The Value of Testing

As Mark’s physical health stabilized and his awareness consistently improved, his daily therapy sessions became a test to find out what he remembered and what he needed to relearn. The physical therapist, Sharon, didn’t just do range of motion exercises where she did all the stretching, but now tried to teach him how to move his own body. The occupational therapist, Cheryl, and speech therapist, Kris, worked on simple math, reading and writing skills. Evident from the beginning, his long term memory was good. He remembered not only family and friends, but employers and events from his past. However, remembering what happened the day before or even just hours earlier in the day was poor. The therapist gave him a notebook and instructed him to write what he had worked on after each therapy session. In the next session, the therapist asked him about the previous therapy. When he couldn’t remember what he had done, they reminded him to check his notebook.This occurred in all six therapy sessions each day in hopes to improve his short-term memory.

The tilt table was as unpleasant as any test could be for Mark. After transferring him onto the padded table, Sharon positioned his feet so they rested on the footplate. Safety belts strapped his body to the table to ensure he wouldn’t slip off. Sticky patches (electrodes) were placed on his chest, legs and arms and were connected by wires to an electrocardiogram (ECG or EKG) machine, which monitored his heart rate. A cuff was wrapped around his arm to check his blood pressure. While pushing a control button, the table slowly moved from a horizontal to a vertical position. His heart rate and blood pressure regulated the degree Sharon would angle the table in each session. If his blood pressure dropped or there were prolonged pauses between heartbeats, she slowly returned the table to a horizontal position. It took several therapy sessions before Mark could tolerate going from lying flat to a head-up position. Once he could endure the vertical position, Sharon extended the length of time being upright from five to forty-five minutes over the next few weeks. She vigilantly monitored Mark and I always felt like he was safe. However, it appeared to me he felt unsafe, possibly confined or maybe light-headed because he despised the tilt table. When I asked him why or what was wrong, he said, agitated, “It’s just a waste of time!” While in the upright position, he often lashed out at the therapist, “Get me out of this senseless contraption,” or he’d demand I take him home.

When Cheryl and Kris gave Mark simple math problems and he correctly answered, my heart soared like a kite. He could read children’s books with little difficulty, but Mark had double vision, which made it nearly impossible to read the small print in adult books or a magazine. After reading a couple of paragraphs to him, the therapist questioned him on the content and he’d have trouble remembering what they had read. Mark seemed frustrated and/or embarrassed. My heart dropped into a dark hole as I remembered his perfect grades in college and the pride I had the previous year as he passed the ultimate test and earned his Electrical Master’s License. I wanted to give him the answers and save him from the humiliation. Other times it appeared he had the correct answer on the tip of his tongue, but the words came out wrong. Knowing he’d given the wrong answer, he struggled to find the right words to correct it. Irritated and impatient with himself, he’d say he was useless or felt inadequate. By the end of his daily therapy schedule he’d be exhausted and discouraged. It definitely was the hardest and most painful work he had ever done. The brightness of the day came at night when I’ brought the kids for a visit. They didn’t ask him trivial questions, or expect him to do hard and painful movements. They loved him unconditionally and were pleased just to see him awake and have him close to home. Every night they filled his empty cup with love and encouragement, which helped him get ready for the next day’s drain.

Mark was anxious to come home and nearly every night he’d make a comment like: “You need to take me home with you.” or “This is not a good place to be, please get me out of here.” Another night he said,“You need to take me far away from here. They ask silly questions.” One night he recited our home address and told me specifically, “That’s where you need to take me!” I was happy he remembered our address. I understood his longing to be home, to return to familiar surroundings and a normal way of life. I had the exact same yearning. Our house didn’t feel like home without him, but I silently worried about the future. How long would we have to deal with this new way of life? When would Mark be able to come home? How could we speed up this rehabilitation program? My biggest question: What changes did I need to make to improve this situation?

Learning how to transfer Mark in and out of his chair was the first answer that came to mind. It took two aids to do that. Could I learn to do it by myself? I went to the hospital library and checked out a how-to-video on transferring. That night I watched it and the next morning I told Sharon I wanted to learn how to transfer Mark. She demonstrated how she positioned her feet in front of Mark’s, pressing her knees on his legs. Her arms stretched over his shoulders with her hands reached under his arms. Using her body leverage she pulled him forward and up towards the chair and then set him down gently. I felt confident and anxious to try it, so I did and to my relief, I didn’t drop him. From then on we no longer had to wait for the aides to help Mark, which made us one step closer to getting him home.

Essential Members of a Rehabilitation Team

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?

image from dreamstime.com

Physical Therapy

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.

Occupational Therapy

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.

image from paraplegiker-zentrum.ch

Speech Therapy

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.

Respiratory Therapy

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?

Welcome to Western Rehab

The sixty mile ride in the ambulance seemed so strange and unlike the ride I had the day of the accident. I was grateful to be in the passenger seat and not on the stretcher in the back. Both technicians were very friendly and asked lots of questions about the accident and our experience over the past seven weeks. It felt unreal as I talked to them about it. How could all of this have happened to me? Events like this happen to someone else, not me, somebody who is better prepared for it. When would I wake up from this bad dream? A sense of being stuck in it hit me hard.

