Okay, I already posted something earlier today, so if you missed it, scroll down to the next entry.

December 20, 2006

Oops, I forgot to put in another the thing Gary learned yesterday. After we did the floor-to-wheelchair transfer, the PT took us outside to the garden area where there is a flight of steps, and Gary learned how to go down them backwards while in his chair. The stairs had rails on both sides, and the technique was for Gary to hang onto both rails, lean way forward, “nose to his knees” (not quite physically possible for him), and slowly back down. I was to stay behind him, hanging onto his push handles, one leg on the stair below the one where his wheel would next go (so he wouldn’t run into me), the other leg on the step below that, my hip to his chair to help support it as it came down. I don’t know how much help I was supposed to give, but I was in “better safe than sorry mode” and I hung onto that chair for dear life, supported the weight of the chair on my hip, and guided the chair down slowly.

Wednesday morning began with the group fitness class, which went much as it always does ;-). The next hour was more swimming! The Shepherd pool was ideal for the pool exercises the rec therapist went through with Gary – in fact, I’ve never seen another pool that has an underwater ledge along the side that you can sit on and be about waist-deep in water. In a more typical pool, Gary would either have to sit on a step to do these exercises, or, the therapist suggested, stack some pool aerobic steps (assuming the pool has water aerobics classes). He would need to stick a towel under his bottom so he doesn’t scrape it on the pool floor, and, in case I forgot to mention it before, he should always wear pool shoes so his feet don’t scrape on the pool floor.

She gave him a pair of “resistance paddles” – they are about fifteen inches long, have a bar in the middle that you hold onto, and have paddles on each end with little holes in them, the paddles providing resistance as you push them through the water. For something similar to what he was using, see http://www.waterworkout.com/products.amp?product=pp.

She took him through a series of exercises, doing twenty reps of each. I sat behind him on the ledge and held him under the armpits to help him keep his balance. Indee, he said that the exercises mainly worked his balance, not finding them difficult in the strength sense. I wasn’t sure how much support he would need, so tried to give as little as possible, but I did find I had to put forth effort – he definitely needed my support and it was a little bit awkward and tiring for me to stay in that position behind him holding him upright the entire time.

He started with his arms out to the sides at shoulder height and pushed the paddles down to his thighs. Next he held his arms out front and pushed them down to his knees. Next were one-armed biceps curls. Next he held his arms out in front at shoulder level and gave big sideways sweeps to the back and then to the front, one arm at a time. Next he did stirring motions with the paddles, one arm at a time, clockwise, then counterclockwise. Finally he did punches, one arm at a time.

I asked her if they ever taught a type of “drown proofing.” I had meant like what is taught in swimming lessons, a method for surviving in water disaster scenarios: you float vertically (assuming you are not one of those relatively few people with negative buoyancy), making minimal movement, face-down in the water; when you need a breath, you gently push down on the water, exerting just enough effort to clear your mouth from the water to take a breath, and then relax.

But she misunderstood me and told him that if he is ever near water in his chair (on a boat or a dock) that he doesn’t want to have his seat belt on – if he falls in the water, he doesn’t want his chair attached to him. I wish I had pursued my question, but I didn’t. I want him to try the drown proofing method next time he is in the water, though.

After he finished with these six water exercises, we swam a couple laps, him on his back, the therapist and I swimming along. I asked the therapist if he’d be able to do the crawl stroke, and she said first she would want to teach him how to breathe by rolling over onto his back in case he wasn’t able to catch a breath the normal way one does while swimming the crawl. This was more like what I had been trying to get at with my question of drown proofing. So, anyway, she taught him how to do that. If he couldn’t clear his mouth for a breath while doing the crawl, he was supposed to put his arms in “Indian chief position,” to use a politically incorrect description (one arm folded on top of the other), then since he breathes to his right side, he was to punch up with his right elbow while pushing down with his left hand against the water and, at the same time, attempt to roll over to his left side and onto his back. So he practiced this a couple of times, and then he tried to crawl stroke. He said it felt very different, not using his legs. The therapist was holding onto his waist as he did this, walking along the pool bottom with him as he swam along. I do not know how much support she was giving him – since his legs don’t float, but rather would drop down, and he couldn’t use them for any stability in the water, I suspect her help was not insignificant. She didn’t have me try it with him, and I regret not asking to do so. So, we will have to try it on our own the next time he is in the water. Or, maybe the next time he’ll be in the water is with the therapists, because he wants to go to the Adventure Skills Outing on Lake Martin that Shepherd holds annually, and he can try it again at that time.

