Vitamin D and the Winter Months

​Vitamin D is important for:
​

• bone growth and strength
• muscle health
• our immune system
• wound healing

 
The main way of obtaining vitamin D is to produce it ourselves by exposing our skin to the sun.  In the winter it’s hard to get enough direct sunlight to maintain our vitamin D levels. If our vitamin D levels are low we can be at risk to a wide variety of health issues, including:

• bone diseases (eg, rickets, osteoporosis, hip fractures)
• cardiovascular diseases (eg, coronary heart disease, heart failure, stroke)
• infectious diseases (eg, tuberculosis, acute respiratory infections)
• altered immune function (eg, rheumatoid arthritis, Type 1 diabetes)
• cancer (eg, colorectal, breast)

 
You may be more at risk to low levels of vitamin D if you:

• have a dark skin and are of Maori, Pacific Island, African or Indian descent 
• have a gut condition like Crohn’s or Coeliac disease which prevents you from absorbing vitamin D. 
• cover your skin with cloths for cultural or religious reason
• avoid the sun and always apply sunscreen if outside no matter what time of the day or year.
• are elderly, disabled, immobile and spend most of your life inside.
• are a baby, teenager, pregnant or breastfeeding as you will require higher levels of vitamin D.

 
Signs you may have low vitamin D levels include:

• cramps
• aches and pains in your muscles
• repeated colds and flu

​When exposure to sunshine is limited, especially in the winter in the South Island, we may need to find other sources of vitamin D, eg food. 



Foods containing vitamin D include:

• fatty fish eg salmon, herring, mackerel, sardines, tuna
• eggs
• fortified milk and yoghurts
• some margarines
• butter
• liver

You may need a vitamin D supplement if you can’t get outside regularly and your levels are low.  Discuss supplements with your Doctor, they are not recommended for everyone.
 
If you want help to improve your dietary vitamin D intake our friendly Dietitian can help. 
 
Just contact Therapy Professionals. 
 
                        Ph:                              03 3775280 
                        Email                          admin@tpl.nz
                        Website:                    therapyprofessionals.co.nz
 

 I don't want to be a bother

As we age our bodies don’t function with the same ease they once did. This can be a slow and insidious process or a sudden shock after an accident or illness.  Over time we start finding some things aren’t as easy to do as they used to be, like: 

• turning on taps 
• getting out of chairs or cars
• pulling plugs out of the wall 
• lifting jugs and opening cans
• getting out and about
• showering and dressing
• cooking or swallowing
• gardening and cleaning
• hearing the phone or doorbell

 
Many of us stop doing things because it’s too hard and having to ask others to do or help with these tasks can be frustrating, inconvenient and embarrassing. 
 
Many of us don’t want to ask for help as we ‘don’t want to be a bother’and we leave seeking help until we get into difficulty. We may struggle alone at home with little knowledge of the help available to assist our independence.
 
Feeling as if you are relying on family can make you feel like a burden and we want time with family to be precious and enjoyable, not a chore. You don’t have to struggle alone professional advice is available to help you maintain your freedom and avoid an unnecessary crisis. 

                           key turner                                              tap turner                                     electric plug puller

If you, or anyone you know, is struggling to maintain their independence and confidence Therapy Professionals friendly therapists can help to make life easier.  They will suggest adapting your home or lifestyle, recommending alternative ways of doing things or giving tips on useful gadgets and equipment. 
 
You don’t have to struggle alone, we can help, we come to you.
 
Just contact us at 
 
            Therapy Professionals Ltd
            PO Box 7807, Christchurch
            
            Phone:          03 377 5280                Email:     admin@tpl.nz
            
            Website:        www.therapyprofessionals.co.nz

Building or Refurbishing your Buildings - 
​Advice for Residential Facilities

Keeping your clients and staff safe, keeps your business safe.
 
Planning for a safe, workable environment is cost effective.
 
