Thanks Rob. Yes, she definately needs to address dynamic sitting balance. But this will improve quickly. She's been wearing her TLSO for many, many months and we just started weaning her off.
Will you further explain the "press transfer". The patient has NO LE movement. I envision that she will need to physically place her LE in the direction of transfer and then push up her bottom and swing her torso over her legs. Is this technique the same as the "press transfer". She has no bowel/bladder control so toilet transfers are not an issue. I already talked with her about hand controls. Keep the ideas coming. Also, I'm sure more questions will develop with time. Ron ----- Original Message ----- From: Rob Koch <[EMAIL PROTECTED]> Sent: Saturday, May 26, 2007 To: [email protected] <[email protected]> Subj: [OTlist] OTnow Colloboration With Spinal Cord Injury RK> Ron, RK> I always start by considering what the person needs to RK> do in daily life. RK> At this level of injury the person should become RK> completely independently from the wc. So the goal is RK> to try to get the patient to buy into the idea that RK> the goal is to be independent - not walk again! RK> Unless of course she has an incomplete injury with leg RK> movement. RK> So on to a purely occupational therapy session! RK> Start with LE dressing in bed or first transfer RK> intothe wc and then get dressed. RK> She may be able to get dressed better in the chair. RK> The goal should be to press transfer (without board) RK> at her level. RK> Next she can practice transfer to toilet and do RK> toileting. RK> Transfer to the tub transfer bench and do bathing RK> Obviously all these functional tasks require sitting RK> balance work. RK> After self care is done time to make breakfast. RK> Propelling chair into and around kitchen opening RK> refrigerator, drawers, cabinets and using the stove, RK> microwave. RK> A big part is making sure everything is accessible RK> from wc. RK> Since she doesn't have to do lifting and self care RK> activities with the child she can work on making RK> breakfast for the family. RK> If she is a homemaker it is on to homemaking RK> activities from the chair RK> Laundry, dishes, etc emphasizing accessiblity all the RK> time and work simplification RK> If she if off to work car transfers will be mandatory. RK> She should be able to drive with hand controls. RK> She should also experience life in the community - RK> shopping, movie, buying gasoline, etc - how accessible RK> is the world around her? RK> Find out in OT! RK> Many, many opportunities for good "occupation-based" RK> therapy. RK> Rob Koch RK> I assume the woman has a complete injury - otherwise RK> squat/stand pivot transfers RK> --- Ron Carson <[EMAIL PROTECTED]> wrote: >> Here are some specifics: >> >> 1. There is no insurance >> >> 2. The patient is young, late 20's, mid 30's >> >> 3. She lives with her husband, sister and her >> husband >> >> 4. She has a 4 y/o daughter >> >> 5. There is no primary care doctor; She typically >> uses the ER >> >> 6. We have just starting weaning her off her TLSO >> >> 7. She has a donated power w/c (reclining captain's >> back) >> >> 8. She has no pressure ulcers >> >> 9. She is able to sit without assistance and >> without her TLSO. But she >> has LOB with UE movement. But this will shortly >> correct with practice >> >> 10. She is undergoing a sacral nerve stimulator >> trial to hopefully d/c >> cathing and suppository/digital stimulation. It >> seems to be working OK >> >> 11. She has good UE strength >> >> 12. Initial goal is indpendent with transfers. >> Currently uses a sliding >> board with min - max assist depending on incline. >> I envision that she >> will be able to d/c sliding board and do her >> transfers w/o assistance. >> >> 13. I also think a long term goal is for her to get >> a ultralight-weight >> w/c. >> >> 14. She has a weight issue but she is struggling to >> find enough activity >> to off-set her caloric intake. >> >> 15. They have no computer so on-line resources are >> not possible at this >> time. >> >> OK, hit me with some transfer ideas!!! And any other >> suggestions. >> >> ----- Original Message ----- >> From: Ron Carson <[EMAIL PROTECTED]> >> Sent: Friday, May 25, 2007 >> To: [email protected] <[email protected]> >> Subj: [OTlist] OTnow Colloboration With Spinal Cord >> Injury >> >> RC> Hello All: >> >> RC> I recently agreed to treat a patient who >> suffered a T9-T10 SC injury >> RC> late last year. She has just been d/c to her >> home after several months >> RC> of rehab. While I have worked with SC injury >> patients, I do not consider >> RC> it a speciality. There are SO many issues to >> manage and address that it >> RC> can be a bit overwhelming. Given that I >> work alone, I don't have a >> RC> 'team' to bounce off ideas, so I'm hoping that >> OTnow members will be my >> RC> surrogate team? <smile> >> >> RC> I would like to give and receive advice on >> topics relating to this case. >> RC> Do you think this will work? Will people >> participate?? >> >> RC> Thanks, >> >> RC> Ron >> >> >> >> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] >> >> RK> ************************************************************************************** >> Enroll in Boston University's post-professional >> Master of Science for OTs Online. Gain the skills >> and credentials to propel your career. >> www.otdegree.com/otn >> RK> ************************************************************************************** >> RK> Need Functional Therapy Activities? RK> http://hometown.aol.com/MrFunction RK> ____________________________________________________________________________________Got a little couch potato? RK> Check out fun summer activities for kids. RK> http://search.yahoo.com/search?fr=oni_on_mail&p=summer+activities+for+kids&cs=bz -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
