Approximately eight months ago, Jane, a 43 year old married female suffered cervical neck strain in a motor vehicle accident. As a result, she can no longer participate in activities that she previously was involved in, such as being a DATS (Disabled Adults Transportation Service) bus driver and helping her children with their homework. She was recently referred to a vocational rehabilitation center to undergo assessment and treatment due to ongoing reports of increased pain and headaches. Jane has been diagnosed with only a mild to moderate extension sprain of the cervical spine, and her prognosis is good. However, she must proceed with therapeutic activity at a slow and gradual pace. Jane complains of radiating pain between her shoulder blades, pain on the dorsum of her forearms and a constant frontal headache. Her headaches are aggravated by activities that consist of prolonged and/or repetitive neck and shoulder movements, such as shoulder checking while driving. Assessment of her ROM revealed limited neck flexion, lateral flexion and rotation, tightness of the upper cervical extensors, pectoral and scaleni muscles, weakness of the rhomboid muscles, spasms in the paraspinal muscles, and weakness in the upper extremity median nerve distribution. Although Jane's sensation was assessed to be intact, she complains of altered sensation in her fingertips. Due to the above physical limitations, the chosen therapeutic activity of drawing and coloring must be altered, adapted and graded accordingly.
Jane's physical disabilities can be accommodated for by adapting and grading the chosen activity of drawing/coloring. This will enhance strengthening, healing and proper functioning while reducing pain, discomfort and the chance of further injury.
The adaptations, grading and therapeutic benefits of drawing/coloring are as follows:
1. Adaptations - The seat must be adapted by incorporating adequate back supports and adequate head and arm rests.
2. Grading - Depending on the progress of the client, she can slowly remove the added supports.
Therapeutic Benefits - These adaptations will promote good posture and decrease awkward and stressful body positioning. Good seating will encourage Jane to use and strengthen the stabilizing muscles in her upper back, torso and neck. Eventually, this will allow Jane to sit for prolonged periods with more comfort and ease while driving. Having the arm rests positioned at an adequate height will enable Jane to rest her arms when they become physically stressed or fatigued.
2. Adaptations - The drawing surface must be adapted so that the plane is tilted towards Jane instead of being positioned horizontally.
Grading- By using an adjustable drafting table, this activity can be graded to accommodate Jane's functional progress. For example, as Jane gets stronger and more physically tolerant, the table could be gradually lowered and more horizontally positioned.
Therapeutic Benefits - The ability to adjust the tilt of the drawing surface is beneficial as this would enable Jane to draw/color without extensive or prolonged neck flexion. This would also promote the functional use and strengthening of her arm and forearm muscles as a result of not being able to rest them on a flat, horizontal surface. The recommended position of the drawing table should be midway between a horizontal and vertical plane. A vertical plane would cause further injury as beyond because of flexion beyond shoulder height. A good example of an adjustable drawing surface is a drafting table. A drafting table also allows for more than one individual to draw at any given time due to its large drawing surface. This could be used as a therapeutic means for Jane to interact with her family members.
3. Adaptations - The location of the drawing/coloring materials could be adapted by setting these materials up on either side of Jane or slightly behind her. This would encourage neck and trunk rotation and lateral flexion.
Grading - By adjusting the placement of the materials, the activity could be graded according to Jane's functional level. For example, the distance between Jane and the materials should be increased as she progresses.
Therapeutic Benefits - The following adaptation allows Jane to strengthen her neck muscles and help reduce fatigue and discomfort. This will help Jane shoulder check while in the DATS vehicle.
4. Adaptations - The duration of the activity should be adapted to meet Jane's needs. Prolonged sitting may aggravate the injury or induce the onset of early fatigue. Thus, it is important that the activity does not last for more than 20 to 30 minutes. Frequent breaks are necessary.
Grading - Gradually Jane can increase the duration of the activity as she becomes stronger and more physically tolerant.
Therapeutic Benefits - Her career as a DATS bus driver require her to rotate her head for shoulder checks. As well, she needs to improve her neck flexion for other activities. These areas will be worked on through the above adaptations.
5. Adaptation - A variety of graded tools and materials should be available to Jane at her drawing station. For example, drawing utensils could be varied in length, width and/or size..
Grading - These tools and materials will be graded to accommodate functional progress. For example, grading can be achieved by using a shorter pencil to promote forearm extension. If Jane fatigues early or has more strength and motivation, she also has the option to upgrade or downgrade the activity by choosing a more appropriate tool.
Therapeutic Benefits - With the use of a variety of tools, Jane's functional capabilities will begin to improve as she gains more strength. This will enable her to resume daily activities with comfort, ease, and enjoyment.
Secondary
Benefits
The activity of drawing/coloring also works as a good therapeutic medium
for addressing the psychological concerns of Janeís disability.
Drawing/coloring promotes relaxation, thus decreasing tension and frustration,
is a form of stress management, encourages emotional expression, reduces
boredom, promotes independence and self worth, and provides reassurance.
It also is a form of education teaching the client that the activity does
not necessarily mean tissue injury or pain and discomfort as long as the
activities are carried out slowly and gradually.