July 5, 2006

Gary’s first scheduled activity was to learn how to do the bowel program on himself. As this took place at 7am, I did not attend ;-) (I will have to do it on him a week from tomorrow – I need to learn how to do it in case he ever is too sick to do it on himself). The good news was he lasted the twenty minutes; the bad news is he wasn’t able to do on his own everything he needs to. He will have another attempt at it next Tuesday.

When I got to his room later in the morning, he told me the OT thought the ankle pillows would work (I think I should get paid for this idea ;-), as I’m sure they’ll use it in the future on patients here). The next step is for him to sleep with them on as he would at home, starting from the prone position and then turning onto his side.

We went to the gym for the PT session. While we waited for his therapist, I noticed that Gary’s roommate, sitting nearby, was wearing sandals, not the ubiquitous velcro tennies. Gary looked at his own shoes and said that though they were fine for here, he wanted something less dorky when he went home. I asked him what he had in mind. He still wanted the velcro, and thought he might find something at Target or Wal-Mart. I told him to forget Target – I had looked at every single men’s shoe they had and they had nothing with velcro (except for one pair of a similar style). Maybe he can find something on the internet.

When the PT came, she said that the first activity would be to do a car transfer, which is more difficult than the transfers he’s been doing. Today he would do one using Shepherd’s Saturn (“Twin Cam”), next Tuesday we’ll use my car (Note to self: clean out front of car). We had to go to his room to get his long transfer board, and on our way we ran into his doctor. Gary asked him about the two kinds of power-assist wheels, because while Gary had liked the second kind, the doctor had been encouraging him to get the first kind. The reason for this became clear when we learned that with the first kind, you lift a battery out of each wheel in order to make the chair into a manual chair, with the result that the chair immediately becomes about thirty pounds lighter while keeping the same tires (he could keep the batteries at the office); whereas with the second type of chair, to make it into a manual chair, you have to go through the rigamarole of exchanging the tires for a different set.

Gary agreed with the doctor that in theory the first kind of wheels sounded better but said that he hadn’t had a good experience with them – he’d had trouble “steering” the chair (which could be a matter of practice), and even worse, the wheels didn’t work as they should most of the time. His doctor told him not to let a defective demo model deter him and that in his opinion the first kind would better suit Gary’s needs. I remarked to Gary later that it is hard not to let a defective model deter you when that’s all you have to go by; Gary agreed, so while he is now leaning toward the first model, he wished he could try out a demo that worked as it should; his PT is going to try to get such a demo.

We next went off to the parking garage, and the PT talked him through the transfer. Again, it is a matter of balance and position and technique – and again it struck me how time-consuming something like just getting his own legs in and out of the car becomes.

On the first transfer into the car there was a lot of head banging (on his part, I mean ;-)), so I kept my hand placed where he would hit it instead of the door frame. After he’d transferred back out, she had him transfer back in again. That time went much, much more smoothly, and we were all pleased. The PT said I would have to help him, as she was doing, from behind him – as small as I was, there was no room for me to get between his chair and the front of the opened car door and be able to help lift him.

After this, it was time for a session with the tech. As at some point she was going to have him do his stretches and he’d forgotten his chain loops, I went off to get them and to bring him his protein drink. When I came back he was on the edge of the mat practicing throwbacks – throwing his arms behind him as if to catch himself should he fall backwards. But what he was doing – starting with his hands placed in front of him to the side of his thighs and then throwing them behind him – didn’t seem like it recreated a falling backwards experience and, in my opinion, it wasn’t going to ingrain the proper reaction in him. I said this to him, and as if to prove my point, he went to move his arms forward, really did lose his balance, and started to go backwards; instead of throwing his arms backwards, which was what he was supposed to do and what this exercise had been meant to teach him, he grabbed forward at the mat, as he always automatically does, and which had never before been successful. And even though it was successful this time at preventing him from falling backwards, he saw my point. I suggested he sit and purposely lose his balance backwards and then do the throwback to prevent himself from falling over. He refined that idea: he practiced balancing sitting with both hands up; at some point he loses his balance while doing that, generally going backwards. When that happened, he did the throwback. We both agreed that this was a more effective way for him to practice what he was supposed to do in the situation of him losing his balance backwards. After he did over twenty of these, one time he balanced way too long ;-), and taking a cue from the PT, I gave him a tiny push. He went backwards but caught himself with just the kind of throwback he was supposed to be learning. He gave me the eye. “You really would have felt bad if I’d fallen backwards onto the mat,” he said. He was right, I would have, but as I told him, “I was confident you weren’t going to, based on what you’ve been doing.”

