Running head: THE BOTTLE-LOCK

The Bottle-Lock: An Adaptive Device for Opening a Bottle of Wine William Unger Touro University, Nevada

THE BOTTLE-LOCK

2 Introduction

For this project, I chose to construct an assistive device which would aid an individual suffering from unilateral hemiparesis or hemiplegia secondary to a cerebral vascular accident in opening a standard size bottle of wine using only their unaffected upper extremity. While consumption of wine is not a necessity on par with many other ADLs and IADLs, it can be an important part of an individuals meal routines and social occasions. Furthermore, the tasting and collecting of wine can be considered a hobby or leisure activity, and is one which has longstanding historical and cultural roots. In this way, independence in the task of opening a bottle of wine can be ranked as a very important occupation for individuals with such a passion. Occupational Profile Edward is a retired 64 year old man who recently suffered a cerebral vascular accident which resulted in a loss of sensation and mobility of his left side. While his recovery has been marked with significant improvements, he still has difficulty functionally using his left upper extremity. As a result, Edward has had to implement a number of adaptive strategies in order to continue engaging in meaningful occupations. Edward lives with his wife of 35 years, Elizabeth, in their single story home in Henderson. Edward and Elizabeth had both been enjoying their first year of retirement prior to his stroke, and had been in the process of planning a month long vacation along the California coast to visit some of their favorite vineyards. Edward and Elizabeth are both longtime wine enthusiasts, and Edward has been collecting bottles from around the world for the past three decades. Edwards childhood home was located on a small vineyard in southern California owned by his father, and the cultivation and fermentation of wine has been a part of his familys culture and heritage for generations. While Edward did not continue on in his family trade,

THE BOTTLE-LOCK

instead choosing a vocation as a commercial airline pilot, he had never lost the passion for wine shared by his family. For the past 6 years, Edward and Elizabeth had hosted a get together of close friends twice a month to taste samples of wines from different regions. Prior to serving a particular wine, Edward would perform detailed research on the history of the vineyard from which it came, and his wife would prepare small dishes which would pair well with each bottles individual bouquet. The events were a source of great joy for the both of them, and acting as host gave Edward incredible satisfaction of observing his familys traditions. Since Edwards stroke, however, the couple has not hosted any such events, and Edward has begun to become socially isolated. While his friends continued to visit from time to time, Edward feels a strong sense of loss. He still enjoys an occasional glass of wine, but is unable to open the bottle on his own, and as such is unable to serve in his traditional role of a host. Independence and self-reliance is a very important component of Edwards sense of self. In a way, his fierce determination to be independent served as a powerful catalyst for progress during his recovery. With respect to his passion for serving wine to friends and family, however, all of Edwards ingenuity and resourcefulness had failed to produce success. The primary issue with opening the bottle lied in his inability to properly stabilize the base as he used his unaffected arm to open it. He had attempted to hold it between his legs, but residual loss of strength and motor control of his left side made it too difficult to apply sufficient pressure when gripping the bottle between his knees. In addition, he felt the whole approach made him look weak and foolish, and he had stated that he would be too embarrassed to attempt it in front of company. He had tried using a variety of mechanical bottle openers, and had found some success through their use, but still found it too challenging to safely remove the cork

THE BOTTLE-LOCK

without toppling the bottle or spilling the wine. The only strategy which had produced reliable success was that of his wife holding the bottle steady as Edward opened it, but this notion ran contrary to Edwards insistence on independence. The subject of Edwards inability to engage in this occupation had arisen during his most recent visit to his occupational therapist. Edward had been seeing his occupational therapist at an outpatient rehabilitation clinic once a week for the past 3 months of his recovery. Early goals had almost exclusively focused on his ability to independently engage in ADLs and IADLs, particularly because Edward had repeatedly stated that he did not wish to be a burden of any kind to his wife. His progress, while slow at first, had become increasingly consistent, to the point in which he had regained a modified version of independence in nearly all his most important areas of occupation. During his most recent visit, however, it was revealed to Edwards occupational therapist that he had been feeling bored and depressed, and that he was frustrated at feeling unable to engage in his primary passion of leisure and socializing by hosting wine tastings in the way he once had. After performing a few functional assessments of Edwards capability, his therapist determined that an adaptive device would be the best intervention to restore Edwards participation in this meaningful occupation. He and his therapist discussed the prospect of the use of such a device, and Edward showed a great deal of enthusiasm and anticipation to try anything which might restore his independence. After some initial research, however, the therapist was unable to find any device to serve this purpose. Instead, after receiving Edwards approval, the therapist chose to construct a custom device. Description of Items Construction and Use The device is called the Bottle-Lock, and it serves as a stabilizing mechanism to secure a wine bottle in place while its user opens it with a corkscrew. The device is made of two

