|This is the Occupational Therapy gym in Q3 ward. It is not uncommon to have 20+ people in here for therapy (patients + family members.)|
|A corner area of the OT gym in Q3.|
|Another shot of the OT gym.|
|I was able to sneak a few photos of some of the empty beds on the ward just to give you an idea of the conditions of the rooms. A little bare, but the staff makes it work well.|
|Another shot of a general ward bed.|
|Another bed in a different bay of the general ward.|
The main difference I saw was not in the injury or assessment of injury, but in the treatment of the injury. The end goal of therapy here is different for a number of cultural and financial reasons. The largest influence on treatment goals is the family. Have you heard this before? It is true. The family bathes, toilets, dresses, and feeds the patient if they cannot do it themselves. It is a cultural thing. Families come together to provide for the patient. Independence then becomes a matter of the family unit, not just the patient.
Financial means also impact the treatment goals, especially for those of lower socio-economic status. Family income is often reduced when someone becomes injured. This is often not just a reduction of one income, but also of the family members that now care for the patient rather than work. With a shortage in finances, the means to purchase equipment is also not there. Wheelchairs and adaptive devices are difficult to afford, thus treatment and discharge planning is done without relying on such things.
Literacy also impacts treatment plans and goals. Many of the patients in Q3 ward were being treated for grade three and four pressure sores. It seems like it is a challenge to get patients and families to understand the importance of skin care and pressure relief for patients with spinal cord injuries. Some of the therapists I worked with mentioned literacy when I asked about the high prevalence of pressure sores.
Treatment for patients with spinal cord injuries in the Q3 ward follows this general pattern. They are taught upper extremity exercises to promote the ability to engage in pressure relief at least once every twenty minutes. The patient and family are taught positional changes in bed to prevent pressure sores; changes are to be made every two hours. Patients and families are taught to rub Neem Oil over the patients insensate limbs to prevent rats and bugs from compromising skin integrity when they are lying on their mats on the mud floors of their homes. (Neem Oil is bitter oil that prevents unwanted guests from biting the skin.) Education is provided on skin care. Positional tolerances are also part of treatment for spinal cord patients, depending on whether or not they have healing pressure sores.
|While this patient was spending time in a standing frame for physical therapy, the occupational therapist was working on bilateral arm function. After lying prone for so long (due to pressure sores) he has lost some range of motion in his shoulders.|
|This patient was engaging in push-ups to maintain upper extremity strength to increase independence in functional mobility upon discharge.|
Treatment for patients with brain injuries also follows a little bit of a pattern. In Q3 they use functional coma stimulation and traditional coma stimulation. Traditional coma stimulation is using the five sense to evoke a response, and as the patients becomes more alert the responses become more appropriate. Functional coma stimulation is using objects and passive range of motion to increase awareness and alertness and stimulate the ability to follow commands.
In Q3, the number one goal of patient care is to get them medically stable. Therapy is administered to prevent decline (contractures, decreased muscle strength, etc.) and maintain function. If gains are made, all the better. Once the patients are stable, they are generally transferred to the rehabilitation institute where therapy becomes the focus.
I learned a lot during the last week. The differences and similarities in occupational therapy services continue to intrigue me. I am looking forward to working in the rehabilitation institute towards the end of my posting at CMC. I will then get to see many of the same patients I saw in A2 and Q3, only with more focus on rehabilitation.