August 8, 2006

Okay, the driveway of the apartments where we are living leads to a red light. Across the street is Shepherd. There are two lanes at this light. I assumed that since I was going straight, I should be in the right lane (I was taking my cue from what one does at stop lights on the street). As I sat in that lane, a guy pulls up behind me and starts honking his horn. And honking and honking and honking. I kept looking straight ahead, but pointed that I was going straight, not turning right, which was obviously what he wanted to do. He kept honking (the light stays red for a very long time in that direction). He even pulled forward and hit my bumper, scaring me, though he didn't do it hard. I did nothing but stayed in the car my heart going a mile a minute and my blood pressure going all over the map. After eons had passed, the light finally changed and I drove straight into Shepherd. So tell me, was I in the wrong lane? I mean, if someone had been turning left from that other lane, I sure wouldn't have wanted to be stuck behind him. (Gary thought I was in the correct lane and the guy was just an asshole; he said it would have served the guy right if after he bumped me if I had called the cops and insisted on filing an accident report to delay the guy further; but of course, I was afraid to get out of the car and confront the guy).

That little bit of anxiety over, Gary decided to give me a new source for it ;-) He wanted to practice wheelies for a short time before he got up on the standing frame, which was what was first on his schedule. So we did that, and since he was not going to practice curbs while doing them, we kept his tip bars on. Maybe because they were still on, he seemed a bit more relaxed than yesterday when he did them, and he stayed in place better.

Next I cranked him up in the standing frame. He got a little dizzy a short time in, so I brought him back down, then took him up again when he felt recovered. We played rummy to pass the time, plus he called the LETA bus service to find out about "Paratransit." They said he would need his doctor to fill out a form saying he needed the service, and after his approval, the service would be free for him -- apparently that is true for anyone connected with the university (I assume the university contributes to the service).

Next was an OT session, during which he practiced transfers. The exercise mat was first kept at the level of his chair, then after he'd done that transfer there and back, the mat was electronically raised about two inches. He did a great transfer there and back; the OT praised him and said it was time to raise the mat. He asked if he couldn't rest on his laurels instead. The answer was clear when she raised the mat again. Afer each successful transfer back and forth, she raised the mat farther until it was about six inches higher than his chair. All his transfers were really nice, the OT helping with his balance but not his lift. This reminded me of a question I had, and I asked her how we would know when Gary was ready to start transferring on his own. She said that we could now go to the stage where when the transfers were between two level surfaces I just stood at ready but didn’t actually have my hands on him (her words causing me a little case of the jitters :-)). She then lowered the mat so that it was even with his chair and had him do a transfer on his own where she just sat close in front of him. He looked a little wary, but she reminded him that she was right there. So he did the transfer – not as impressive as the ones he’d just did, and she told him she thought that was psychological. She then had him switch his chair around so he’d be transferring from his other side (since he needs to practice transferring from both sides), and she had him do it again, with a similar result: he made the transfer but didn’t get much height and landed closer to the edge than one would like. She then went through the process of raising the mat again, telling him to emphasize lowering his head (I think I mentioned before that he tends to just dip his head without getting his whole body into it), to aim his nose down past the knee opposite to his travel, reminding him of the physics involved: head low and to the left means butt will go high and to the right. For some reason this finally clicked with him, and he swung his head and upper body down low and as a result got even greater height on these transfers, the last one, the hardest one, his best. Inspired by the paralympics T-shirt the OT was wearing, I joked that they ought to make this a paralympic event: the butt jump – they could keep raising the mat until the contestants couldn’t make the transfer anymore.

Next we went out to the “family area,” which has a couch and some chairs. There he practiced transferring to the incredibly low couch – the OT pointed out that if he could master this one, he could do any couch there was! Going down onto the couch, was, of course, not much of a problem, but getting up from it to his chair was another matter – the difference in heights was much greater than the transfers he’d just done, and the OT told us she was supplying about 50% of his lift. Since she’s not planning on living with us ;-), she had me practice it with him. Since it was something new, in my nervousness I supplied probably much more lift than he really needed – at any rate, he rocketed through the air and made the transfer no problem.