Getting the design or redesign of your building wrong can cost a lot in:

• fixing the mistakes
• potential Staff injury
• inefficient working spaces
• disruption to your business while the problem is fixed 

 
It is more cost effective to get your building future proofed while under construction. Our Therapists have seen some very expensive mistakes made over the years and recommend you consider the following:

• Have the bedrooms large enough for two people to work on both side of the beds
• Use lino floor coverings for ease of moving people and equipment.  If you have carpet, ensure it’s low pile.
• Have extra wide internal doors so equipment can be moved easily
• Have enough space between chairs, and other furniture in lounges, bedrooms, bathrooms, and the dining room for two people to assist a resident on both sides
• Put overhead hoists in all areas
• Have wet area bathrooms with non slip floor surfaces
• Have direct seamless access into the building (not stairs)
• Have storage spaces for equipment close to where the equipment is needed 
• Have hallways wide enough to manoeuvre equipment into and out of rooms with ease.
• plan for an increasing number of larger residents

 
Architects, project managers and building companies are great at the big picture of a building, however they don’t understand the complexities of the work you do.

Handwriting is Crucial for Development
 
For most of us handwriting is a task we take for granted.  We don’t consider how much goes in to it, nor do we think about the implications of not mastering this skill.
 
Handwriting is a complex process.  It involves:

• quickly transferring a thought into words
• accessing memory to choose the correct letters that make up a word (symbols)
• holding and directing the pen
• feeling the page and coordinating eyes to form the letters on the page.

 
Today with technology we increasingly use typing in place of handwriting.  Although typing and technology are useful tools handwriting has many benefits.  According to research three areas of the brain light up in a highly coordinated way when a person is handwriting and no such activity is observed with typing.
 
The physical act of handwriting helps improve:

• reading and writing
• reading comprehension
• memory and recall
• critical thinking and conceptual development
• creativity
• calming the body and nerve ends
• managing depression and anxiety
• problem solving
• organising and processing information
• focusing on tasks.

 
Children who struggle to write by hand often avoid it or are encouraged to type instead.  Unfortunately they then miss out on all the benefits derived from handwriting and from gaining help for the underlining cause of their difficulty, which may include problems with:

• fine motor weakness or weak hands
• poor coordination between hands
• poor core muscle strength or posture control
• poor eye hand co-ordination
• poor processing of their senses

 
These functions are necessary for many other life skills and activities, eg tying shoe laces, using a knife and fork, dressing and grooming
 
Occupational Therapists are experts in improving handwriting and hand skills.  If you know a child who is struggling with their handwriting contact us at Therapy Professionals as our friendly Occupational Therapist can help.  Just contact us:
 
                             Phone:                03 377 5280                            
                             Email:                  admin@tpl.nz
                             Website::             www.therapyprofessionals.co.nz

 Falls and Eyesight

Currently, one in seven New Zealanders are 65 and over. Around 30% to 60% of people in this age group have a fall each year.  And 10% to 20% will end up in hospital with a fracture.
Those over the age of 85 are 15 times more likely to fracture their hip in a fall than a 65-year-old.  Hip fractures can have a huge impact, with 30% of those over 85 who suffer one requiring placement in aged residential care.
 
Research shows there is a link between poor eyesight and falls in older people.
 
As we age most of us will become long sighted (presbyopia), making it hard to focus on things close up and we’re slower to adjust to light.  This is because the muscles of the eye lens harden.  Eventually we will all need glasses.
 
Other age related eye conditions that contribute to falls are cataracts, glaucoma, macular degeneration and diabetic retinopathy.
 
Some tips to prevent falls associated with eyesight issues:

• Get your eyes and glasses checked regularly
• As you’re statistically more likely to fall in the first few days after getting new classes, be careful and don’t rush!
• With bifocals, the change in focus is not instant, which is important when walking – looking from your feet to the footpath, then to the view, so be careful and slow down
• When moving from a well lit to a darker area – turn on a light or slow down so your eyes can adjust.
• On rough ground ‘stop’ before you look at the view.
• Clean your glasses regularly (at least daily)

​Follow this advice and you will help to reduce the chances of falling.
​
For other tips on falls prevention check out these links:
 
http://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/be_aware_of_your_feet.pdf
http://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/getting_yourself_up_from_the_floor._.pdf
http://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/footwear_matters__.pdf
http://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/to__exercise_or_not_to_exercise_.pdf
http://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/hpme_gym.pdf
 
​For more information and advice on preventing falls our friendly Physiotherapists can help,
just contact Therapy Professionals :
 
Phone:    3877 5280                Fax:    03 377 5281
Email:      admin@tpl.nz         www.therapyprofessionals.co.nz

Do you need a walking stick?