The therapists called the pool at the university for Gary, and they found out that there is no pool lift chair, like Shepherd has, but they do have a wheelchair ramp down into the pool. I assume this means they would have a pool wheelchair for him to use to get into the water. If not, he could bump out of his chair as he’s just recently been learning, though he would have to be very careful of his bottom on the rough surface of the pool deck and the pool – maybe we’d have to get some pad to put under him. Anyway, we’ll just have to see.

After this session we lingered in the hot showers and then we were supposed to do “Dressing with Caretaker.” I don’t know if they had wanted Gary to practice dressing in the chair, but by the time we were out of the shower it was 11:30, and there wasn’t enough time for him to practice dressing in the chair, do his IC, and have lunch, if we were to make the 1pm session. So, he dressed on the mat in the men’s restroom instead, and of course I was with him, helping him with the transfer out of the shower chair that he had transferred into at poolside and getting our clothes out of the locker and helping him with his pants in the interests of time.

The first session of the afternoon was with the PT, and she told us to do the floor-to-wheelchair transfer; she wasn’t going to help at all, and I was supposed to give minimal help. Gary got a battle wound this time – he cut his lip during the process. The PT said he could say I gave him the fat lip, but he said he was going to tell people he got it because he didn’t do what his PT told him to do – which is true, but perhaps not in the way people might take that. What happened is he didn’t put his hands on the wheels during the second push up when he was trying to get his chest on the back of his chair. He had his hands too far back, on the legs of the chair, and he ended up scraping his face along the back of the chair.

The next task was to go backwards down the stairs in the wheelchair while using just one rail, since most stairways don’t have two. He said this was actually easier on his shoulders. The only “problem” was that he forgot to communicate with me and nearly ran me over, taking the next step before I had backed down another step. He said he didn’t realize I was back there doing anything. I didn’t let him try it by himself so he could tell what help I was giving. ;-) We had an audience of Nurse Mark, one of our favorite people here. Mark gave Gary the thumbs up and applause, and was suitably impressed that we had mastered the floor-to-wheelchair transfer.

Next we went back into Shepherd to practice a “low sofa to wheelchair” transfer. We passed through the rec room where a Christmas party was going on. A quadriplegic was singing a blues song – he was very good. It was all the more impressive because he had only recently gotten off a trache tube, and I’m sure his lung capacity had been diminished.

At the sofa, the PT told us that if Gary had to make such a low transfer, he could, if he wanted, stack the sofa cushions on top of each other to make the surfaces more equal in height – though that might make the surface of the couch squishier, which would affect his transfer. He could also stack blankets, or if it was to a surface in our home that he would regularly use, he could put a piece of thick plywood under the cushions. She did the transfer with him, and then it was my turn to do it with him. I had to give him a bit of lift, but not a huge amount.

Next we had a session with an OT, a different one than we have been having (that one left for the holidays). First on the agenda was, again, dressing in the chair. This person also had a useful tip for Gary – to lean on one hand and push up on it to get the opposite hip to raise up for getting the pants over his hips and butt. It now just seems a matter of practice. He has had various people give him various tips, and he will just have to practice to see what works for him. We should hold a celebration the first time he gets his pants on entirely on his own while in the chair ;-). Since at this stage it takes so much more time than dressing in the bed, he doesn’t seem eager to practice it at home.

Next we headed for the “practice kitchen” on the second floor of the building. On our way we passed a sight that gave my heart a wrench – a newly injured young girl, maybe around eight (I didn’t get a look at her face-on), in a wheelchair.

In the kitchen the OT showed Gary a short-handled broom that many patients seemed to like. Gary had told her the story that he had tried to sweep the floors before my sister Janet and brother-in-law came to visit and that I hadn’t been impressed with the results :-). He liked this broom – it was easy to handle and had a broad sweeping surface. The therapist said another one of the therapists had been selling them and she’d look into seeing if there was one Gary could buy. She then showed him a short-handled dust pan that “closed up” when the handle was lifted. Gary liked that too, saying he found it impossible to sweep into a regular dustpan. (He hadn’t told me this and had evidently been sweeping the stuff into a pile and then putting it into the trash by hand – ewww!) She said they had picked theirs up at a Dollar Store, but maybe we could find one in a place like “Bed, Bath, and Beyond.” (Not that our town has one of those.) She also pointed out the mirror they have on the stove so that one can see how the cooking is going in the back pots. Gary told her he got such a mirror (which either I didn’t know or simply don’t remember) but hasn’t figured out how to attach it to the back of our stove.

