If there is an easy way to solve a problem why take the hard way?

Equipment is given to people to enable them to do tasks or occupations that they may not otherwise be able to manage independently. This could be because of:

• pain;
• weak muscles; or
• shortness of breath.

Sometimes equipment will be offered to keep someone safe. In the case of people with rheumatoid arthritis the specialised equipment is most often given out in order to protect joints from unnecessary strain. The reduced strain on the joints will help to reduce pain.

A study by Nordenskiold1 in 1994 reported that pain decreased significantly when the subjects were using assistive devices (disability equipment). The report stated:

‘assistive devices increase the capacity and the ability to work at home and outside the home.’

On the whole many people with rheumatoid arthritis are likely to be apprehensive about using special equipment because they feel labelled as ‘disabled’ if they use it. Generally speaking changing the environment, the technique being used or buying useful items that are universally available will be more acceptable. In fact many items that are useful for people with disabilities would be very useful for other people to use too. The following pages outline some of the most useful items that may be of help to you in your everyday life as well as some suggestions to make life easier for you. Ask your local Social Services or Citizens’ Advice Bureau for details of a local disability resource centre or shops that sell disability equipment. Social Services may be able to give you equipment if it is needed for essential activities of daily living.

EQUIPMENT FOR THE KITCHEN

Kitchen equipment is the most usual equipment that you are likely to be offered. This is because almost everyone is involved in drink and meal preparation every day of their lives, so it makes sense to reduce the strain on joints and minimise the likelihood of deformities.

Drink preparation

Use a light kettle or a kettle tipper (see Figure 6) and a light plastic jug to fill the kettle. Use a mug with a substantial handle. Kettle tippers are not always the answer if there are a lot of people sharing the kitchen and they also tend to make people feel disabled. It may be better to have a small or light kettle. Alternatively use two hands to lift the kettle.

Meal preparation

• Ensure knives are sharp. You can use knives with L-shaped handles if you have limited strength (see Figure 7).

• Choose utensils with wide grip handles, and pans and dishes that are light or double handled. This type of equipment is now more universally available than it used to be when I first needed it. You could use a frying basket to lift vegetables out of the water and then you can empty the saucepan separately when it is lighter. Alternatively you can steam vegetables or put them into the microwave on a light dish.
• Save the trouble of peeling potatoes by cooking jacket potatoes or boiling potatoes with their skins on. If they need to be peeled use a potato peeler with an enlarged handle or use my method as discussed previously.
• Use a wall tin opener or an electric can opener for your tins.
• There are many bottle and jar openers available but try them out before you purchase any. I have a v-shaped opener that is fitted under a wall cupboard and this has been successful over the years for opening jars and bottles (see Figure 8a and 8b). Ring pull tins may be opened by using a knife as a lever to release the pressure and then by using the knife to assist in levering the lid off. Alternatively turn the tin upside down and use the tin opener or purchase a ring pull opener.

• I have also found that a food processor is an essential requirement if you intend to do a lot of chopping and grating. If at all possible plan the kitchen so that pans can be slid along, to save lifting, and ensure that worktops are the appropriate height for what you are doing. Take care when you are choosing equipment: always try it out as much as possible.
• Lastly always have a good pair of scissors handy for all that awkward packaging that is so irritating!

EQUIPMENT AND TIPS FOR PERSONAL CARE

Washing/showering/bathing

Equipment will probably not be needed unless you have problems with your hips and knees or are having a flare-up of your symptoms. In this case you may need some bath equipment. There are many different types of bath-boards and bath-seats available so do your homework thoroughly before purchasing. There are also various types of battery-powered lifts that will allow you to press a button and rise up and down from the bottom of the bath.

A bath is very beneficial when you have rheumatoid arthritis as the warm water relaxes muscles and eases pain. Alternatively use a shower. The effect is not so relaxing but it does keep you clean! A power shower is almost as good as having a bath. It may be difficult to reach around your back so a long-handled sponge or a loofer with handles can be useful.

I have found shampoo blocks are very useful as bottles are sometimes difficult to hold and to open. I tend to use sponges and shower gel to wash with. Sponges are easier to squeeze out and cover all the body much more easily than flannels. Buy shower gel in containers that are easily squeezable or leave bottles upside down, ready for use.

Cleaning teeth

To clean teeth choose a brush with a thick handle or an electric toothbrush. Take care when choosing toothpaste because some tubes and pump action toothpastes are much easier to squeeze than others. You can squeeze out the toothpaste by squeezing the tube with your arm placed on top, if it is painful or difficult to use your fingers.

Shaving

Try out any electric shaver that you intend to buy to ensure that you can manipulate it, or otherwise you could use light plastic disposable razors if this is easier for you.

Make-up

I normally use a make-up sponge as this puts less strain on joints and is also better for the skin. Choose products that have a wide handle and tubes that have larger lids and are easy to squeeze. Alternatively use jars with wide necks.

