Day 35 – Making therapy fun

Shout out to everyone in the CRP, patients and staff!

Update: Aaliyah is half-way through the chocolate tart and has started her marble cake. As a point of pride, I have not yet asked her for any but am sneaking handfuls of the excess chocolate chips when possible.

Aaliyah came with me at the start of today to observe my bedrest patients that have high spasticity. I wanted her opinion and advice but also to give her experience because we may never come across something like it again. For my non-physio readers, spasticity – put simply – is when the muscle becomes very rigid/elastic and sort of has a mind of it’s own. It can cause the limb to have a limited range of movement but also to hold the limb in tight, flexed positions or to cause spasms when mobilising. It can also present in the form of a tremor which is usually relaxed through stretching and soft tissue massage. Each person’s spasticity is unique. My first patient who always has a smile is tetraplegic; when we first move him in the morning his legs can jerk out unexpectedly or his hands remain in a forceful grip or he cannot extend his arm, like his hand is tied to an elastic band around his shoulder. Another patient has very strong tremors such as if you talk during movements of their limb, your voice will also tremor at the same tempo and it is difficult to know whether to work in the limited range or relax the muscle through overpressure. And the final high tone patient, whom I left with Aaliyah today as she took on the challenge, has tone that has become so rigid it takes a lot of pressure and soft tissue massage of the quadriceps to fully extend his leg or to achieve any kind of dorsiflexion (90 degree angle) at the ankle. This makes any kind of standing practise or possibility of walking seem like a distant, unrealistic future. But it can be overcome, and he is a very motivated patient.

I was also asked that if I had time, to help out with ward 10. Not so unexpectedly, Ash did not turn up for therapy, even though he’d said he would come and I went back to remind him first 30 mins prior, then 15 mins prior. Then the damn occupational therapists had got to my remaining patients at 11am so I had an unexpected hour (as Ash did not turn up at 10:30) with nothing much to do until 11:30 when I had to take 2 patients at once. Thanks, OT. So, I went to go see Tee as usual who looked very confused to see me and I tsked when she didn’t smile immediately. As I had the time, I did her therapy for 30 mins.

After lunch, as promised, I went and woke Abdul by poking him with his crutches and then I sent Aaliyah to go wake Al though I doubt her method was quite so cruel. Furthermore, I made Abdul walk from his ward to the rehab room with only one crutch instead of two as was his norm so hopefully he was already knackered by the start of the session. I was told he would soon be moving to ward 11, so I needed to enjoy this torment while it lasted. Aaliyah, Son, and Man were the audience, I was the trainer, and Al and Abdul were paced through 10 press ups, sit ups, crunches, 30 second plank and straight leg raises. We then took it outside to do squats, lunges, abductions and hip extensions with the bar, then sit to stand practise. It was all a complete joke. I’m sure we must have woken the entire campus with our laughing as Al took on the characteristics of an old man and Abdul started to talking in a different language none of us understood. Man, I’m gonna miss this so much.

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