July 24, 2006
Today’s therapy started off with the PT, and she started by having Gary practice tub transfers (onto a shower bench in a regular bathtub, as many places he’ll travel to are not going to have a roll-in shower). At this stage, she has to help him quite a bit – 50 to 75% , mainly with getting his legs in and out, but also with the transfers – so unsurprisingly she doesn’t expect him to be “cleared” to do this by the end of this week. She claimed, however, that she should be able to clear him for bed transfers on his own by the end of the week. “Naturally” I felt uneasy about this, but Gary did too – his near slipping off the edge of the bed is too fresh in our minds. We told her about that, and she reminded him that if he found himself with less than half each thigh on the bed, he should throw his head forward and down while depressing, in order to scoot his butt back on the bed. But of course, this is assuming he has the balance to do this – as well as the immediate recognition that he should.
Our bringing this up decided her on having bed transfers using the hospital bed in the gym be the next thing he worked on – the bed is like the one he’ll be getting for home use. After he did a couple transfers back and forth (why is it he always does exceptional ones when they’re watching?), she had him try something new – “hovering.” Here he was supposed to depress upward in his chair as if he was going to do his transfer to some other surface, but then he was to hold it there for a second, and then “ reverse” the direction, literally using his head to do so, in order to end up back in the chair. A harder version of this exercise would be to actually begin to carry through the transfer to the other surface, but then reverse it in mid-air so that he ends up back in his chair and not on the other surface. (“O. . . kay,” Gary had said dubiously when the PT brought this exercise up first – she then had him do the easier version.) The application of this harder exercise would be the following: if it should happen that some time when he is doing a transfer he realizes there is something not quite right about it, he would be able to reverse his direction (thus going against the direction of his momentum) and go back to his chair without making the transfer.
He didn’t advance to that harder version of that exercise today, but even practicing the easier version would build his strength, the PT said, and Gary could see that. The PT also pointed out that it would help him develop more control with his transfers, that he needed to learn to transfer out of strength and control, not just out of momentum as he has been doing up to now (and was what they’d wanted at the time – the first goal is to always have the patient end up in the chair! Finesse comes later).
It was the end of his session with her, and he asked her what the therapy tech would do with him later (the therapy tech does what the PT tells her to do). When Gary found out it would be strength training, he brought up his shoulder problem. It now seems to be centered in the front of his shoulder, and the PT said it was biceps tendinitis. She told him not to do any exercises that gave him pain and to ice the area after his session with the tech (I brought him ice wrapped in a latex glove after both that session and this one with the PT).
We had a little break before his “Bladder Two” class, and he used it to call the people who would bring out a van for him check out. The person emailed him with the information, and later in the day Gary picked out a minivan he’d like to see (a Toyota Sienna with a ramp, removable seats, wheelchair tie-down) and arranged for it to be brought to Shepherd tomorrow afternoon.
The “Bladder Two” class was on dysreflexia, which I’ve already told you about. After that came a break for lunch and so forth, and then the first thing scheduled for the afternoon was a session with the OT.
With the OT, Gary brought up the problems we’d run into during our TLA experience, so she had us simulate the experience. First Gary and I got him transferred into bed. I went to lift his legs up, but she asked him what of that he could do on his own. He surprised himself (and me) by getting his upper legs onto the bed (by leaning on his elbow on his side and tugging at them). After that came another surprise of him being able to sit himself up from this side position by hooking his arm around his thighs and pulling (he’d done this a couple times before, but this was so much smoother than he’s ever done). He needed to do this to get himself properly oriented in the bed, i.e., head toward the top. Because of flap restrictions this was about the best he could do, which left his lower legs for me. But since that was so much less weight for me to handle, that was much, much easier than getting his entire legs on the bed. Easier on me, that is. I guess it’s going to be a matter of whose needs are greater at the particular moment he needs to get his legs up on some surface, since as you can probably see, he had to do quite a bit of work to get this far. But, he wants to be independent, and this is what he has to do to help get him to that state.
