Reduce Your Risk of Cervical Cancer

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January is Cervical Health Awareness Month, and there’s a lot that women can do to help prevent cervical cancer.

Cervical cancer happens when normal cells in the cervix, the bottom part of the uterus, change into abnormal cells and grow out of control. Most women whose cervical cancer is found and treated early do well.

In 2021, the American Cancer Society estimates 14,480 new cases of invasive cervical cancer will be diagnosed in the United States and 4,290 women will die from it. One of the major causes of cervical cancer is Human papillomavirus, or HPV. HPV causes 99 percent of cervical cancer. HPV can also cause vaginal, penile, anal, mouth and throat cancer.

HPV is a very common infection that spreads through sexual activity. About 79 million Americans currently have HPV, but many of them don’t even know that they’re infected. That’s because HPV generally doesn’t have any symptoms. In fact, in many cases, the body can fight off HPV naturally, but in serious cases, the body is at risk for serious complications.

Thankfully, the number of cervical cancer cases is declining, because of screening tests that are able to find cervical precancerous cells before they turn into cancer. The HPV vaccine also protects men and women from HPV.

At MidMichigan Health, we encourage women to begin getting regular Pap tests at age 21. Talk to your gynecologist or health care provider to determine how often you should get these screenings.

We also encourage pre-teens to get the HPV vaccine; it is most effect for boys and girls to get the vaccine between the ages of nine to 12. Teens and young adults age 13 through 26 who have not been vaccinated or who haven’t gotten all their doses should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens.

If you haven’t received a Pap test or the HPV vaccine, it’s important that you talk with your health care provider to determine a course of action that works best for you and your health. Being proactive in your health care is key!

Brendan Conboy, M.D., is a board-certified obstetrician/gynecologist who sees patients at MidMichigan Medical Center – Alpena. He received his medical degree from Wayne State University School of Medicine, and completed his residency at William Beaumont Hospital in Royal Oak. Those who would like more information about becoming a patient may contact his office at (989) 356-5228.


Sustainable Change

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The New Year is a time of change. Many embrace the season as an opportunity to create resolutions with great intentions to be healthier but are often disappointed weeks later when they are unable to sustain them. There are several reasons why resolutions prove to be difficult to maintain, but with thought and planning, one can make lasting change for the better.

A potential problem with a resolution is that it is too far outside a person’s norm. Not only is this type of resolution hard to start, it’s difficult to sustain.

For example, if someone doesn’t exercise, setting a goal of exercising 60 minutes a day may be too far outside their normal exercise time of zero. The difficulty with this type of goal is self-image. If you don’t see yourself as someone who exercises, it will be hard to sustain a goal of 60 minutes a day of exercise.

The following are some of the dos and don’ts of kicking off the new year with a commitment of
healthier habits.

 Set a goal that is too lofty to attain
 Choose something you are physically unable to do
 Expect change to be easy
 Proceed without a plan
 Give up too quickly; plans can be adjusted

 Set a small goal to begin and build from there
 Work on self-image; visualize yourself being a person who is successful at it
 Engage in deliberate self-talk like “I am choosing healthy behavior” and “I can do that”
 Work the resolution into your routine by connecting it to something you already do until it
becomes a daily, healthy habit
 Understand that even small increments of change are successes

No matter what type of change one is working on, a better chance at sustainability includes starting small, visualization, recognition that it can be accomplished and connecting it to something already present in one’s routine. Small steps become habits until the larger goal of living a healthier lifestyle is reached.

“Focus on one day at a time, one step at a time. Soon days turn into weeks and each
small step becomes a habit and helps you reach your larger goal. Remember doing something is better than doing nothing at all

Michelle Lucchesi, M.A., L.L.P., is a therapist at MidMichigan Medical Center – Gratiot’s Psychiatric Partial Hospitalization Program. To learn more about the program, call (989) 466-3253, or visit


What You Need to Know about Taking Medication During Pregnancy

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Whether you’re thinking about getting pregnant, or you’re currently pregnant, you might be wondering how to know which medications are safe to use during your pregnancy. This includes everything from prescription medications, to over-the-counter cold remedies to your daily multivitamin. How do you know what’s safe, and what you should
stop taking to protect yourself and your baby?