I have to admit I am pleased when I come up with these little ideas that aid him in his therapy and in other matters.

After the throwbacks he did stretching. Then came pushups – fifty! But he did them in five sets of ten. This turned out to be easier than the twenty-five straight he’d done last time, I believe, basing my opinion on the fact that he didn’t collapse purple-faced onto the mat when they were over. He got himself to the end of the mat by himself again, and then I helped him transfer into his chair. I needed to give him more lift than I had before – we think his muscles were tired out from the pushups.

He was next to do five sets of ten of those “dips” where he holds the extended position for five seconds. But he got to five on the second set and literally couldn’t get up on the sixth one.

Well, it was past quitting time, anyway.

He realized later that what he should have done was change the order of his exercises: first do the pushups, then the stretching, then the dips. Trying to do the dips right after the pushups was too much for his muscles (makes me proud, Gary trying to figure out how he could have done more work).

After lunch he had a session with the gardening rec therapist (the graffiti sign was still up in the garden). We are still trying to figure out who this therapist reminds us of, some TV character. She has a fairly strong Minnesotan accent, kind of reminds us of the Dakotan accent in “Fargo,” but not quite that strong.

Anyway, she gave us a half-inch-thick stack of printed material on adaptive gardening and some tool catalogs she has found useful. She showed us a “J-pad,” which is a pad that Gary can sit on that straps to his legs – so if he moves, it moves with him. He would only be able to use it for maybe a couple hours at a time, if that, because it is not nearly as thick as his wheelchair pad. But if he wants to grow his in-ground tomatoes, this could be useful. We’re thinking we might have to make the raised beds in the backyard shorter (or rather, we’d have to hire someone to do this), and probably eliminate the middle beds (there are six) and use wood planks between the beds, all in order that he can wheel his chair between the beds. By next summer, we’re hoping he’ll be able to either transfer to ground level or onto some kind of rolling cart lower than his chair (now he can’t possibly do either of those on account of the flap), so he do his gardening from there rather than from his chair.

The rec therapist asked him if he wanted to do a class on transplanting, and he said sure (adding, perhaps unwisely ;-), that it would be easier than another PT or OT session). She asked him what he would like to transplant. Turns out she has a small tomato plant that needs transplanting, and she said he could do that – and that for the rest of his stay he would be responsible for its care and it would be his to take home (meanwhile I’m sitting there wondering how I’m going to get it home – let’s see, do I want to fit the tomato plant in the car or him?).

She kept on saying throughout this session that she wanted to show him the adapted hand-controlled power mower, and he kept saying he wasn’t interested in mowing. At the end of the session, she ran off to get it (“just in case you ever changed your mind about wanting to mow the lawn”). She came riding over on this big, noisy machine. She obviously loved the thing, running through all its features with Gary. We laughed about that afterwards.

As we left the garden, Gary commented that that class had actually been useful (not referring to the mower, of course), not only because of the information but because she was going to get a J-pad ordered for him and, best of all, he was going to get a tomato plant out of it, assuming he didn’t kill it in trying to transplant it (I’m not sure why he’s worried about that – he’s transplanted his own tomatoes before, and I can’t see why the technique would be all that different now – next week I’ll let you know how it goes).

Next on the day’s schedule was a scavenger hunt in “group.” We knew by now that “group” was not all fun and games like the therapists seemed to like to pretend it was. We wondered what the scavenger hunt would entail.

