June 21, 2006
Mail call: thanks to Corinne Wurdeman.
Latest freebie: if anyone wants approximately a quarter of a cord of hardwood, it is free for the taking – just give Joe a call first to let him know you are coming (use our home phone number).
This morning Gary’s longtime physician called, and she said she was willing to keep him on as a patient; not only that, she exhibited some knowledge of the special problems of those with SCIs, bringing up the increased risk of pneumonia and bladder infections, for instance. Another unexpected plus – she said she has a partner who is a rehab doc, and she thought the two of them would make a good team for Gary!
On our way to the therapy gym, our case manager came out of her office and told Gary she wanted to shake his hand. The first thing that went through my mind was this was going a little overboard in enthusiasm for him having done his own IC :-) but she said it was on account of what had happened at their team meeting (ie, the weekly meeting of his team) this morning. They were all impressed with him, how he’d gone straight from bedridden to full participation in the rehab program, starting off at a higher level than he’d left off at (cuz of all that weight training in bed!).
First Gary had the OT, and he started by asking her questions. They had recommended we get an overhang from a garage to our house so he wouldn’t get soaked in rainy weather, but what was he supposed to do at work, where there wasn’t such an overhang? He’s not supposed to sit in wet clothes. And somehow erecting a big umbrella over his wheelchair didn’t seem practicable or even effective – rains aren’t always cooperatively coming straight down. The best solution the OT came up with was to wear a big poncho.
Another question he had involved transferring to our futon couch. This is what we sit together on to watch TV at night. It’s like a cross between a bed (since we can stretch our legs straight out in front of us on it) and a couch, since it has a back. Problem is, the top of it is only 11 inches up from the ground. Gary’s OT – and his PT, who just happened to wander by at that moment – thought it would be too difficult for him to not only transfer from his chair to something that low, given his flap restrictions on his types of transfers allowed, but to transfer back up from it to his chair – it would turn a leisure activity into a chore (and that might be true no matter what transfer he eventually does). They suggested replacing it with a couch, but in all my years I have never found a couch I am comfortable on, and we have looked. So I am hoping we (Joe? :-)) can figure out a way to lift the futon couch up – on blocks, or some kind of frame or something.
After we talked about such things, the OT said she was going to give him more IC training, so we went back to the room to do that. Tomorrow he will do it in the bathroom, in preparation for a real-life situation.
After that came lunch, and then it was time to see the PT. In the gym his PT started off by telling us she’d talked to his skin nurse, and he will be allowed brief periods of bending down to reach his ankles, so as long as he doesn’t have to get in an extreme stretch to position pillows down there when he turns in bed, he should be able to do this himself. Great news to both our ears! (Of course, he still has to practice and see if he can physically do it.) She then explained about the power-assist wheels option for his wheelchair, about how such wheels require half the energy expenditure of manual wheels – when you give them a push, they add an extra push of their own, giving you twice the distance. Gary told her his doc had already talked to him about them this morning, and Gary was going to get some for when he had to travel long distances or get somewhere fast (like if he has to teach his class in one building and to be at a meeting in another building immediately after the class). But he will not use them all the time – there is a weight disadvantage, as they are heavier than the manual wheels, and it is best to have as light a chair as one can operate; and also, he would not need the extra boost they give when he’s just tooling around the house or around the math building.
Next she had him transfer from his chair to a seated position on the exercise mat, using the transfer board, so this is the first time I got to see him do this. She still gives him help to make sure he doesn’t slide on his flap along the board or lose his balance off it, but she told him she was doing much less for him this time than she had Monday. It was neat to see these beginning steps – I’m sure he’ll be an old hand at it soon.
We then watched a video of paraplegics doing various skills that Gary will be learning or is already practicing. The video showed people sitting and doing balance exercises – the PT pointed out how they were using their heads (literally) to control their balance point. Next the video showed people dressing in bed. (The PT said when Gary does this I may have to give him a start with his pants, getting them up over his knees – it depends on the flap restrictions and on his flexibility, the former restricting how much he’s allowed to bend up his knee toward him (using his hands to bring the knees up), the latter determining how much he needs bend his knees to get his pants over his ankles and up his legs.)
I tell you, while watching the people twisting around to dress themselves in bed or while in their chair, the thought kept going through my mind of what a production it was, how complicated the “simple” act of pulling up your pants or getting your pullover shirt down over your torso becomes. No wonder they say maintenance eats up a huge chunk of the time of those with SCIs, especially in the beginning days.
Next the video showed people doing transfers out of bed into their chairs, and from their chairs to a car, and it also showed the reversal of these transfers. It also showed more advanced skills that Gary can’t learn until the flap restrictions are lifted – such things as how to get back into your chair if you’ve fallen out. (It seems a hell of a lot simpler to call for help than to go through what has to be done, but the goal is independence – although if Gary falls out (and they say it always happens sooner or later), the PT said we would have to get two strong people to get him back in his chair, because on account of the flap he isn’t allowed for x amount of time (x to be determined by his doctor some time in the future) to make the movements required to get back in the chair). Less traumatically, similar skills as those needed to get back in the chair after a tumble are used in going from sitting on the floor to sitting back in the wheelchair.
