Running head: ASSISTIVE DEVICES

Assistive Devices: The Colored Pencil Carousel and the Mobile Hand Rest
Melody Klatt
Touro University Nevada

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Description of the Client

Judy is a 69-year-old grandmother and wife who lives with a diagnosis of multiple
sclerosis. Multiple sclerosis is a disease that involves damage to the myelin sheaths around the
bodys nerves, inflicted by the bodys own immune system (Mayo Clinic Staff, n.d.). This
damage results in impaired signal conduction between the brain and the body, which can affect
multiple areas in the body and can cause the nerves themselves to deteriorate (Mayo Clinic Staff,
n.d.). According to the National Multiple Sclerosis Society (NMSS), individuals who are
diagnosed with multiple sclerosis may experience a wide variety of symptoms in different areas
of the body, depending on which nerves are affected, but one of the most common and
significant concerns that most individuals experience as a result of multiple sclerosis is fatigue
(n.d.).
Individuals with multiple sclerosis may experience fatigue from sources that could affect
anyone, such as depression or a disrupted nights sleep, but there is a specific type of fatigue
known as lassitude that is unique to individuals with multiple sclerosis (NMSS, n.d.). The exact
cause of this type of fatigue is unknown, but its effects can be extremely detrimental to an
individuals ability to perform everyday tasks (NMSS, n.d.). Characteristics of this fatigue
include the fact that it is usually considered to be more severe than fatigue caused by other
sources, the fact that it tends to occur on a daily basis, the fact that it usually worsens as the day
goes on, and the fact that it can come on suddenly and without apparent cause (NMSS, n.d.).
Judy is among the individuals with multiple sclerosis who suffer from this type of
fatigue, and therefore as part of the adjustments to her daily life that she has made as a result of
this diagnosis she has become an avid user of energy conservation techniques to help her cope
with the fatigue she experiences on a daily basis. Judy is recently retired, and when she is not

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maintaining her house or spending time with her husband at home, Judy enjoys taking time to
work on art projects particularly sketching and colored-pencil work which is a hobby she has
valued and excelled in since she was a young girl.
Literature Review
There is a great deal of research available regarding the value of energy conversation for
individuals who have been diagnosed with multiple sclerosis. Multiple disciplines within the
health care field acknowledge the severity and detrimental effects of the type of fatigue that is
specifically associated with multiple sclerosis, and much of the research that focuses on
managing the symptoms of this fatigue discuss the effectiveness and importance of energy
conservation techniques.
One article, entitled The Concept of Fatigue in Multiple Sclerosis from the Journal of
Neuroscience Nursing, describes these topics in depth. The article discusses the nature of the
fatigue that individuals with multiple sclerosis face, as well as mentioning the most common
treatment methods that are implemented to help clients manage this fatigue. While describing
the importance of assessing fatigue for individuals with multiple sclerosis, the author also
mentions that is important to distinguish between the two types of fatigue that these individuals
face: Primary fatigue, which is related directly to the disease process; or secondary fatigue,
which is caused by other issues such as depression, lack of sleep, or infections (Johnson, 2008).
It is important to distinguish between the two types of fatigue because treatment strategies for
each type will typically differ; secondary fatigue is generally considered to be more directly
treatable because of the factors that cause it, while the causes of primary fatigue are not well
understood and are therefore difficult to treat (Johnson, 2008). The author mentions that it is

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important to treat secondary fatigue first, if possible, because it is generally more treatable and it
will reduce the effects of any primary fatigue that may be present (Johnson, 2008).
While discussing different types of treatment for fatigue (both primary and secondary),
Johnson identifies that energy conservation is an important and effective nonpharmacologic
means to manage fatigue symptoms (2008). It is also stressed that energy conservation strategies
are very important for individuals with multiple sclerosis to implement in their daily lives,
because fatigue associated with this diagnosis can severely impact their health-related quality of
life (Johnson, p. 76, 2008). This includes their ability to participate in functional tasks at home
and at work (Johnson, 2008). The author indicates that education about energy conservation
techniques is a very important part of treatment for clients with multiple sclerosis and should be
consistently promoted by health care professionals (Johnson, 2008).
A second article, entitled Use and Perceived Effectiveness of Energy Conservation
Strategies for Managing Multiple Sclerosis Fatigue from the American Journal of Occupational
Therapy further discusses the use of energy conservation strategies for individuals with multiple
sclerosis. The article describes the effectiveness of a 6-week course that was used to educate
individuals with multiple sclerosis on energy conservation techniques, and then analyzed which
techniques were most used and most effective for these individuals when managing their fatigue
(Matuska, Mathiowetz, & Finlayson, 2007). 123 participants were actively involved in the study
and completed a survey following the 6-week course to report on their use of the energy
conservation techniques.
The results of the study indicated that the energy conservation techniques were wellreceived by the participants, and that all strategies were newly used by at least 50% of the
participants and rated as effective (Matuska, Mathiowetz, & Finlayson, p. 62, 2007). The

