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    Rehab - what to expect, what to demand

    Hi guys,
    My fiancee will be starting her rehab shortly. She wants to go back to work (she's a software consultant) latest by June. Is this realistic? Is there a typical benchmark rehab duration? Or does it depend completely on how fast you are able to learn/re-learn?

    She's T6 one year post. Complete/incomplete debate is on [img]/forum/images/smilies/rolleyes.gif[/img] It's been delayed so long coz she had some complications from the fall, fractures that took 6 months to heal, and then she was not able to accept her state and went on to try her luck with Ayurveda/Homeo, etc.

    What do we look for in a rehab programme? We've made a list of all the things she'd like to be able to do herself and hope that the programme will enable her for that.

    Any advices about choosing and getting the most out of the rehab?

    Actually, we don't have much choice about the place, since there are not that many SCI rehab centers in India. We are leaning towards the Christian Medical College Hospital, Vellore. But we've to be able to make the programme do everything she needs to be independent.

    Cheers
    Raj

    [This message was edited by iyerraj on Feb 21, 2002 at 03:45 AM.]

    #2
    rehab

    Originally posted by iyerraj:

    Hi guys,
    My fiancee will be starting her rehab shortly. She wants to go back to work (she's a software consultant) latest by June. Is this realistic? Is there a typical benchmark rehab duration? Or does it depend completely on how fast you are able to learn/re-learn?

    She's T6 one year post. Complete/incomplete debate is on [img]/forum/images/smilies/rolleyes.gif[/img] It's been delayed so long coz she had some complications from the fall, fractures that took 6 months to heal, and then she was not able to accept her state and went on to try her luck with Ayurveda/Homeo, etc.

    What do we look for in a rehab programme? We've made a list of all the things she'd like to be able to do herself and hope that the programme will enable her for that.

    Any advices about choosing and getting the most out of the rehab?

    Actually, we don't have much choice about the place, since there are not that many SCI rehab centers in India. We are leaning towards the Christian Medical College Hospital, Vellore. But we've to be able to make the programme do everything she needs to be independent.

    Cheers
    Ra
    Hi Ra. My son is currently in rehab. He was injured on Jan.1,2002.He is T4 complete. He works alot on upper body strength as well as balancing.(no abs yet) He is working on transfers from chair to bed and back. I have been pushing for hydrotherapy and he will start on friday.( I've read this could be very good for him)Tell her to stay positive and work hard and never give up hope. the doctors told my son that his rehab will last from 3 to 6 months. To be totatly independant. We'll just have to wait and see, but this is the timeframe they have given us. Good luck

    Comment


      #3
      Everyone's rehab time frame is individual, and depends on many factors. If your fiancee is deconditioned from her long complicated stay, she'll probably start with a reconditioning program just to build her strength up. Of course, individual learning skills play a part, and of course the biggest factor is health care insurance, and how much coverage she has.

      Positive attitude, realizing that it may be bumpy going for a while, and never giving up are all attributes that will help you both tremendously!

      Sorry I couldn't be more specific, but hope this helps.

      _____________
      Tough times don't last - tough people do.
      _____________

      Comment


        #4
        marmalady

        thanks! i wasn't very specific either [img]/forum/images/smilies/smile.gif[/img] that's coz, frankly, i didn't know what to ask. we'll probly be travelling to Vellore next Tuesday and start the rehab on Wednesday. The nearest airports at both ends are about 100 miles away, so we're thinking of going by railroad. reserve a 4-person cabin and you have all the privacy in the world, and no bumpy roads to and fro the airport. she's got a leak problem now even after switching to an indwelling cath, and a mother-of-all-sores on her butt and she's worried whether this will delay the start of her rehab programme.
        Yesterday she was reading John Grisham's Painted House and said she wanted a kid like Luke. I said, "Sure, who says you can't? Just let's get married, then see", and she started crying and I didn't know what to say to the telephone. Her parents can't handle the situation well (I'm not blaming them, but isn't it natural for one to hate one's in-laws? [img]/forum/images/smilies/wink.gif[/img])and if I take a break from my job there's a great chance that I won't have one to come back to with the IT industry being in this splendid shape [img]/forum/images/smilies/biggrin.gif[/img]
        okay, i'm moving away from the topic myself [img]/forum/images/smilies/rolleyes.gif[/img]
        so, what did you like/dislike/appreciate/miss when your loved one was in rehab?

