On our first day at Western Rehab, I was introduced to a team of therapists and their schedule. It didn’t always flow as perfectly as it looked on the white board, but having a written schedule put order back into my life. It also brought hope for improvement and was reassuring. Even though Mark was still comatose, I felt a consistent routine would be helpful for him as well.
I had been familiar with physical therapy for the past seven weeks, but occupational, speech and respiratory were new for Mark. How important is therapy while a patient is in a coma?
Mark’s first therapy after the accident was with a physical therapist. Right from the start they oversaw positioning in the bed and later got him up in a chair. The PT stretched his legs and arms to keep them flexible, doing range of motion exercises. Sometimes splints were used to help prevent foot drop, clenched fist or flexion of the wrist and elbow. They worked to keep the joints moving and the muscles from getting tight and stiff. As the patient progresses they work on strengthening, coordination and transferring. The ultimate goal is becoming as mobile and independent as safely possible.
In the beginning, the therapist provides sensory and basic motor training therapy to keep the patient engaged in routine activities, even while in a coma. The repetitive motions help with the relearning process. As the patient improves, the OT coaches the activities of daily living such as dressing, brushing teeth, combing hair and eating. A brain injury may cause these skills to be lost or compromised. They work to improve coordination, endurance and fine motor skills. They provide adaptive equipment needed such as specialized utensils for eating, bathroom equipment and wheelchairs. The OT overlaps and supports both PT and speech therapists.
At the first stage of treatment, the therapist focuses on simply getting a general response to sensory stimulation. This may include touching the patient’s hand, talking loudly into the ear or even letting the patient smell an object or food. As the individual processes they may also use a flavored sponge swab in the mouth to stimulate the tongue with something to taste.
The therapist also teaches the members of the patient’s family how to interact with their loved one by asking “yes” and “no” questions and reminding them to blink once for “yes” or twice for “no”. Another method used was to raise one finger or two. Once the patient becomes more aware and responds to stimuli, the treatment focus is keeping the individual’s attention and informing them of the day of the week, date, where they are and why they are there. In time the therapist ask the patient those questions building their cognitive development. They not only work on speech, but writing, reading and expression skills aimed at both comprehension and communication. For a person with a traumatic brain injury it may be difficult to pay attention. Organization, planning and sequencing skills may need to be relearned. They specialize in teaching memory strategies for treating the classic problem.
A respiratory therapist evaluates the patient’s respiratory care, status and treatment progress. They manage the ventilator, oxygen levels, aerosol medication treatments and breathing exercises.
All therapists work closely with the family, doctor and nurses in a rehabilitation hospital, so they are informed of any changes and can help and encourage progress outside of the therapy session. The therapists also help educate the family on what their loved one might be going through and what to expect.
I greatly appreciate the professionals that are skilled in helping others regain abilities lost due to injury or illness. Mark has had many wonderful, hardworking and innovative therapists who have made a positive difference in his life and abilities. Social workers, neuropsychologists, dieticians, family and friends are also important contributors to a rehab team.
Did I miss anyone on your rehab team? How has therapy benefitted you or your loved one? Who made the greatest difference?