THE BOTTLE-LOCK

stacked 5 by 5 square cuts of durable redwood through which a 3 in diameter circular hole has been cut using a 3 hole saw. This hole is slightly larger than the diameter of a standard wine bottle, and serves as the gripping surface to stabilize its base. The two stacked cuts of wood were fused together with a durable epoxy, and were cut lengthwise to split the structure in two. After being cut, a hinge was attached to the back of the structures, joining them together and permitting it to be opened and closed around a bottles base. At the front of the structure, a latch was installed to secure the two halves in place and keep a firm grip around the bottle. Inside the hole itself, one half of the interior was lined with a common slip resistant rubber drawer liner. This further secures the bottles base, and fills in any gap between the edge of the bottle and the circular cut in the wood. This same slip resistant material was used to line the base of the structure, and an additional square piece was cut to go underneath the structure and on top of the kitchen counter or table itself, preventing the occurrence of any slip while downward pressure is being applied to the bottle. To operate the device, its user first must bring the bottle to a nearby counter. Next, the user opens the latch on the front, and swings the left half open a few inches. The user then secures the bottle inside the right half which has been lined with the gripping material, and closes the left half before securing the latch. At this point, the user must remove the foil which typically covers the top of a bottle of wine. This is easily accomplished with one hand through the use of a foil cutter, an inexpensive tool commonly found in liquor stores. Once the foil has been removed, the user will begin to insert the coil of the corkscrew into the cork. While a variety of corkscrews can be utilized, the style found to be the most successful during the creation of this device is one which encircles the neck of the bottle, and which requires only one hand to unscrew the cork. Additionally, some bottles of wine now utilize an aluminum screw-

THE BOTTLE-LOCK

top, a feature which is also compatible with the gripping force of the Bottle-Lock. As the cork or screw-top is being removed, the downward pressure on the bottle coupled with the wide base of support and stable no slip surface of the Bottle-Lock enables the user to successfully open the bottle with ease. The Bottle-Lock is then opened by opening the latch and swinging out the left half. The bottle is likely to still be securely wedged in the contour of the rubber lined right half, but can easily be removed from the Bottle-Lock by tilting it to the left. Photographs of the Use of the Bottle-Lock

THE BOTTLE-LOCK

THE BOTTLE-LOCK

THE BOTTLE-LOCK

THE BOTTLE-LOCK

10

Materials and Cost The Bottle-Lock was created with easily obtainable materials, and can be constructed at limited cost. First, a builder must obtain 2 5 x 5 blocks of redwood to form the bulk of the structure. Unfortunately, most lumber retailers will only sell lengths of wood much longer that what is required, so a builder will likely need to purchase more than they will actually need. The shortest length I was able to find was a 2x6x8 length of redwood which cost just under $10. Next, the builder must obtain a roll of no-slip shelf liner. As with the redwood, it will likely not be possible to purchase only the segments needed for a single device. I was able to find a 12x10 roll of such a liner for $6. Next, the builder will need to obtain a quick drying epoxy to fuse the two blocks of redwood together. The price of epoxy can vary greatly depending on brand and retailer, but I used a fairly inexpensive type which cost around $15 dollars for a medium sized bottle. As was the case for both the redwood and the shelf liner, such a bottle will have sufficient supply to create multiple devices. Finally, the builder will need to obtain a metal hinge and latch to both permit and restrict the movement of the two pieces of redwood. I was able to purchase both of these for just under $5 at a hardware store, and they included all needed mounting screws.

