top of page
ree

Imagine this: you're an Occupational Therapist (OT) working in a bustling clinic, buzzing with activity. You've got a team of colleagues, access to a variety of specialized equipment, and a full schedule of clients. Now, picture yourself on the other side of the world, in a remote village with limited resources. Same mission – to empower people with disabilities to live their lives to the fullest – but with a completely different set of tools at your disposal.


That's the beauty of OT – it's adaptable. But how can we, as OTs, bridge the gap between well-equipped clinics and those with limited resources? Enter LEAN, a concept you might not typically associate with disability care, but trust me, it's a game-changer.


**The LEAN Toolbox: Tools for Transformation**


LEAN isn't just a one-size-fits-all solution, it's a toolbox filled with practical strategies that can be adapted to any situation. Here are a few key principles that OTs can leverage:


* **Value Stream Mapping:** This involves visually mapping out the entire client journey, from initial assessment to intervention. By identifying unnecessary steps or bottlenecks, like mountains of paperwork slowing things down, we can streamline the process and free up valuable time to focus on what matters most – our clients.


* **Eliminating Waste:** LEAN identifies seven types of waste, but in the context of OT, we might focus on things like excessive documentation that doesn't directly benefit the client, waiting times for appointments or equipment that could be used for therapy, or underutilized resources like a therapist's expertise being bogged down by administrative tasks. By minimizing these wastes, we can maximize the impact we have on our clients' lives.


* **Continuous Improvement:** LEAN is all about a never-ending quest to get better. This means encouraging open communication with colleagues and clients to identify areas for improvement and constantly refine our processes. Maybe a client suggests a simpler way to track their progress, or a colleague notices a more efficient way to schedule appointments. Let's embrace these suggestions!


* **Standardization:** While every client is unique, there are often common elements in our interventions. By standardizing certain procedures, like basic assessments, we can ensure consistency and efficiency without sacrificing quality on the crucial individualized care plans we create.


**Making Every Minute Count, With or Without Fancy Equipment**


Let's face it, in some settings, we're not going to have access to a fancy gym full of equipment. But that doesn't mean we can't be effective. Here's where we, as OTs, truly shine. Innovation and resourcefulness are woven into the very fabric of our profession.


We **don't** need to be reminded that fancy equipment isn't the key. We **already** know this! It's time to embrace that inherent creativity and flexibility, the skills that often set us apart from other medical professionals.


Think about it: can't afford a fancy balance trainer? No problem! Let's use some strategically placed pillows or a chalk line on the floor to create a balance beam. This isn't about reinventing the wheel, it's about getting back to the core of OT – using our ingenuity to create new pathways to meet the same goals.


**The Bottom Line: Empowering Your Practice with LEAN**


At the end of the day, whether you're working in a bustling clinic with all the bells and whistles or a remote village with limited resources, the goal remains the same: improving the lives of people with disabilities. LEAN principles give us the tools to do that more efficiently and effectively, regardless of the environment.


So next time you feel bogged down by paperwork or limited resources, remember this: a little LEAN thinking combined with your inherent OT superpowers can go a long way. Let's revolutionize disability care, one village clinic (or bustling center) at a time.

 
 
 
ree

The Art of Adaptation: Crafting a Princess-Worthy Wheelchair in Indonesia


A number of years ago, I had the privilege of meeting Anya, a vibrant seven-year-old living with quadriplegic cerebral palsy. Her bright eyes and mischievous smile were a stark contrast to her ill-fitting borrowed wheelchair. As an occupational therapist, I was eager to contribute to the ongoing efforts to improve Anya's mobility and comfort.


The challenge was creating a custom seating system that addressed multiple needs: proper support, pressure distribution, and comfort – all while contending with the relentless Indonesian heat and limited resources. It quickly became clear that textbook solutions from Western clinics wouldn't cut it here.


One crucial aspect I had to consider was 24-hour positioning. However, Anya's family shared that she spent significant time on the floor, which meant the wheelchair wouldn't be her primary seating option. This insight was vital in shaping our approach. We needed to strike a balance between providing adequate support and creating a chair that could be easily folded and transported in the family's small car.


