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Thread: Wiggling Toes, C3-C4 Injury for Senior

  1. #21
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    Trach + Speaking Valve

    Hi Bill,

    What is a cuffless trach? How stable does he need to be?

    The rehab center used the Passey-Muir on my Dad pretty much when he arrived. He did well on the first try. Afterwards, he didn't do very well - I think that it had to do with the pneumonia and there was a Speech Therapist who walked him thru the process (what to expect and the "feeling" - cuz my Dad is very detailed-oriented).

    Sorry for the dumb questions.

    Joey

  2. #22
    Joey, questions by someone concerned with their loved one's health are not dumb.

    When I was learning to speak with the vent during rehab, the Passy-Muir Valve (PMV) was an afterthought. But in hindsight, I don't know why it wasn't introduced earlier. It certainly enables the best speech, but it really shouldn't be used 24/7 (for humidity reasons; at least not how my vent situation is) so maybe that's why they want people to get comfortable speaking without it first. I am speculating though.

    A cuffless trach is exactly what it sounds like -- a trach without a cuff. If your Dad can get to the point where his cuff is deflated "permanently" (i.e. not inflated for several months) then I would switch to a cuffless style trach, for a couple reasons. First, think about a deflated swimming pool raft -- even deflated, there is still plenty of plastic.

    The same goes with a deflated plastic cuff. With me, I had granulation tissue adhere itself to the deflated cuff which made trach changes a bloody, painful mess (my pulmonologist literally would rip it out). But my granulation tissue doesn't stick to the other parts of the trach, so with a cuffless trach, changing my trach became easy enough that my caregivers do it at home.

    I don't know if the granulation tissue & cuff adherence is fairly common with trach patients, but that's what my situation was and switching to the cuffless trach made a big difference. It also reduced my volume of secretions and my theory why is that without the cuff, there is less foreign stuff in my trachea to cause irritation.

    My primary tip for getting accustomed to a PMV is... try to exhale some air while the vent is actually giving the breath. That allows me to get comfortable and feel like I'm in control of my breathing and regulating my air. Once the user is comfortable doing that, try speaking.

    Merry Christmas and God bless!

    Bill Miller
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

    Checkout the below CareCure thread about a new way to bowl!
    http://sci.rutgers.edu/forum/showthread.php?t=87066

  3. #23
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    Sensations - Does it mean anything?

    I've been helping my Dad with exercises which are linked to the repetitive motion approach.

    For the legs, it's been the bicycle exercise. For the arms, it's less "repetitive" (martial arts routine) and not as simple. The majority of time has been spent on the legs; sometimes, I don't have time to exercise the arms.

    Results (maybe linked): My Dad has indicated that he can feel his left buttock and lower left side. The odd thing is that he can feel it for a couple of days and then, he can't. However, the exercising seems to revive the sensations -- and, my Dad smiles when the sensations return!

    When my Dad arrived at the rehab center, the rehab doc had discovered that my Dad has feelings in an area under his right thigh. Thus, with the exercises, the area which he can feel has expanded to his right buttocks.

    So, it's wierd: he can feel his butt. Sorry to go into this other area, but my Dad has mentioned that he can sometimes feel when the suppository is being inserted -- I thought this was good news if the feeling becomes permanent.

    He is still getting "sometimes" feelings (like a radio station which he can sometimes pick up) - the description has ranged from tingling to numb to a "pressure" feeling (something is pressing down on him).

    The rehab doc mentioned that one of the first areas where sensation returns is the buttocks area. The reason is that this is on the outer rim of the spinal cord. He claims that patches of sensations will happen, but still insists that my Dad will not regain any movement since too much time has lapsed.

    1) Any experiences or feedback?


    2) Any place where I can find a description of interesting exercises?

  4. #24
    Joey, other CareCure people can comment on sensations for I essentially have none.

    However, the doctor's comment insisting on no return because too much time has elapsed is inaccurate. I don't know what the primary timeframe for return is, but I've read here about people getting significant return well more than 6 months post injury. And your Dad hasn't even reached the six-month mark yet.

    God bless.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

    Checkout the below CareCure thread about a new way to bowl!
    http://sci.rutgers.edu/forum/showthread.php?t=87066

  5. #25
    this was on another thread i responded to. there it was stated by poster doctors said euthanize him. was on old wise poll thread...

    fwiw, here:

    http://sci.rutgers.edu/forum/showthread.php?t=16491

    page 12.
    Last edited by cass; 01-15-2012 at 04:40 AM.