THE BOTTLE-LOCK

11

The total cost for all of these components comes to $36; however, the actual cost per unit is likely to be a fraction of this figure due to the required bulk purchase of many of the materials. This being the case, it might be more practical for a builder to see this purchase as an initial investment with which to construct several units for different clients. Alternative Populations While the Bottle-Lock was designed to be used by an individual suffering from generalized unilateral weakness in the upper extremity secondary to a cerebral vascular accident, it could equally useful for individuals of different diagnoses with similar restrictions. Individuals with an above elbow amputation would likely have similar issues holding the bottle in place without the use of prosthesis, and would benefit from the quick and convenient use of the BottleLock. Similarly, the Bottle-Lock would be of use to individuals with unilateral contractures or arthritis which would prevent them from effectively gripping the bottle. Additionally, the BottleLock could be helpful to individuals with muscle tremors by providing a solid base of support upon which to open the bottle. Practically any condition which limits the unilateral use or bilateral coordination of an upper extremity could benefit from the stabilizing features of the Bottle-Lock. Limitations The primary limitation to the Bottle-Lock is that its utility is restricted only to the use of a standard size wine bottle. Many bottles of sparkling wine or champagne commonly have a wider base which would not fit this current design of the Bottle-Lock. This limitation could be overcome with a separate model for wider base bottles, or through a larger standard model with different inserts to accommodate wider or narrower bottle sizes.

THE BOTTLE-LOCK

12

A second limitation to the Bottle-Lock is that it requires downward force to most effectively keep the device in place. While this force is inherent in the use of a corkscrew by individuals with typical upper extremity strength, it might present a challenge to those with weakness in the stronger of the two extremities. This limitation could be overcome with a vice attachment to the Bottle-Lock which would firmly secure it to the table or edge of a counter. Literature Review Since a device with this specific purpose is, to the best of my knowledge, not previously in existence, my evidence based foundation for its clinical utility instead had to be based on the importance of engagement in occupations of leisure for individuals with physical disability. To begin this process, I first evaluated documented evidence of how the perceptions of physiological and psychological changes following a stroke impact an individuals quality of life. In Lyn Jongbloeds 1994 study, Adaptation to a Stroke: The Experience of One Couple, a series of qualitative interviews with a single couple were examined to provide insight into the social dynamics of a longstanding marriage after a partner suffers a stroke. The interviews painted an excellent picture of challenges faced by the couple in adapting to changing roles resulting from the onset of the impairment. The subjects of the study were respectfully kept anonymous by the authors, referred to only as the woman or the man (Jongbloed, 1994). The woman was 55 years old, and had suffered from a right cerebrovascular accident (Jongbloed, 1994). Her and her husband, age 61, were interviewed 5, 9, 14, 20, and 29 months after her stroke (Jongbloed, 1994). The couple had been married 35 years at the time of her stroke, and reported a fairly consistent distribution of roles throughout the duration of their relationship (Jongbloed, 1994). These roles could more or less be seen as the traditional notion of gender typical, with the woman being responsible for

THE BOTTLE-LOCK

13

the large bulk of household and cooking tasks, and the man being responsible for labor and handyman related tasks, as well as being the sole income earner (Jongbloed, 1994). The man, who had retired 6 months prior to his wifes stroke, expressed disappointment in the hindrance her condition had placed on their plans to travel (Jongbloed, 1994). He also seemed uncomfortable with the additional responsibilities he had to take on as a result of her stroke, including being solely responsible for her transportation as well as many of the tasks previously delegated to her role as a homemaker (Jongbloed, 1994). It was expressed by both the man and the woman that difficulty adapting to the new circumstances had introduced new problems in their relationship (Jongbloed, 1994). The woman, despite regaining a large degree of independence over the course of her rehabilitation, seemed weighed down by feelings of guilt regarding her condition (Jongbloed, 1994). She saw her inability to fulfill her prior roles as a burden upon her husband, and this sentiment was unfortunately reinforced by her husbands disparaging attitude towards her condition (Jongbloed, 1994). While it was apparent that her husband still cared for her deeply, his somewhat controlling personality seemed to come in conflict with the circumstances of her condition. He seemed to regard the condition as an inconvenience to the life of retirement he had planned out for the two of them, and his resentment towards his wife for her condition was the primary source of their newfound relationship problems. Over subsequent interviews, however, the couple appeared to become increasingly accepting of the situation, and the husband in particular began to adapt to the necessary changes he would have to make to his vision for their future. A particularly important event which improved the couples relationship occurred when the woman regained the ability to drive, a change which significantly reduced the both the husband and the wifes perception of the woman as a burden (Jongbloed, 1994).