The local team's approach was heavily influenced by the book "When Helping Hurts" by Steve Corbett and Brian Fikkert. This philosophy aligns perfectly with the principles of Community-Based Rehabilitation (CBR). Both emphasize empowerment over handouts, and sustainable solutions over quick fixes.


In Anya's case, this meant:


1. Avoiding the temptation to import expensive, hard-to-maintain equipment

2. Focusing on solutions that could be replicated and repaired locally

3. Involving Anya's family in the design process to meet their specific needs

4. Building local capacity by working alongside Indonesian therapists and craftspeople


The team had already done incredible work in understanding Anya's world. They shared insights about her family's priorities, cultural context, and daily routines. School was important, mealtimes were crucial, but nothing topped playtime with her siblings.


The solution that emerged wasn't textbook-perfect, but it was brilliantly practical. We used breathable mesh fabric for the seat to allow crucial airflow in the sweltering climate. Foam padding was strategically placed for support without compromising comfort or the chair's ability to fold. We also explored alternative seating options for her floor time, ensuring a holistic approach to Anya's positioning needs.


This experience offered valuable lessons for Western therapists engaging in global health projects:


• Approach with humility and openness to learn

• Invest time in understanding local cultural contexts and family needs

• Focus on partnership rather than imposing solutions

• Embrace resourcefulness and creative problem-solving


By integrating the "When Helping Hurts" approach with CBR practices, we ensured that our efforts would have a lasting, positive impact. We weren't just solving an immediate problem; we were laying the groundwork for ongoing, community-driven support for children like Anya.


Anya's story highlights the persistent challenge of resource limitations in developing countries. It's a call for increased support for therapists in these settings, but also a testament to the power of ingenuity and adaptability.


In the end, the "best" solution isn't always the most technologically advanced. It's the one that empowers a child, respects family values, and integrates seamlessly into their unique world. Sometimes, that means thinking outside the box – or in this case, reimagining the wheelchair entirely.


As I reflected on my brief time with Anya and the dedicated local team, I was reminded that sustainable change comes through collaboration, cultural understanding, and a willingness to adapt. This experience underscores a crucial lesson: effective assistance, especially in healthcare, must be culturally sensitive, economically sustainable, and deeply rooted in community involvement. It's not just about the wheelchair – it's about fostering an environment where local innovation can thrive long after foreign helpers have gone home.


These lessons will undoubtedly shape my approach to future projects, both at home and abroad.


Carey Cheung

Occupational Therapist

International Disability Consultant

 
 
 

ree

A young girl in a rural village, eager to help her family make chapatis, the beloved flatbread that's a staple in many Asian households. There's just one catch – her cerebral palsy makes handling a traditional rolling pin a real challenge. This scenario isn't just a hypothetical; it's a daily reality for many occupational therapists (OTs) and allied health professionals (AHPs) working in resource-limited settings. How do you provide effective assistive technology (AT) solutions when fancy equipment is out of reach?


This is where creativity becomes our secret weapon. Let's dive into the world of MacGyver-style AT – adapting everyday objects and readily available materials to create game-changing interventions. Spoiler alert: it's all about embracing trial and error, collaboration, and a healthy dose of flexibility.


**Assistive Tech: More Than Just High-Tech Gadgets**


Before we roll up our sleeves, let's broaden our understanding of AT. It's not just about cutting-edge electronics – AT has been around for millennia! Did you know eyeglasses were invented in Italy between 1268 and 1289? Or that the first recorded wheelchair dates back to 5th Century China?


ree

AT solutions range from no-tech to high-tech:


- No-tech: Using blue paint on floors for wayfinding to elevators

- Low-tech: Homemade grips on utensils or tools

- High-tech: Eye-gaze activated speech generating devices


The beauty of AT is its versatility. Solutions can be store-bought, modified (like tennis balls on walker legs), or even custom 3D-printed prosthetics!