You may benefit from using a walking stick If you feel:

• nervous about being able to walk safely
• concerned about falling when out and about especially on uneven ground
• unwell or sore because of a flare up in your arthritis

            
    or when you want to walk further than usual.
 
Using a walking stick is not a sign of ‘giving in’ and can often be used as a temporary measure to keep you safe and relieve the pain of sore joints.

Choosing a walking stick:
 

• There are many types eg wood, steel, and adjustable sticks.  All of these are fine.
• Height is very important.  To ensure your walking stick is the right height:
• Stand upright with your arms relaxed by your side.
• The top of the stick should be in line with the bony knob on the outside of your wrist.  This means your elbow should be slightly bent when your hand is resting on the handle of the walking stick.
• Ensure the rubber stopper on the end does not wear through.

Using a walking stick correctly:

• Hold the stick in the hand opposite to the painful or unstable leg.
• Place the stick forward, either before or at the same time, as the painful or unsteady leg.
• Take some weight on the stick and on the painful leg
• Up and down stairs:

           -  Going up, the good leg goes first, and then the sore leg and stick last
           -  Going down, the stick goes first, and then the sore leg and the good leg last
 
                                          Compiled for you by our physiotherapists

If you need more advice on how to choose the correct walking stick, just contact us at Therapy Professionals our friendly physiotherapists can help. 

                 Phone:           3877 5280   Fax:  03 377 5281
                 Website:        www.therapyprofessionals.co.nz                                                                                                                                                     
                 Email:            admin@tpl.nz


 

 
Leaky water works - Incontinence
 
There are many myths about incontinence, which are not necessarily true.  For instance many people believe incontinence is an inevitable consequence of ageing or if you drink less it will improve the problem.  Neither of these beliefs is helpful.
 
Some facts about our Water Works:

• The bladder is an expandable muscular bag that gradually fills and once full it automatically contracts to force urine out.
• The bladder can hold 300-400 mls during the day and up to 800 mls overnight.
• We normally empty our bladder 5-7 times a day. 
• Your pelvic floor and urethra sphincter muscles are important in stopping leakage and we have control over these muscles.
• We need to drink 6-8 standard glasses of fluid a day.
• Caffeine, artificial sweeteners, alcohol, some fizzy drinks and medications, including diuretics, are known to irritate the bladder.
• Infection and inflammation of the bladder and urethra will cause pain, discomfort and urgency.
• We can train our bladders to empty before it’s full.

 
There are two types of incontinence – Stress and Urgency.
 
Stress incontinence
 
With stress incontinence there may be leaking when coughing, sneezing, jumping, lifting, pushing, laughing and pulling.  This is caused by weak pelvic floor and urethra sphincter muscles.  The trick is to strengthen your pelvic floor and urethral sphincter muscles and tighten your pelvic floor muscles before stressful activity occurs.
 
Urgency incontinence 
 
Urgency incontinence is the sudden need to go, for example, when opening the front door you generally get the urge. It’s caused by an overactive bladder, which has been trained to empty before it’s full. Typically small amounts of urine are passed more frequently -10 plus times a day.

Preventing or fixing incontinence
 
For both types of incontinence strengthening your pelvic floor and urethra sphincter are important.  To do this:

• sit comfortably with feet and knees apart
• lean forward at the hips with your back straight
• breathe normally throughout
• find your pelvic floor by imagining stopping yourself from passing urine or wind
• tighten your pelvic floor muscles on the out breath 
• close the openings by squeezing and LIFTING inside 
• aim to hold for 3 -10 seconds, rest 5-10 seconds, repeat 5-10 times.  Do this three times a day.

Once you’ve mastered the pelvic floor exercises, practice regularly eg every time you stop at red lights.
 
Tips for managing and training urgency incontinence
 
When you experience the sudden urgency to pass urine, it is often associated with a feeling of panic.  The following may help:

• keep calm – don’t panic
• stand still or sit down
• remember the bladder is a large bag and you do not actually need to go
• let the tummy muscles relax
• KEEP BREATHING
• pull up the pelvic floor muscles hard ie PULL THE BRAKES ON!
• think of something else.
• wait until the urgency passes, usually about 10-30 seconds, and then carry on with activity or slowly make your way to the toilet.