THE BOTTLE-LOCK

14

I found this study to effectively highlight the psychosocial implications that a stroke can have on the dynamics of a married couples relationship. The sudden shift in roles which had more or less been constant throughout 35 years of marriage came as quite a shock to the couple, and resulted in a less than desirable period of challenging adaptation. While the attitude of the husband came across as fairly uncooperative in the article, it did shed light on an important phenomenon in the challenges faced by individuals coping with the sudden life-altering changes caused by a stroke. As was the case in the couple interviewed in Jongbloeds study, the fictional individual which I based my project on had a difficult time adapting to his inability to participate in his prior roles. By introducing an adaptive device which enabled him to return to these roles in a modified fashion, the individual would feel an increased sense of a return to normalcy, and would hopefully experience a decrease in the distress that was present in the subjects of Jongbloeds study. To further support the importance of an intervention based on increasing an individuals capacity to engage in leisure activities, I found evidence documented in Specht, King, Brown, and Foris 2002 study, The Importance of Leisure in the Lives of Persons With Congenital Physical Disabilities. While the fictional individual upon whom my adaptive intervention was based suffered from an acquired disability rather than a congenital one, the importance of leisure skills in an individuals quality of life was noted by the authors to provide similar benefits amongst both populations (Specht et al., 2002). The authors of this study identified four primary functions accomplished by participating in leisure activities: providing mental and physical health benefits, enjoyment, opportunities to develop a concept of self and increase self-esteem through proving ones abilities, and opportunities to build and enhance social relationships (Specht et al., 2002). Within the fictional

THE BOTTLE-LOCK

15

context of the client created for this project, the leisure occupation of collecting, serving, and tasting wine fulfills nearly all of these roles, with perhaps the exception of physical health benefits. Furthermore, the study highlighted the challenges which social, attitudinal, and environmental barriers to participation in leisure activities can have on the fulfillment of these four important roles (Specht et al., 2002). Finally, the study examined the benefits of enabling influences for leisure participation, such as support provided by peers or professionals, or the aid of adaptive equipment (Specht et al., 2002). The authors of the study concluded that additional focus on leisure participation was warranted within the field of occupational therapy interventions (Specht et al., 2002). It was suggested that such interventions would best serve the needs of their clients by proactively identifying potential barriers and concurrently promoting enabling influences to leisure participation (Specht et al., 2002). This approach is similar to that which would be taken through the implementation of an adaptive device such as the Bottle-Lock. First, a therapist would identify the physical barrier which unilateral upper extremity dysfunction would present on an individuals ability to independently engage in the activity of opening and serving a bottle of wine. Once this barrier has been identified and examined, the implementation of an enabling device such as the Bottle-Lock would enhance the clients adaptive capacity to the point which they are again able to engage in the occupation with modified independence. Both of these articles provide an evidence based background upon which an intervention centered on the promotion of role engagement and leisure participation for individuals recovering from stroke could be based. While the hobby of wine collecting and tasting may not be as common as other forms of leisure, barriers to participation to those which consider it a passion would be equally detrimental to quality of life. By supporting the ability of an individual

THE BOTTLE-LOCK

16

to return to prior roles as well as enabling an individual to engage in a desired occupation of leisure, an adaptive intervention utilizing a device such as the Bottle-Lock would be well warranted within the scope of occupational therapy practice.

THE BOTTLE-LOCK

17 References

Jongbloed, L. (1994). Adaptation to a stroke: The experience of one couple. American Journal of Occupational Therapy, 48(11), 1006-1013 Specht, J., King, G., Brown, E., Foris, C. (2002). The importance of leisure in the lives of persons with congenital physical disabilities. American Journal of Occupational Therapy, 56(4), 436-445.