Thinking Outside the (Cardboard) Box

When we talk about our community based rehabilitation outreach programme  for people with disabilities, we often mention the provision of Occupational Therapy services alongside medical services.

But what is Occupational Therapy exactly? In the words of our Occupational Therapist, Daniel: “Occupational Therapy is a client-centred approach which is focused on the promotion of the health and well-being through meaningful and purposeful activities that are age and gender appropriate as well as culturally accepted”.

Even in most Western countries, Occupational Therapy is not something that is widely known. Here in Tanzania, where many people don’t even have access to very basic healthcare services, you hardly find a person who has heard of Occupational Therapy let alone is familiar with the practice.

There is only one university in the whole country that offers studies to become an Occupational Therapist and in 2019, Daniel’s graduation year, there were only 30 students.

Apart from the service and its health benefits being rather unknown, another challenge Tanzanian Occupational Therapists struggle with is the procurement of specialised equipment. Not only is it hard to find, but once sourced, it can also be really expensive.

To bridge this gap, Daniel got creative! It is really impressive what you can do with a little cardboard and a utility knife – but see for yourself what he has crafted!

Occupational Therapist Daniel explains below his innovative use of everyday materials to aid patients regain movement.

The Puzzle

The beloved children’s game can function as OT equipment. Daniel is presenting us a puzzle made out of cardboard for his youngest patients. It improves the children’s shape identification and problem-solving skills and further enhances their motor and coordination skills.

The Range of motion Arc

This interesting looking therapeutic equipment uses a bio-mechanical approach. It promotes and improves the range of motion of the patient’s shoulder, elbow, wrist and joint and is used in all cases where the range of motion of the upper extremities is limited, for example due to a stroke, burn or head injury.

Lid Activity

The lids are used to practice and improve grasping skills, hand-eye coordination and range of motion by opening and closing the lid. It is used for all cases in which the patient shows a limited hand function and, with practice, helps them to perform activities of the daily life such as opening and closing windows and doors or – you guessed it – bottles.

In case you got curious and want to see more of the equipment Daniel and the team have crafted, check out how he created a device for mirror therapy .

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Thank you.

Get to know Our Team

This is Daniel Samwel, our Occupational Therapist. Daniel is passionate about his job and we enjoy working with him. The people of Nyamatongo Ward benefits from his creative solutions to provide Occupation therapy that is accessible and affordable.

The Magic of Mirror Therapy

Access to rehabilitation services has not been a priority in Eastern Africa, but things are slowly changing. I have been working with The Cedar Foundation Tanzania in the Community Based Rehabilitation (CBR) project for several months now. Most families cannot afford to buy therapy equipment. So as an occupational therapy practitioner in the villages of Nyamatongo ward, my main challenge is to bring affordable therapy to the village level. One way I do this is by adapting local materials, such as rocks, sand, mirrors and boxes, to make equipment that can be used for therapy. And my vision for the Community Based Rehabilitation project is to promote the use of adapted therapeutic equipment for the benefit of my patients in order to give them the highest chance possible to retain their existing skills and to develop new skills too. In this way the patients will increase their daily activities and therefore enhance their levels of independence in the community.

As part of the outreach program I encountered Issa* - a 59 year old male patient, who had sustained a right hemiplegic stroke in 2016 (paralysis of the muscles of the lower face, arm, and leg on one side of the body), due to hypertension. On our first meeting, I conducted an initial assessment and found that Issa had contracture in his right arm due to being in a flexion pattern for such a long time. The right hand had grade 1 muscle strength and the motor skills were all intact (both fine and gross motor skills). His cognitive and sensory abilities were all fine with the exception of his vestibular system (the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance.), which was weak and thus affected his balance. My two month objectives with the patient were the following;

• To achieve full passive range of motion to the affected arm

• To increase muscle strength and to activate motor skills to the affected arm

At the end of one month’s therapy, the patient was able to achieve full range of motion passively, without experiencing pain. It was at this stage that we introduced the Mirror Therapy box, for motor activation. I had designed and constructed the mirror box by using local materials. I found that the patient really enjoyed this therapy, and soon began to improve in his fine motor skills in the affected arm.

MIRROR THERAPY EXPLAINED

The mirror therapy theory is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred to the affected limb. It involves placing the affected limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb’ says G. Moseley.

A mirror box is a device that gives opportunities to the therapist to easily create this illusion. It is a box with one mirror in the centre where on each side of it, the hands are placed in a manner that the affected limb is kept covered always and the unaffected limb is kept on the other side whose reflection can be seen on the mirror. The activities that are mirrored are those performed by my patients in their daily lives, for example writing, grooming, eating and even catching a ball.  

This theory is based on the neuro-plasticity mechanism/principle. It activates the brain’s mirror neurons, to create a mind illusion that then activates the motor ability of the patient’s missing limb and aids in pain management.

The patients that benefit most from this technique are those who have had amputations. This technique has been found to reduce phantom pain sensations in amputees. Stroke patients also benefit greatly from the mirror technique to reactivate motor skills.

Take Action and be part of the drive to bring occupational therapy to Nyamatongo Ward.

* For privacy, the name Issa has been used but it is not the patients real name.

by Daniel Samwel, Occupational Therapist, Cedar Tanzania.