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This piece is dedicated to a remarkable individual I had the privilege of treating for approximately two weeks. 'S' - a young man in his early twenties, from a small village in Assam, India - arrived at our department in a wheelchair, due to the sequelae of a non-traumatic spinal cord injury (SCI). Despite his physical challenges, S displayed an exceptional level of positivity and resilience...
S was an aspiring fashion designer, who moved to Delhi to follow his passion. The lack of funds for his higher education forced him to look for a part-time occupation, which led him to take a keen interest in the make-up and beauty industry. Soon, S realised that he had a talent for using knowledge of colour theory in applying make-up and started gathering a small clientele for himself.
Tragedy struck with the advent of COVID-19 and, along with many others, S was also a victim of its atrocities. Within time, he was rendered paraplegic, requiring full use of a wheelchair and with 'no possibility of going back to work again'.
Clinically, S presented with impairments in:
trunk control
upper limb strength
functional skills
wheelchair mobility
Recognising his aspirations and potential for rehabilitation, I immediately initiated a comprehensive treatment plan, tailored to address these areas of concern.
Our first target was to establish good trunk control and dynamic sitting balance, by engaging him in activities that challenged him in these areas. For example, overhead ball throwing and graded stooping in a high-seated position. Once that was established, we worked on improving upper limb strength and endurance, as it was essential for wheelchair mobility and transfers. Push-ups were a great option and his performance was evaluated based on clearance, endurance and level of assistance provided. Perfecting a static push-up was essential for relieving pressure during long sitting hours, to prevent pressure ulcers. Dynamic push-ups were necessary for independent transfers, from bed to wheelchair and vice-versa.
During our therapy sessions, one of the main issues to address was how his current functional status affected his work, to a point of resigning as a make-up artist (MUA).
He educated me on all the postural and technical difficulties a male MUA faced, while doing his job in a wheelchair. His biggest challenge was the lack of trunk stability. The other issue he faced was positioning the client to accommodate his wheelchair. He wasn’t comfortable with the idea of leaning over the client’s face with the risk of falling over them while he worked. Another problem he faced was engaging in bilateral activities like hair washing and setting, since it involved him moving all around the client while working. He wouldn’t be able to manoeuvre the wheelchair if his hands were coated in any hair-care products...
In order to better understand these hurdles, we conducted a simulation with some modifications, to better suit his functional status. Two of my colleagues assisted as volunteers; we gathered all the basic tools and equipment needed for him to apply basic make-up over a client.
We were immediately able to identify some factors that affected his activity performance:
The quality of wheelchair used significantly affected his performance. The size, material, state of repair, presence of chest strap, quality of brakes and removable armrests were important aspects to take into account.
Environmental factors, like accessibility and open space, were necessary to take into account.
Using more handheld tools and gloves helped with prevention of cross-contamination.
Having the client, in this case, the volunteer, seated at an inclination instead of lying supine also made a positive difference.
A detachable lapboard to place all his tools on was also a better option than the trolley that was usually used by them.
Throughout our sessions, S's determination and creativity shone brightly. Despite facing financial constraints and the devastating impact of COVID-19, he remained unwavering in his pursuit of regaining independence and pursuing his passions.
With the support of his mother and close friends, S embarked on a journey of self-discovery and adaptation.
Incorporating occupational therapy, vocational rehabilitation and physical therapy, our sessions focused on enhancing S's functional abilities, while exploring opportunities for him to re-engage in his interests. Despite initial scepticism, S embraced the idea of utilising his talents in the makeup and beauty industry - leveraging his knowledge of colour theory and artistic skills.
Our therapy sessions evolved into a collaborative exploration, of adaptive techniques and strategies tailored to S's unique needs. From mastering wheelchair positioning for optimal makeup application, to implementing pressure relieving techniques during prolonged sessions, each session served as a learning opportunity for both S and myself.
As our time together drew to a close, S's remarkable progress and unwavering optimism left a lasting impression on me. His resilience in the face of adversity serves as a testament to the human spirit's capacity for adaptation and growth.
S's journey continues, as he undergoes long-term rehabilitation at another branch of our institute. While I may no longer be directly involved in his care, I remain inspired by his tenacity and consistent determination to overcome challenges and pursue his dreams.
In conclusion...
S's story exemplifies the transformative impact of rehabilitation and the strength of the human spirit. As healthcare professionals, it is both our privilege and responsibility to empower individuals like S, to reclaim their independence and pursue their passions - irrespective of the challenges they may face.
Further reading and learning
World Health Organization (WHO) (2013) Spinal cord injury (online). Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury. Accessed 13 April 2024.
OT CPD Courses: Fundamentals of Posture, Pressure and Ergonomics (2022, The Occupational Therapy Hub). Plus+ Member access to participate and receive a certificate.
