Method for putting on and taking off socks for people with tetraplegia

Abstract

FIELD: restorative medicine.SUBSTANCE: used to teach people with tetraplegia how to put on and take off socks independently. In a patient with tetraplegia, the range of motion of the upper body is determined within 5–15°, the presence of a hook grip with one finger of the hand. To perform the exercises, socks are used, on the sides of which two loops or two rings are attached to the top of each sock, or two holes are made for hooking with the fingers. Moreover, if the disabled person has the ability to perform movements of the upper body within 5°, then they are used to put on and take off socks with loops or rings. If a disabled person is unable to insert fingers into soft loops, metal rings with a diameter of 3 cm, made of an iron-nickel alloy, coated on the inside with polymorphus thermoplastic, are used. If the disabled person has the ability to perform bends from a sitting position within 6–15° and returning to the starting position without using the hands or with one hand, then holes with a diameter of 3 cm are made on the sides of the toe. Next, a course of 15 individual training sessions is carried out by an occupational therapist for 40 minutes daily in the morning in the presence of a caregiver, with 3-minute breaks every 10 minutes for the disabled person to rest. In the first 6 sessions, the disabled person learns to put on a sock on one foot, alternating feet every day. From the 7th session, the lesson includes training in putting on and taking off socks for 20 minutes on each foot. From the first day of classes, the disabled person and the caregiver practice putting on and taking off socks from each foot once in the evening. On weekends, put on and take off a sock from each foot twice a day, morning and evening. During independent exercises, the disabled person sits, and the caregiver places the shin of the leg on which the sock will be placed across the thigh of the other leg. The disabled person bends his body within 5–15° and throws the sock over the toes. Then, straightening up and leaning the torso back, the disabled person pulls the sock onto the forefoot. In this case, the disabled person leans back and turns the body in the same direction as the leg being put on, and pulls the sock onto the heel. Next, tilting the body to the side of the leg being put on, the disabled person pulls the top of the sock onto the shin. The caregiver lowers the disabled person's shin to the floor; to remove the sock, use a hook grip with the thumb of the hand opposite the leg. The disabled person grasps the loop, or ring, or hole on the inside of the sock and moves the toe down and toward the front of the foot, bending and turning the torso forward and to the side opposite the leg being undressed within 5–15°.EFFECT: social and everyday adaptation of disabled people with tetraplegia.1 cl, 4 dwg, 3 ex

Description

[0001] The invention relates to medicine, namely to restorative medicine, and can be used for independent putting on of socks by disabled people with tetraplegia.

[0002] Most people with tetraplegia experience difficulty putting on and taking off clothing, particularly socks. Special clothing has been developed for these individuals, but it does not include foot coverings, such as socks, knee-highs, or stockings. Reaching and putting on these items is difficult for people with paralysis.

[0003] There are devices for putting on socks and stockings addressed to other categories of patients, in particular, compression stockings (Device for putting on compression stockings Lyscov A.N. Patent for invention RU 2771119 C1, 04 / 26 / 2022. Application No. 2021118665 dated 06 / 27 / 2021).

[0004] The disadvantages of the device as applied to disabled people with tetraplegia are the need for a formed cylindrical grip for its use, which is absent in this pathology, and the presence of a bulky structure, which limits its use to the place of residence, or requires transportation together with the disabled person.

[0005] A device for putting on socks is known (Device for putting on socks Chufistov O.E., Pavlov A.I., Chufistov E.A., Zolkin A.N. Patent for utility model RU 220670 U1, 09.28.2023. Application No. 2022133165 dated 12.16.2022).

[0006] The disadvantage of the device as applied to disabled people with tetraplegia is that its preparation for each use is carried out by caregivers, thus the disabled person does not gain independence and autonomy, and caregivers are not freed from participating in the process of dressing the disabled person.

[0007] A device for putting on socks was proposed (Device for putting on socks Chufistov O.E., Chufistov E.A. Patent for utility model RU 227040 U1, 02.07.2024. Application dated 28.02.2024).

[0008] A disadvantage of this device is that it requires caregivers to assist with dressing, while the goal of social adaptation for a disabled person is to enhance their independence and autonomy. Furthermore, the device is quite bulky, limiting its use to the disabled person's residence or requiring transportation when the user moves.

