For this operation, I had to exercise much care, because I didn't want
to drop the diskette. I had to stretch to my limits and concentrate at the
same time. I remembered Kun-Fu every time I had to do this, and there was
a nice feeling of accomplishment after every successful disk insertion.
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But, as technology advanced, I found one less opportunity in my office
setting to reach and stretch. I got a 368sx computer with a 105 mb hard
drive, and I no longer needed to stretch for inserting a diskette. I then
needed to think of something else to have to do to take its place.
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WORK AND EXERCISE
WAS FUN WITH
THE MOUSE X-Y HELPER
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| In search for new functional independence, and to compensate for
the lost excuse to exercise, I designed the Mouse X-Y Helper. It was a
mechanical means to operate a regular computer mouse with a mouthstick.
Not only did this device allow a mouthstick user to operate
a mouse as well and as easily as an able-bodied person does by hand; it was
also fun, and best of all, it gave the user an excellent opportunity to work
and exercise at the same time. It was simple mechanics: a tilted board with
a smooth surface, an x-y set of linear bearings and tracks, a holder for
the mouse, and a spring-loaded counterweight.
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| But the apparatus was too large to use in conjunction with my 101-key
keyboard, and I chose instead to use a new Track Ball pointer that had
a "drag" button that locks. I was no longer able to compete with everybody
else by using the Track Ball pointer. Having to leave the ball in
order to depress the buttons slows down the operation to at least half the
speed. The efficiency, the fun and the heavy exercise all vanished.
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DIGNITY
vs. MOTIVATION
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A handicapped individual may feel uncomfortable with
the idea of putting a mouthstick in his/her mouth. I refused it when my
father first made one for me to try. It felt like an insult to my dignity.
But I tried it, just not to let my father down. After
all, he was only trying to help. Well, not 3 minutes passed before I felt
in love with it. For the first time in 3 months after my accident, I was
able to do something by myself!
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NO REASON TO FEAR
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It has been recognized that the use of a well designed mouthstick,
such as the H-A Modular Mouthstick (by Extensions for Independence), does
not cause harm to the user's teeth or molars, but on the contrary, it makes
them stronger! And that the use of the mouthstick involves not only the
muscles of the neck and shoulders, but all the muscles available to the
user that he/she can still move at will, such as the biceps, etc.
PROVEN BENEFITS
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| For example, I have learned from experience that, while typing
with a mouthstick strengthens the muscles of the neck and shoulders, "hand"
(mouth) writing puts all available muscles to work. And why is this so?
I don't know for sure. A theory is that while typing requires less precise,
but definite motions, "hand"writing requires a more complicated set of concentrated
precision motions, which of course involves a greater number of muscles.
Some of these muscles, such as the biceps, seem to work in maintaining equilibrium
in the process. I remember that I had much stronger biceps when I was at
school and had to do a lot of "free" writing. Now that I type most everything,
my biceps are weaker, much weaker.
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WITH EFFICIENCY
ALSO IN MIND back
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Efficiency is important. If a speech-recognition upgrade on
my computer is going to allow me to input 50 words per minute instead of
25, and if I do a lot of writing and time is highly valuable to me, I should
use one. But I don't have to give up my mouthstick. Instead, I could learn
to coordinate the pressing of keys with talking, after all, the H-A Mouthstick
was specifically designed with talking-while-using in mind. The combination
might result in 60 or more words per minute! I can't wait to try this.
SIMPLE IS BEST
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At this point, I cannot think of any combination of electronic
equipment which could surpass or even equal the general function of my mouthstick.
The mouthstick serves me for many other tasks which are typical for office
work. I would not give it up, even if it were not also a great instrument
for exercise.
Instead of ever thinking of underestimating the usefulness
of my mouthstick, I would first find a substitute which would give me both,
the function and the exercise, and which would only cost more in the proportion
that would be better.