 
If desperate:

• cross the legs, or
• press on the pelvic floor muscles by sitting on the arm of a chair or pressing with the hand.

 
If you are still struggling there is help:

• Consult your Doctor to rule out inflammation, infection or drug irritation
• Contact the Nurse Maude Continence Service
• Contact our friendly Physiotherapist who will be able to help you improve your pelvic floor and urethra strength.

 
You don’t have to suffer alone - contact us we can help
 
 
Ph:                   03 3775280
Email:              admin@tpl.nz
Web:                www.therapyprofessional.co.nz
 
 
 
Reference:     Women’s Waterworks – Curing Incontinence by Pauline E Chiarelli

Teaching Shaving Skills
 
Shaving is a major part of growing up and for a boy, it signals the transition from childhood into manhood.  Shaving is a complex task, which requires consideration of safety and sensory challenges.
 
How can you make this easier?
 
Get him used to the idea he will be shaving his face one day by:

• telling him routinely he will be shaving when he starts getting whiskers on his face 
• getting him to watch someone experienced shave regularly
• getting him used to handling an electric razor in front of the mirror and turning it on and off under supervision
• using mime to pretend he is shaving
• using pictures with simple words for each step of the shaving process 
• talking about when shaving will happen in their daily routine eg before or after their shower

 
We would recommend using an electric razor to start with, as they can be easier and safer to use.  However, for some, the noise or vibration may be too much and a razor blade may more successful.
 
Like all skills, there are a large number of smaller skills or activities used when shaving eg with an electric razor.

1. Go to the bathroom
2. Get razor from drawer
3. Take off safety cap
4. Plug electric cord into razor 
5. Plug cord into the wall socket 
6. Turn razor on
7. Shave right cheek then the left cheek  
8. Shave upper lip 
9. Shave chin 
10. Shave neck  
11. Check in the mirror you haven’t missed any hairs
12. Turn the razor off
13. Unplug razor from the wall socket
14. Unplug razor from the electric cord
15. Brush the hair out of the razor into the sink
16. Turn on the cold tap and wash the hair away down the sink
17. Place safety cap on razor
18. Return razor to drawer.

To assist teaching, take photos of each of these steps:

• in the environment the shaving will take place 
• with the equipment he will be using
• with the individual doing the activity himself, where possible. 

 
If it is not possible, try and locate pictures from the internet showing the shaving steps.
 
Put the photos or simple pictures in the correct sequence with simple words describing the activity.  Use this schedule as a prompt while teaching. Initially you may have to use verbal and physical prompts along with the schedule.
 
If you are experiencing any problems with the development of these skills our Occupational Therapist may be able to help.  
 
 
Just contact us at Therapy Professionals 
 
Phone:                03 3775280
Email:                  admin@tpl.nz 
Web:                    therapyprofessionals.co.nz

​https://www.carautismroadmap.org/shaving-for-young-men/

About Dietitians

Dietitians help you to improve your health, wellbeing and prevent illness through good nutrition. They can translate scientific information about nutrition into practical dietary advice and tailor an eating plan based on your individual factors (age, medical history etc). 
 
Dietitians can help with a range of health problems and chronic diseases such as: 

• unplanned weight loss or gain 
• a restricted diet eg gluten free, vegetarian, dairy free
• high cholesterol 
• heart burn (reflux)
• allergies/intolerances 
• diabetes (high or low blood sugars)
• stomach cramps, bloating, nausea and vomiting
• vitamin and mineral deficiencies
• constipation
• wounds that won't heal 
• easily broken bones 
• dry mouth 
• fatigue, low energy and dietary deficiencies

 They will recommend practical solutions for: 
 

• maintaining optimal health and energy levels
• balanced nutrition 
• personalised meal planning and preparation 
• grocery shopping 
• reading nutritional labels 
• keeping food safe to eat
• portion control
• fluid intake
• healthy eating on a budget
• reducing the risk of chronic disease eg cancer, diabetes and heart disease
• sports

 
Dietitians are able to prescribe:
 

• nutritional supplements
• tube feed formulas
• vitamin and mineral supplements

 
What's the difference between a Dietitian and Nutritionist? 
 