[0009] There is a device for putting on socks by disabled people who do not have both arms (Device for putting on socks by disabled people Vorontsov F.S. Author's certificate SU 992052 A1, 30.01.1983. Application No. 3359211 dated 21.07.1981), containing rods for fixing socks, made from a twisted spring arc with hooks at the ends, located in a plane perpendicular to the arc, and bent in opposite directions.

[0010] The device has some drawbacks for use by individuals with tetraplegia: it requires coordinated leg movements, which this group lacks; it also requires hook and interdigital grips with the feet, which individuals with tetraplegia lack.

[0011] A sock (variants) is known that is equipped with a bandage in the ankle joint area, which consists of at least one bridge and one ring (Lambertz B.V. Patent for invention RU 2414154 C2, 03 / 20 / 2011. Bulletin No. 8. Application No. 2008134893 / 12 dated 12 / 19 / 2006).

[0012] The device has the following disadvantages:

[0013] 1. The socks do not have loops, rings or holes on the sides of the top for hook-and-loop fastening.

[0014] 2. A pinch grip is required to put on and take off socks.

[0015] 3. To put on and take off socks, you need to maintain a stable sitting position, bend, turn, and return to the starting position.

[0016] 4. Putting on and taking off socks requires active movements of the finger joints.

[0017] 5. Putting on and taking off socks requires active movements in the joints of the legs.

[0018] In the scientific and technical literature, as well as according to patent search data, no methods for putting on and taking off socks for disabled people with tetraplegia were found.

[0019] The purpose of the invention is to create a method for putting on and taking off socks by disabled people with tetraplegia, who have only a hook grip with one finger of each hand, allowing them to put on and take off socks independently, using only the existing hook grip.

[0020] The purpose of the invention is achieved by a method for putting on and taking off socks for individuals with tetraplegia. A patient with tetraplegia is assessed for upper body range of motion within 5°-15°, and the ability to use one finger to hook the sock. Then, for these exercises, socks are used with either two loops or two rings attached to the sides of the upper part of each sock, or two holes for hooking the fingers. If the individual can move the upper body within 5°, socks with loops and rings are used for putting on and taking off socks. The loops are made from cotton shoe laces, the ends of each loop are sewn to the top of the side surface of the sock for 1 cm, the length of the free loop is 7 cm. If the individual is unable to insert fingers into the soft loops, metal rings with a diameter of 3 cm, made of an iron-nickel alloy, coated on the inside with polymorphus thermoplastic, are used.If a disabled person is able to bend from a sitting position within 15° and return to the starting position without using their hands, or with one hand, then holes with a diameter of 3 cm are made on the side surfaces of the toe.

[0021] Then, the individual undergoes a course of 15 individual training sessions with an occupational therapist, conducted daily for 40 minutes in the morning in the presence of a caregiver, with 3-minute breaks every 10 minutes for the individual to rest. During the first 6 sessions, the individual learns to put on a sock on one foot, alternating feet each day. Beginning with the 7th session, the session includes training in putting on and taking off socks for 20 minutes on each foot.

[0022] From the first day of classes, the disabled person and their caregiver complete the following task: after completing all procedures and resting in the evening in the ward, put on and remove a sock from each foot once. On weekends, under the supervision and assistance of the caregiver, the disabled person completes homework: put on and remove a sock from each foot twice a day, morning and evening. Putting on socks involves the following steps:

[0023] 1) The disabled person is in a sitting position, the occupational therapist / caregiver places the shin of the leg on which the sock will be placed across the thigh of the other leg.

[0024] 2) the disabled person tilts the body within 5° - 15° and throws the toes over the toes;

[0025] 3) straightening up and leaning the body back, the disabled person pulls the sock onto the forefoot;

[0026] 4) tilting and turning the body in the same direction as the leg being put on, the disabled person pulls the sock onto the heel;

[0027] 5) tilting the body to the side of the leg being put on, the disabled person pulls the upper part of the sock onto the shin;

[0028] 6) The occupational therapist / caregiver lowers the disabled person’s lower leg to the floor;

[0029] To remove a sock using a hook grip with the thumb of the hand opposite the leg, the disabled person grasps the loop, or ring, or hole on the inside of the sock and moves the toe down and toward the front of the foot, tilting and turning the torso forward and to the side opposite the leg being undressed within 5° - 15°.

