Cold Shoulders & Paranoia At Rehab

This is one of those "good news/bad news" posts. The good news is that Bob got an extension on his therapy, both occupational and speech/swallow, but (the bad news) the therapists only agreed to four more sessions. Which isn't much. But I suppose it's better than nothing. And, on top of it, those two therapists are certainly acting different since receiving the doctor's order for continued therapy.

The occupational therapist was especially cold. Although she agreed to continue, she gave me a big lecture about how the insurance company may not pay for the additional sessions because Bob's progress was "too slow" and we may end up paying the whole amount ourselves. I found this odd, since I had already talked with the case manager at Rehab (he's the guy in charge of insurance issues) and he told me that the insurance would be "no problem" for the extended sessions.

The speech/swallow therapist was another story. She was positively paranoid. She did get out the e-stim unit for swallow therapy but refused to give Bob anything to swallow. She wanted him to "dry swallow" which Bob didn't seem to understand (he seemed to think she was asking him to cough or clear his throat, which he kept trying to do). The whole session was simply ridiculous. Previously, swallow therapy has involved attaching electrodes to Bob's throat (these electrodes sort of grasp his muscles to help induce a swallow reflex) and at the same time giving Bob a small teaspoon of pudding or italian ice to swallow. He's been doing this therapy ever since he got home from the hospital, with various therapists, without a problem. So, I don't know what the big deal is all the sudden. When I asked her why she wouldn't give him anything to swallow, she told me a long story about some other patient who aspirated and ended up in the hospital with aspiration pneumonia, then went on and on about Bob's swallow video results and how she couldn't be sure that anything she gave him would go down his throat the "right way".  She also said, "if I were you" that she wouldn't give him anything to practice swallowing with at home, either, as it was far too "dangerous".

Good grief. Who do you believe? The neurologist said Bob's recent swallow test was "better" than the last one. After the last one, in February, the speech pathologist told me that Bob could have anything that was "apple sauce consistency" for "pleasure and practice" at home, although he would have to be supervised while he was eating and should only be given a "small" amount. Which we've been doing. And Bob loves pudding, especially vanilla/chocolate swirl, and mashed potatoes with gravy.  And now I'm supposed to stop doing this?

And how the heck is he supposed to improve his swallow if he isn't allowed to practice???? I know there are some "exercises" for the tongue but it just isn't the same thing as actually swallowing which uses all those throat muscles. And as far "dry swallow": Bob doesn't seem to understand this concept and I don't know if he can even do it, as he's been suffering from what the doctor calls "dry mouth syndrome" and is not producing much saliva....

All I can think is that the speech/swallow therapist is doing the old "CYA" (cover your ass) because she doesn't want to be responsible if Bob aspirates. But now, she's got me a bit paranoid.

And a bit more good news/bad news is that I think we are finally seeing some results from the Bioness machine. Bob has indicated to me that he has some sensation now in his fingers. This is certainly a new development. But the bad news is that the occupational therapist is only going to do four more sessions with that machine.....

Lord, it seems for every step forward, we are thrown two steps backward.