Picture from http://www.healthsouthutah.com.       Formerly Western Rehab Hospital

Before I knew it we were pulling up to the entrance of Western Rehab. My excitement to finally be there turned to fear, like the first day of elementary school. You can hardly wait to go, but when you get there you realize you don’t know what it’s going to be like. My eagerness turned to worry as the EMT’s unstrapped the stretcher from the ambulance and wheeled it into the hospital. I hadn’t given much thought about what would be expected or how hard and painful it would be until we walked through the doors. Yes, I had taken a tour of the hospital and had met some of the staff before, but all that was discussed on that visit was the details of the facility and their therapy program. My confidence turned to insecurity as we approached the front desk to check in with Mark lying on the stretcher in a coma.

Picture from http://www.healthsouthutah.com. Formerly Western Rehab Hospital

The receptionist welcomed us and said Mark’s room was going to be in the special care unit right in front of the nurse’s station.  She directed us to go straight down the hallway. One EMT pushed the stretcher from the head of the bed while the other guided from the foot. My mother had followed the ambulance in her car and met up with us at the receptionist desk. As we walked by Mark’s side, I noticed a man in a wheelchair with his head bolted to a halo. The sparkling clean, wide tile hallway seemed filled with pain and suffering. I was overwhelmed by what some of the patients were enduring. Sights of treatments for injuries I had never seen before. Would I get used to seeing discomfort, agony and grief? Mark was in a peaceful coma; what would his recovery be like? Am I strong enough to handle it?

As we approached the nurse’s station we were greeted by Rita, a cheerful, friendly nurse who escorted us to Mark’s room. While the EMT’s were getting Mark transferred from the stretcher to the hospital bed, Rita opened the closet door and said, “Bring some clothes for Mark because we plan to dress him every day. He will need loose fitting pull over shirts and pull on pants with high top shoes. Socks and underwear can go in these drawers, along with any other personal belongings you want to bring,” she said as she pulled out one of the drawers on the left side of the closet.  She pointed to the white board on the right side of the closet. “This will be Mark’s daily schedule.” Written on the board was:

Therapy

9:00 am OT – Cheryl

10:00 am Respiratory

11:00 am PT – Leslie

Noon – 1pm – Rest

1:30 pm  Speech – Chris

2:00 pm OT – Cheryl

3:00 pm PT – Leslie

4:00 pm  Respiratory

4:30 pm Speech – Chris

10:00pm Respiratory

Sitting Up

Up – 11:00 am                   Down – 12:00 pm

Up – 2:00 pm                     Down – 4:00 pm

Up – 8:00 pm                     Down – 9:30 pm

Wow, what a busy schedule. How can Mark do all that? At McKay-Dee Hospital Mark didn’t have a set schedule, so I was thrilled they thought he could do it, yet flabbergasted at what seemed unrealistic.  In my mind I could see the doctor at Mackay-Dee Hospital, saying “I tried to tell you it’s too soon.” I pushed the thought out of my head as I remembered my first day of school and the overwhelming feelings of schedules and expectations. However, from the past I’d learned I could adapt, so I silently committed to help Mark in every way adjust to this new schedule and meet their expectations.

I was familiar with the range of motion routine the Physical Therapist (PT) would do with Mark at McKay-Dee Hospital, but I couldn’t imagine why he needed a Speech Therapist (ST) or an Occupational Therapist (OT).

“What will Mark do in speech therapy while he’s in a coma and has a trachea tube?” I asked the nurse as she detached the tube from the portable ventilator to the stationary hospital ventilator and hung his IV to the post on his bed.

“The therapist will come by and explain what they will do in their therapy sessions and the doctor should be in any minute now. Make yourself at home and let me know if I can get you anything.”

I sat in the chair next to Mark’s bed and Mom took one on the other side. I looked at Mark and was relieved that the move appeared to go unnoticed by him. He slept peacefully through the ambulance ride and transferring from the stretcher to the bed. He seemed unaware of his new surroundings. I was grateful to be in our home town of Sandy, UT.

A young, handsome man walked into our room and introduced himself as Mark’s new neurologist, Dr. Wright. He reviewed the reports he’d read  from McKay-Dee Hospital with us and we discussed the  treatment plan. His mannerism was gentle and compassionate. Immediately I felt at ease with him and confident Mark’s recovery was in good hands. He explained Mark would be completing the powerful intravenous anti-biotic in five days and he ordered all therapies to be done in his room until then.

“What will they be doing in respiratory therapy?” I asked, pointing to the schedule.

“The therapist will keep the tracheotomy cleaned and gradually turn down the ventilator, weaning him off of it. The respiratory therapist will help Mark learn to breathe on his own again.”

“What about speech therapy?” I asked.

“They use objects like bells and whistles to try to get Mark to respond to them.”

“Cool,” I said, hopeful and excited. This staff is planning for him to come out of his coma!