Ron Carson <[EMAIL PROTECTED]> wrote:
> Not what you mean by "stemming".

Aha - that's just Danish for doing "push up" for pressure
reliefs etc - my mistake - I thought it was international:-)

> Solid  seat??  Not  necessarily but my concern with an
> open
> seat is that
> she will not be able to "clear" her bottom across the
> opening.

Makes sense - but some holes for drainage might be useful.
Wouldn't water flow from the bench to the floor else? (I
don't know a thing about US bathrooms, but I guess the floor 
isn't well drained since you go for the tub and not the 
shower
wheelchair...).
Oh - grab bars placed strategically may assist with balance 
while leaning for cleaning down there. You can always hang 
towels on them later on:-)

> She  just does not have the strength and/or strategy to
> clear
> her bottom
> UNLESS  she  has  elevated  hand  rests.  For example, she
> can
> clear her
> bottom  while sitting in her w/c by using the arm rests.
> But
> she can not
> clear her bottom while sitting on a solid surface with no
> armrests.

Not sure if I'm stating the obvious here, but many (most?) 
people need to bend over very significantly to clear the 
bottom - a push-up doesn't do it. We really gotta find a way 
for you to see those videos!

I noticed the "JGNI" videos run in quicktime format on my 
computer, and that they take a looong time to load. And then 
"Shaun" on Windows media player. The video formats are MPG 
and WMV - maybe you could download another player to run 
them if you're on a mac or something?


> She  does  have  a  shower wheelchair but no roll-in
> shower.
> MONEY is an
> issue as there is no insurance.
>
> One thing that I know is that she is determined to be
> independent.

I think she will be. With her level it'd take serious 
complications to not be. But it may take time - even years 
for certain things. (example being cleaning yourself up 
after a bowel accident.)

> I have previously worked with a couple people who are s/c
> injury and now
> live independently in the community. I'm considering
> asking if
> they will
> take a trip with me to the patient's home.

Wow, Ron - you're one committed OT! Guess that's what's 
meant by rehab without walls!

> I  am also going to consult with a DME specializing in
> lightweight w/c's
> to see about getting the patient out of her cumbersome
> power
> w/c.

Important step - I believe she'll also find that very 
helpful with her weight issues.

> So much to work on!!

Yeah - an SCI sort of affects everything. And all those 
"things" are so interconnected, that it's hard to chose 
limited therapy goals to work on. I believe you made fine 
choices - the results of which will rub off on other 
important things. Often bowels and bladder management is the 
center which everything turns around, but I guess she has 
reasons for not involving you much in that part -  and what 
you are doing will eventually benefit her independence with 
that too, so kudoes for working as client centered as you 
do!!

susanne 


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