Nearly every pregnant woman will face a decision regarding medication at some point
during their pregnancy. However, there’s not detailed information on effects of many
medications when it comes to pregnant women, because they are not included in safety

What we do know, though, is that there are some cases in which it would be more harmful to stop taking a medication during pregnancy, if, for example, the medication helps control a health condition. On the flip side, there are also certain medications that increase the risk of birth defects, miscarriage or developmental disabilities. Certain things, such as the dose of the medication, during what trimester you take the medication and what health conditions you have, all play a role in this as well.

The best thing to do is to discuss any medications you are currently taking with your
health care provider. You can do this even before you are pregnant, as there are some
medications that are unsafe in early pregnancy. Your provider will help you create a
treatment plan so that you, and your baby, are as healthy and as safe as possible.

Throughout your pregnancy, you’ll want to check in with your doctor before starting or
stopping any new medication, and this includes prescriptions, vitamins, supplements or
over-the-counter remedies. Even after you deliver your baby, your doctor will be able to
work with you to determine if you should continue taking your medication or, when it’s
safe for you to resume taking medication you stopped taking during pregnancy.

Together, you and your doctor can work together to come up with a plan to keep you and your baby as healthy and safe as possible.

Obstetrician/Gynecologist Shawna Ruple, M.D., sees patients at MidMichigan Obstetrics & Gynecology in Midland. Dr. Ruple specializes in routine and problem gynecology care, gynecologic surgery, prevention of female reproductive cancers, birth control options, caring for women while pregnant and more. For more information on in-office treatments and procedures, contact her office at (989) 631-6730.


7 Ways to Show You Care During the Pandemic

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These simple acts of kindness will help reduce community spread of COVID-19 and ensure hospitals and businesses can remain open to serve you!

Wear A Mask

Wear a Mask

Protect yourself and others by properly wearing a mask that covers your nose and mouth at all times when in public. Learn more at MaskUpMichigan.

Stay Home

Stay Home

Right now, staying home unless you absolutely need to go out is one of the best ways to help flatten the curve. When you do go out for work, groceries or exercise, stay 6 feet apart, wear a mask and wash your hands.

Celebrate Safely

Celebrate Safely

Public health officials cite private gatherings such as weddings, funerals and parties among the most common causes of new outbreaks. Avoid gatherings and find safer ways to celebrate such as virtual events or dropping off food and gifts.

Donate Blood

Donate Blood

With state- and nation-wide blood shortages, this is one thing you can do to directly save lives. If you are healthy with no COVID symptoms, it is still safe for you to donate blood. Find a blood drive near you.

Call Ahead for Health Care

Video Visit

Don’t neglect your health, but do call ahead to your doctor’s office or Urgent Care so they can prepare for your visit and safely accommodate you. Or call your primary care provider to schedule a video visit.

Thank Essential Workers

Thank You Heroes

It seems simple, but a colorful sign in your yard or window, or a note of encouragement and gratitude on social media can go a long way to remind essential workers of your support.

Make a Donation

Hands Holding Hearts

Consider supporting non-profit organizations that are providing COVID relief, such as securing needed medical supplies or assisting vulnerable populations.


Is Sitting Down Really That Bad for You?

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Over the last few years, there have been many articles detailing how bad sitting can be for the body. You may have even seen the phrase, “Sitting is the new smoking.” But how bad is sitting down, really?

As a physical therapist, I see many people who come into my office and sheepishly admit that they sit all day long for their jobs. As our reliance on technology for our jobs increases, this becomes more and more of the norm for society.

Personally, I think sitting has gotten a bad rap, and what we really need to do is look at our lack of physical activity overall. When we sit every day for our job, it can have a negative impact on the body, but an overall lack of physical activity is much more concerning than sitting itself.

When we sit, our bodies adapt to that position. There are several things that occur, such as a tightening of the hamstrings and a forward head and rounded shoulder posture. We don’t use our core muscles when we sit, because our body is supported, so there can be a weakening of those muscles as well. Our body gets used to not having to use these muscle groups. Then, when you do try to get out and be active, or work in the yard, you might be more susceptible to injury or pain because your body isn’t used to that kind of stress.

In short, you don’t need to quit your day job to pursue a career that involves standing all day. What you really need to do is increase your activity level outside of work and incorporate some regular exercises that combat the negative effects of sitting. These exercises can include core strengthening, stretching of the hips and chest and exercises to reverse your forward posture.

