As before Jo rejected the electrically powered one as she thought it might encourage dependence and, after trialling the self-propelled model, decided she preferred to be more independent and motivated, controlling her own propulsion. We now have an up to twelve week wait for the chair to be delivered. Let us hope Jo is able to walk to the front door to take delivery of the wheelchair by then.
Jo has been persuaded to start taking warfarin. I have my doubts about the necessity of this and some misgivings too. With one untreated aneurysm and a clipped one that may be still healing I question the wisdom of thinning her blood at this stage. The consultant physiotherapist brushed these concerns aside but he could only quote statistics in rebuttal. I will seek other advice.
As well as being an inspiration, this story lends the lie to the oft-quoted shibboleth that all repair of the brain ends after two years. That two year figure is actually the length of time of any studies done to date, not any true figure of the optimum length of time during which the brain can heal at all.
Jo had a good physiotherapy session today, doing several good stands unassisted and walking with the support of the gutter frame. All was going well until she crossed the threshold between the living room and the hallway. This required her to focus attention on the amount of support required of her left leg and, despite the fact it was holding her up rather well, she began to panic. The physiotherapist agreed this was entirely due to the residual loss of confidence caused by the fall back in March, when the carers did not follow procedure, attempting a transfer with only one carer and causing Jo to fall.
This evening Jo spontaneously put out her hand to me whilst sitting and raised herself up to a standing position so we could have a hug.
Our mood today was like the weather, restless and weary. I am heartened, however, by discovering the seven stages of rehabilitation as described by Brunnstrom.
Brunnstrom separates neurological recovery into seven separate stages based on progression through abnormal tone and spasticity. These seven stages of recovery describe tone, reflex activity, and volitional movement.
Jo would seem to be at Stage 3, moving to Stage 4. Before the cranioplasty she was “plateaued” at Stage 2.
This explains why she is finding standing and walking harder than before, even as she can move the limbs more, as spasticity has increased.Jo managed a really good stand and swivel from the commode to chair today, because she did not stop to think about it, she just did it.
The Thai massage in the evening really helped. This is the third such massage and where the others were just painful, Jo is now feeling the benefits and the masseuse is concentrating her efforts on Jo's left side where the "muscles have been sleeping long time."
Jo managed to walk from her chair to the door today, using the gutter frame. There was less pain but she was very tired afterwards.
Another plateau day for Jo. She has been extremely tired at night lately, hopefully due to returning sensations.
The physiotherapists tried Jo walking with the gutter frame today. Jo was in pain at first, which seems to be more muscular than neuropathic, possibly as a result of Jo moving the affected limbs more. When Jo stood up initially she had pains in her foot, her leg, arm and hand. By the end of the session the pain was largely confined to her foot.
Jo revealed today that her left breast has been feeling "strange" and heavy, which would seem to be awareness of her left side returning. Today she was also sitting with her left leg bent up, another sign of functionality returning.
Today Jo managed to lift the toes of her left foot from the heel, something she has not managed before.
Jo's rehabilitation continues to gather pace. We tried the gutter frame today and it seemed a good fit. More importantly Jo managed to stand to the frame quite well and it gave her inspiration that the frame would help her move to the next phase.
Everybody seems to be noticing the acceleration in Jo's rehabilitation except Jo, who keeps complaining of being fed up. My concern is that this attitude is not productive. On the other hand it does manifest itself as positive drive when the physiotherapists are here. Jo was annoyed at missing half her session due to being on the toilet and losing the full benefit through not taking her pain control tablets.
Jo's physiotherapy session was stymied by two things today. The time available was halved as the timing coincided with Jo's morning bowel movement and, once the session was underway, Jo experienced pain in her left leg, which I later discovered was due to Jo neglecting to take her medication.
Despite this the physiotherapists professed their satisfaction with Jo's progress, saying her steps were stronger and expressing the view that the pain was due to the limb waking up.
Jo had a mixed physiotherapy session today. Due to an accident with an uncontrollable bowel movement she was tired and her transfers were hesitant. Despite this, when the physiotherapist performed manipulation on her left leg she reported that there was increased movement and power in Jo's left buttock.
Jo's rehabilitation seems to be gathering pace, with more controlled movement in her left leg every week. Her left hand appears to be loosening up too.
The NHS installed a bed stick by Jo's bed today. Hopefully this, coupled with the bed elevator, will help her get herself out of bed.
In the evening Jo was sitting in the recliner chair with her legs elevated. She found she was able to move her left foot back from the ankle, something she has not achieved before. Earlier in the day she had been exercising these muscles by pulling her foot back with a strap looped around the foot. It would seem remarkable that this small stimulus has shown such immediate improvement so perhaps it is just her rehabilitation progressing.
Jo had a recliner chair delivered today, enabling her to elevate her footrest and potentially to lift her forward into a standing position.
They also fitted a bed elevator which works mechanically to raise her to a sitting position.
The physiotherapists came and explained their strategy, which is to have two sessions a week; one practising manipulation; as conducted yesterday and the other practising walking. The collaborative care sessions previously held are replaced by Jo performing the exercises I have described in a previous entry.
All this is because they see Jo as making progress and to focus Jo on taking a more active role in her own rehabilitation as she becomes more mobile.
They then proceeded to get Jo to practise walking in the hallway, four steps forward and four steps back, using the banister for support. This was repeated twice. Jo was stepping well with the left foot going forward but dragging it going back. Conversely she was better at transferring her weight onto her left leg when going backward, which suggests it is largely a matter of confidence.
The physiotherapist came for the first of Jo's two weekly visits. She spent the time manipulating Jo to encourage the muscles in her left thigh and buttock to work with some success.
Today Jo was able to hold her left foot up to allow her shoe to be put on and managed to lift her foot on to the footplate of the wheelchair, the first time she has managed this.