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strategies that were rated most effective by the participants (more than 70%) included the
following:
Changed body position for certain activities, planned the day to balance rest and work,
modified the frequency or outcome standards of activities, included rest periods in the
day or at least 1 hour, adjusted priorities, simplified activities, communicated need for
assistance, and rested during longer activities. (Matuska, Mathiowetz, & Finlayson, p.
62, 2007).
In addition, participants who reported that they did not implement the new strategies
stated that this was due to the fact that they had already been using the strategy before they took
the course (Matuska, Mathiowetz, Finlayson, 2007). Overall, the results and conclusion of the
study indicated that energy conservation strategies are very effective when used by individuals
with multiple sclerosis to manage fatigue, and this supports the clinical implication that
education in relation energy conservation strategies is an important part of treatment for
individuals with this diagnosis.
The Devices
The devices that have been created for Judy are a Colored Pencil Carousel and a Mobile
Hand Rest. These devices have been designed to help her decrease the amount of energy she
expends while completing her artwork, thus minimizing the amount of fatigue she experiences
during the activity. The designs and specific purposes of the devices will be discussed below.
The Colored Pencil Carousel
This device has been designed to require Judy to expend a minimal amount of energy
while retrieving her colored pencils. The carousel has been built on a turntable that can be easily
moved at the base, so that Judy will never have to reach up and around in order to find the pencil

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she wants. The pencils themselves are attached to the carousel with a small amount of adhesive
Velcro, so that they may be easily retrieved and replaced on the carousel while expending
minimal energy, and will also allow Judy to keep the pencils organized and visible in front of her.
Similar devices. Many different standing colored pencil holders currently exist. Their
shapes and sizes vary greatly; some are standing structures with holes available to place the
individual pencils inside, and others are simply single units that are composed of multiple cuplike structures to keep the pencils together and standing up. They can be purchased online
through websites such as Amazon.com, or they can be purchased from common art stores such as
Hobby Lobby or Michaels. The prices for these colored pencil holders typically range from
$20-$60, though obtaining a simple pencil cup or pencil case can be a cheaper alternative to
purchasing these items.
There are also utensil tabletop carousels that are available for purchase, mainly through
online websites or specialty office and art stores. These devices also typically cost somewhere
between $20-$60, and they are designed to be able to hold utensils upright either in cup-like
structures or in holes or slots. The carousel-like component to them makes them most similar to
the device that has been designed for Judy. However, these devices are still made with a design
that keeps the pencils standing straight up, which would require someone with multiple sclerosis
to use more range of motion in order to retrieve a pencil from the case.
Cost analysis. A detailed cost analysis was composed for this device, based on the
materials that were required to create it. The list of supplies and costs is as follows:

Turntable: $8.57
Krazy Glue: $8.71
Foam (1/4 of 10x1 Disc): $0.99
Velcro: $6.78
Poster Board: $1.21
Total: $26.26

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The Mobile Hand Rest

This device has been designed to allow Judy to rest her hand and wrist comfortably on a
movable structure while she is drawing. The device will eliminate the need for Judy to hold her
hand above the paper while using her art supplies, and the tiny metal wheels will minimize any
smudging even if they are placed over the drawing itself. This device will be a preferable
alternative to other products that have been made or used to minimize smudging while drawing
or writing, as it provides more comfortable and ergonomic support while protecting Judys hand
and her drawing from smudges.
Similar devices. There are several resources and devices that have been created to help
artists with smudging issues during drawing activities. Most focus on one particular issue that
pertains to smudging more than another. For example, there is an item available for purchase
online called SmudgeGuard, which is a glove that was created to cover the ulnar side of an
artists hand and reduce smudging and hand friction while they are writing, drawing, or using
something like a Wacom tablet. The glove is sold for $14.99 plus $3.50 for shipping and
handling. While this seems to be very effective particularly for tablet users and for the purpose
of protecting the users hand from smudges while drawing or writing, there does not seem to be
any confident statements about whether this truly protects the drawing or writing piece from
being smudged. The glove is also fairly expensive, and certainly more expensive than the mobile
hand rest that has been created for Judy.
Another device focuses more on preventing the issue of arm fatigue that may occur as a
result of an artist having to hold their hand above the paper while drawing to prevent smudging.
This device is called a Mahl Stick, and it is comprised of a wooden stick with a padded head
that is meant to rest on the paper while an artist draws or paints. The artist rests their hand on the

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wooden stick while they are working, which keeps their hand suspended above the paper, and
this allows them to keep from smudging their hand and their artwork. However, the Mahl Stick
can be uncomfortable when used for long periods of time, and can sometimes encourage ulnar
deviation while drawing or painting, depending on what motions the artist is trying to perform.
The Mahl Stick is also expensive, usually ranging from about $20-$40 in price.
Cost analysis. A detailed cost analysis was also composed for this device, and the list of
supplies and costs is as follows:

Memory Foam: $0.48

Krazy Glue: $2.77
Foam (1/2 of 12x4x2 Block): $1.50
Foam Coat: $5.97
Cell Phone Case: $0.99
Wheels: $0.99 (steel wheels - $2.97 for 8)
Total: $12.70

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References

Johnson, S. L. (2008). The concept of fatigue in multiple sclerosis. Journal of Neuroscience

Nursing, 40(2), 72-77.
Matuska, K., Mathiowetz, V., & Finlayson, M. (2007). Use and perceived effectiveness of energy
conservation strategies for managing multiple sclerosis fatigue. American Journal of
Occupational Therapy, 61, 6269.
Mayo Clinic Staff. (n.d.). Multiple sclerosis: Definition. Retrieved from
http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/basics/definition/con20026689
National Multiple Sclerosis Society. (n.d.) Fatigue. Retrieved from
http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Fatigue