Finally the video showed people doing wheelies up over step-ups, and going up and down ramps (going down ramps many people raise the front tires of their wheelchairs up, because some ramps have a lip at the end, and if the front tires thud down it at an angle, the whole chair could tip over forward).
So far, neither the OT or PT had Gary doing much physical stuff, a change from the usual routine, but the PT finished by having Gary work on his balance. He would do things like slowly raise both hands from his knees while sitting with no back support and with his legs over the edge of the raised mat. Once he’d gotten his balance (again, something we take for granted, but watching him work at trying not to fall over, really brings home what all is involved in doing such a “simple” thing – I never appreciated my abdominal muscles so much before!), she would have him reach out to her hand – in front of him, upward, to the side, to the back – always using head position as a counterbalance (but of course it is a delicate thing – can’t compensate too much or you fall in the direction your head is leaning). She had him practice shifting back and forth between a sitting forward position (hands to the front) and a sitting backward position (hands behind you). Finally she told him he had to sit upright with both hands raised (in front of him, above his knees) for a minute.
She cheated! After thirty seconds, she gave him a little push! He wasn’t prepared for that, and he had to drop his hands to the mat and save himself from falling over. She had him start again, but this time she gave him little pushes throughout while he tried to compensate. He wasn’t always successful, but I thought he did pretty good.
To end the session he transferred back to the chair, and she told him she’d given him the least amount of help with that yet.
Shortly after, Gary was hoisted back into bed. The PT came again, saying they had to go through the ASIA test again – that is the test they did toward the beginning of his stay here. They touched him with a cotton swab to see how well he could detect a light touch, then touched him with the sharp and dull ends of a safety pin (he didn’t seem to be able to feel anything he couldn’t before), then they finished up with some muscle strength testing.
I stepped out after this to talk with someone I’d met at the chiropractor’s; she’d come up to Gary’s room, as I’d arranged with her. She is a yoga teacher and a nurse here at Shepherd (in the MS section, I believe). We went to the gym and she suggested some exercises she thought I’d find helpful for my back – including for stretching my hamstrings and strengthening my abs.
Right after that I left to indulge in a massage (ahhhh!). Tomorrow, the chiropractor returns from his visit to his parents, and I will see him then and again on Friday.
All for today, except to report I found out the guy with the unleashed dogs has been living at the motel for four years! Even if he pays the rate I do, that’s a rent of about $1600 a month. I thought surely he could find some place cheaper, but Gary said maybe not in Buckhead. Then Gary added, maybe the guy likes the linen service.
Mail call: thanks to Corinne Wurdeman.
Latest freebie: if anyone wants approximately a quarter of a cord of hardwood, it is free for the taking – just give Joe a call first to let him know you are coming (use our home phone number).
This morning Gary’s longtime physician called, and she said she was willing to keep him on as a patient; not only that, she exhibited some knowledge of the special problems of those with SCIs, bringing up the increased risk of pneumonia and bladder infections, for instance. Another unexpected plus – she said she has a partner who is a rehab doc, and she thought the two of them would make a good team for Gary!
On our way to the therapy gym, our case manager came out of her office and told Gary she wanted to shake his hand. The first thing that went through my mind was this was going a little overboard in enthusiasm for him having done his own IC :-) but she said it was on account of what had happened at their team meeting (ie, the weekly meeting of his team) this morning. They were all impressed with him, how he’d gone straight from bedridden to full participation in the rehab program, starting off at a higher level than he’d left off at (cuz of all that weight training in bed!).
First Gary had the OT, and he started by asking her questions. They had recommended we get an overhang from a garage to our house so he wouldn’t get soaked in rainy weather, but what was he supposed to do at work, where there wasn’t such an overhang? He’s not supposed to sit in wet clothes. And somehow erecting a big umbrella over his wheelchair didn’t seem practicable or even effective – rains aren’t always cooperatively coming straight down. The best solution the OT came up with was to wear a big poncho.
Another question he had involved transferring to our futon couch. This is what we sit together on to watch TV at night. It’s like a cross between a bed (since we can stretch our legs straight out in front of us on it) and a couch, since it has a back. Problem is, the top of it is only 11 inches up from the ground. Gary’s OT – and his PT, who just happened to wander by at that moment – thought it would be too difficult for him to not only transfer from his chair to something that low, given his flap restrictions on his types of transfers allowed, but to transfer back up from it to his chair – it would turn a leisure activity into a chore (and that might be true no matter what transfer he eventually does). They suggested replacing it with a couch, but in all my years I have never found a couch I am comfortable on, and we have looked. So I am hoping we (Joe? :-)) can figure out a way to lift the futon couch up – on blocks, or some kind of frame or something.
After we talked about such things, the OT said she was going to give him more IC training, so we went back to the room to do that. Tomorrow he will do it in the bathroom, in preparation for a real-life situation.
