When I arrived at Kindred this morning Daniel was turned toward the door--his head turned to the left. He slept comfortably and I did not wake him. Instead I read the journal that Vero brought for all of us to sign and record any thoughts, reflections or prayers. It is an intimate acount of our visits with Daniel. Please feel free to log in next time you come to see Daniel.
As I read, two skilled therapists entered and quickly the room came to life. Isabella, the occupational therapist, jotted down some notes about Daniel's interests including hiking and traveling. It turns out that she has a shared interest with Daniel because she also knows jiu jitsu. Theresa, the physical therapist, also showed a genuine interest in Daniel and his family. Together they make a confident and expert team.
Working in tandem, the skilled therapists, quickly began to evaluate Daniel. He favors his left side they said. And that we should work with him to shift his focus to his right side; he needs to pay attention to his right side. On the PT side: Daniel is hyper extending...he is pushing his legs out. Daniel is very tight! His hip flexion was at 90 degrees which is good. His knees bent a little less than that, but his ankles are especially tight. His toes are pointing downward towards the foot of the bed constantly. This hyperextension can lead to contracture: the permanent shortening of muscles or tendons due to continued stress exerted on that muscle or tendon. Contracture cannot be excercized or stretched away.
The restorative therapists will work with Daniel for approximately 30 to 40 minutes a day, but this is not nearly enough!
We can help with range of motion excercises. Look for the diagrams that show how to perform these excercises on the cork-board with the family pictures. Or ask anyone who has done them to teach you how to do them, they are simple and easy to learn. As the RT puts it, WHEN Daniel is ready to walk, the more flexibility he has the better.
The highlight of my visit today was when I was able to sit next to Daniel side by side holding him up along with the help of the therapists (as they evaluated). I had my arm around him as I propped him up and his face was next to mine. Are words necessary to describe the joy of once again being able to sit next to my brother, shoulder to shoulder, heart to heart, in unity of spirit?
Skilled therapy really begins once Daniel is able to participate even minimally in his own rehabilitation. When he is able to follow commands and move on his own. Another high point today was that it was evident to the therapists and myself that Daniel was able to loosen his grip when asked: he was able to open and close his left hand on command after several repititions. The lesson here is that Daniel must relearn everything. It is not enough to simply tell him to do something, one must actually help him do it. These repititions will help train his muscles as neurons create new paths and circuits in his brain. Every interaction counts!
Monday, June 29, 2009
Sunday, June 28, 2009
Rehabilitation Is the Goal!
The key difference between Sharp and Kindred is that Sharp is a short-term care facility and Kindred is long-term. Kindred is a rehabilitation facility. The pulminologist, Dr. Clark, believes in aggressive treatment. He is also an internest and critical care specialist. With an interdisciplinary perspective he is able to treat Daniel with the big picture always in mind.
The immediate goal for Daniel is decanulation within 8 to 10 days.. Decanulation means that the trach-tube comes off completely. In order for this to happen Daniel must pass several tests. First, he must be able to breathe on his own without ventilator assist. Next, the RT would attach a one-way valve (known as a pmv or "speaking valve" because it permits patients to speak) that would allow Daniel to exhale through his nose and mouth. If Daniel passes this test, that is if he is able to exhale through nose and mouth, the next step would be to plug the trach entirely to see if Daniel can both inhale and exhale through nose and mouth.
The final most critical test is the swallow test. This test inolves the use of ice chips with food coloring. Daniel is given ice chips through his mouth (I'll bet he would love to taste ice once again, think of how refreshed he will feel) with the hope that Daniel will SWALLOW these into his belly via his esophogus. If, after suctioning his lungs, there is any evidence of food coloring or dye, then the ice has gone down the proverbial "wrong pipe." If this is the case then Daniel will have to practice swallowing--a skill we take for granted and do automatically.
The RT points out that youth is again on Daniel's side. However, because he isn't as "awake" and "alert" as we'd like he cannot consciously correct his swallowing as we do when we begin to choke. So when Daniel finally passes the swallow test and he has been breathing independently then the trach has served its purpose and can be removed. The hole, in his throat, once healed, will hardly be noticed.
Kindred has a very high success rate with this kind of rehabilitation. Then what? Well, Daniel will be evaluated for occupational, physical or speech therapy. Kindred has all of these specialists "in-house." My hope is we'll be able to access these resources for Daniel for some time. Kindred's multi-prong approach to acute care and rehabilitation is perfect for my perfect brother!
Thanks again and with Love,
Victor
The immediate goal for Daniel is decanulation within 8 to 10 days.. Decanulation means that the trach-tube comes off completely. In order for this to happen Daniel must pass several tests. First, he must be able to breathe on his own without ventilator assist. Next, the RT would attach a one-way valve (known as a pmv or "speaking valve" because it permits patients to speak) that would allow Daniel to exhale through his nose and mouth. If Daniel passes this test, that is if he is able to exhale through nose and mouth, the next step would be to plug the trach entirely to see if Daniel can both inhale and exhale through nose and mouth.
The final most critical test is the swallow test. This test inolves the use of ice chips with food coloring. Daniel is given ice chips through his mouth (I'll bet he would love to taste ice once again, think of how refreshed he will feel) with the hope that Daniel will SWALLOW these into his belly via his esophogus. If, after suctioning his lungs, there is any evidence of food coloring or dye, then the ice has gone down the proverbial "wrong pipe." If this is the case then Daniel will have to practice swallowing--a skill we take for granted and do automatically.
The RT points out that youth is again on Daniel's side. However, because he isn't as "awake" and "alert" as we'd like he cannot consciously correct his swallowing as we do when we begin to choke. So when Daniel finally passes the swallow test and he has been breathing independently then the trach has served its purpose and can be removed. The hole, in his throat, once healed, will hardly be noticed.
Kindred has a very high success rate with this kind of rehabilitation. Then what? Well, Daniel will be evaluated for occupational, physical or speech therapy. Kindred has all of these specialists "in-house." My hope is we'll be able to access these resources for Daniel for some time. Kindred's multi-prong approach to acute care and rehabilitation is perfect for my perfect brother!
Thanks again and with Love,
Victor
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