Earlier today I posted an entry for Dec 23-25. Please scroll down for that.



Dec 26, 2006

A reiteration of the goals Gary had going into Day Program and how he/we fared:

Goal: Raised toilet seat – how to transfer onto it and how to use it for the bowel program

Result: Gary has the basic technique down. He will need to practice the transfers with me for a while until we are comfortable with him doing them by himself – and first, we need to get a proper-height piece of equipment, because we discovered on coming home that the raised toilet seat they gave us is much too high! So, we haven’t yet had the chance for him to actually get on it at home; in particular, we haven’t been able to see if looping his chain loops (which are normally used to assist him in stretching) over the grab bar in the shower and then hanging onto a loop while he leans over to do his bowel program is going to work for him – it seemed a little scary for him to do so to me, the grab bar being so far away. If that doesn’t work we’ll have to figure something else out, maybe installing a floor-mounted grab bar.

Goal: Work on Transfers from wheelchair to the following and from the following back to the wheelchair:

raised toilet seat (Result: see above)
floor (Result: We got the techniques down, both the technique of bumping up into the chair backwards using an aid like a step and that of going directly into the chair frontwards, both ways requiring assistance from me at this point in time)
our car (by himself and possibly without use of transfer board) (Result: he still needs assistance and we still need the transfer board and we decided the way we had made up was better than the “official ways” being taught to us, because by going from the car into the wheelchair backwards Gary doesn’t have to worry about banging his butt on the frame of the car.)
an SUV like Michel’s, which has a seat so much higher than our chair (Result: Gary learned the technique and got it down, with assistance of course.)
shower bench (Result: an alternate way was suggested, that of transferring from the raised toilet seat to the shower bench, which would eliminate the problem of not being able to get the wheelchair at an advantageous angle to the shower bench. We haven’t tried this at home yet.)
low to high transfers in general (Result: Gary can do these much better than at previous Day Program; requires assistance at this point in time)

Goal: Dressing while in the wheelchair, trousers especially (so he doesn’t have to get back into bed to dress himself)

Result: he has the techniques; it will just require practice to be successful – he hasn’t been able to get the very last part of getting his pants on over his butt without assistance. So far, he hasn’t been eager to practice this at home, sticking to dressing in the bed.

Goal: Decreasing the number of ICs to four (though that may be a problem because at this point it would mean he would have to get himself out of the prone position at midnight and lay on his side to do the IC, and he would then have to wake up an extra time during the night because he’s not allowed to stay on his side for more than six hours and he isn’t comfortable staying on his side for even that long – and he doesn’t want to wake up an extra time!)

Result: because of the aforementioned problem, no change was made.

Goal: Curbs and wheelies

Results: able to do four-inch curbs about fifty percent of the time, less able to do six-inch curbs; therefore, he will in neither case be doing these on his own yet as we don’t want him tipping over backwards, even if he now knows how to get the chair upright, him in it, should that happen (assuming he isn’t too dazed to even try); he can do these curbs with assistance, however.

Goal: “Regular bed techniques” – in other words, now he does everything in a hospital bed, which has those nice electronic controls and rails to aid him. Since he eventually wants to travel, he wants to be able to do his maintenance tasks in a regular bed, so he needs to “re-learn” how to pad and position himself, and turn from side to side, and do his bowel and bladder stuff, etc., in a regular bed. Also, he wants to learn how to prone himself, because he is definitely dependent on me for that.

Result: This didn’t turn out to be as big a problem as he thought it might be. He can do his bowel and bladder care, and turn from side to side, and pad himself while on his side with no problem. As for proning, he can get padded off and in the prone position, but at this point I still need to check that his pillows have ended up correctly above and below his knees to make sure there is no pressure on his knees. We also had a tradition of a “thank you very much pillow,” which is the pillow he puts under the side of his face while he is lying in the prone (face-down) position, and is the last pillow that is put into place for the night. Our tradition was that I would throw this pillow with some force on top of the back of his head every night, at which he would say, “Thank you very much” and then put the pillow under his cheek. Hey, we have to have our fun. We missed our tradition when he was putting that pillow in place himself, so we went back to me smacking him with it.