He and I then got him in the prone position, as I’ll have to help him with that for the time being. I got him padded off and put the sheet and blankets on him as I always do. Then we pretended it was that four in the morning time, and he needed to come off the prone position and go onto his side all by himself. It actually worked okay after the OT gave him a couple of tips. The blankets didn’t seem a problem – he got them off far enough that he could maneuver, and later, got them back on – whereas the previous day he’d found them an insurmountable problem (insurmountable without help, that is). We’re not sure about his foot padding, because a pillow ended up directly under one foot, whereas ideally the foot would float, so we’ll just have to try that out and keep a watch on his skin for any negative changes there.
Once on his side, he was able to get a pillow between his legs, by following the OT’s advice of getting up on an elbow and “walking” it so he ended up in a position curled enough to enable him to push the pillow with one hand and pulling it with the other (and the same technique would allow him to remove such a pillow). (Speaking of pillows, the OT remarked that in moving about the bed, he looked like he was swimming in a sea of them. Gary laughed. “And I need them all,” he noted.)
I asked him why he’d had such problems the previous day with the covers, etc., so that we could recreate the difficulties, but he said that he didn’t know, that maybe he’d just run into a mental block at 4am and given up too easily.
The OT said she had to soon leave to see another patient, and told Gary to now work at getting over to the edge of the bed and his lower legs over it from the side-lying position he was in. As he worked at it, she remarked, similarly to what she had before, that he was not at all like a member of the senior team (again, “senior team” meaning those over 55), that he was more like the twenty-year-olds she worked with (we still can’t quite believe that). She also mentioned that he was far more advanced than people she usually worked with, that people usually left here earlier than at his present level of skill. Again that surprised us. Gary told me later he would have thought it downright dangerous to leave much sooner than where he was at now, and that he would have found it scary to leave much sooner than we plan to.
Back to his task of getting over the edge of the bed in preparation for a transfer to his wheelchair: it took a lot of time and a lot of effort – and the OT left before he finished, but he did it. He said it was great to know it was possible.
Next up was a session with the therapy tech. Gary did his terrible threes, then some balance exercises. One thing he has definitely improved on is that he now catches himself well when he loses his balance ;-) (Actually, that is very important.) He even made up an exercise of his own, trying to reach out for a two-handed touch. It took him a few tries before he could do one of those with a degree of control instead of a quick bat. After the successful one, he looked up at the tech and asked, “Isn’t time up yet?” We all laughed (including Gary), though we knew he wasn’t saying this purely in jest. Time really was up, though, so we did his transfer and went back to his room. I went to the chiropractor a little earlier than usual (he expressed approval of the work done by my latest massage therapist) and then I did my usual evening routine.
Through most of the day I had still felt a little subdued by our TLA experience, but I felt back to my normal by the time I returned to Gary’s. I got there as early as I could, so we could have a bit of a phone conversation with Joe. In order for things not to go too late, I threw Gary into the bed (well, okay, we did a transfer – and in fact, Gary got his own upper legs on the bed just as he’d practiced with the OT earlier! Saved me some effort, cost him some, and at this point he won’t always have the energy to expend on that, but it’s another sign of his growing independence), and he talked to Joe while I did the stretches on him (I caught snatches of conversation about the house, the new garage, our pets and Joe and Dolores’s pets). After their conversation ended, Gary and I went through the rest of our routine.
While lying in bed with him, I had the thought that I should probably follow him around at the university his first few days – so I can give y’all a report on how things go ;-). Gary joked that if I stuck to the accomplishments at home, the entries would look like: “Today, Gary successfully fed the kitties.” He then decided that would actually be nontrivial – that he was now so slow at everything that by the time he’d opened the bag and put in the measuring cup, the cats would have dived into the bag and inhaled all the food – not a mark of success (unless you’re taking the feline point of view).
As typical, our conversation was stopped by the speaker phone conversation of Gary’s roommate. We heard him talking about the hoyer, and whoever was on the other end of the phone misheard and thought he’d said that in order to lift him, he was attached to the hoyer by his neck (he’d really said “net”). I told Gary we should tell his roommate that that was indeed the new method for using the hoyer, and demonstrate it on him. We started laughing so hard that had the rails on Gary’s bed not been up we would have fallen out. (Lest you think otherwise, this roommate is a very nice guy and we really like him – except when he talks on the phone.)
To finish, another picture taken by Janet Rogers (see the blog http://drpeg2003.blogspot.com/ ). Evidently last Saturday the math volunteers decided our family room needed more illumination. The caption below the picture is Janet's.
How many mathematicians does it take . . .?
