Hello Mary Alice:

Just to clarify, I practice in the US.

Also, at the moment, the patient is ineligible for state assistance.

The  patient  has  a  small  amount  of  money  that  has  been donated.
Prioritizing where to spend that money is going to be an important goal!

Ron

----- Original Message -----
From: Mary Alice Cafiero <[EMAIL PROTECTED]>
Sent: Saturday, May 26, 2007
To:   [email protected] <[email protected]>
Subj: [OTlist] OTnow Colloboration With Spinal Cord Injury

MAC> Another thought I had, I don't know if there is anything similar in
MAC> Canada to what we have in Texas called DARS which is the Department
MAC> of Adult Rehabilitation Services. This is a state agency which steps
MAC> in when a person has an injury, accident, illness etc and the person
MAC> has a goal of returning to work. The agency will provide counseling,
MAC> training, and/or funding to help make the going to work possible.  
MAC> Some examples that are very helpful are that they will pay to adapt a
MAC> vehicle with hand controls, adapt a vehicle with a lift for a power
MAC> chair. Sometimes they will pay for the actual wheelchair when there
MAC> isn't other funding.

MAC> Obviously, I don't know a lot about funding in Canada, but I do know
MAC> a lot about equipment. Having the appropriate chair can make a huge
MAC> difference in so many aspects of life that I think it is one of the
MAC> most important parts of rehab. I know you said your patient doesn't
MAC> have insurance, but I wonder what other creative funding sources are
MAC> available. Does the family have any financial resources for  
MAC> equipment? I just wonder if this is something that you have explored.
MAC> Mary Alice
MAC> On May 26, 2007, at 5:24 PM, Joan Riches wrote:

>> Hi Ron
>> I've read Rob's post and agree for the most part. However he left  
>> out what
>> does the client WANT to do? If ever there was a place for the COPM  
>> it is
>> here. My mind is full of questions. What was her life before the  
>> injury?
>> What does she miss most? Is the four adult household the previous  
>> norm or is
>> it temporary? Is there someone at home with her or does she need to  
>> manage
>> alone for part of the day? Not sure why Rob thinks there are no  
>> child care
>> demands (the child's age perhaps).
>> I like Rob's emphasis on analysing every task for simplicity and
>> accessibility. Be aware that she is forming habits and routines  
>> that need to
>> last her for many years. People with SCI age just like the rest of  
>> us so
>> staying open to continuous adaptation is a good attitude to  
>> develop. Energy
>> conservation is critical so available energy is focused on the most
>> meaningful things. Down the road some thought then to how to manage  
>> if she
>> gets the flu, is especially tired etc.
>> Is employment or further education a possibility?
>> Are there community resources? I'd be looking at the Canadian  
>> Paraplegic
>> Association for support both physical and emotional. What about the  
>> social
>> network? Is there someone with the skills to lower closet rods,  
>> install
>> railings etc.
>> What has been addressed in rehab?
>> What were this couple's plans for their family? Were they planning  
>> more
>> children? If no-one else is addressing issues of sexuality and family
>> planning you need to be prepared to do this or refer. One of the most
>> satisfying experiences I've ever had was a very similar situation  
>> helping my
>> client to manage and enjoy pregnancy, birth and newborn care. She was
>> already independent in her w/c when I met her.
>> I really like your request for collaboration. It will be easier to  
>> focus
>> when the questions are more specific.
>>
>> A thought to end - Independence doesn't always mean doing everything
>> yourself with no help. A critical part of independence is taking
>> responsibility for your own activities, planning, supervising,  
>> negotiating
>> and appreciating the assistance that others provide.
>>
>> Go for it, Ron. She's a lucky client. Joan
>>
>>
>> -----Original Message-----
>> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On  
>> Behalf
>> Of Ron Carson
>> Sent: Friday, May 25, 2007 3:24 PM
>> To: Ron Carson
>> Subject: Re: [OTlist] OTnow Colloboration With Spinal Cord Injury
>>
>> 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
>>
>>
>>
>>
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