If you are experiencing pain related to sitting for long periods of time, a physical therapist can help you identify a more targeted exercise program.

Physical Therapist Kyle Stevenson, D.P.T., sees patients at MidMichigan’s Rehabilitation Services location in Greater Midland North-End Fitness Center. He has a special interest in sports medicine, and enjoys working with athletes of all ages. He has completed specialized coursework and training for the throwing athletes. New patients are welcome with a physician referral by calling (989) 832-5913. Those who would like more information about MidMichigan’s Rehabilitation Services may visit


What is W-sitting, and Why is it Important?

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W-sitting is a normal developmental position that babies usually discover when they sit back straight from their hands and knees. Their legs will then form a “W.” Often, babies also transition back to a single hip, toward a side sitting position. When a baby varies his or her sitting position, W-sitting is rarely a problem.

However, when a baby sits back straight to a W-sit consistently, they don’t get the opportunity to elongate and activate lateral trunk muscles to develop their core muscles. W-sitting is a very stable position that children find useful, however, it allows them to play without developing muscle that provide the ability for kids to reach out to their sides or rotate across their midline, leading to underdevelopment of lower trunk muscles, which stabilize the pelvis.

When a child uses this position as their preference without the normal variety in movements, it can affect development. They may demonstrate an in-toeing gait, core weakness or balance difficulties. The hips are positioned in extreme internal rotation, placing stress on the hips and the knee joints. This can lead to hip and knee orthopedic issues as the child develops.

So, what can you do to prevent any development issues? Encourage your child to alternate sitting positions, such as side sitting (alternating sides), ring sitting, or, with older children, sitting in a chair or on a ball. This might be challenging initially, but once your child gets used to it, they may just need reminders.

If it’s difficult for your child to sit in alternate positions or they begin to show other developmental concerns, a referral to a physical therapist may be helpful to facilitate trunk muscle development.

Eileen McMahon, M.S.P.T., is a physical therapist at MidMichigan Health.


Baseball Throwing Exercises in the Off Season

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Many athletes have had their baseball season shortened or cancelled due to COVID-19. This extra rest can be helpful in decreasing stress on the shoulder and elbow joints, but it can also lead to decreased strength and ROM. Overhead athletes need to keep their bodies strong, and a great way to achieve that is by performing a regular strengthening program. With many gyms remaining closed or limiting access during social distancing, that can be even more challenging. However, there are many exercises that can be done at home with minimal equipment needs.

A great program to focus on during the off season is the Thrower’s Ten program that was developed Continue reading.


Why Virtual Care is Flourishing During COVID-19 and Why We Can Never Go Back

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Have you ever woken up with a sore throat and used your phone to get a virtual visit? The odds are it’s not available to you, and there is a reason for that. You may be hearing about how virtual care, often described as telehealth or telemedicine, is beneficial during COVID-19 and how health systems are offering virtual access like never before. There’s a reason for that, too.

For the past few weeks I’ve seen Facebook posts daily from former nursing colleagues in metro Detroit, one of the hardest hit areas in the country, as they provide front-line care to patients with COVID-19. It makes me very proud to call these nurses my friends. As a former emergency department nurse, I recall the feeling of satisfaction knowing that I’ve helped someone on the worst day of their life. One of the best parts of being a nurse is knowing you matter to the only person in health care that truly matters: the patient.    

Several years ago I made the difficult decision to no longer perform bedside nursing and become a nurse administrator. The biggest loss from my transition is the feeling that what I do matters to the patient. COVID-19 has forced a lot of us to rethink the role we play in health care and what the real priority should be. Things that were top priorities three months ago have been rightfully cast aside to either care for patients in a pandemic or prepare for the unknown future of, “When is our turn?” For me, COVID-19 has reignited the feeling that what I do matters as virtual care has become a powerful tool on the forefront of care during this crisis. It has also shown that many of the powerful rules and regulations that limit virtual care are not needed and should be discarded permanently.      