Today’s therapy started off with the PT, and she started by having Gary practice tub transfers (onto a shower bench in a regular bathtub, as many places he’ll travel to are not going to have a roll-in shower). At this stage, she has to help him quite a bit – 50 to 75% , mainly with getting his legs in and out, but also with the transfers – so unsurprisingly she doesn’t expect him to be “cleared” to do this by the end of this week. She claimed, however, that she should be able to clear him for bed transfers on his own by the end of the week. “Naturally” I felt uneasy about this, but Gary did too – his near slipping off the edge of the bed is too fresh in our minds. We told her about that, and she reminded him that if he found himself with less than half each thigh on the bed, he should throw his head forward and down while depressing, in order to scoot his butt back on the bed. But of course, this is assuming he has the balance to do this – as well as the immediate recognition that he should.
Our bringing this up decided her on having bed transfers using the hospital bed in the gym be the next thing he worked on – the bed is like the one he’ll be getting for home use. After he did a couple transfers back and forth (why is it he always does exceptional ones when they’re watching?), she had him try something new – “hovering.” Here he was supposed to depress upward in his chair as if he was going to do his transfer to some other surface, but then he was to hold it there for a second, and then “ reverse” the direction, literally using his head to do so, in order to end up back in the chair. A harder version of this exercise would be to actually begin to carry through the transfer to the other surface, but then reverse it in mid-air so that he ends up back in his chair and not on the other surface. (“O. . . kay,” Gary had said dubiously when the PT brought this exercise up first – she then had him do the easier version.) The application of this harder exercise would be the following: if it should happen that some time when he is doing a transfer he realizes there is something not quite right about it, he would be able to reverse his direction (thus going against the direction of his momentum) and go back to his chair without making the transfer.
He didn’t advance to that harder version of that exercise today, but even practicing the easier version would build his strength, the PT said, and Gary could see that. The PT also pointed out that it would help him develop more control with his transfers, that he needed to learn to transfer out of strength and control, not just out of momentum as he has been doing up to now (and was what they’d wanted at the time – the first goal is to always have the patient end up in the chair! Finesse comes later).
It was the end of his session with her, and he asked her what the therapy tech would do with him later (the therapy tech does what the PT tells her to do). When Gary found out it would be strength training, he brought up his shoulder problem. It now seems to be centered in the front of his shoulder, and the PT said it was biceps tendinitis. She told him not to do any exercises that gave him pain and to ice the area after his session with the tech (I brought him ice wrapped in a latex glove after both that session and this one with the PT).
We had a little break before his “Bladder Two” class, and he used it to call the people who would bring out a van for him check out. The person emailed him with the information, and later in the day Gary picked out a minivan he’d like to see (a Toyota Sienna with a ramp, removable seats, wheelchair tie-down) and arranged for it to be brought to Shepherd tomorrow afternoon.
The “Bladder Two” class was on dysreflexia, which I’ve already told you about. After that came a break for lunch and so forth, and then the first thing scheduled for the afternoon was a session with the OT.
With the OT, Gary brought up the problems we’d run into during our TLA experience, so she had us simulate the experience. First Gary and I got him transferred into bed. I went to lift his legs up, but she asked him what of that he could do on his own. He surprised himself (and me) by getting his upper legs onto the bed (by leaning on his elbow on his side and tugging at them). After that came another surprise of him being able to sit himself up from this side position by hooking his arm around his thighs and pulling (he’d done this a couple times before, but this was so much smoother than he’s ever done). He needed to do this to get himself properly oriented in the bed, i.e., head toward the top. Because of flap restrictions this was about the best he could do, which left his lower legs for me. But since that was so much less weight for me to handle, that was much, much easier than getting his entire legs on the bed. Easier on me, that is. I guess it’s going to be a matter of whose needs are greater at the particular moment he needs to get his legs up on some surface, since as you can probably see, he had to do quite a bit of work to get this far. But, he wants to be independent, and this is what he has to do to help get him to that state.
He and I then got him in the prone position, as I’ll have to help him with that for the time being. I got him padded off and put the sheet and blankets on him as I always do. Then we pretended it was that four in the morning time, and he needed to come off the prone position and go onto his side all by himself. It actually worked okay after the OT gave him a couple of tips. The blankets didn’t seem a problem – he got them off far enough that he could maneuver, and later, got them back on – whereas the previous day he’d found them an insurmountable problem (insurmountable without help, that is). We’re not sure about his foot padding, because a pillow ended up directly under one foot, whereas ideally the foot would float, so we’ll just have to try that out and keep a watch on his skin for any negative changes there.