[0030] Novelty of invention:

[0031] 1. The basis is socks made of soft materials such as fleece, microfleece, wool, velour, terry, velvet, plush, velsoft, cotton and other pile or lint-free fabrics.

[0032] 2. On the sides of the upper part of the sock there are loops 7 cm long, designed for hook-like grip with the fingers of the hands, with the help of which the disabled person puts on and takes off the socks.

[0033] 3. On the sides of the upper part of the sock there are rings with a diameter of 3 cm, designed for hook-like grip with the fingers of the hands, with the help of which the disabled person puts on and takes off socks.

[0034] 4. There are 3cm diameter holes on the sides of the upper part of the sock, designed for hook-like grip with the fingers of the hands, with the help of which the disabled person puts on and takes off the socks.

[0035] 5. The method of putting on socks involves hooking the top of the socks through a loop, ring, or hole.

[0036] 6. The method for putting on socks involves tilting the body back, turning and tilting it to the same side as the leg being put on within 5° - 15°.

[0037] 7. The method for removing socks involves bending the torso forward, turning and bending to the side opposite to the leg being undressed within 5° - 15°.

[0038] The socks have loops, or rings, or holes on the sides of the top for hook-and-eye attachment.

[0039] 1. To put on and take off socks independently, tetraplegics only need to have a hook grip with one finger of each hand.

[0040] 2. Putting on and taking off socks with loops independently requires a 5° change in upper body position while sitting. Therefore, they can be put on and taken off by people with disabilities who are able to bend to a minimum angle (up to 5°) and return to the starting position with the help of additional support with one hand.

[0041] 3. Putting on and taking off socks with rings independently requires a 5° change in upper body position while sitting. Therefore, they can be put on and taken off by people with disabilities who are able to bend to a minimum angle (up to 5°) and return to the starting position with the help of additional support from one hand.

[0042] 4. Putting on and taking off socks with holes requires a 15° change in torso position. Therefore, they can be put on and taken off by people with disabilities who are able to bend their torso in a sitting position with an amplitude of up to 15° and return to the starting position with the help of additional support with one hand.

[0043] 5. People with disabilities who do not have active movements in the joints of their legs can put on their socks independently.

[0044] The combination of essential features allows us to obtain a new technical result:

[0045] 1. The proposed design of socks and the method of putting them on allow quadriplegic individuals with only a hook grip to put on and take off their socks independently.

[0046] 2. The socks of the proposed design serve as a training device for teaching independent putting on and taking off of socks using a hook grip with the fingers of paralyzed hands by tetraplegics, who are capable of eventually mastering putting on and taking off regular socks.

[0047] 3. Socks of the proposed design serve as a training device for restoring upper limb function and regulating sitting posture. Each independent donning and doffing of the socks, in addition to achieving the primary goal (putting on and undoing the feet), serves as a form of exercise aimed at restoring posture regulation while sitting and the function of the paralyzed upper limbs. The patient performs this exercise daily each time they put on and take off their socks.

[0048] 4. Socks of the proposed design encourage individuals with tetraplegia to use their paralyzed upper limbs to perform everyday functions, such as independently putting on and taking off socks. This develops skills in using their remaining motor abilities, contributing to the social and everyday adaptation of individuals with tetraplegia.

[0049] 5. Involvement of paralyzed upper limbs in appropriate motor activity: putting on and taking off socks of the proposed design forms an orderly polymodal afferent flow, which stimulates regression of neurological pathology.

[0050] The device is explained by the drawings shown in Fig. 1-4, which have continuous numbering.

[0051] Fig. 1-4 show socks with loops, rings and holes for hook-and-loop grips, options for putting on and taking off such socks by disabled people with tetraplegia.

[0052] Fig. 1 shows socks with loops made of cotton lace (A), rings made of metal covered with polymorphus thermoplastic (B), and holes in the side parts of the top of the sock (B).

[0053] Fig. 2 shows the process of putting on socks with loops at the top: A - putting on the forefoot; B - pulling on the heel; C - pulling on the ankle area; D - pulling on the shin.