**The Science Behind Simple Solutions**


Studies in Community-Based Rehabilitation (CBR) consistently show that low-tech AT can pack a serious punch. The World Health Organization's "CBR Guidelines" hammer home a crucial point: effective AT needs to fit the cultural context and be affordable. It's not about the fanciest gadgets; it's about what works in real life.


A review published in "Disability, CBR, and Inclusive Development" takes this even further. Their findings? In resource-limited settings, those DIY, low-tech solutions often outperform their high-tech counterparts. It's a powerful reminder that ingenuity trumps big budgets every time.


**From Struggle to Empowerment: The Chapati Maker Revolution**


Remember our aspiring chapati chef? While tweaking techniques and seating positions can help, sometimes the answer is delightfully simple. Enter the store-bought chapati maker – an affordable kitchen tool that flattens dough with minimal hand strength required. Suddenly, our young friend isn't just watching from the sidelines; she's an active participant in a cherished family tradition. That's the real magic of AT – it's not just about tasks, it's about belonging and independence.


ree

**5 Low-Tech AT Hacks You Can Try Today:**


1. **Utensil Makeovers:** Got a client struggling with forks and spoons? Time to raid the garage! Bicycle grips, pool noodles, or even foam pipe insulation can transform skinny handles into graspable tools. Suddenly, mealtime isn't a frustrating ordeal – it's a chance to reclaim independence.


2. **Grip Boosters:** Writing, brushing teeth, or any fine motor task giving someone trouble? Think texture and size. Wrap pens and toothbrushes with foam grips or bicycle handlebar tape. It's amazing how a little extra circumference can make a world of difference in control and comfort.


ree

3. **DIY Throne Lifts:** For folks who find standing up from chairs a challenge, especially around toileting, consider some strategic height boosters. Sturdy wooden blocks or bricks can create instant raised seating. It's a simple hack that can dramatically increase confidence and reduce the risk of falls.


4. **Dressing Made Easier:** Buttons and zippers can be tricky for some. Enter zipper pulls and button hooks! These simple tools can transform frustrating mornings into smooth sailing.


5. **Low-Tech Reminders:** For individuals needing memory support, try visual schedules or to-do lists using pictures or symbols. A basic whiteboard can become a powerful organizational tool.


**Exploring AT Categories**


AT solutions span a wide range of needs. Here's a quick overview of some major categories:


- Vision: Magnifiers, talking devices, Braille displays

- Hearing: Personal amplification systems, vibrating alarms, captioning devices

- Speech: Voice amplifiers, communication boards, speech-generating devices

- Cognition: Memory aids, text-to-speech systems, reminder apps

- Mobility: Wheelchairs, walkers, canes, scooters

- Daily Living: Adapted kitchen tools, reachers, switch-adapted appliances

- Environmental Control: Door openers, ramps, remote-control systems

- Computer Access: Alternative keyboards, voice recognition software


**Teamwork Makes the Dream Work**


Here's a pro tip: involve everyone in the brainstorming process. The person with the disability, their family, even local craftspeople – they all bring unique perspectives to the table. Their lived experiences and practical know-how often lead to the most ingenious, culturally-appropriate solutions. Remember, we're not just solving problems; we're building community in the process.


**Your Turn: Share Your AT Wins!**


This is just the tip of the iceberg, and we want to hear from you! What low-tech AT hacks have been game-changers for your clients? What challenges are you still trying to crack? Share your stories in the comments below. Together, we can build a global toolkit of accessible AT solutions, empowering individuals with disabilities to thrive, no matter where they call home.


**Let's Keep the Conversation Going:**


* What's the biggest AT roadblock you've faced in your community, and how did you tackle it (or how are you planning to)?

* Tell us about an "aha!" moment where a simple AT adaptation made a huge difference for someone.

* How can we better connect OTs, AHPs, and local communities to create sustainable AT solutions? What's worked for you?


Remember, the most brilliant solutions often come from the most unexpected places. So let's get creative, share our wins (and our learning experiences), and keep pushing the boundaries of what's possible with AT!


Carey Cheung

Occupational Therapist

Global Disability Consultant

 
 
 
bottom of page