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I love the scene in the movie, Pretty Woman, when Julia Roberts attends a business dinner in a posh restaurant. She is served escargot and attempts to grasp one with a snail tong.  With a snap, the appetizer is sent sailing across the room and deftly caught by a waiter.

Although Julia’s struggle with her meal is humorous, I’m not as quick to laugh when my own lack of dexterity is the center of attention. Because I have Charcot-Marie-Tooth disease, my hands are curled and weak.  When I eat out, my husband often cuts my steak or peels my shrimp.

See an Expert
If you have weak hands and difficulties at meal time, you may need to see a Physical Therapist (PT), Occupational Therapist (OT) or Certified Hand Therapist (CHT).

Marianne Mortera, PhD, OTR, is an Assistant Professor of Clinical Occupational Therapy at Columbia University and the editor of the American Occupational Therapy Association’s Physical Disabilities Special Interest Section Quarterly. She explains that a therapist will assess your gross, sensory, and fine motor function; strength, range-of- motion, severity of weakness; manipulation, and more.  A therapist will take a detailed medical history.

Typical questions might include:

• Are you feeling clumsy or dropping things?
• Are you having any difficulty cutting your food?
• Have you changed what you eat or prepare because of your hands?
• For example, it may be easier to eat a bowl of cereal rather than make a sandwich.

Behavioral changes such as these can indicate you are compensating for your weak hands. Perhaps you’ve changed habits and did not consciously realize your hand weakness was progressing.

Therapists may test swelling, sensation, and strength where appropriate. Therapists assess any problems in functional use of the hands, starting with general weakness, and narrowing down to specific activities of living, such as starting the car, eating or opening a jar.

A person may have weak hands and still be able to grasp.  Or perhaps the pincher grasp—the ability to pick a straight pin up from the floor—is not functional.  There is even a cylindrical grasp—the one that let’s you wrap your fingers around a tall glass of lemonade and bring it to your lips.

“Evaluating hand weakness is more than opening and closing the fingers. Of all the things that the human body does, using our hands is the most complex activity.  From buttoning a collar to gently placing a contact lens on the eye, hands are unique,” said Mortera.

Tools
With a therapist’s assistance, you can find a variety of modified and adaptive tools for use in the kitchen and dining room.  Some examples include built-up handled silverware for weak or incomplete grasp, rocker knives, special cutting boards, non skid placemats to prevent food from sliding across the table, and even stirring and pouring assists.  

“Hand therapists also often make custom orthoses or splints to stabilize or assist weak muscles or help position the hand in functional positions,” said Christine Muhleman, 2006 President American Society of Hand Therapists.

“A few more products out there every year, but many are custom-built by therapists and may never go into production,” said Muhleman. “I personally like to use pieces of plumbing insulation tubing, wrapped around different handles (from knives to toothbrushes) to enlarge them.  It's a quick, easy, washable, and inexpensive modification.

Muhleman added, “Commercially available products such as Coban and Vetwrap (brand names) may also be used to modify handles by wrapping them around a handle to build it up and customize the shape.  There are also materials that can be heated to soften and then mold for a custom shape.”

Coping Strategies
Living with a disability means adapting to change.  If you are dining in a restaurant, you may want to bring adaptive utensils or ask the waiter to have your steak cut in the kitchen or get assistance from your dining partner.  Muhleman suggests using straws in beverages to minimize lifting and moving glassware.

What you eat is a personal choice.  If I don’t want someone helping me cut my meal when dining out, I order the fish. (It's soft and easy to cut.) Eating can be messy. I carry Tide to Go, a stain remover pen, in my purse for embarrassing spills. I tend to drop things rather easily, so at home; I drink out of plastic cups and use lightweight dishes.

I used to break glass coffee pots until I bought a Cusinart On Demand Coffee Maker, which didn’t come with a pot. Instead, I put a coffee cup under the dispenser and push a button—like what you find at a convenience store.

Every kitchen needs an easy-to-use can opener. I use the Hamilton Beach Classic Chrome Heavyweight Can Opener.  It’s taller than an average can opener and it doesn’t tip over.  Also, the “cutting unit” removes easily for washing.

If your hands shake, like mine, look for a cool-touch toaster to prevent burns. I use Oster. And a refrigerator with a water/ice dispenser on the outside is well worth the extra cost. 

Night on the Town
The next time my husband and I go to dinner, I’ll choose a romantic restaurant that is dimly lit—preferably with candles.  We will sit in a secluded corner and when Jim leans in to assist me with my dinner, the other patrons will simply assume we are enjoying an intimate moment.

Resources

Certified Hand Therapists
A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist who has a minimum of five years of clinical experience, including 4,000 hours or more in direct practice in hand therapy. In addition, the CHT must successfully pass a comprehensive test of advanced clinical skills and theory in upper quarter rehabilitation. A CHT is required to demonstrate continued professional development and competency by recertifying every five years.  To locate a CHT, visit the Hand Therapy Certification Commission (HTCC) website http://www.htcc.org/ and click on “Directory” for a listing of therapists by location.

American Society of Hand Therapists (ASHT) http://www.asht.org/  ASHT is a professional organization comprised of licensed occupational and physical therapists, some of whom have earned the advanced designation, Certified Hand Therapist (CHT), and who specialize in the treatment and rehabilitation of the upper extremity.

The American Occupational Therapy Association, Inc. http://www.aota.org/

American Physical Therapy Association http://www.apta.org/

Products
Start your search at the National Public Website on Assistive Technology (http://www.assistivetech.net/).  Under Product Search, click on “Activity” and select “Activities of Daily Living.” The “Feeding/Eating/Drinking” category lists more than 20 types of products. For example, under “Eating utensil” you will find 102 products with links to vendors and costs.