[0054] Fig. 3 shows the process of putting on socks with rings at the top: A - putting on the forefoot; B - pulling on the heel; C - pulling on the ankle area; G - pulling on the shin; D - the sock is put on the foot.

[0055] Fig. 4 shows the process of putting on socks with holes in the upper part: A - putting on the forefoot; B - putting on the middle part of the foot; C - pulling on the heel and ankle area; D - pulling on the shin.

[0056] The method is as follows.

[0057] The range of motion of the upper body of a patient with tetraplegia is determined (within 5°-15°). To independently put on and take off socks, a hook grip with one finger is sufficient for tetraplegics.

[0058] The base is made from socks made of soft materials such as fleece, microfleece, wool, velour, terry, velvet, plush, velsoft, cotton, and other pile or lint-free fabrics. Two loops or two rings are attached to the sides of the top of each sock, or two holes are made for hook-and-loop gripping with the fingers.

[0059] The loops are made of cotton shoe lace. The edges of each loop are sewn to the top of the side surface of the sock for 1 cm. The length of the free portion of the loop is 7 cm (Fig. 1A). This length is sufficient for a hook-like grip with one finger. The cotton shoe lace is stiff enough to keep the loop pointing upward, eliminating the need for the user to bend over deeply to slip the sock over the forefoot.

[0060] If the disabled person is unable to insert his fingers into the soft loops, metal rings with a diameter of 3 cm are used, made of an alloy of iron and nickel, which provides them with strength and elasticity, covered on the inside with polymorphus thermoplastic to increase adhesion to the skin of the fingers and fixed to the top of the sock (Fig. 1B).

[0061] If a disabled person has the ability to bend from a sitting position within 15° and return to the standing position without using their hands, or with one hand, in order to avoid unnecessary clothing parts, holes with a diameter of 3 cm are made on the side surfaces of the sock instead of loops for a hook grip when putting on or taking off socks (Fig. 1B).

[0062] Custom-made loops, rings, or holes allow socks to be tailored to the individual's range of motion, number, and thickness of fingers needed to perform a hook grip with sufficient force to put on or take off socks.

[0063] To put on and take off socks with loops or rings, a 5° range of motion in the upper body is sufficient. To use socks with holes, a 15° range of motion is required.

[0064] The Sock Putting Method is a 15-session course of individualized instruction for a disabled person by an occupational therapist, conducted daily for 40 minutes in the morning in the presence of a caregiver, with 3-minute breaks every 10 minutes for the disabled person to rest. During the first 6 sessions, the disabled person learns to put on a sock on one foot, alternating legs each day. Starting from the 7th session, the lesson includes practicing putting on and taking off socks for 20 minutes on each foot. From the first day of the lesson, the disabled person and their caregiver are assigned to put on and take off a sock on each foot once after completing all procedures and resting in the evening in the ward. On weekends, the disabled person, under the supervision and assistance of the caregiver, completes homework: put on and take off a sock on each foot twice a day, morning and evening.

[0065] Putting on socks involves the following steps:

[0066] 1) The disabled person is in a sitting position, the occupational therapist / caregiver places the shin of the leg on which the sock will be placed across the thigh of the other leg;

[0067] 2) the disabled person tilts the body within 5°-15° and puts the toes on the toes (Fig. 2A, Fig. 3A, Fig. 4A);

[0068] 3) straightening up and leaning the body back, the disabled person pulls the toe onto the forefoot (Fig. 2B, Fig. 3B, Fig. 4B);

[0069] 4) tilting and turning the body to the side of the leg being put on, the disabled person pulls the sock onto the heel (Fig. 2B, Fig. 3B, Fig. 4B);

[0070] 5) tilting the body to the side of the leg being put on, the disabled person pulls the upper part of the sock onto the shin (Fig. 2G, Fig. 3G, Fig. 4G);

[0071] 6) The occupational therapist / caregiver lowers the disabled person's lower leg to the floor.

[0072] To remove a sock using a hook grip with the thumb of the hand opposite the leg, the disabled person grasps the loop, or ring, or hole on the inside of the sock and moves the toe down and toward the front of the foot, tilting and turning the torso forward and to the side opposite the leg being undressed within 5° - 15°.