Dietitians are health professionals registered under theHealth Practitioners Competence Assurance act 2003 and meet standards required by the NZ Dietitians Board. 
 
Dietitianshave a science degree in human nutrition as well as a postgraduate Diploma or Masters in Dietetics. By law, a Dietitian must hold a NZ current practicing certificate, participate in a continuing competency programme and adhere to a code of ethics. 
 
Nutritionists: The term nutritionist is not protected and can therefore be used by anyone regardless of qualifications. Nutritionists who meet set criteria are able to become registered Nutritionists with the Nutrition Society of New Zealand. 
 
Therapy Professionals has a Dietetic service, so if you need help you just call us we come to you. 
 
            Therapy Professionals Ltd
            Phone No:       (03) 377 5280
            Email:              admin@tpl.nz
            Website:         www.therapyprofessionals.co.nz
 

Skin injuries caused by pressure
 
For those of us caring for people who barely move or rely on others to move them, it is important to know how to best look after their skin. Pressure injuries, otherwise known as pressure areas, ulcers or bedsores, are among the negative effects of immobility.
 
What is a pressure injury?
 
A pressure injury is damage to an area of skin, usually around a bony part of the body, which has been under pressure for some time. The pressure stops the blood flow feeding the skin in the area and if the pressure is not removed the skin will break down and eventually become an ulcer.  Friction from chaffing, or rubbing over these bony areas can also cause sores and ulcers.
 
What areas are prone to pressure injuries?
 
The diagrams below indicate where most pressure injuries generally occur, however people with unusual posture may develop them elsewhere.

Who is likely to develop pressure? 
 
Anyone who is immobile or can’t feel any sensations are at serious risk, especially those who:

• are bedridden after surgery or during a long illness
• have a health condition such as diabetes, stroke, chronic obstructive airways disease and malnutrition
• have had pressure injuries before
• sit or lie in one position for hours because they can’t move themselves 

 
 
How will I know someone is developing a pressure injury?
 
The skin area around a bony part of the body may:

• be discoloured - dark or red 
• feel hard
• be warm
• not go white when pressed with your finger
• have a blister, blood blister, crack or open wound

 
How can I prevent pressure injuries?
 
A pressure injury is serious, can take a long time to heal, and many are preventable.
 
We can help prevent pressure injuries by relieving direct pressure on the bony areas, taking good care of the skin and having a healthy diet and adequate fluids.  Here are a few tips:
 
Avoid direct pressure

• change position regularly, at least two hourly
• use special pressure-relieving mattresses and cushions
• don't drag heels or elbows when moving, bathing or dressing 
• make sure the bed sheets and clothesare smooth, not wrinkled 
• use cotton or silk like fabric sheets and clothing

 
Skincare 

• keep skin clean and dry
• avoid scented soaps as they can be more drying
• moisturise skin thoroughly after washing and keep well moisturised
• avoid using talcum powder as this dries the skin’s natural oils

 
Diet

• provide a well balanced diet
• give at least 2 litres of fluid a day 

 
What should I do if you think a pressure injury is developing?
 
Immediately reposition the person to completely take all pressure off the affected area and follow all the prevention tips above.  Seek help from:  

• their GP, who may refer to the community therapy or nursing team if required
• Therapy Professionals Physio, Occupational Therapists and Dietitians.

 
How can Therapy Professional’s Therapists can help?
 
Our therapists can help with:

• education on pressure injury prevention 
• manage current or recurring injuries

 
Dietitians:  advise on:

• nutritional requirements to aid wound healing. 

 
Occupational Therapists: advise on: 

• pressure relieving products e.g. cushions, mattresses, heel protectors
• positioning for pressure relief

 
Physiotherapists:  advise on:

• moving and turning people in bed safely to avoid friction on the skin
• changing position and movements to prevent staying in one position for too long.

 
If you require education on prevention and management of pressure injuries, our friendly Physio and Occupational Therapists and Dietitians can help, just contact us at Therapy Professionals. 
 
Ph:                  03 377 5280
Email:             admin@tpl.nz
Website:        therapyprofessionals.co.nz