Merry Christmas! Thanks to those who sent holiday cards, email or otherwise. And special thanks to those of you who have kept in touch over the months, lending your moral support. It means a great deal to us. As well, thanks to those who are more silent about it but read the blog :-).

December 21, 2006

Shoot, there’s another thing I forgot to tell you about the floor-to-wheelchair transfer – namely, how to do the reverse, that is, how to intentionally and directly go from the wheelchair to the floor. For that, Gary locks the brakes, puts his feet forward off the footplate, puts one hand on the chair leg, the other on the floor, and then walks his hands forward QUICKLY so that his body follows and ends up straight out on the floor (do you remember “wheelbarrow” races from when you were a kid?). As spotter, I kneel next to him and hang onto a belt loop (or belt, if he wears one) with one hand, while the other hand I put under his chest to keep him from falling on his face. After the first couple arm movements he makes, however, he goes too fast for me to keep up with him (scrambling along on upright knees), so the rest is up to him. In our practice, that went fine.

As we moseyed toward the third-floor gym on Thursday morning, we ran into Gary’s doctor. He asked Gary if he would talk to a recently admitted patient, someone in the senior group, as Gary had been. The guy’s level of injury is a bit lower than Gary’s (T9, complete), but fairly comparable. The doctor said the guy is bummed out, and the doctor thought Gary would be a good person to talk to him, so that the guy can talk to someone who’s been through therapy, been home, and has seen improvements in his capabilities over the months with therapy. Gary said sure, he’d do that, though looking over his schedule, he and I thought he’d probably wait until tomorrow after he was all through with therapy (and Day Program!).

We then passed by the PT, who commented on the scabs Gary now had on his lips. She said she was sorry that had happened, but he said it would serve as a reminder to get his hands up on the wheels when doing the floor-to-wheelchair transfer.

First on the agenda was a meeting with the case manager, who filled out Gary’s discharge papers (though she jokingly reminded us we couldn’t skip out until tomorrow). She commented that both Gary and I had a calm, confident look about us, that even if we are not quite there on some things, we know we *will* be there. I was wondering if she was contrasting our look to when she first saw us enter Day Program last July. We (and probably especially I) were frazzled and distraught on account of the whole new crop of problems that had arisen over the weekend (that’s when his leaking problem started and also his flap suddenly looked worse) on top of the getting used to doing the whole shebang of his care on our own.

At any rate, she is exactly right. Gary (with some help from yours truly) has accomplished more in this session of Day Program than he thought himself capable of. And the things he is not quite there on, for example getting those damn pants on while in the chair, we know is just a matter of practice – he has the techniques.

The next hour was spent (wasted ;-) on doing that ASIA test again – the “touch tests.” It seems rather silly to have it done ten days after the last time he had it done, especially seeing that nothing had changed from last August to Dec.11 when they tested him. But evidently it is somebody’s requirement that he be so tested.

The next hour we met with yesterday’s OT. She had a broom for us to buy and also had made Gary a velcro strap for the oven, so he tried those out in the practice kitchen. Then we went back to the third-floor gym and Gary practiced dressing again. He picked up another tip – to try leaning straight forward in the chair as far as possible in order to get the pants up in back. Since his balance is so much better, he is more confident of making such a lean. (And now he knows that if he should overbalance and can’t catch himself, he can walk forward on his hands as in the chair-to-floor technique.) The OT also suggested we could sew loops inside Gary’s pants so he has something to hang onto when he is pulling them up. I’m not sure we’ll do that, but it’s something else to have as a possibility.

Next came IC and lunch. After that we met with the therapist who had gone over curbs with us, only this time it was for more bump-up practice from the low mat to the high mat – this is where he has the J-pad strapped under his bottom, has his back to the upper mat, and “on three” throws his head down and pushes with his arms to get his butt up and back over the higher mat. I assume this practice was in preparation for the next hour when Gary would be bumping up the stairs. I think the PT had been giving him a not insignificant amount (which is somehow different than a significant amount ;-)) of help last time when he did these, because he was not able to do them without the therapist and/or I guiding him back over the top mat – he got his butt up, but not back. He did a bit better at them when I suggested he sit cross-legged instead of frog-legged, since he could get his head down lower that way. He made a couple of those with minimal help. BUT, he didn’t want to overpractice because these are tiring, and he knew going up the stairs was coming next. Before that happened, however, a little performance took place. A teen-aged girl who had been recently admitted had apparently been taking dance classes. A couple friends of hers put on a little dance performance. I guess that girl is braver than me – had I been a dancer and could no longer dance, the last thing I would want to see so soon after my injury would be a performance put on by my dance friends.