CLOTHING

The hands are usually the first joints to be affected by rheumatoid arthritis, and getting dressed may be difficult due to stiffness, pain and weakness. Any damage to joints, especially if there are any deformities, will reduce function because of the loss of the range of movement at the joints. In either case it makes sense to have clothes that are stretchy or loose fitting, and easy to get in and out of. Buttons and zips should be an adequate size to be managed with the least strain on joints. There are gadgets for pulling zips up and down if these are needed; alternatively attach a length of ribbon or cord. Velcro fastenings can be useful although Velcro does wear out more quickly if it has to be opened a lot, for instance Velcro at the opening of trousers. A dressing stick may be useful if it is difficult to get jumpers, tops or coats on and off (see Figure 9). It can also be used to pull up socks or reach items that are too high.

Shoes

Footwear is very important. Always wear shoes that support the arch and the inside of the foot. If you are going for a long walk then boots or shoes that give good support to the ankle are also a good idea. The sole of the shoe should be capable of cushioning the foot on hard or uneven ground. It will then act as a shock absorber which will help to prevent damage to the joints and will reduce pain in the feet. The heel should always be supported too, otherwise the shoe has to be held in place by the muscles and joints and ligaments of the foot. Socks should be loose fitting so that they do not constrict the circulation, particularly if there is swelling.

If it is uncomfortable or painful to walk then a referral to podiatry (the foot health service) may well be useful. At foot health you may have a bio-mechanical assessment. The chiropodist will assess the way that you walk to see how you are using your joints and muscles. Your feet will be examined and then you may be prescribed orthoses (inserts) for your shoes. These will improve the positioning of your feet when you are walking and help to prevent further deformities. They will also make it more comfortable to walk. The chiropodist will also give advice about footwear and foot-care.

I have never been able to wear shoes with heels higher than an inch or two and now I rarely wear tights or stockings. It is just too difficult to put them on and not worth the trouble except on very special occasions. It is a good job that I am happy in trousers with buttoned blouses and tops, which I wear with zipped up jackets and cardigans. I have to be careful when I am trying them on.

I could easily become stuck and unable to get clothes off whilst I am in the fitting room! I always start the selection process by thinking: is the neck big enough? Are the sleeves wide enough? Can I manage the fittings? Is this too tight-fitting for me? After that I can then think about the style and whether it suits me!

I can never understand why so few fitting rooms have chairs or call buttons. Once when I asked for a chair I was told that there was not one in the whole shop. The assistants obviously had to stand all day long!

SELECTING FURNITURE

Beds/chairs

As new furniture is purchased ensure that the height of the seat or bed is appropriate for you so that you can get on and off without struggling and putting a strain on the knee and hip joints (see Chapter 5).

• Chair and bed raisers can be used to raise the existing furniture if this is necessary.
• The toilet should also be an adequate height and many are made too low. If it is a struggle to get off then a raised toilet seat can be fitted. Alternatively toilets can be raised on plinths, however this is a lot more expensive.

Taps and fittings

• Lever taps are best and these can be purchased in most general DIY stores.
• Ensure washers are changed regularly and taps are not turned off too tightly.
• Lever handles are always more suitable than knobs for all your doors.
• Ensure that any drawers run in and out easily.
• Plugs on vacuum cleaners and irons that are used frequently should be changed for plugs with handles (see Figure 10). These will protect joints and make it easier to pull the plugs out.

• If keys or doorknobs are difficult for you to manage then key turners or knob turners can be bought to give more leverage (see Figure 11 and 12).

• Choose phones that are easy to hold, with buttons that can easily be depressed.
• Use pens with wide handles or use a pen grip. Writing with a standard pen can put a lot of strain on finger joints if you do a lot of writing.

ADAPTATIONS

If you think that you may need adaptations to your home you could request an assessment by an Occupational Therapist. You will need to contact Social Services if you are seeking funding or advice from an OT. A grant may then be available for necessary and appropriate adaptations, although it is likely to be means tested and this means that many young working people are usually ineligible. In council housing these adaptations are presently provided without a means test (in my own area) if they are necessary and appropriate. Some authorities also have schemes for lending money if the means test has eliminated you from obtaining a grant. Low cost adaptations like grab rails or steps may be provided without a means test. Different councils and county councils have different rules so you will have to investigate.

Kitchen adaptations are most commonly provided for clients with rheumatoid arthritis. These could be alterations to worktops or cupboards, or changing unsuitable handles, taps or plug points. In the bathroom the most frequent adaptations would be the provision of a shower or providing a seat for a shower, lever taps or hand rails. Another common adaptation is the provision of a stair-lift if someone finds that it is very painful and difficult to go up and down the stairs. Rails of all kinds, such as banister rails, are regularly provided by Social Services and can be very useful for maintaining independence or keeping people safe.

Some people with disabilities are not very happy to have any adaptations that make them feel disabled, and it is also important to maintain muscle strength and keep the joints moving. It really comes down to weighing up the potential benefits of activity against possible joint damage as well as the need to be safe. For example, if someone can manage stairs safely and without too much pain it is probably better to manage without an extra banister rail or stair-lift unless there is a lot of joint damage to the hips and knees or the person is at risk of falling down the stairs. If an activity is carried out repeatedly, or is very painful, then aids and adaptations are very useful. Otherwise it is important to keep the joints moving and take exercise. The next section examines the value of exercise and the importance of good posture.