When I became the director of virtual care at our organization in 2015 I knew nothing about telehealth. Sure, I had seen a stroke robot in some Emergency Departments, and I had some friends that told me their insurance company lets them FaceTime a doctor for free (spoiler alert: it’s not FaceTime). I was tech-savvy from a consumer perspective and a tech novice from an IT perspective. Nevertheless, my team and I spent the next few years learning as we built one of the higher volume virtual care networks in the state of Michigan. 

We discovered a lot of barriers that keep virtual care from actually making the lives of patients and providers better and we also became experts in working around those barriers.  But, there were two obstacles that we could not overcome: government regulation and insurance provider willingness to cover virtual visits. These two barriers effectively cripple most legitimate attempts to provide value-added direct-to-consumer virtual care, which I define as using virtual care technologies to provide care outside of our brick-and-mortar facilities, most commonly in the patient home.

The need to social distance, cancel appointments, close provider offices, keep from overloading emergency departments and urgent cares and shelter in place created instant demand for direct-to-consumer virtual care. In all honesty, I’ve always considered direct-to-consumer virtual care to be the flashy, must-have holiday gift of the year that organizations are convinced will be the way of the future. If a health system wants to provide on-demand access to patients for low-complexity acute conditions, they will easily find plenty of vendors that will sell them their app and their doctors and put the health system’s logo on it. What a health system will struggle with is to find is enough patient demand to cover the high cost. Remember my friends from earlier that told me about the app their insurance gave them? Nearly all of them followed that up by telling me they’ve never actually used it. I am fortunate that I work for an organization that understands this and instead focuses on how can we provide care that our patients actually want and need from the doctors they want to see.

Ironically, this fiscal year we had a corporate top priority around direct-to-consumer virtual care. We wanted to expand what we thought were some successful pilots and perform 500 direct-to-consumer visits. This year has been one of the hardest of my leadership career because, frankly, up until a month ago I was about to fail on this top priority. With only four months left, we were only about halfway there. The biggest problem we ran into was that every great idea a physician brought to me was instantly dead in the water because practically no insurance company would pay for it. 

There are (prior to COVID-19) a plethora of rules around virtual care billing but the simplest way to summarize it is that most virtual care will only be paid if it happens in a rural location and inside of a health care facility. It is extremely limited what will be paid for in the patient home and most of it is so specific that the average patient isn’t eligible to get any in-home virtual care. Therefore, most good medical uses for direct-to-consumer care would be asking the patient to pay cash or the physician to forgo reimbursement for a visit that would be covered if it happened in office. Add to that the massive capital and operating expenses it takes to build a virtual care network and you can see why these programs don’t exist. A month ago I was skeptical we’d have a robust direct-to-consumer program any time soon and then COVID-19 hit.

When COVID-19 started to spread rapidly in the United States, regulations and reimbursement rules were being stripped daily. The first change that had major impact is when the Centers for Medicare and Medicaid Services (CMS) announced that they would temporarily begin reimbursing for virtual visits conducted in the patient’s home for COVID-19 and non-COVID related visits. We were already frantically designing a virtual program to handle the wave of COVID-19 screening visits that were overloading our emergency departments and urgent cares.  We were having plenty of discussions around reimbursement for this clinic: Do we attempt to bill insurances knowing they will likely deny, do we do a cash clinic model or do we do this as a community benefit and eat the cost? The CMS waiver gave us hope that we would be compensated for diverting patients away from reimbursed visits to a virtual visit that is more convenient for the patient and aligns with the concept of social distancing. Realistically we don’t know if we will be paid for any of this. We are holding all of the bills for at least 90 days while the industry sorts out the rules. 

I was excited by the reimbursement announcement because I knew we had eliminated one of the biggest direct-to-consumer virtual care barriers. However, I was quickly brought back to reality when I was reminded that HIPAA (Health Insurance Portability and Accountability Act) still existed. I had this crazy idea that during a pandemic we should make it as easy as possible for people to receive virtual care and that the best way to do that was to meet the patient on the device they are most comfortable with and the application (FaceTime, Facebook, Skype, etc.) that they use every day. The problem is nearly every app the consumer uses on a daily basis is banned by HIPAA because “it’s not secure.” I’m not quite sure what a hacker stands to gain by listening into to my doctor and me talk about how my kids yet again gave me strep throat but apparently the concern is great enough to stifle the entire industry. Sure, not every health care discussion is as low-key as strep throat and a patient may want to protect certain topics from being discussed over a “non-secure” app but why not let the patient decide through informed consent? Regulators could also abandon this all-or-nothing approach and lighten regulations surrounding specific health conditions. The idea that regulations change based on medical situation is not new. 