[0073] Clinical Examples

[0074] Case 1. Elena M., born in 1996. Diagnosis: traumatic spinal cord injury, conduction disturbance starting from level C5, upper flaccid spastic paraparesis, lower spastic paraplegia. Disabled person, Group 1. At the time of starting the sessions, the injury had been present for 6 months. The patient was able to maintain a sitting position with additional support from the backrest and armrests of the wheelchair. Trunk range of motion (bending, turning, and returning to the starting position) was limited to 5°.

[0075] The occupational therapist was tasked with teaching the patient to put on and take off clothing, including independently putting on and taking off socks. Since the patient's range of motion while sitting was limited, socks with loops were made for the patient, requiring minimal changes in body position (within 5°) when putting on and taking off.

[0076] Training took place daily, individually, with an occupational therapist, for 40 minutes in the morning, in the presence of the patient's spouse. Three-minute rest breaks were taken every 10 minutes. During the first six sessions, the patient learned to put on a sock on one foot, alternating legs each day. Beginning with the seventh session, the session included practicing putting on and taking off socks for 20 minutes on each foot. From the first day of training, the patient was instructed to practice the learned sock-putting-on and take-off skills once per evening, on each foot, after completing all rehabilitation procedures and rest. The spouse's role was to prompt the patient with instructions and assist during the first days of training. On weekends, under the supervision and assistance of the caregiver (spouse), the patient completed homework: putting on and taking off a sock on each foot twice a day, morning and evening.

[0077] To teach putting on and taking off socks, the patient was seated in a wheelchair, the leg to be worked on, raised, and placed with the shin on the thigh of the opposite leg (Fig. 2A). From this starting position (SP), the patient learned to put on and take off socks. Using the index fingers of both hands to grasp the loops at the top of the sock, she pulled it over the forefoot, bending slightly. Then, with one hand, she gradually pulled the sock over the forefoot, heel, and lower third of the shin (Figs. 2B-D), straightening the torso. With the other hand, she supported herself against the armrest. To remove the sock, the patient learned to use the thumb of the opposite hand to grasp the loop on the inside of the sock, moving it downward and toward the forefoot. The exercise was then repeated, reversing the position of the legs and switching hands. For 15 days, the patient worked with an occupational therapist in the morning and independently with her husband in the evening.As a result, she learned to put on and take off her socks independently. The rehabilitation goal was achieved.

[0078] At the same time, the patient began to better maintain her sitting posture: she was able to sit for up to 7 seconds without additional support from her back and arms on the back and armrests of the wheelchair.

[0079] Case 2. Daygyl H., born in 1994. Diagnosis: traumatic spinal cord injury, conduction disturbance from level C4, type A, upper flaccid paraplegia, lower spastic paraplegia. Disability group 1. At the time of admission to the Rehabilitation Center, the injury was 8 months old. Duration of rehabilitation at the Center is 1 month.

[0080] Upon admission, the patient was unable to sit independently without a torso support, and had no active limb movements. The social adaptation task was set: putting on socks independently.

[0081] The patient was able to maintain a sitting position with additional support from the backrest and armrests of the wheelchair. Under these conditions, he learned to move his torso within 5°, moving his head and shifting his center of mass. The patient's arm and finger movements were limited in range, strength, and coordination. Therefore, socks with rings were used. Metal rings, 3 cm in diameter and coated with polymorphus thermoplastic, were attached to the outer and inner sides of the patient's socks.

[0082] Training in putting on and taking off socks with rings was conducted daily, individually with an occupational therapist, for 40 minutes in the presence of the patient's spouse. Three-minute rest breaks were taken every 10 minutes. During the first six sessions, the patient mastered putting on a sock on one foot, alternating legs each day. Beginning with the seventh session, the session included practicing putting on and taking off socks for 20 minutes on each foot. From the first day of training, the patient and his spouse were instructed to practice the acquired skill of putting on and taking off socks once per evening, on each foot, after completing all rehabilitation procedures and rest. On weekends, under the supervision and assistance of a caregiver (his spouse), the patient completed homework: putting on and taking off a sock on each foot twice daily, morning and evening.