Turned out to be nothing like a traditional scavenger hunt, of course, but it turned out fine. As Gary said afterwards, “I finally had fun on one of these things (meaning “group”).” There was a list of tasks to be done. First was to find the Bridge office and find out about the peer support program (you may recall that the purpose of Shepherd’s Bridge Program is to help “bridge” one back into the community after being a patient here). Gary took off at top speed in order to be the first to find the office, which cracked me up – I thought that was more my personality, not his. He found the office, but because he wanted his protein drink after being out in the hot garden, I went off to make up the drink for him rather than stay to hear the conversation he was having with the (paraplegic) woman who ran the office. When I returned with the drink, all the other scavenger hunt participants and therapists were there, and the woman Gary had been talking to had moved out into the hall to explain to all of them about the peer support group. I had missed most of what she’d said to them, but I did hear her say that her office could help with any problem that came up any time after they were discharged from Shepherd, assuring them that no matter what the problem was, someone had no doubt already experienced it, and Shepherd could help find the answers; I also heard her say it usually took about two years to adjust emotionally to having an SCI, and that that was where the peer support group came in. She said she knew firsthand just how important such support could be - when people she meets tell her now how well she was doing, she tells them that for the first two years after her injury she was suicidal.

When that task was accomplished, Gary asked what his prize was for getting there first. He seemed disappointed to learn that there was to be no prizes on this hunt (again cracking me up). “What is a scavenger hunt without prizes?” he asked, not entirely joking. But it turned out the Bridge person did have some ponchos she could give away, and since this was something he’d really wanted, he thought that was great.

I asked him what else had gone on when I wasn’t there, and he said she’d talked about the peer support group that meets twice a week at Shepherd. Since that wasn’t something he’d be able to attend, he’d asked about an online group. I didn’t get a chance to ask what she’d said about that, because he tore off to do the next thing on the list (he later told me there was an online chat group, though not run by Shepherd).

The next task was to find the pool and ask the requirements for using it. Gary was there first, of course. It became clearer that what we were doing was not going to have all that much relationship to a traditional scavenger hunt, as the participants were definitely not pitted against each other – indeed, after Gary found out the requirements for using the pool, the therapists made him tell the late-arriving participants what the requirements were (he forgot a couple, but I remembered those and added them to his list; the requirements were things like no skin sores, no open trache hole (I’m sure you can see why that would be a problem!), and so forth). Next task was to find out the gym hours, and Gary got there first again and made his report to the others. Next we were to go to the library and find out where the books on home modification were kept. Gary probably did that first too, but I went off to get another cup of his protein drink and they were coming out of the library by the time I got back. Next on the list was to go to the garden and count the fish in the pool (I’m not sure what the practical benefit of that was). While there, I beckoned Gary’s roommate over to the sculpture and showed him our sign. He started laughing at it, and said to me, “I hear that” (maybe a Southern country expression for “I can relate”). Unfortunately a rec therapist got curious and came over and checked out what we’d been laughing at. She looked at me. I looked innocently up at the sky. Anyway, if it’s not there tomorrow, we’ll know why.

The final task on the list was to find the cafeteria (again, of no practical benefit to Gary ;-)). Gary was first again, by a long shot. As we waited for the others, he started laughing. “I’m an eager beaver at this today, aren’t I?” he asked. I agreed and told him I thought he’d had a personality transplant – mine into his (not that I would like a scavenger hunt, but if I had to do it, I would strive my utmost to be first at it).

There was actually one more thing on the list for the hunt, but the rec therapist simply explained it to everyone. It was the Outpatient Program, which is the step after the day program. That program entails going to therapy two, three times a week. Since Gary can’t come to Shepherd do that, we’ll have to see if he can do it somewhere in our area; if not, another possibility is Home Health, where a therapist comes to the home and works with the person. That’s not as good an option, though, since a therapy gym would have all kinds of specialized equipment.

Soon after that I left for the chiropractor. I was able to get back to Shepherd a bit earlier than usual in the evening, but I wanted to leave earlier as well – tomorrow would be a long day of family training, starting with an 8 am wet (shower) run.

Mail call: Thanks to Mark Meschke.

All for now.