July 20, 2017 10:00 pm
Craig Hospital's welcome packet included a list of unsavory behaviors common in TBI patients. One of those is "offensive language." Maybe Josh's diagnosis of "severe injury" accounts for his severe foul language today. I hope it doesn't get worse than it was today. Wow!
Josh didn't sleep well last night. They gave him Trazodone to help him sleep, but it had the opposite effect. Between 8:00 pm and 8:00 am, he slept a combined total of 5 hours, on and off. So he started the day very tired.
Fortunately, Josh had a short day today. He had an x-ray at 8:00 then OT helped him dress at 8:30. Josh was able to mostly dress himself.
9:00 was PT. Josh rode a stationary bike for 15 minutes. He was very interested in the other patients in the room, so sometimes he would stop peddling altogether. But here is a video from when he started the exercise, before he got distracted.
After riding the bike, he went to a quiet room for flexibility testing. They wanted him to be as relaxed as possible, which worked to Josh's advantage because he was asleep as soon as he laid on the table. It was a win-win situation.
But Josh had to wake up at 10:00 for OT. He was tired and confused and didn't do well. She handed him a piece of paper that said:
NAME
AGE
DOG NAME
By NAME he wrote DAY
By AGE he wrote 19
By DOG NAME he wrote Day
She asked him if Day was his name, and he nodded that it was. She asked him to write his name again and he wrote "Argay." That was the end of that exercise.
Next, she handed him a piece of paper with a series of lines of different lengths. She pointed at a line and asked him to draw an "x" where he thought the middle of the line was. He seemed confused, so she showed him. Then she pointed at a different line and asked him to draw an "x" where he thought the middle of the line was. This time he took the pen and wrote the word "DAY" on the line. This continued until he'd written the word "DAY" on 8 lines. She moved on to a different exercise.
She pulled out a money box and put a penny, a nickel, a dime, and a quarter on the desk. She asked him to hand her a nickel. He did! Then she asked for a penny. He handed her a quarter. She told him the name of each coin and asked for a dime. He handed her a penny. This continued for quite some time. Apparently the nickel answer was just a lucky guess.
Next, she gave him 2 of each coin and 5 pennies. She asked him for 15 cents. He did it. She asked him for 20 cents. He gave her a quarter, but she said it was wrong and he gave her two dimes. As it turned out, 60% of the time Josh handed her the right coinage if she was asking for an amount that could be handled with 2 coins. If she asked for an amount that exceeded 2 coins (like 17 cents), he couldn't calculate it. The same thing happened with dollar bills. If she asked for $30, he could do it, but he could not do $32.
PT ended 30 minutes early, so during our free time I took Josh to a room that has letters and numbers on the wall. I asked him to point to "L." He couldn't find it. "M," "Q," etc. He couldn't find the numbers either. But if I asked him, "What letter is this?" or "What number is this," he knew the answer every time. If I asked, "What letter is this?" and he said, "N," then I said, "Point to the letter N," he couldn't find it.
Next came ST, and it was more torturous than PT was. It started well. She asked Josh to repeat a list of words: dog, church, envelope, etc. He got them all correct except the last one: refrigerator. He said "re-flig-ah-later." She asked him to say it again, and he gave the same answer.
She then asked him to copy sounds, like saying kah-kah-kah-kah-kah fast. He got all those right, even the really hard ones.
Next she showed him a book that had pictures on it; for example, a pencil, a building, a rhinoceros. Josh figured out pretty quickly that the same picture was on the other side of the page, but the other side of the page was multiple choice! He kept trying to cheat and look at the other side (not sneakily - he didn't think he was doing anything wrong, but he was insistent). Finally, the therapist let him choose the multiple choice side. Most of the answers he gave was the word on the top right. Four times the top right answer was correct, he chose a different answer. In all, he got about 7 of 50 pictures correct. He could read the multiple choice words, but he didn't choose the right one to go with the picture.
Next was a series of yes/no questions. Here are a few she asked:
Is your name Smith? He said yes.
Is your name Brown? He said yes.
Is your name Josh? He said yes.
Do you eat your banana before you peel it? He said yes.
Does it snow in July? He said yes.
Do you cut grass with an ax? He said yes.
Will a stone sink in water? He said no.
He got a few (maybe 5) of the questions right. Statistically speaking, with a 50/50 chance he should have done better than he did.
Next were a series of 2 opposing questions that had opposite answers, like these:
Is 2 pounds of flour more than 1? He said yes.
Is 1 pound of flour more than 2? He said yes.
He said yes to every single question asked in this series.
Next she asked him to point at objects. "Point to the chair." He pointed at his elbow. "Point to the clock." He clasped his hands. "Point to the pen." He had no idea where to go with that one. She handed him a pen and said, "Grab the pen." He did. She took it out of his hand. Holding the pen next to and in front of his good eye, she said asked him again to point to the pen. He looked all over the room and eventually pointed to the clock. He couldn't point to a book or the door either.
He was glad when that was over, and exhausted. He ate lunch (BBQ chicken, mashed potatoes and gravy, chocolate milkshake, chocolate milk, apple juice, 2 different types of vanilla yogurt, and a chocolate pudding - he didn't eat the chicken, potatoes, or apple juice, but finished the rest) then went to bed. He slept solid - and snoring - for an hour and a half.