        Comment


          #5
          Raj, The cath problem they'll be able to fix pretty quickly at rehab - can she see someone about it before she goes? if she's got a pressure sore, my guess is she'll probably have to stay off it til it heals.

          I just don't know how rehab centers work in India; they may have different protocols than we do here in the States. What we liked when my son was in rehab was the absolute dedication of the therapists; and the tears of joy they shed when they saw progress being made. What we didn't like was the lack of staffing; nurses and therapists and docs alike were overworked, and patient care suffered as a result. Matt also disliked the food (as did everyone else!) - he's a vegetarian, and we had scenes with the nutritionist telling us 'he's got to eat 60 grams of protein a day', and then the kitchen sending a plate of mashed potatoes and green beans for his lunch!!! I ended up bringing his lunch and dinner in every day.

          You sound like an awesome partner, and I know how much your support means to your lady. I think once you/she actually get to rehab, you'll probably have loads more questions.

          _____________
          Tough times don't last - tough people do.
          _____________

          Comment


            #6
            That pressure sore should be treated first

            Your fiance has a pressure sore from your description and it should be treated before she enters rehab. You don't want to spend her precious rehab time lying on her stomach doing nothing while her butt heals. Once she has that under control and enters rehab be sure she sees a good occupational therapist (OT) so she can avoid getting more pressure sores.

            A good seat cushion is mandatory!! My personal preference leans towards Roho air bladder cushions. Leaning forward is a good way of shifting weight and avoiding pressure sores if she cannot lift herself off the cushion yet. This should be one of the goals she should set in rehab.

            Depending on her age I would suggest another goal be bounce transfers. That does not mean she will not need a sliding board (it is a safer way of transferring) it just means she will have the upper body strength to be independent.

            If it is available have her get aquatherapy. Swimming is one of the best all-round exercise things we can do. It builds body strength, enhances breathing, and helps stretch out the muscles.

            I hope she does well. I figure she has a good start having such a loving caregiver such as you to stand by her.

            "And so it begins."
            "And so it begins."

            Comment


              #7
              Choosing rehabilitation

              Here is a link on some things to consider when choosing a SCI rehabilitation program. It is written for those in North America primarily, but may give you some tips:

              http://www.spinalinjury.net/html/_finding_a_rehab.html

              If her pressure ulcer is deep, then she may need not only bedrest but surgery and an extensive post-op period of bedrest prior to starting her formal rehab program. Some places this is all done in the rehab center. Find out from them before going to the center if they do the surgery, recovery, sitting program, etc. all at the SCI center, and if this would at all impact the time she has available for rehabilitation.

              She should expect at the end of her rehabilitation program to have the following skills (or at least have the ability to reach these skill goals that she is interested in obtaining):

              -able to do all transfers by herself (wheelchair to bed and back, tub, shower (with equipment), floor to wheelchair, car, etc.

              -able to push a manual wheelchair at least a mile, manage ramps up to at least a 10% grade, and negotiate over grass, gravel, sand and uneven surfaces such as cobblestones or brick paving. She should know how to direct others to safely take her up and down stairs when needed.

              -drive with hand-controls

              -stand a minimum of an hour daily

              -do her own range of motion exercises for her legs daily. Have a routine of arm and trunk exercises that she can do at home daily and be able to do these by herself.

              -dress herself, including shoes, socks, legs, underwear and upper body clothing

              -do all her own grooming and hygiene, including bathing totally independently

              -Take care of her own bowel and bladder. She will need to choose her initial bladder management program between an indwelling catheter and self catheterization. Avoid using diapers (padding) with her current skin condition.

              -know about the common SCI complications and how to prevent them as well as how to manage them if the do occur. This needs to include UTI, constipation/impaction, skin breakdown, autonomic dysreflexia, osteoporosis and fractures, shoulder problems, contractures, spasticity, etc.

              -know about her potential for and issues around sexual activity and childbearing, any complications she would need to be careful about during pregnancy and childbirth, and be knowledgable about issues such as birthcontrol specific to SCI related risk factors.

              -know about resources in your community and activities available to her for recreation, sports, education and disability advocacy as well as benefit programs for income that she may be eligible for.

              -know about how to maintain her wheelchair, cushion, commodes, etc. and when they should be replaced or repaired, and how to go about this.