Next up was a session in the ProMotion Gym, where he got on the Easyglide for the first time – you might recall I told you this is a machine like the standing frame, except not only does it lift him to a vertical position, but also he can pull and push on some handlebars to move his legs back and forth like he is on a cross-country machine ( this machine being good for stretching the leg muscles, for circulation, and for weight-bearing, according to the rec therapist with us). As always seems to happen, he had to go back down after a few minutes because of dizziness, but after a few minutes more he got back upright and stayed there nearly thirty minutes. He didn’t work the machine the whole time though – all that transferring had tired him out some.

Across from us, we watched a man on a “Robot Assisted Walking Trainer,” called a “Lokomat” (if you search for that on the web you can find a picture of it). It kind of reminded me of “6 Million Dollar Man,” for some reason, the guy on the treadmill seemingly covered from neck to toe in all kinds of wires and slings and such (his injury must have been in the lumbar region). We also watched someone lying down on his back and pedaling with his hands to make his feet, which were strapped into pedals, go round and round like on a bike (the machine was called a Giger) – the rec therapist told us that machine was mostly good for cardiovascular training, and the Nu Step, which is like a seated version of the Giger is good for strengthening the muscles as it gives greater resistance.

Next came Gary’s IC time, followed by lunch. While waiting for Gary I checked my email and got the report that all the concrete had been poured for the garage so we will be able to get Gary into the house this Friday without having to wheel him over our lawn. I also got two separate reports that it was probably due to Janet Rogers’, um . . . gentle persuasion techniques? . . . that the job was done as speedily as it was (remind me never to get on your bad side, Janet ;-)).

After lunch, we had a little more time to spare, so we went to the library where I drafted the opening paragraphs of this blog entry and Gary looked through a book called “From Here to There,” which was narratives about various people with spinal cord injuries at various levels. Gary commented that “From Here to Eternity” would also have been a good title for such a book, if only that title hadn’t been taken yet.

After lunch Gary had a proning session with me. I suggested he could do his terrible threes or instead of proning for the whole hour we could do stretching or balance exercises. He decided it was a good time to take a nap. Hmm.

But maybe it was good he rested up – next was a session on floor transfers. This is not something he can really practice now (because of his flap), but they wanted to show the two of us how we could do such a transfer if need be – the need being if he accidently ends up on the floor, which they claim is inevitable (this of course is not the only reason one learns such transfers – it is used for any activity where one wants to be at ground level; for instance, gardening).

There are three ways to make a transfer from wheelchair to floor and back, but two of them involve more bending than Gary is allowed, which is unfortunate because that left us with the one requiring brute strength as opposed to taking advantage of body mechanics. The two requiring a great deal of bending were the backwards transfer and the side transfer. In the backwards transfer one slides forward in the chair, and then with hands on the end of the chair lowers oneself butt first to the floor – it requires shoulder flexibility, which Gary is unlikely to ever get on account of his arthritis. To get back up, from the position you now finds yourself in, you do a version of a depression transfer, practically bending yourself in half to get your butt up on the chair by bending your head down low while pushing with those hands you have behind you on the edge of your chair. In the side transfer, you lower yourself down sideways very similarly to the backwards transfer, but one hand is on the ground or on a couch or some other object instead of having both on your chair.

The front transfer is a bear. You get to the edge of the chair, bend over and walk your hands down the frame, and reach for the ground as soon as you can, then walk your hands along the ground in front of you until you are in a prone position (it might help you to think of that “wheelbarrow” game you played as a kid, where someone held your legs and you walked along the ground on your hands). Instead of ending up prone, you can also twist and get on your side.

