Dedication

Dedicated to Intensive Care nurses everywhere

Wednesday, November 11, 2015

A Day in the LIfe - Rehab by the Numbers - Part nine

Continues...






Core business of the ward was physiotherapy.  The other specialists worked around this given.  Most days were taken up with the physiotherapy regime, mornings and afternoons.  Upper limb therapies were integrated into the workings of the gym.  An afternoon a week the various specialists got together for a ‘case conference’, where the progress and treatment regime for each patient was discussed.  This afternoon was ‘time off’ for the patients.  It was the only unstructured period during the business week.  Weekends were also unstructured.   

The resources of the gym were in great demand throughout business hours.  The physiotherapist cadre was supplemented by an assistant and final year students undertaking practical units toward completion of their degrees.  Much of the ‘hands-on’ therapy was managed by students under close supervision.  Again, the teaching function of the hospital was to the fore in gym operations.  We enjoyed the attentions of this enthusiastic cadre of young people, some of whom were studying at our alma mater, the University of Sydney.  

Rotation of student cadres under the gym schedule enables it to function more effectively.  Without these resources it was obvious the gym would struggle to meet the demands of the ward.  Brain trauma patients alone would have tested the capacity of the unit.  Treatment of certain patients was resource intensive, demanding regular attention from qualified therapists.  The students enabled the latter to manage their ‘hands on’ workload flexibly, whilst maintaining overall quality control of gym therapy.  It was impressive.


Over the weeks Carolie began to find renewed strength and flexibility.  The palsy on her left side was a major challenge.  With a lot of treadmill work and other strengthening exercises over many weeks she went from being wheelchair bound to walking with assistance for small stretches, including on a stair apparatus.  Upper limb therapies were an integral component of the overall strategy. 

Occupational therapists targeted her left side palsy with a range of activities, including showing her how to dress with limited left side mobility.  A glove was employed to encourage Carolie to favour her left hand in doing basic tasks.  A little later they encouraged her to try basic kitchen tasks such as making tea.  She is naturally left handed so palsy on this side was especially challenging.  It was important to position oneself on her left side to encourage left-sidedness responses and consciousness.  Her body had to revive communication channels between the brain and the complex processes that make up movement.  All manner of stimuli were employed to reawaken the ‘signals systems’ and the interconnected channels that enliven the limbs.



My core activity was to accompany her for a large share of the daily gym program.  I assisted with some of the routines such as sitting and standing exercises, and gentle encouragement to keep her going on certain tasks.  Her concentration wandered and tiredness would descend mid-activity.  Bouts of nausea continued to wrack her body and we frequently had to stop gym work to enable her stomach to settle.  Vomiting was debilitating and frustrating as it disrupted her physical progress.  Sometimes the urge to sleep would get the better of her but a fierce determination to recover her moorings would see her back in harness after short naps and drugs to ease the nausea.  It was harrowing at times but we ploughed on.

To be continued....

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