So, in the stairwell, the PT first had Gary do a transfer from his chair to a stair – this was a different kind of transfer than he’d done before, and he did a good one. Then a belt was tied above his knees to keep his legs together and in good position. The actual bumping up (and down) the stairs Gary said was scarier than the other bump-ups – because “on three” he was throwing his head downward toward a flight of stairs. First I spotted him from in front and the PT from behind, then the PT and I switched places, and finally, I spotted him all by myself. When spotting him by myself while he was going up the stairs, I had to switch positions from being in front of him to behind him, depending on what stage of the process he was in. When he is doing the actual bumping up a stair, I am seated two stairs above where he starts, and I hang onto his J-pad and make sure he lands on the next stair (he did these better than the mat transfers we had just done because his legs are in a better position to help him). Then I continue to hang onto him as he does little depressions wiggling first one hip back then the other until he is fully on the stair (the PT said that that is the most dangerous part of the maneuver and for me to hold on good). Now his legs are two stairs ahead of him and he needs to get them to the stair just below him. At this stage I go in front of him and put my hands on him to make sure that while he is moving his legs up to the next stair he doesn’t lose his balance and go tumbling down.

Getting back down the stairs I hang onto the J-pad from behind as he lowers himself down to make sure he goes down gently, then come to the front to spot him while he repositions his legs on the stair two away from his butt.

The PT said we had now basically met all the goals Gary had when he came here, that now it was a matter of practicing what he/we had learned, and that because of that, and because there was still some time left in our hour with her, she was going to go through with us an advanced technique she hadn’t expected to get to with him: how to get his chair upright, him in it, if he should go over backwards in it. The first thing he should do if his chair is going over backwards is to put his right hand behind his head (to protect it) while tucking his chin and put his left hand on his right knee, to prevent his legs from coming up and smacking him in the face. Now, instinctively Gary wants to instead bend and reach forward with both hands to try to counteract the fall – but that ain’t going to work if the chair’s momentum is backwards.

Once he is on the ground, he puts the brakes on and pulls on the tires so his hips are firmly in the chair, then he snugs his seat belt. At this point the PT looked down at Gary and said, “Now you have to get up from there.” There was a pause, and then she said, “Why are you looking at me like I’m crazy?” He said, “Because you are.”

His next step was to push up on his right elbow and get his right hand on the ground, then to reach with his left arm over and up to the right top side of the wheelchair’s seat frame. Then he pushes with his right hand and the idea is the chair rotates around the fixed tire and into an upright position. Now, supposedly when he is advanced enough he’ll be able to do this entirely by himself, but how we did it at this time is that I am holding his push handles while he is on the ground and at the time he starts to push with his right hand, I push upward on the handles to help raise the chair. But, I wasn’t using much force at all to do this – it was mostly Gary. In fact, for both of us it was less effort to get him upright in the chair this way than it was to get him in the chair doing the floor-to-chair transfer. I half-joked that if he ever fell out of the chair we should get him back in it this way, but of course if we tried that there is the problem of getting him in that initial position of being seated in the chair.

The PT now asked Gary if he still thought she was crazy. "That I can do this myself? Yes," he replied.

The PT then left, that being the end of the session. Gary was obviously thrilled we could do this advanced technique with no problem. He started to say to me that this particular PT was really good – and he became so overwhelmed he started crying. He finished his statement, saying that the PT really had a way of instilling confidence in him, that he can do things with her that he never thought he’d be able to do.

The day finished with a group exercise session, led by a different therapist than usual. She had a good tip about balance in the chair – that in reaching forward it is good to have the large part of the castor wheel pointing forward because that gives greater stability to the chair. She was really into breathing (“Now hold the position and breathe and breathe an breathe”), and as the session went on she revealed she taught yoga classes to those in wheelchairs. I’m afraid I had all I could do to keep from laughing at her manner, though. She spoke in a dramatic tone as if she were addressing a large group of people rather than five of us, and she reminded me of one of the instructors at "Freidlich Sensitivity Spa" in the episode, “Sensitive Steele,” a reference that only a very few of you will appreciate, to your loss ;-).

On our way out of the building I made a mistake and held the door open for Gary. I joked that we had to go back inside so he could open it himself.

The rest of the afternoon and evening I spent much of the time packing up as much as possible, loading the car, and cleaning the apartment. I should have skipped the stupid vacuuming though – my back and leg hurt when I was done.

Gary wanted fish for dinner, and for some reason the oven started smoking while the fish was cooking. That set off the fire alarm. I couldn’t figure out how to shut it off, so I opened the door to the apartment to let any smoke out and stood on a chair fanning the fire alarm. That shut it off, fortunately!