[0083] To teach putting on and taking off socks, the patient was seated in a wheelchair, the leg to be worked on, lifted, and placed with the shin on the thigh of the opposite leg (Fig. 3A). From this position, the patient learned to put on and take off socks. Grasping the sock with a hook-like grip of the middle or index fingers of both hands by the rings at the top of the sock, the patient pulled the sock over the forefoot, performing a minimal lean. Then, gradually, with one hand, the patient pulled the sock over the forefoot, heel, and lower third of the shin (Figs. 3B-D), leaning back against the back of the wheelchair. At this time, the patient supported himself with the other hand on the armrest. To take off the sock, the patient learned to use a hook-like grip with the thumb of the opposite hand on the ring on the inside of the sock, moving it downward and toward the forefoot. The exercise was then repeated, changing the position of the legs and switching hands. For 15 days, the patient worked with a methodologist in the first half of the day and independently with his wife in the evening.As a result, he learned to put on and take off his socks independently. The rehabilitation goal was achieved.

[0084] At the same time, the patient began to maintain a sitting posture better: he was able to maintain a sitting posture with a straight back for up to 5 seconds without additional support with his back and arms on the back and armrests of the wheelchair.

[0085] Case 3. Vladimir A., ​​born in 2001. Diagnosis: traumatic spinal cord injury, conduction disturbance from level C6, type C, upper flaccid paraplegia, lower spastic paraplegia. Disability group 1. At the time of admission to the Rehabilitation Center, the injury was 4 months old. Duration of rehabilitation at the Center is 1 month.

[0086] The patient could maintain a sitting position without additional support on the back and armrests of the wheelchair, perform tilts and turns of the torso from this position within 15°, and to return and IP he needed additional support with one hand on the armrest of the wheelchair.

[0087] The occupational therapist was tasked with teaching the patient how to put on and take off clothing, including independently putting on and taking off socks. Taking into account the patient's ability to bend and twist his torso, he was given socks with holes. These socks don't add unnecessary bulk to his clothing and allow for a greater range of motion when putting them on, increasing the load on his postural muscles during the learning process.

[0088] Training took place daily for 40 minutes in the morning, with 3-minute breaks every 10 minutes, in the presence of the mother. During the first six sessions, the patient learned to put on a sock on one foot, alternating legs each day. Beginning with the seventh session, the session included practicing putting on and taking off socks for 20 minutes on each foot. From the first day of training, the patient and his mother were instructed to practice the learned skill of putting on and taking off socks in the evening once on each foot, after completing all rehabilitation procedures and rest. On weekends, the patient, under the supervision and assistance of a caregiver (the mother), completed homework: putting on and taking off a sock on each foot twice a day, morning and evening.

[0089] To learn how to put on and take off socks, the patient was seated in a wheelchair. The leg to be worked on was raised and placed with the shin on the thigh of the other leg (Fig. 4A). From this position, the patient learned to put on and take off socks. Using a hook grip with the index, middle, and ring fingers of both hands, the patient would slip the sock over the forefoot, leaning the torso toward the foot being put on. Then, using both hands, he gradually pulled the sock over the forefoot, heel, and lower third of the shin (Figs. 4B-D). This patient did not require additional hand support on the armrest to stabilize his posture and straighten his torso during the last 5 sessions. The patient learned to remove a sock by using the thumb of the opposite hand to grasp the hole on the inside of the sock, moving it downward and toward the forefoot. The exercise was then repeated, with the legs and hands reversed.For 15 days, the patient worked with an occupational therapist in the morning and independently with his mother in the evening. After 15 sessions, he learned to put on and take off socks with holes independently and began practicing putting on and taking off regular men's socks, which required greater hook strength and improved motor coordination. By the end of the training, the patient confidently took off regular men's socks, and was successful in putting on regular men's socks one or two times out of five. The rehabilitation goal was achieved.

[0090] At the same time, the patient began to maintain a better sitting posture: while sitting in a wheelchair, he was able to bend, turn, and return to the initial position without additional support from his back and arms on the backrest and armrests.

[0091] These socks have been used at the Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled for two years to support the social and everyday adaptation of individuals with tetraplegia. Successful work has been conducted with 24 patients, three of whom have learned to put on regular socks independently.

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