HEALTH AND FUNCTION
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I am not going to talk for the persons with conditions I am
not familiar with, but I can talk for myself and for those in a condition
similar to mine. A high-level quad can live a healthier and more productive
life if he or she exercises regularly. And the more he/she exercises, the
better.
I therefore strongly advocate careful selection of the methods
a patient should be treated with to accomplish functionality. For example,
I very much question the need to fuse the vertebrae of a high-level quad's
neck, which, on the other hand, reduces his chances for otherwise fuller
functionality.
| The motion of the neck is a great asset for the rehabilitation
of a C-4 quad. The more he or she can move the neck, the better he or she
will be able to use a mouthstick. Surgeons, therefore, should re-consider
before they fuse the cervical vertebrae of a broken neck. Is it a must,
or should an alternative method be considered?
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HOW MUCH EXERCISE?
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Nobody knows what amount of exercise is best for anybody. But
everybody agrees that, unless a special condition prevails, the more a person
exercises (within reasonable limits), the better fit he or she will be. Likewise,
the less a person exercises, the less chances he or she will have to live
a long and healthy life.
CONCLUSION
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If a quad has only one functional muscle, he should exercise
that muscle as much as possible. If he has two, he should exercise both...etc.
Two things count in exercising: the muscle itself, which becomes stronger,
and the heart, which also becomes stronger. It is the condition of the
heart which matters most, and the heart doesn't feel the difference whether
it is one or 20 muscles being exercised. It only feels the overall intensity
of the exercise, and the use of a mouthstick can be very intense, if it
is used for everything.
A mouthstick is also a simple tool, which is relatively cheap
and does not break easily. It is very versatile: it can be used for many
things, such as typing (on any keyboard, of a computer, typewriter, calculator,
etc.), dialing or pressing the buttons of a telephone, turning pages of
books, filing, operating remote controls and switches, and also, it doesn't
tie the user to anything. The user picks it up when needed, and puts it away
when it is not needed.
Let those who can't use a mouthstick, not to use one. But if
a patient has no use of hands or arms, but has control of the muscles that
move his head and wants to be functionally independent and keep physically
well at the same time, urge him or her to use one!
REFERENCES/PUBLICATIONS
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(Note: copies of the papers and articles from this list are
available on request. Please allow 2-4 weeks for delivery.)
- "Work & Exercise For High-Level Quads", Proceedings
of the Sixth Annual CSUN Conference (Technology and Persons with Disabilities),
Los Angeles, Calif., March/1991, pp. 399-407.
- "Five New Pieces of Equipment for Quads", Proceedings
of the Ninth Annual Conference on Rehabilitation Technology, RESNA, Minneapolis,
Min., June/1986, pp.96-98.
- "Creating new avenues for Independence", Paraplegia News,
Sep/1983, p.58. 8. "Equipment Makes the Difference", Proceedings of the
6th Annual Conference on Rehabilitation Engineering, San Diego, 1983.
- "The Heyer-Abadie 'Talking' Mouthstick", Proceedings of
the International Conference on Rehabilitation Engineering, Toronto, 198O,
pp.344-347.
- "Functional Independence for High-Level Quads with a 'Talking'
Mouthstick and 'Peripheral' Equipment", Proceedings of the 5th Annual
Conference on Systems and Devices for the Disabled, Houston, 1978, pp.66-69.
- Custom-Designed Office for a Mouthstick User", Reh.Gazette,
1978/Vol.XXI, pp.38-39.
- "Preparing Quads for Independent Living", Reh.Gazette,
1976/Vol.XIX, p.31.
- "Liaison Engineer", Rehab.Gazette, 1975/Vol.XVIII, p.17.
- "Engineering", Rehabilitation Gazette (American Rehab.
Journal), 1971/Vol.XIV, pp.32-33.
- "Quad Engineer Puts Talent to Work", Responaut (English
Rehabilitation Journal), Sept. 1972.
Note: most of the equipment
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