For example, in my home state of Michigan, adolescents are essentially considered emancipated if it involves sexual health, mental health or substance abuse. Never mind that this same information is freely given over the phone by every office around the country daily without issue, but I digress. While my job is to innovate new pathways for care, our lawyer’s job is to protect the organization and he, along with IT security, rightfully shot down my consumer applications idea. A few days later I legitimately screamed out loud in joy when the Department of Health and Human Services announced that it would use discretion on enforcing HIPAA compliance rules and specifically allowed for use of consumer applications. The elimination of billing restrictions and HIPAA regulations changed what is possible for health care organizations to offer virtually. Unfortunately both changes are listed as temporary and will likely be removed when the pandemic ends.

Six days after the HIPAA changes were announced, we launched a centralized virtual clinic for any patient that wanted a direct-to-consumer video visit to be screened by a provider for COVID-19. It allows patients to call in without a referral and most patients are on-screen within five minutes of clicking the link we text them. They don’t have to download an app, create an account or even be an established patient of our health system. It saw over 900 patients in the first 12 days it was open. That is 900 real patients that received care from a physician or advanced practice provider without risking personal exposure and without going to an already overwhelmed ED or urgent care. 

To date, 70 percent of the patients seen by the virtual clinic did not meet CDC testing criteria for COVID-19. I don’t believe we could have reached even half of these patients had the consumer application restrictions been kept. A program like this almost certainly wouldn’t exist if not for the regulations being lifted and even if it did, it would have taken six to 12 months to navigate barriers and implement in normal times. Sure, the urgency of a pandemic helps but the impact of provider, patients, regulators and payors being on the same page is what fueled this fire. 

During the virtual clinic’s first two weeks, my team turned its attention to getting over 300 providers across 60+ offices virtual so they could see their patients at home. Imagine being an immunocompromised cancer patient right now and being asked to leave your home and be exposed to other people in order to see your oncologist. Direct-to-consumer virtual care is the best way to safely care for these patients and without these temporary waivers it wouldn’t be covered by insurance even if you did navigate the clunky apps that are HIPAA compliant. Do we really think the immunocompromised cancer patient feels any more comfortable every normal flu season? Is it any more appropriate to ask them to risk exposure to the flu than it is to COVID-19? And yet we deny them this access in normal times and it quite possibly will be stripped away from them when this crisis is over. Now 300 to 400 patients per day in our health system are seen virtually by their own primary care doctor or specialist for non-COVID related visits.  Not a single one of these would have been reimbursed one month ago and I am highly skeptical I would have gotten approval to use the software that connects us to the patient. Lastly, recall that prior to COVID-19, our system had only found 250 total patients that direct-to-consumer care was value-added and wasn’t restricted by regulation or reimbursement.

COVID-19 has been a wake-up call to the whole country and health care is no exception. It has put priorities in perspective and shined a light on what is truly value-added. For direct-to-consumer virtual care it has shown us what is possible when we get out of our own way. If a regulation has to be removed to allow for care during a crisis then we must question why it exists in the first place. HIPAA regulation cannot go back to its antiquated practices if we are truly going to shift the focus to patient wellness. CMS and private payors must embrace value-added direct-to-consumer virtual care and allow patients the access they deserve. COVID-19 has forced this industry forward, we cannot allow it to regress and be forgotten when this is over.

Tom Wood is the director of trauma and virtual care for MidMichigan Health, a non-profit health system headquartered in Midland, Michigan, affiliated with Michigan Medicine, the health care division of the University of Michigan. The views and opinions expressed in this commentary are his own.


Preventative Foot Care in Diabetes

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When dealing with all of the aspects of diabetes, it’s easy to let your feel fall to the bottom of the list. But daily care and evaluation is one of the best ways to prevent foot complications. It’s important to identify your risk factors and take the proper steps in limiting your complications. Two of the biggest complications with diabetes are peripheral neuropathy and ulcer/amputation.

