Authors: (including presenting author): :
Wong CY(1), Chan OY(1), Tsai KL(1)
Affiliation: :
(1) Occupational Therapy Department, Haven of Hope Hospital
Keyword 1: :
Occupational Therapy
Keyword 2: :
Chopsticks training
Keyword 3: :
Graded Protocol
Introduction: :
Chopsticks use is a culturally meaningful activity of daily living especially for Asian. Various clinical conditions including neurological injury, age-related decline, deconditioning or other musculoskeletal conditions lead to a loss of ability in using chopsticks, affecting patient’s feeding independence and self-image. Wide variation in material of chopsticks, chopsticks design and in users’ grasp modes complicates chopsticks selection and training approaches.
Objectives: :
To improve the quality of OT service by providing an evidence-based grading rubric for chopsticks selection and training workflow in chopsticks training.
Methodology: :
Literature review was conducted involving two major directions: 1. Chopsticks design including material, handle shape and diameter, tip geometry and presence of grooves; 2. Chopsticks rehabilitation and training direction and workflow. Clinical workflow integrating brief motor and cognitive screening, choice of chopsticks/ assistive device and staged chopsticks skills training is then formulated from the reviewed studies.
Result & Outcome: :
A total of 32 reviews were selected and reviewed. From the selected studies, chopsticks grading can be varied in the means of material, handle shape, length and diameter, tip angle and presence of grooves. It is recommended that rounded bamboo chopsticks, with 6mm handle diameter and grooved tip (with tip angle 2”/ 4”), would be the starting design for chopsticks training. Clinical workflow is also suggested in the protocol, including selection of assistive devices, staged skills training and repetitive chopsticks training. Brunnstrom recovery stage - Upper extremity stage 4 or above and sound cognition indicate potential patient for functional chopsticks/ or spoon use. Three main focuses are highlighted in chopsticks training: 1. intrinsic muscle training for movement of thumb, index finger and middle finger; 2. coordinated movement of fingers; 3. repetition to enhance force regulation. Bedside rehabilitation approach in restoring hand function for chopsticks manipulation, other compensatory approaches including use of assistive devices, change of grasping mode and training of non-dominant hand use are also highlighted in the protocol especially for patients indicated as “limited” potential. The protocol was implemented on several cases which echo the reviewed studies. More clinical trials are still necessary in future so as to pilot the protocol to various case types.