For another "kitchen problem" Gary has, she showed him the velcro strap they have on their oven, and Gary thought that was something he’d find useful. Our stove door tends to slam shut if you don’t pull it down all the way, but if he pulls it down all the way he can’t get anything in or out of it because he can’t get the wheelchair close enough. So he says it’s been a hassle trying to hold the door partway open with one hand and reach in with the other – a challenge to his balance and on the dangerous side, but he never told me about this problem before.

Next on the agenda was “Gym with caregiver,” so we headed there and got Gary strapped into the Easystand. A Latino woman came up to us and started talking to us about it. The young man with her, who didn’t speak much English, was very excited to see Gary in this piece of exercise equipment and wanted to know how he got to do it. So we told them that Gary had done the standing frame a few times first, and because he didn’t have a great deal of problems with dizziness, they then let him use the Easystand, with me supervising. (Neither of us knew how it would be for him, using this equipment after not having stood for several months, but he has had little problem with it, just once complaining of not feeling good, a feeling which soon passed.)

We skipped out of the gym about fifteen minutes early because we had things to do before going to the concert tonight – we wanted to have everything ready so that when we got home from it Gary could pretty much just “hop” into bed and do the things he needed to do before sleep (undress, skin check, greasing flap, IC, getting into prone position – skipping the bed bath because he had showered at the pool).

At the Woodruff Art Center, we parked in the parking garage and took an elevator that disgorged us on a patio-like area from where we could enter the Art Center. We had to go to the box office to pick up our tickets. The signs to the box office were strangely marked – it turned out we made a complete circle of the building (or actually, a square) and ended up almost at the point where we had entered the building. We joked that if the arrow on the sign had pointed in almost any other direction than what it did, we would have found the box office quicker. After getting the tickets we had to cross to the other side of the building – it was like an obstacle course for Gary, trying to pick out a path to go, what with the crush of people.

In the auditorium the wheelchair seating was in the second-to-last “row,” which consisted of spaces for wheelchairs to pull up into and plush folding chairs for the people accompanying those in wheelchairs. We had a good view of the stage, better than if Gary had taken an aisle seat, which would have been our only other option.

The guest conductor was Michael Krajewski, who had also been the conductor the last time we were here, last Christmas time. He likes to liven up the performance with the occasional (bad) joke. After the introductory piece of “Winter Wonderland,” he turned to give his opening remarks. At that moment a family with several children was causing a bit of a disturbance, moving down one of the first few rows all the way from the aisle to the middle seats (there is no middle aisle at this facility). So Michael made some cracks about that, saying something along the lines like, “Children, when mommy says to hurry up or you’re going to be late, she means it.” Somewhere in his introductory remarks he talked about how in getting here he had been going through the airport and had noticed that they had hung mistletoe over the baggage check-ins. He had thought that strange, so he asked the airport personnel the reason for that. The reply was, “So you can kiss your bags goodbye.” You saw that coming, didn’t you?

After the “March of the Toys” was played, Krajewski introduced the featured artists, the Von Trapp Children – these are four children from ages twelve to eighteen who are the great-great grandchildren of Captain von Trapp and Maria, of “Sound of Music” fame. After the von Trapps came to America, they earned their living as a singing act. These descendants revived that tradition. They were very good, not just living off their name. They sang a few songs from “Sound of Music” – “Do Re Mi,” “My Favorite Things,” and, as you might guess, “Sound of Music” (which reminded me that when I was a kid we had to sing this in glee club, and as a joke one day, we all screamed in mock fright after singing the first few words, “The hills are alive.” I decided not to recreate this experience for those in the audience this night.) My favorite songs they sung were: “Carol of the Bells” (one of my favorite Christmas songs), “Do You Hear What I Hear,” and what might seem an odd thing to include, “Anything You Can Do” from “Annie Get Your Gun.” It was sung by one of the girls and the twelve-year old boy. My favorite part was their duel, “Anything you can sing, I can sing higher.” The twelve-year-old boy “won.” I guess they’re going to have to delete that selection when the kid’s voice changes in a few years.

We left after intermission because we didn’t want to make too late a night of it, but I was very glad Gary had suggested we do this – it was a lot of fun. We had a slight problem coming out of the building – we couldn’t remember in which direction to go to get the elevator. We made the wrong choice and ended up wandering around for a while.

We got home and got to bed about a half-hour later than usual. But, we would get to sleep in about an hour because the rec therapist had conspired to make her the first thing on the schedule for Thursday, with the understanding that we would not show up for it because we had done a “rec therapy outing” on our own by going to the concert.

And that ended Wednesday!