Symptoms of peripheral neuropathy include numbness, tingling and/or burning in your feet and legs. You can slow the progression of developing neuropathy by making it a point to manage your blood sugars and keep them in the normal range. If you are experiencing these symptoms, it is important to establish and maintain a relationship with a podiatrist. Your podiatrist can make sure things are looking healthy and bring things to your attention to monitor and keep a close eye on.

Open wounds or ulcers can develop secondary to trauma, pressure, diabetes, neuropathy or poor circulation. If ulcerations do develop, it’s extremely important to identify the cause and address it. Ulcers can get worse quickly, so it’s necessary to seek immediate medical treatment if you find yourself or a loved one dealing with this complication. Untreated ulcerations often lead to amputation and can be avoided if proper medical attention is sought right away.

There are important things to remember when dealing with diabetic foot care. It’s very important to inspect your feet daily, especially if you have peripheral neuropathy. You may have a cut or a sore on your feet that you can’t feel, so your body doesn’t alarm you to check your feet. Be gentle when bathing your feet. Moisturize your feet, but not between your toes. Do not treat calluses or corns on your own. Wear clean, dry socks. Never walk barefoot, and consider socks and shoes made specifically for patients with diabetes.

Kristin Raleigh, D.P.M., is a podiatrist who sees patients at Foot & Ankle Specialists of Mid-Michigan in Midland. Those who would like to make an appointment may contact her office at (989) 488-6355.


The Most Useful Pieces of Adaptive Equipment

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Occupational therapists strive to help their patients be as independent as possible with meaningful activities. Often times, when a patient sustains a bodily or neurological injury, they are left with weakness or paralysis. Other times, after a joint replacement or bone fracture, there are restrictions placed on the person that limits their safe movement.

Adaptive equipment presents a great way for occupational therapists to help people develop compensatory strategies in order to complete the tasks that are most meaningful to them. The items can be temporarily used until the person returns to their previous functional level, or they can be used indefinitely as a way for the patient to regain independence and control of their environment and self.

In my opinion, the top 10 most useful pieces of adaptive equipment are:

  • Built-up foam grips: These grips can be added to utensils to make the handles bigger, which helps people who’ve suffered from strokes, arthritis or hand weakness.
  • Long-handled reacher: These are great for getting dressed and managing the surrounding area around a person.
  • Sock aid: These allow people to get their socks on. It’s especially helpful for those who have had hip surgery with flexion precautions. Many people struggle to bend down for a variety of reasons, and this allows for the person to load the sock, and pull the sock on without leaving the seated position.
  • Universal cuff: This is a staple within the OT community. This cuff can substitute for grip dexterity and strength by strapping around the hand and allowing a utensil to be inserted. This way, the person can use the ability they have in their arm to feed themselves, brush their teeth, shave or comb their hair despite a weakened grip or dexterity. It’s often used in patients who have muscle atrophy or spinal cord injuries.
  • Scoop plate with suction pad: This is good to be used in tandem with a universal cuff, but can also be used on its own. It allows a person who has an upper extremity that is somehow affected to feed themselves with one hand, as the food can be pushed to one side for easier scooping. Models with a suction cup are nice, but otherwise using a non-slip material can help the plate not slide easily.
  • Adaptive cutting board: This is great for someone who is limited to one arm for functional use. It allows for the item to be fixated with the nails so chopping/slicing is easily accomplished. It can be used in a sitting or standing position.
  • Dycem (name brand non-slip material): This is another therapy staple, and a cost-effective, easy way to introduce more control with devices. It can be used as a grip to open jars. It can go underneath scoop plates so they don’t move on the table when eating. Basically, if you don’t want the item to slide, this material can be placed underneath to prohibit movement.
  • Elastic shoelaces: These are a great solution for those who struggle to tie their shoes. They can be used from pediatrics to geriatrics, and for anyone who might be struggling with hand weakness or dexterity issues. It can also be used for those who have cognitive delays or problems, so that the complex process of tying shoes can be bypassed.
  • Button hook/dressing aid: This is used to apply buttons with one hand when dexterity is an issue. Often they are equipped with a hook on the end that can be used to pull up a zipper.
  • Rocker knife: A great way to cut food with one hand. Often, this is used when the person does not have the strength to push/slice food conventionally. It can be used in tandem with the cutting board or scoop place, or normal plates.

Sam Penkala, O.T.R.L., is an occupational therapist at MidMichigan Health.