  6. #26
    Quote Originally Posted by Joey_SF View Post
    2) Any place where I can find a description of interesting exercises?
    I don't know how good our leg ROM routine is, but my legs seem to be in pretty decent shape, and here's what I wrote a long time ago for new nurses to perform my leg range:

    Leg range of motion: there are three main exercises to do. The order doesn't really matter, but they are (1) knee-to-chest (primarily stretching my gluteus/butt: bend my knee and push my knee & heel -- they should remain in line, i.e. parallel to my other leg -- toward my chest, then straighten my leg again, and repeat); (2) straight-leg straight up (primarily stretching my hamstring: simply raise my whole leg and try to get my heel pointed at the ceiling -- while keeping my knee from bending; lower down and repeat); and (3) straight-leg sideways and back (primarily stretching my groin: simply pull my leg SLOWLY from its position on the pillow out to the side; it's ok if my hip pops, that's common; bring back and slightly cross over the other leg, then repeat).

    There are two additional leg range items: heel stretch (cup my heel with your hand so that the ball of my foot is against your forearm, and stretch my heel & Achilles upward toward my head; relax my foot back, and repeat); and also a hip rotation (after doing knee-to-chest as described above, with my thigh and knee straight up, but with my lower leg horizontal, i.e. that leg should look like I'm in a seated position, simply rotate my thigh by moving my foot in and out, similar to a windshield wiper -- but my leg won't rotate out very much at all, which is fine).


    Regarding leg range, NEVER FORCE THROUGH RESISTANCE. When you meet resistance, hold it there for several seconds, then see if the muscle will give and allow a greater stretch (if not, don't force it). Also, it's basically your choice whether to do each exercise 3-5 times while holding each stretch for at least 30 seconds, or doing each exercise 10-12 times while holding each stretch for roughly 5-10 seconds.


    That completes my leg range, which is usually done when I'm sleeping. I don't have a written description of arm range, because I usually instruct new people how to do so when I'm awake.

    Hope this helps -- and if someone has descriptions of better leg range exercises, I'd be interested to check it out.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

    Checkout the below CareCure thread about a new way to bowl!
    http://sci.rutgers.edu/forum/showthread.php?t=87066

  7. #27
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    Sensations + Speaking Valve

    1) Thanks for the exercises - any additional exercises for the buttocks?

    2) I'll tell my Dad re the tip for the speaking valve. Right now, the speech therapy is focusing on eating so he hasn't been practising - so, any tips would be appreciated. Any more?

    I noted that one therapist told him to take a breath to speak when he felt the intake of oxygen.

    3) Yes - I would like to hear from others about sensations.

    4) Any rule of thumb for suctioning? How do you know when you need suctioning? My Dad "coded" twice with dropping oxygen level -- suctioning revived him. Should he merely be suctioned each time after he is turned/moved?

  8. #28
    The nurses and respiratory therapists should be listening to his chest to tell when he needs to be suctioned, as well as listening to how "gurgly" he is when the vent is working. Most people with SCI who are on vents are quite expert in knowing when they need to be suctioned too. If his 02 sats are dropping slowly, suctioning should be done as this is usually due to accumulated secretions. A sudden drop is nearly always a mucous plug, and also requires suctioning.

    I should note though that he should be using the Cough Assist machine(inexsuffilator) preventively at least 4X daily to bring secretions up from deep in his lungs. This can sometimes prevent the need for deep suctioning, which ironically also increases the need for suctioning. If he still needs suctioning after using the Cough Assist (and manual qual coughing too), it is much more likely that only shallow suctioning (which is safer) will be needed.

    The Vest (which is worn around the trunk) is also quite valuable in loosening secretions so that they can then be removed with either the Cough Assist machine or suctioning. It works better than a chest PT "thumper" or vibrator. We use both.

    It is critical at this point that he be hyperoxygenated with an ambu bag or the ventilator sigh mechanism with 100% oxygen both before, between, and at the end of any suction catheter passes. People with SCI are much more sensitive to bradycardia (very slow pulse) caused by suctioning, esp. deep suctioning, and if his blood oxygen level is already low, he is even more sensitive to this "vagal stimulation".

    Here is a website where you can see some short videos of good range of motion exercises: http://www.irrd.ca/education/present...p?refname=e1a2

    (KLD)

  9. #29
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    Vest?

    Sorry, what is a Vest?

    I noticed the corset (made of elastic) which is worn around the trunk of the body... approximately from the waist to under the nipple line... which I thought was worn for blood pressure purposes... is this the Vest?

    If it is, is it okay to it all the time?

  10. #30
    I'm pretty sure this is the Vest that KLD is referring to:

    http://www.thevest.com/

    I know very little about it. But I'm a big CoughAssist fan. In general, I'm for whatever works best for the person. Some people prefer suctioning. To each their own.

    God bless.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

    Checkout the below CareCure thread about a new way to bowl!
    http://sci.rutgers.edu/forum/showthread.php?t=87066

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