OT: Any PTs or occupational therapists?

[ColleenM]

My father has been in the hospital for a little over a month. Brief story is that he's been ill for weeks, maybe months and we did not know until he was crawling on the floor. ER surgeons removed his colon and spleen. He is at a VA hospital that is for ER only so once he was somewhat recovered he was transferred to a Skilled Nursing Facility. The downfall is that at this particular location, the therapist just quit My dad can't walk at all now (always limped from polio anyway) and is having trouble with eye/hand coordination amd memory loss. My sister, DH and I are trying to think of as many ways as possible to give him some therapy. For example, we are having him play solitaire, playing black jack, poker, dominoes, singing to music and doing crosswords (we write, he gives us the answers because he can't write yet and can't get the pen to the write spot on the paper). Can anyone think of anything else that might be beneficial? He is also very weak (105 lbs at 6 ft when we brought him in and he is still not eating; altho they are tube feeding) so we'd like to try to help him gain some strength back. We are trying to make him sit in a wheelchair dailiy but it's a battle with each day.

Thanks in advance.

Colleen

 

[groundhog]

I am not a pt/ot but I spend enough time in it. For eye hand cord. they used to have me use clothes pins and put them on and off a wire. They also used to put me on a muscle stimulatior machine it contracts the muscles in the arm and hand and builds up muscle strength. You should be able to get one of those thru his doc. As far as lower body, I dont really have any suggestions, mine was arm, wrist shoulder and forearm. Good luck to you and your father, I hope he recovers in full!!

 

[cab0899]

I'm an occupational therapist in Canada. I have quite a few years of experience with similar type of patients. I'm so sorry that your dad is going through such a terrible illness.

It sounds like you and your family members are doing some great therapy already! Any actiivities that he is interested in are great for therapy.

Sitting up in the wheelchair is a great precursor to starting to walk by builing tolerance for being upright (also very important for when he starts oral feeding again.) Why is it such a battle to get him in the wheelchair?? Maybe he needs a more supportive wheelchair? More details might help me provide some advice. If he's better seated he'll have much better trunk and upper body movement to do some of the activities you've provided for him.

Did he have memory loss prior to being sick? Does he have trouble just with new events like who was in visiting today or long term memory such as names of family members?

You mentioned that he was having trouble getting the pen to the right spot on the page.Why is this? If it's due to tremors try either a weighted pen or a very little wrist weight to control the tremors.

Is he starting to some grooming like combing his own hair and washing his face. Great therapy activities!

Anyways I'll be online tommorrow if I can help at all

Kim

 

[ColleenM]

Thank you both!

Kim,

It is a bit hard to piece things together. And kind of long, so bear with me. But I really appreciate this!! My dad lived 3 hours away and never let on there was a problem. Even the day he was 'gray' and rushed to ER surgery if you asked him he said he was "just fine". We saw him just six months prior and played shuffleboard and we ate a huge pizza so I'm not sure how fast the sickness progressed. Or how long it was going on. I do know at Christmas he was ok.

There seems to be some kind of mental problems in several areas:
1. He hadn't showered, bathed or changed his clothes in seven weeks, combed/washed hair, etc. Basically, 7 weeks before he "went down" my sister went up and noticed something wrong. We went up weekly and it took us that long and for him to actually fall down beefore he'd leave. He still refused to go to the hospital. We tricked him and told him he was coming to live with me (which he will one day hopefully). Then the doctors had to sign a 5150 and commit him for 8 hours and we finally convinced him to stay. He still fights being groomed Oh and there isn't much to groom. He was so dirty that they cut off all his hair and almost completely shaved him. But he was really "proud" of his hair so this is something to look forward for him to do!! I'll make a note!!
2. He refuses to eat most things. Says he isn't hungry. Part of this is due to swallowing problems (he can't even keep his dentures in) but a speech therapist is supposed to be working with him. But prior to all this, for the last 4 years, he has decided he only needs to eat one meal every other day. He's an alcoholic and smoker also. By some miracle does not have signs of liver, stomach or lung cancer yet. The drs also said it must have felt like a heart attack in his gut when he did eat when the colon was being "killed" (blood supply was cut off and it partially perforated into the abdomen, also spleen was removed). If we do get him to eat it is just sweets: strawberry shakes, fudge ripple shakes, m&ms, hostess cupcakes.
3. When we cleaned out his apartment I noticed notes all over the place reminding him of things. When we spoke and visited, I didn't notice any major memory loss. At first they told us it was "ICU psychosis" and not to worry but it isn't getting much better. He can remember things that seem to be from his long-term memory yet not short-term memory. He often forgets what city he is in (we haved moved him twice to two different cities tho), what year it is, when my sister or I visited, if he got up yesterday or today or an hour ago, etc. He also lived by himself, with all the windows and curtains drawn and never left the house except to get his newspaper, so I am assuming there must be some kind of depression.
4. As far as the wheelchair, I think there are several factors: he is stubborn; and very very very weak. It takes a huge amount of effort for him to grab his cup and take a sip of his shake. It could be too scary for him, too much work, etc. The day we visited the aide used a chair lift and it was terribly hard for him. He thought if he let go, he would fall. We couldn't get him to understand that the band underneath his arms would support him. So I think that part was scary.
5. I think for writing, again he is too weak. It is such an effort for him to do just about anything. When he first got to the SNIF, he couldn't use the little triangle thign to help move himself around. Now he can pull himself up a bit and adjust, so he is getting stronger. When he was at the ER hospital, he couldn't sign his name, he was too weak. Now he can make something close to his name, but it still isn't very legible.

Thanks again for the help!

Colleen

 

[cab0899]

Just some more thoughts Colleen:

1) It will take time and some real digging by the staff to determine if the memory loss is secondary to being so physically sick (very common with the elderly), related to depression or a more permanent diagnosis of some type of dementia either alcohol or non alcohol related. Quite possibly a combination of everything and you will see some his memory improve as his physical health improves.

In the meantime, you might like to look at some type of memory cues such as calendars in his room. Maybe post some family pictures with family information underneath, this also helps staff to reinforce info. If he's interested you might want to help him get a memory book or journal. Each day you could jot down what he did, who visited, names of the staff working with him and encourage him on the next visit to look up the information so he gets used to using it.

2) Swallowing- that's great that the speech therapist is involved to asses his swallowing needs. You menitioned that it's difficult for him pick up his cup. With his limited energy if eating is too much work he might avoided it for that reason so need to make it as easy as possible. Try experimenting maybe a cup with a lid or straw is easier for him. (But check with the staff before you try in case there's a reason they don't want him using these things) Cups with double handles or lighter weight might be easier. Utensils might be too hard to grip and you could trap wrapping foam around the spoon to see if it makes it easier to hold on to.

3) Grooming. There could be different reasons he's reluctant. He's may have lost some insight on why grooming is necessary, if he's depressed he maybe just doesn't have the motivatin or with his lack of strength it just too hard physically. Try simple tasks like just hand him a damp washcloth and get him to wash his face. Explain why it's necessary each time you do it. Tell him it's good exercise also.

4) Check with the nursing staff about some simple exercise like just lying in bed and lifting each heel up 10 times and reaching arms above head. Squeezing a sponge or washcloth in his hands just to build up some general strength.

5) Getting transferred from bed to wheelchair is scary. Once he gets to know the staff and the get a routine down hopefully it becomes a better experience. Kim

 

[ColleenM]

Kim,

THANK YOU SO MUCH!! I really appreciate your thoughts and time in putting this together for me! I'm going to print it out and bring it down to my sister and we can get a plan going! Thanks again!!!

Colleen