After that came lunch, and then it was time to see the PT. In the gym his PT started off by telling us she’d talked to his skin nurse, and he will be allowed brief periods of bending down to reach his ankles, so as long as he doesn’t have to get in an extreme stretch to position pillows down there when he turns in bed, he should be able to do this himself. Great news to both our ears! (Of course, he still has to practice and see if he can physically do it.) She then explained about the power-assist wheels option for his wheelchair, about how such wheels require half the energy expenditure of manual wheels – when you give them a push, they add an extra push of their own, giving you twice the distance. Gary told her his doc had already talked to him about them this morning, and Gary was going to get some for when he had to travel long distances or get somewhere fast (like if he has to teach his class in one building and to be at a meeting in another building immediately after the class). But he will not use them all the time – there is a weight disadvantage, as they are heavier than the manual wheels, and it is best to have as light a chair as one can operate; and also, he would not need the extra boost they give when he’s just tooling around the house or around the math building.
Next she had him transfer from his chair to a seated position on the exercise mat, using the transfer board, so this is the first time I got to see him do this. She still gives him help to make sure he doesn’t slide on his flap along the board or lose his balance off it, but she told him she was doing much less for him this time than she had Monday. It was neat to see these beginning steps – I’m sure he’ll be an old hand at it soon.
We then watched a video of paraplegics doing various skills that Gary will be learning or is already practicing. The video showed people sitting and doing balance exercises – the PT pointed out how they were using their heads (literally) to control their balance point. Next the video showed people dressing in bed. (The PT said when Gary does this I may have to give him a start with his pants, getting them up over his knees – it depends on the flap restrictions and on his flexibility, the former restricting how much he’s allowed to bend up his knee toward him (using his hands to bring the knees up), the latter determining how much he needs bend his knees to get his pants over his ankles and up his legs.)
I tell you, while watching the people twisting around to dress themselves in bed or while in their chair, the thought kept going through my mind of what a production it was, how complicated the “simple” act of pulling up your pants or getting your pullover shirt down over your torso becomes. No wonder they say maintenance eats up a huge chunk of the time of those with SCIs, especially in the beginning days.
Next the video showed people doing transfers out of bed into their chairs, and from their chairs to a car, and it also showed the reversal of these transfers. It also showed more advanced skills that Gary can’t learn until the flap restrictions are lifted – such things as how to get back into your chair if you’ve fallen out. (It seems a hell of a lot simpler to call for help than to go through what has to be done, but the goal is independence – although if Gary falls out (and they say it always happens sooner or later), the PT said we would have to get two strong people to get him back in his chair, because on account of the flap he isn’t allowed for x amount of time (x to be determined by his doctor some time in the future) to make the movements required to get back in the chair). Less traumatically, similar skills as those needed to get back in the chair after a tumble are used in going from sitting on the floor to sitting back in the wheelchair.
Finally the video showed people doing wheelies up over step-ups, and going up and down ramps (going down ramps many people raise the front tires of their wheelchairs up, because some ramps have a lip at the end, and if the front tires thud down it at an angle, the whole chair could tip over forward).
So far, neither the OT or PT had Gary doing much physical stuff, a change from the usual routine, but the PT finished by having Gary work on his balance. He would do things like slowly raise both hands from his knees while sitting with no back support and with his legs over the edge of the raised mat. Once he’d gotten his balance (again, something we take for granted, but watching him work at trying not to fall over, really brings home what all is involved in doing such a “simple” thing – I never appreciated my abdominal muscles so much before!), she would have him reach out to her hand – in front of him, upward, to the side, to the back – always using head position as a counterbalance (but of course it is a delicate thing – can’t compensate too much or you fall in the direction your head is leaning). She had him practice shifting back and forth between a sitting forward position (hands to the front) and a sitting backward position (hands behind you). Finally she told him he had to sit upright with both hands raised (in front of him, above his knees) for a minute.
She cheated! After thirty seconds, she gave him a little push! He wasn’t prepared for that, and he had to drop his hands to the mat and save himself from falling over. She had him start again, but this time she gave him little pushes throughout while he tried to compensate. He wasn’t always successful, but I thought he did pretty good.
To end the session he transferred back to the chair, and she told him she’d given him the least amount of help with that yet.
Shortly after, Gary was hoisted back into bed. The PT came again, saying they had to go through the ASIA test again – that is the test they did toward the beginning of his stay here. They touched him with a cotton swab to see how well he could detect a light touch, then touched him with the sharp and dull ends of a safety pin (he didn’t seem to be able to feel anything he couldn’t before), then they finished up with some muscle strength testing.
I stepped out after this to talk with someone I’d met at the chiropractor’s; she’d come up to Gary’s room, as I’d arranged with her. She is a yoga teacher and a nurse here at Shepherd (in the MS section, I believe). We went to the gym and she suggested some exercises she thought I’d find helpful for my back – including for stretching my hamstrings and strengthening my abs.
Right after that I left to indulge in a massage (ahhhh!). Tomorrow, the chiropractor returns from his visit to his parents, and I will see him then and again on Friday.
All for today, except to report I found out the guy with the unleashed dogs has been living at the motel for four years! Even if he pays the rate I do, that’s a rent of about $1600 a month. I thought surely he could find some place cheaper, but Gary said maybe not in Buckhead. Then Gary added, maybe the guy likes the linen service.
posted by Peg Daniels at 9:46 AM
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