Once on his side, he was able to get a pillow between his legs, by following the OT’s advice of getting up on an elbow and “walking” it so he ended up in a position curled enough to enable him to push the pillow with one hand and pulling it with the other (and the same technique would allow him to remove such a pillow). (Speaking of pillows, the OT remarked that in moving about the bed, he looked like he was swimming in a sea of them. Gary laughed. “And I need them all,” he noted.)
I asked him why he’d had such problems the previous day with the covers, etc., so that we could recreate the difficulties, but he said that he didn’t know, that maybe he’d just run into a mental block at 4am and given up too easily.
The OT said she had to soon leave to see another patient, and told Gary to now work at getting over to the edge of the bed and his lower legs over it from the side-lying position he was in. As he worked at it, she remarked, similarly to what she had before, that he was not at all like a member of the senior team (again, “senior team” meaning those over 55), that he was more like the twenty-year-olds she worked with (we still can’t quite believe that). She also mentioned that he was far more advanced than people she usually worked with, that people usually left here earlier than at his present level of skill. Again that surprised us. Gary told me later he would have thought it downright dangerous to leave much sooner than where he was at now, and that he would have found it scary to leave much sooner than we plan to.
Back to his task of getting over the edge of the bed in preparation for a transfer to his wheelchair: it took a lot of time and a lot of effort – and the OT left before he finished, but he did it. He said it was great to know it was possible.
Next up was a session with the therapy tech. Gary did his terrible threes, then some balance exercises. One thing he has definitely improved on is that he now catches himself well when he loses his balance ;-) (Actually, that is very important.) He even made up an exercise of his own, trying to reach out for a two-handed touch. It took him a few tries before he could do one of those with a degree of control instead of a quick bat. After the successful one, he looked up at the tech and asked, “Isn’t time up yet?” We all laughed (including Gary), though we knew he wasn’t saying this purely in jest. Time really was up, though, so we did his transfer and went back to his room. I went to the chiropractor a little earlier than usual (he expressed approval of the work done by my latest massage therapist) and then I did my usual evening routine.
Through most of the day I had still felt a little subdued by our TLA experience, but I felt back to my normal by the time I returned to Gary’s. I got there as early as I could, so we could have a bit of a phone conversation with Joe. In order for things not to go too late, I threw Gary into the bed (well, okay, we did a transfer – and in fact, Gary got his own upper legs on the bed just as he’d practiced with the OT earlier! Saved me some effort, cost him some, and at this point he won’t always have the energy to expend on that, but it’s another sign of his growing independence), and he talked to Joe while I did the stretches on him (I caught snatches of conversation about the house, the new garage, our pets and Joe and Dolores’s pets). After their conversation ended, Gary and I went through the rest of our routine.
While lying in bed with him, I had the thought that I should probably follow him around at the university his first few days – so I can give y’all a report on how things go ;-). Gary joked that if I stuck to the accomplishments at home, the entries would look like: “Today, Gary successfully fed the kitties.” He then decided that would actually be nontrivial – that he was now so slow at everything that by the time he’d opened the bag and put in the measuring cup, the cats would have dived into the bag and inhaled all the food – not a mark of success (unless you’re taking the feline point of view).
As typical, our conversation was stopped by the speaker phone conversation of Gary’s roommate. We heard him talking about the hoyer, and whoever was on the other end of the phone misheard and thought he’d said that in order to lift him, he was attached to the hoyer by his neck (he’d really said “net”). I told Gary we should tell his roommate that that was indeed the new method for using the hoyer, and demonstrate it on him. We started laughing so hard that had the rails on Gary’s bed not been up we would have fallen out. (Lest you think otherwise, this roommate is a very nice guy and we really like him – except when he talks on the phone.)
To finish, another picture taken by Janet Rogers (see the blog http://drpeg2003.blogspot.com/ ). Evidently last Saturday the math volunteers decided our family room needed more illumination. The caption below the picture is Janet's.
How many mathematicians does it take . . .?
posted by Peg Daniels at 6:59 PM
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