By Jane Catchpole Dip C.O.T., S.R.O.T.

Conservation of Energy and Pacing of Activity

When conservation of energy, management of joint problems and care of joints is necessary, the following guidelines should prove helpful.

Planning

• Use your joints sensibly and think about them.
• Always keep a little energy in reserve to avoid over-exertion.
• List the tasks to be carried out. Prioritise.
• Consider: can it be eliminated? postponed? done by someone else? stopped?
• Divide heavy and light tasks throughout the week.
• Alternate active tasks with those which can be done while sitting down.
• Can heavy tasks be simplified or divided into lighter components?

General Tips

• Be flexible.
• Sit to carry out tasks where possible, many tasks can be done equally well sitting
• Don't feel guilty about stopping when you feel tired.
• Avoid lifting heavy articles.
• Avoid repeated bending and stretching.
• Re-arrange kitchen, if necessary, to keep frequently used objects close at hand.
• Use of labour or energy saving gadgets should be considered.

Joint Care

• Do think carefully each time you use a joint.
• Don't think you must do particular things because they are good for you.
• Avoid continuous grip or keeping joints in one position.
• Realise you cannot work off pain and swelling.
• Avoid strain on individual joints.
• Don't get involved in lengthy tasks that tax you beyond your capabilities.
• Only start a job with the understanding that you can stop it if necessary.
• Take adequate rest.
• Wear prescribed splints and supports.
• Use prescribed equipment.
• Always keep a little energy in reserve.
• Pace your activity, rest, exercise.

Rest and Exercise

A balance is needed between rest and exercise.

Rest	Helps muscles regain their energy. Rest on a bed rather than a chair.
	The amount required will depend on the individual.
	Consider posture while resting.
Exercise	Maintains muscle strength, remember to exercise within your daily routine.
	Avoid sudden muscle activity, which will put a strain on the joints.
	Don't overtire muscles and exercise different muscle groups.
	Concentrate in muscles around lax joints

Posture

Always think about maintaining good posture with weight evenly distributed.

Standing	Back straight, shoulders relaxed, tummy and bottom tucked in
	Stand on both feet - taking weight evenly
	Wear comfortable, supportive shoes
	Avoid standing for long periods of time
Sitting	Avoid low soft chairs
	Ensure good support, adequate back support, arm rests, head rest
	Good supportive, comfortable upholstery
Working	Position work at correct height for the chair
	An inclined working surface may help
Lying	Good height - avoid strain getting in and out
	Firm mattress with good support
	Use a small pillow, the head should not be pushed forward

Personal Care

Bathing	Sit to have a shower
	A bath board and seat may be of help
	Sit down on toilet or stool while washing and drying
Toilet	A raised seat helps reduce strain on muscles and joints
	Hair Have an easy style to manage
	Wash hair while in the bath or shower
Clothing	Sit as much as possible while dressing
Bedroom	Keep a flask or kettle in the bedroom for making a drink

Domestic Activities

Housework	Keep a bag at the top and bottom of the stairs, articles to be taken up or down can be placed in it and taken in one trip
	Use a lightweight carpet sweeper rather that a vacuum cleaner
	A long handled dustpan and brush saves bending
	Iron only what is absolutely necessary
Kitchen	A continuous, level working surface enables pots and pans to be pushed rather than lifted
	Fill the kettle with a jug rather than lifting the kettle
	Soak items to be washed up and use a brush, this lessens the pressure needed to clean
	Dry dishes in draining rack
	Plan cooking to reduce the utensils needed to a minimum
Shopping	Trolleys which incorporate a seat can be useful
	Ask for packing and carryout assistance in supermarket
	Enquire if local firms have a delivery service
	Use mail order firms

Mobility

Feet	Wear supportive shoes
	Moulded insoles may help
Walking Aids	Consider: a stick, crutches, walking frame
	Ensure you are assessed for the most suitable and instructed in correct use
Scooters	Consider: kerb climbing ability, speed, distance covered on one battery charge
	Suspension, support of seat, is there a choice of seats
	Will it dismantle to fit in a car? Have you someone who can do this for you if the components are too heavy?
Wheelchair	Consider: Attendant pushed/self-propelled/powered.
	Folding to be put in a car. If powered points as for scooter, above.
	Correct size
	Supportive cushioning/ optional extras or special requirements.
	Wheelchairs are available through the Disablement Services Authority, usually via Mobility Service of the District Health Authority
	Ensure appropriate prescription by referral to a wheelchair clinic.
	Advice may be available from the Disabled Living Centre
	If purchasing a wheelchair privately ask the firm to demonstrate the wheelchair in your home.
	Prices and quality vary greatly, take time in deciding.
Driving	Consider: Automatic transmission
	Power steering
	Back supports
	Adaptations: enlarged keys, steering wheel, handbrake
	Wearing splints e.g. collar, wrist supports.
	Inform the DVLC and your insurance company of your condition.
	Car badges issued under the Blue Badge Scheme enable parking near facilities.
General	Many large shopping centres, and National Trust Properties have wheelchairs for loan or hire. Check before planning your trip in case you have to book a wheelchair or scooter in advance.
	Short term loan of wheelchairs is available through the British Red Cross and St. John Ambulance.