He hasn’t practiced in a double bed at home. First we have to figure out what to do about a bed for him. I am going to try sleeping in the hospital bed at least one night – and Gary will have to make the high transfer into my double bed. If we like the results, we have to figure out if we are going to move my bed into his room and the hospital bed into mine, or move both beds into mine and shop for a double bed for him. The hospital bed is rented, and we have it for a total of six months, we think.

Goal: Find out if there’s anything else he should be doing for the “leaking problem,” see what the possible solutions to it are and what their long-range effects would be

Result: He was discovered to have a UTI. We wonder if he may have a near-constant low-level one, which may be causing the leaking. He is going to incorporate cranberry juice in his diet. He is also going to speak with a local urologist about the problem.

Goal: Grease his flap himself

Result: success

Goal: Do his own skin checks of his butt and back

Result: We think he will be successful with this when we get a long horizontal mirror hung on the wall next to his bed.

Goal: Get another wheelchair evaluation – it’s possible the wheels on this could be brought in to make the chair narrower; also, we want to see if his tip bars could be raised and if the footplate is in the proper position (I had to fool around with it from what it was when his new chair came, because he couldn’t roll under the kitchen sink – the position of the footplate made his knees to high – only now, in the position the plate is in his heels don’t rest on the plate). A minor goal is to learn to breakdown and assemble the chair himself, but he doesn’t really see himself doing that, like to get it in a car – it’s too heavy for him. He won’t need to do that when he gets his van, cuz he’ll be able to roll the chair right in; and if he’s a passenger in someone else’s car he’ll depend on them to get the chair in and out for him.

Result: he didn’t bother with the breaking down and assembling of his own chair. All the changes to the chair mentioned above were made, and in addition the back of the chair was raised. He is quite pleased with the changes, and especially the fact that his back no longer aches as it had been doing in the new chair – there is still discomfort there, but it is like it had been before getting the new chair.

Goal: He also hoped to persuade the recreational therapist that a good goal to have would be for he and I to go to the Atlanta symphony Christmas concert next week. The catch is that we’d want permission to not have anything scheduled until 10 am the next day, as it would be a later night for us than usual – otherwise we wouldn’t need to mention this to them as a goal!

Result: We went and had a good time ;-)

Goal: Other rec therapy goals: they may get him in the pool; they are putting him in the standing frame; they may go over a weight training program with him that he would be able to use at our university gym.

Result: He got in the standing frame a couple of times and in the Easystand in the gym with me a few times; the OT gave him a home exercise program; he went swimming twice, the first time being a very emotional experience as he felt the freedom of being able to move his body about in the water easily. It takes so long to shower and dress afterwards, however, that he is not at this point inclined to make swimming a regular thing. Come to think of it, I’m not sure how the university would handle me needing to be in the changing room with him, but we don’t have to worry about that at this point.

Other things that happened on Day Program not on this list:

He learned the technique for getting his wheelchair upright should it fall over backwards – this the two of us were able to do with no problem.

He learned how to bump up and down stairways. We can do this together, though he isn’t eager to be doing a lot of this ;-).

He learned how to go down the stairs backwards in his wheelchair using one or two handrails, with my help – he said he wished he had known how much effort I had been putting into it, because he found it easy and he would have liked to have known if it was all right with the therapist if I didn’t help so much with it.

He learned how to manipulate a knapsack on the back of his wheelchair.

He learned how what tools to use so that he could sweep better (so that when I follow up with the mop, I’m not just smearing the dirt he hasn’t picked up;-)).

He learned about using a velcro strap so that he can hold the oven door open in a way that allows him to balance better.

Finally, we are supposed to be getting a referral to a speech therapist to see if there is something that can be done about his coughing problem (or rather, my problem with his coughing ;-)).

Okay, enough of him for a while. Now I need to get back to my novel and wrestle with my characters ;-)