Question about weight shifts....

[pyrofun]

I was wondering if anyone had any advice for my brother-in-law and sister. My 12 year old nephew is a C5 complete and is scheduled to come home from rehab in 2 days! (For those of you who know his story, this is an awesome thing for him!!) My question is, how will my sister and bro-in-law do the constant weight shifts at night? Is it pretty much a fact of life now that they will have to get up every 2 hours every single night to move him? It may sound like a dumb question, but I just think of how hard it is to have a new baby and you pray for the day that they finally sleep through the night because you are just so sleep deprived. But with my nephew, this isn't obviously something that will pass. This is every 2 hours, every night for the rest of his life. Does your body adjust to not getting hardly any sleep? Will they have to take turns every other night getting up? Are there any other quads out there who have advice on this? He may go to the Kennedy Krieger Institute after the holidays are over, and I'm hoping if he does perhaps he might gain enough strength in his wrists that maybe he could do some shifts himself, but as of right now he doesn't have anyhting in his wrists to help him at all. Thanks in adavance for any info. anyone has!
Georgia

[kkmay]

My mattress is not the softest in the world. I get turned every five hours or so. Just make sure he has some heel protectors to cushion the heel and ankle. I don't even get out of bed that often for the last four years. And I just have one ankle sore. I am the grandmaster when it comes to staying bedridden.

[rfbdorf]

Yes - someone needs to talk to the nurses about mattresses. It's important to make sure there's a good mattress waiting for him when he comes home.
We were issued a terribly hard one that my wife used for several days when she first came home (and I was up every 2 hours to turn her!); I bought a cheap egg-crate pad as soon as I realized the mattress was a problem; eventually we got a Geo-matt foam pad that she uses now. My wife turns a little every 3 hours, but sometimes not for 6 hours. She has a clock with 2 alarms, one set for midnight and the other for 3AM.
- Richard

[lilsister]

Good for your nephew on getting home! Everything is usually a jumble til routines are sorted out and everyone gets used to procedures. Usually people are taught to "toughen up" the skin, gradually increasing time between turning,increasing the turning time by an hour or each night or week. The benchmark is watching the skin carefully to observe for red spots that don't blanch when gently pressed. Good mattresses help and good positioning. Having the head of the bed up for long periods can increase pressure on sensitive areas. Padding with pillows, keeping skin from skin, using padded protectors for feet really help. Having siderails or a reachable bar can help to facilitate self-turning if he is more limber. Everyone is different, even at the same injury level, this includes skin, aptitude and other injuries that may have been sustained. Many people at that level can turn themselves, depends on that person's particular abilities or limitations. For instance, I turn Jim once a night usually and he has great skin, just a special foam overlay on top of mattress. We have a routine which includes no talking so a return to sleep is easier,giving us both a better night's sleep. A good diet, good skin care and positioning will really help with prevention. Best of luck. Deb

[2jazzyjeff]

I was turned every 2 hours in rehab, but now I sleep all the way thru the night without. I sit up with my hospital-type bed for a few hours and lay at about 30 degrees for around 6 hours.. I am bridged with pillows under my back on flat nights and a pillow on my back the next night for side night. I always have my feet propped on 3 pillows with my heels hanging off. 4 years and going strong with no redness.. Knock on wood!!

[betheny]

I remember rope "ladders" on the side of the bed. I could hook my arm at the elbow and haul myself over on my side, from my back. It's a lot harder to do when you're blocked in with pillows though.

Did they work with him at all on turning over, in rehab? I remember working for hours on it.

[tekniko]

I'm a C4 C5 and to tell you guys the truth I can sleep eight hours straight without any turning at all and I don't have any skin problems. My favorite side to sleep on is my right side and like they mentioned above the skin on my right side is much tougher than on my left side. If I sleep on my left side it will be red after eight hours.

[SCI-Nurse]

Turning is important for both skin and lungs. Most people can tolerate 3 hours between turns, but each individual needs to be assessed based on their comfort and skin tolerance. In addition, an appropriate pressure reducing mattress is needed.

For those who cannot turn themselves, if possible, a turning mattress can be used. They are not cheap!! I can recommend the Triline CairTurn RT as a good option for many.

Proning (sleeping on your stomach) is a good option for many. We used to promote this for everyone, as properly bridged the person can be left safely in this position for 8-10 hours or more. It takes getting used to, and skilled assistance in finding a position and working up to that much time is helpful. We used to do this even for our ventilator dependent patients quite successfully.

(KLD)

[pyrofun]

Thank you all for the great and quick responses! I know Austin's parents are really disappointed with the bed and mattress that was sent from the insurance company. It is an old, looks like 1950's model, crank-bed with a plain old mattress on it. I know my brother-in-law already called to complain, so hopefully he'll be getting a better one soon. I will definitely relay the info. to him on that turning bed. He had one of those in San Jose when he was in the PICU up there, but they said that even one of those wouldn't be sufficient enough to rotate him as much as he needed to be. I don't think he's tried the sleeping on his stomach yet, but I know if he could do that it would be great. He has these "space-boots" as we call them for his feet and ankles at night, but other than that they just use a ton of pillows to position him every which way. I will look into the gel pads and also the mattress covers for him. Anything will be better than what he's got right now!
I'm really glad to hear that most of you can go longer than 2 hours without turning! I hope his skin will toughen up some and then it will be easier on everyone. I also like the idea of "no-talking-then-back-to-sleep". I will definitely pass that advice along, because the less interruptions to everyone's sleep the better!
It's wonderful having so many great people to turn to for advice. Thank you all for your words of wisdom. I know I can trust you because you all have been there!
Georgia

[SCI-Nurse]

One of the ways we used to justify a full electric hospital bed for our patients was to have the physician write a letter describing what could happen if he got AD (autonomic dysreflexia) in the middle of the night and could not elevate the head of his bed himself while calling for help. Written the right way, this could be sufficient justification. The same thing needs to apply to the mattress....the cost of a pressure ulcer is MUCH MORE than the cost of an appropriate mattress.

I teach our nurses the no-talking rule too for in the hospital, and to do all care possible during the night by flashlight instead of turning on the patient room lights. You can do turns, caths, etc. this way and it does not awaken the person so much.

(KLD)