Now for the hard part: getting back up. Basically you have to curl up next to the chair on your side with your legs folded, put one hand on the seat of the chair to the side near the back, put the other on the seat near the front, then use brute strength to push up onto your knees (and remember, since you have an SCI you don’t have use of your legs or your abs), probably resting your head on the chair to catch a breath, then push up again to get your body straight, your head resting on the back of the chair, then push up again and twist to get your butt on the chair. She had me practice this while she went to talk to someone else a moment – she wanted me to see what it was like. It was a killer. I finally got the hang of how to get all but the last part – though what I was able to do was quite exhausting – but I couldn’t twist my body around while pretending I had no use of legs or abs.

When she came back, she showed me how she would help me with this transfer (so, I was playing the part of Gary and she was playing the part of me), and it was much easier with her first helping me lift at the hips to get me on my knees and then lifting me under my knees to help me with the pushup and twist parts– but then, she, who is bigger than I am, was lifting me, while I, who am smaller than Gary, would be lifting him.

She next helped Gary get on the floor from his wheelchair using the front technique (he had looked at her like he hoped she was joking, but she wasn’t), and then she helped him back into the chair – this was not easy for either of them, Gary’s lack of shoulder flexibility coming into play here, hindering his ability to push himself up. The OT this morning had said she wanted us to learn this in case Gary ever ended up on the floor before the time he really learns these transfers, so that this way we could get him back in his chair without calling on someone else to help. After this afternoon’s OT (a different one) went through this with us, she thought our wisest course of action would be to call on someone else and me and that person do a two-man transfer of Gary back into the chair. So, hopefully Gary will never accidently spill out of his chair when there is no one anywhere around and we can’t get through to 911!

But she pointed out that the floor transfers are useful to learn – they are a big independence thing. It is good for paras to know that they can get themselves back into their chairs by themselves should they take a spill. So when Gary comes back for Day Program after his flap has healed, this will be something they will work on (this should motivate him to keep his strength program up!).

After this, Gary had “scap class,” for working the shoulder girdle muscles, the upper back, and upper arms. The leader should be the one who teaches those group weight training sessions. She was really good, keeping all the participants working throughout the entire time. I did the exercises too, as they use a theraband (exercise band), and the exercises could be modified so Gary could do some version of them without needing any help from me. We did two circuits of an external rotation exercise, an abduction exercise, and triceps extension, and then two circuits of an exercise she called “diagonal pain,” biceps curls, and one where you mimicked pulling an arrow back on a bow. Each set of an exercise was 30 reps. They burned!

After that I ran off to the chiropractor for my last visit with him. I thanked him and told him I thought he was excellent. Then I came back to the apartment and ruined my adjustment ;-) by organizing our stuff, packing it up, and loading the car for a couple hours, trying to get everything that we won’t need in our last days here packed. After that came dinner, and then we had our own “wet run” – Gary wanted to take a shower instead of having the usual bed bath. We discovered it is a lot harder to have him take a shower with the shower bench in the tub rather than in a roll-in shower, so we are so very grateful Joe has seen we have one of those! The main problem was having so little room to maneuver, making my helping with his transfers awkward. And it gets hard to lift those heavy legs over the side of the tub in that cramped space (there really wasn’t enough room for him to do it himself, at least, not unless we wanted to spend all night there – as it was, it took us forty-five minutes, in the interest of time me helping with the soaping and rinsing a bit more than we’d done on our official inpatient wet runs).

We finished this portion of the night with our usual routine of stretching, wound care, positioning, then went off in search of dreamland.

After the time the therapist said we could do the transfers where I am “on standby,” (ready to aid, but not touching him unless necessary) Gary and I did three of those during the rest of the day Tuesday. Each time he didn’t get a lot of height and he landed too close to the edge, but he accomplished the objective, getting to the other surface, not losing his balance, and doing “hops” to get safely away from the edge. But Wednesday morning I had to grab him and help get him back onto the bed, momentarily fearing that we were going to have to make use of a floor transfer after all – he had made it less than half way to the chair from the bed. He did the transfer over again, this time finding his target.

Well, that was one way to get the blood pumping in the morning!