by Carol LaValley, for Rim Country Health
Independence is a word rich with implications in thought and deed. For those who want to recover from stroke, a cardiac episode, a fall, a break, or even weakness after pneumonia or an extended illness, independence can mean the taken-for-granted act of getting dressed or the ability to request apple instead of orange juice. The occupational, myofascial, physical, and speech therapists at Rim Country Health (RCH) bring their combined century of experience into play as they listen to each patient’s needs and coach them on the road to self-sufficiency.
“Everything you do during the day is part of your occupation,” Occupational Therapist Dale Moore said. “We want to bring a person back to as close to independence as we can, if we can’t, then we want to find different ways of adapting their lifestyle.”
An example: Imagine that you have the use of only the left side of your body and you want to put on your shirt. It might require you to reach across your body and with your left hand, put your right arm through the sleeve hole, pull the shirt over your head and then put the left arm in. If you were right-handed to a fault, learning this daily task is likely to be a bit more difficult. To put your pants on from a seated position you might have to drop them on the floor, use a “reacher” device or “sock aid” to maneuver the leg holes open and pull your pants up. You will have to stand, balanced, long enough to pull your pants on.
“Say a man has a preference for shirts that button. If that is what’s important, then (getting dressed in a shirt that buttons) is what we work toward.” Moore said. Velcro under the buttons or snaps might become the alternative.
“Patients use a lot of energy to dress themselves, so a spouse or caregiver may help,” Moore said.
The patient may have to weigh the importance of dressing versus the importance of going outside, and the getting in and out of a vehicle that traveling might entail. Moore helps the patient prioritize.
“I have had people come in that could care less if they lived or died, worked with them for three months, and watched them walk out of here, wheel out of here; it is rewarding and we get lots of thank you baked goods,” Moore said with a smile.
Occupational therapists often concentrate on upper extremity movement while physical therapists are more concerned with standing and sitting balance, walking and gait training. In the Rim Country, walking is bound to include rocky terrain, hills, curbs and stairs.
“What we do is based on what their home is like,” Physical Therapy Assistant Allan Ralston said. He has a motto: “When you go home, I don’t want there to be any surprises. I want you to feel like, ‘I did this. I am ready.’”
But first, Ralston likes to break the ice with music. The notes of a song often serve the dual purpose of conversation opener and a beat for the patient to match their stride.
Encouragement is a big part of the process too, whether a patient is poised to make the first step holding onto parallel bars after knee surgery or concentrating on picking up their feet as they walk, not shuffle, down the hall.
“I don’t treat a knee, hip, stroke; I treat a patient,” Ralston said. He’s recovered from numerous broken bones and surgeries himself, so he is empathetic.
The stories patients tell are one highlight of Ralston’s workday. “It is like talking with living history books.”
Don’t talk with your mouth full
But what happens when a patient’s speech has become uncertain? Enter Speech Language Pathologist Don Koehnlein.
“We are known for Johnny can’t say his Rs, but speech is such a wide array of things,” Koehnlein said.
People diagnosed with Parkinson’s, early onset dementia, MS, strokes, and other neurological disorders all may need help with the ability to chew and swallow food and water.
Generally, each hemisphere of the brain handles different functions on opposite sides, but when it comes to the vocal cords, voice box, throat, mouth and tongue, there is some cranial crossover.
Good news for the life and recovery prognosis of the patient.
Human beings chew food into a puree in preparation for swallowing. The tongue scoops the food up and brings it around the teeth and keeps it from becoming trapped in a pocket between the lips and teeth or cheek.
“The fact that we don’t bite our tongues every time we eat is a kind of miracle,” Koehnlein said.
Next is the act of swallowing food. The vocal box has to move forward for this to happen and if the timing is off, food and water can easily fall down the windpipe and be trapped in the lungs and that can lead to pneumonia.
Eating is a complex act that Koehnlein takes the time to explain in lay terms so that patient and family are put at ease.
Electrical stimulation is one of the methods he employs to move the patient from feeding tube to pudding and eventually normally prepared meals.
Articulation and the ability to come up with the correct word are also under the purview of the speech therapist. Koehnlein uses objects, pictures of objects and the written word to achieve the ultimate objective, conversation.
The healing potential within everyone
The hands-on therapists at RCH care about each person they treat and strive to deliver the individualized care each person deserves.
“Drop the label of diagnosis when you come to see me,” Richard Staudt said. “Tell me what is going on.” ‘I can’t move my neck.’ Perfect. We can treat that.” Be open to feeling throughout for healing.
Staudt is an occupational therapist who practices myofascial therapy as an integral part of his approach to occupational therapy.
The goal of myofascial therapy is to slowly stretch and loosen the fascia (connective tissues throughout the body) so you can move freely and without pain.
“We must give ourselves permission to learn that there is potential within us to allow healing to occur,” Staudt said.
Furry best friends
Shayé Gurrera is an occupational therapy assistant. She manages the therapy team at RCH and is a woman who likes to see the big picture. She also takes the time to discover what everyday responsibilities patients most enjoy. Interaction with a beloved pet is common.
Take feeding for instance: It takes balance to pick up a food dish from the floor, add the food, and then lift the heavier dish back down to the floor, all while the hungry pet is excited.
“Little dogs can be more dangerous than big dogs because your space is their space,” Gurrera said.
Feeding a pet post accident might mean moving the bowls up higher or using a watering can instead of bending down. It can also mean retraining the animal to sit still and wait. Occasionally Gurrera works with patients and their four-legged companions right at RCH.
“Whatever a patient likes to do I want him or her to be able to keep doing it,” she said.
Access to in and outpatient therapy services at RCH is available via physician prescription, except Richard Staudt offers a free consultation to try myofascial release.
“I have a seasoned team,” Gurrera said. “We have world experience and are used to thinking outside of the box. We are willing to ask assistance of each other.”