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Friday, July 1, 2011

Mixed Messages At PT

Just when you think at least one thing is going good, someone drops a bomb and your little bubble bursts. This is how I'm feeling after yesterday's physical therapy session.

Bob works with three different physical therapists at PT. Two of them are guys and the third, a woman. I am always happy when he's scheduled with one of the guys, because Bob just seems more motivated and comfortable with them and, all around, it seems there is better rapport. Bob calls his favorite male therapist "Meanie", this being said with a fake scowling face whenever the therapist asks him do something, and is always followed by hoots of laughter and a lot of joking back and forth.

This week at Rehab, Bob was scheduled with "Meanie" on Monday and Wednesday. Meanie kept Bob in the parallel bars and at one point the female therapist stopped by to watch and then asked why they weren't using the ARJO to which Meanie replied "I get more work out of him this way." On Wednesday, Meanie seemed quite delighted with Bob's progress, told me Bob's "step quality" was "greatly improved" and also that Bob has started to "self correct" meaning that when Bob's foot falls the wrong way, he is sometimes able to realign it without the therapist's help. He told me, "I've never seen him walking so good!"

So, I'm feeling rather pleased about this. After all, at least one of the therapies is going well! Then came Thursday and Bob was scheduled with the female therapist.

It's no secret that the female therapist wants Bob "out of the bars". This seems to be her mantra lately, i.e. "You can't live your life in the parallel bars," "you won't have bars when you get home", etc. etc. So on Thursday, the therapist brings out the shopping cart. Now this is actually a real shopping cart, in fact it says Walgreens on the handle. So, imagine one of those small drug store shopping carts laden with weights to give it stability. The idea here is that Bob was to push the cart slowly across the room with a therapist on each side of him to keep him steady. I was, again, called into duty pushing the wheelchair behind them.

So, off they went, Bob pushing the shopping cart. Then, his right knee began to buckle. He hasn't had a problem with knee buckling for a couple of weeks, but there it was. The therapist had to brace his knee with her leg, but still they continued on this slow shopping cart trek across the room. At one point, Bob was asked if he wanted to stop but he said "no". I think he pushed that cart about 30 feet, which I thought was pretty good. Then he sat down, exhausted. The therapist said that was enough for today, but Bob indicated (by pointing) that he wanted to work out on the bars. So, we rolled over to the bars and Bob got up and walked the length of the bars, four times. I could tell he was very tired from the trek with the shopping cart. After his fourth turn on the bars, she let him rest. As he was resting, she began her mantra once again, "you can't live your life on the bars," etc. So I piped up and said I thought he did pretty good with the shopping cart, I mean, he really went a long way. She told me that the problem was that they were holding him up the whole time and if the therapists hadn't been holding him up, he would have collapsed. So I asked what she thought the problem might be, his balance? or what? and if there was some type of exercise we could do at home to improve that? But she said that "unfortunately" it seems that it's Bob's "whole right side" that's the problem and he's just "too weak" and really, "it's amazing" that he's gotten as far as he's gotten, but now he's "hit the wall" and he's probably not going to go any further than this.

And I'm thinking: oh shit. Because the female therapist is the one who is "in charge", I mean, she's the one who does the evaluations and pretty much is in control of continuing Bob's therapy, or not...

As we were talking, Bob was certainly listening to all this, because he grabbed onto the bar and started to pull himself up again. I think just to show her that he wasn't giving up. She freaked out, because she wasn't ready for him to get up again, and ran to assist him. And he walked another full length of the bars... Just to show her. Even though he was exhausted.

She said, "well, it's not for lack of trying."

And I asked her, again, what we can do at home to improve this problem? She told me that the only thing we could do is practice standing, get some weight bearing on his right leg.

So, this weekend, while everyone else is enjoying the 4th of July, think of us. Because, damn it, screw the other therapies, I'm going try to get him up and standing as much as I can (which will be no small feat, because Bob really hates "standing practice").....


Barb Polan said...

Diane: How awful for her to say that he has "hit a wall." No one who thinks a wall exists should work with a stroke survivor, any more than a therapist who uses the word "plateau." There is no plateau, just a therapist who has run out of techniques, including optimism, in his/her bag of tricks.

As for pushing a shopping cart, it might seem "functional," but I still have trouble with that and I can walk 2 miles, plus I can walk awkwardly without my brace or cane across a room. I think it's a ridiculous thing to expect Bob to do.

Until I started using the Saebo, I could stand for only about 5 minutes at a time. Because the Saebo unit requires 2 45-minutes of standing per day, in 3 weeks I have actually gotten to that point, with sitting briefly to rest every 15 minutes or so.

In summary, don't buy into any wall/plateau crap - it's just not true. And what seems impossible for Bob now will be easy for him in a year or so. I promise.

Nikki said...

I agree with Barb. Hey, a lot of people said that with my Asperger's that college would be too difficult (which is total b.s. because of my intelligence), but I showed them! Uncle Bob can do anything he sets his mind to!

Jenn said...

Go Nikki! I've a good friend who (now a retired P.E. teacher) who was diagnosed with Asperger's - obviously he attended college, and had a successful career teaching & coaching middle school children. I believe you can do whatever you set your mind to!
And that goes for you, Diane, and Bob. Those p.t.'s don't know y'all too well, now, do they?!

I, too, agree with Barb. There's always some level of growth - perhaps just not something they can see since they don't live with him.