              I am sure others can add to my list.

              (KLD)
              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

              Comment


                #8
                I'd say the sooner she starts working again, the better....I began working as an inpatient in rehab. She does need to accept the fact that the road to a complete recovery will be a long, hard one...never give up the fight, but never give up life either.

                Also, rehab tends to waste lots of time. We had an hour of PT and an hour of OT per day...and bowel class. Get her some literature on the subject she can read.

                One mistake I made was spending too much time reading cure related information. I didn't know enough about topics like bowel care when I left rehab. But I wouldn't have learned anything there anyway. They were too busy shoving soppositories in my body to teach me to digital stimulate. And rather than teaching "clean cath" they had me use touchless...NOT what you are going to be doing outside. Those things are too expensive for anything.

                OH, and I had a list of mediciations PAGES long...
                Eric Texley

                Comment


                  #9
                  Ayurveda

                  Raj,

                  I have read a few books about Ayurveda medicine recently and actually I agree with a lot of the theory it is based on. The whole idea that the body has intelligence even separate from the brain is only now being believed and even proven by modern medicine.

                  For example, the supported ambulation training. Modern medicine calls it activating the "central pattern generator", but really what the heck is that? I don't believe it is something that will show up on an x-ray [img]/forum/images/smilies/smile.gif[/img]

                  Also I believe the article about the Nocebo effect that Dr. Young posted a while back ties in with this in a way. If you are told your condition is incurable and will probably never get any better it affects your outcome.

                  If this is true, it kind of places a new meaning on the "Do No Harm" directive for all doctors. Because they will cause harm every time they predict a negative outcome.

                  Maybe she could combine these techniques with her Rehab as an enhancement.

                  Russ Byrd

                  Comment


                    #10
                    living dinasours

                    1)ıf you accept rehabilition as a exercise is it correct and you can take some benefits.

                    Study shows exercise is best thing you can
                    do to live longer.A new study offers the strongest argument yet for getting fit. California researchers found the ability to exercise - as measured on a treadmill test - is more important in predicting how long a person will live than even obesity, heart disease or smoking.

                    2) But if you think that it is "CURE "ıt is completly wrong .Rehabilitation isn't a science.
                    If it is ascience in möy opinion "living dinasours"It costs 6 billions. Gives zero recovery in terms of "cure".If we pay 6 billions to reseach field ,then there is no SCI in this earth .Rehabilitation is a big lie.

                    Comment


                      #11
                      Ask, no, demand to stand! Most rehab
                      centers have standing frames and these
                      are good for maintaining bone density.
                      Since your girlfriend is a "T" level
                      injury, you will probably be told that
                      standing is good. My daughter being a
                      C6-7 had to ask and was then told it
                      isn't necessary. Well, we had the doctor
                      write a prescription and now own a standing
                      frame that insurance paid for. She stands
                      every day.

                      Comment


                        #12
                        Thank you all for all your suggestions and advice. She's been in rehab for a month now. Things started up slow because she had a bad pressure sore. The rehab center has trolleys on which you can lie prone and move around yourself. She was doing PT and OT even before she could sit. They help her on to a standing frame for 30 min to an hour everyday. From yesterday she has been promoted to stand using parallel bars. There's talk of calipers. Things are speeding up. They are getting her a new wheelchair today. This site had wonderful tips when we were deciding on the specs for the chair.
                        There is a pool for hydrotherapy at the center, but they don't use it now because it is the dry season and there's scarcity of water

                        Comment


                          #13
                          Spasms

                          Is there a recommended way to reduce spasms? My fiance has difficulty most of the times when she tries to cath herself sitting on a wheelchair. The rehab people are giving her some suppressant, but it doesn't seem to help much. I'd like to find out if there is an equivalent to baclofen available in India. There were some earlier posts here that discouraged using baclofen unless really necessary. Are there any side-effects to using spasticity-reducing drugs?

                          Comment


                            #14
                            iyerraj, baclofen is most effective for suppressing spasticity (hyper-reflexia and stiffness) and does not prevent spasms (spontaneous movements of the limbs sometimes associated with stimuli) unless such a high dose of baclofen is given that it weakens the muscles. There is, to my knowledge, no really good suppressant of spasms without weakening muscles. Your fiancee needs to experiment with different positions and catheterization approaches to does not produce as much spasm. How do other people do this? Wise.

                            Comment

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