This morning I did home health treatments again. Two of my cases today were very different and they really stuck out to me. The first man we went to see was having nerve pain in his leg from a fall resulting in a brain injury which was causing him to not be able to walk correctly. This was the first time I have seen him but apparently he has progressed very well. Our goal for the treatment session was to strengthen his lower extremities and work on walking. His personal goal was to walk outside again. So in the treatment session we decided to go outside and walk around in the yard. This treatment session was SO different than what would have happened in the USA for so many reasons. First, the patient didn’t have any shoes; which is a safety issue. Second, we were walking outside on the grass with rocks and stones and divots all over; another safety issue. He also didn’t have a wheelchair around so instead of following him with a wheelchair we carried a wooden chair around the yard. The final and best part about this treatment was that the patient had a catheter and he carried the catheter bag in a big white bucket while simultaneously using a walker. In the US this would never happen. When we left his house we all just started laughing at how funny it would have been if one of our professors at home saw us doing this with how many safety issues there were. But in the end he walked across his entire yard and up the hill and he only needed one break.
The second house we went to was a very different case. This was a family treatment session. The mother had three children age 17, 18, and 19. All three of the children have severe developmental delay and we suspect CP but it is not confirmed. One of the children in in a wheelchair, one is be bound, and the third is technically bed bound but his mattress is just on the floor in the living room. Both of the bed bound children are waiting on wheelchairs to be customized for them. The child that I treated was the 17 year old boy who was bed bound on the living room floor mattress. He had contractures that forced his neck into left side bending, left rotation, and neck extension. He also has a severe flexion contracture at his elbow and wrist of his left hand. The main goal of this treatment was to help relax him and stretch out his muscles to avoid getting any sores or wounds from the contractures. We also wanted to work on getting him to sit upright so that when his wheelchair comes he can tolerate the position. This boy has not sat up in almost 17 years so needless to say it will not be an easy task to get him into this wheelchair. I started off my treatment by working on stretching out his neck muscles. To do this I got down on the mat with him and tried to first make him actively move the muscles by asking him to turn his head to look at me. This only caused him to move his entire body towards me without his head. I then switched over to me moving it passively. To do this I placed his head in my lap and massaged out the tight muscles while talking to him in a soothing tone. As he began to relax his muscles I was able to rotate his head slightly to the right. After a few rounds of this I was able to get his head to neutral and hold it there for 30 seconds. This was a great stretch for him but he became a little fussy throughout it. The second part of my treatment I focused on getting him to sit upright. To so this I had him with his head in my lap and I slowly wiggled by body between his and the floor. As I did this his hips began to flex more and more causing him to sit up. The issue with this is that not only did he not tolerate the position on an emotional and physical level, he also couldn’t handle it due to his lack of cardiovascular endurance. Since he has been laying down for so long his heart can only handle the upright position for so long. I got him to sit up at about a 45 degree angle and we held that position for about 5 minutes before he started to squirm again. This was definitely a tough case because there was a lot going on with my patient and I wish I could do more to help him relax. Also in Belize we don’t have any access to anti-spasticity medications which would be majorly beneficial for this patient. This is another one of those cases that would be very different if he was in the US.
Also here is a picture of the current rehab team for the first two weeks.