When he woke up, we went for a long walk outside. This is one thing I really like about Craig Hospital. Within the confines of safety, they let the patient have as much autonomy as possible. This means that the BA ends up following the patient around, sometimes for long periods of time. There is one guy who walks in circles around our unit, and every other step he says, "Ow" or "No." One nurse told me that she followed a patient who walked around the unit all day. She said her pedometer registered 15 miles that day! It would take a lot of patience to be a BA here, but I think the flexibility and freedom is good for the patient.
The doctor stopped by to visit Josh this afternoon. He asked Josh, "Do you know where you are at?" Josh answered, "Craig!" That is the first time he got that question right, and he was told that answer only this morning during ST. That means he recalled something from earlier this morning! A sign of short-term memory! The doctor asked, "What kind of building is this?" (When the doctor asked him that question this morning, Josh answered "racetrack.") This time Josh answered, "Hospital." He'd been asked that questions a BUNCH of times before, but this is the first time he got the answer correct.
But Josh has a hard time coming up with words. The seat belt on his wheelchair locks with a key. He wheeled up to me, pointed at the lock, and asked, "Do you have a squeegle?" I told him that they haven't given me a key.
Tonight we went to the T-Rec (Therapeutic Recreation) room and played a bunch of games of Foosball. Josh won, and we only let him score the first two goals!
Craig Hospital's welcome packet included a list of unsavory behaviors common in TBI patients. One of those is "offensive language." Maybe Josh's diagnosis of "severe injury" accounts for his severe foul language today. I hope it doesn't get worse than it was today. Wow!
Josh didn't sleep well last night. They gave him Trazodone to help him sleep, but it had the opposite effect. Between 8:00 pm and 8:00 am, he slept a combined total of 5 hours, on and off. So he started the day very tired.
Fortunately, Josh had a short day today. He had an x-ray at 8:00 then OT helped him dress at 8:30. Josh was able to mostly dress himself.
9:00 was PT. Josh rode a stationary bike for 15 minutes. He was very interested in the other patients in the room, so sometimes he would stop peddling altogether. But here is a video from when he started the exercise, before he got distracted.
After riding the bike, he went to a quiet room for flexibility testing. They wanted him to be as relaxed as possible, which worked to Josh's advantage because he was asleep as soon as he laid on the table. It was a win-win situation.
But Josh had to wake up at 10:00 for OT. He was tired and confused and didn't do well. She handed him a piece of paper that said:
NAME
AGE
DOG NAME
By NAME he wrote DAY
By AGE he wrote 19
By DOG NAME he wrote Day
She asked him if Day was his name, and he nodded that it was. She asked him to write his name again and he wrote "Argay." That was the end of that exercise.
Next, she handed him a piece of paper with a series of lines of different lengths. She pointed at a line and asked him to draw an "x" where he thought the middle of the line was. He seemed confused, so she showed him. Then she pointed at a different line and asked him to draw an "x" where he thought the middle of the line was. This time he took the pen and wrote the word "DAY" on the line. This continued until he'd written the word "DAY" on 8 lines. She moved on to a different exercise.
She pulled out a money box and put a penny, a nickel, a dime, and a quarter on the desk. She asked him to hand her a nickel. He did! Then she asked for a penny. He handed her a quarter. She told him the name of each coin and asked for a dime. He handed her a penny. This continued for quite some time. Apparently the nickel answer was just a lucky guess.
Next, she gave him 2 of each coin and 5 pennies. She asked him for 15 cents. He did it. She asked him for 20 cents. He gave her a quarter, but she said it was wrong and he gave her two dimes. As it turned out, 60% of the time Josh handed her the right coinage if she was asking for an amount that could be handled with 2 coins. If she asked for an amount that exceeded 2 coins (like 17 cents), he couldn't calculate it. The same thing happened with dollar bills. If she asked for $30, he could do it, but he could not do $32.
PT ended 30 minutes early, so during our free time I took Josh to a room that has letters and numbers on the wall. I asked him to point to "L." He couldn't find it. "M," "Q," etc. He couldn't find the numbers either. But if I asked him, "What letter is this?" or "What number is this," he knew the answer every time. If I asked, "What letter is this?" and he said, "N," then I said, "Point to the letter N," he couldn't find it.
Next came ST, and it was more torturous than PT was. It started well. She asked Josh to repeat a list of words: dog, church, envelope, etc. He got them all correct except the last one: refrigerator. He said "re-flig-ah-later." She asked him to say it again, and he gave the same answer.
She then asked him to copy sounds, like saying kah-kah-kah-kah-kah fast. He got all those right, even the really hard ones.
Next she showed him a book that had pictures on it; for example, a pencil, a building, a rhinoceros. Josh figured out pretty quickly that the same picture was on the other side of the page, but the other side of the page was multiple choice! He kept trying to cheat and look at the other side (not sneakily - he didn't think he was doing anything wrong, but he was insistent). Finally, the therapist let him choose the multiple choice side. Most of the answers he gave was the word on the top right. Four times the top right answer was correct, he chose a different answer. In all, he got about 7 of 50 pictures correct. He could read the multiple choice words, but he didn't choose the right one to go with the picture.
Next was a series of yes/no questions. Here are a few she asked:
Is your name Smith? He said yes.
Is your name Brown? He said yes.
Is your name Josh? He said yes.
Do you eat your banana before you peel it? He said yes.
Does it snow in July? He said yes.
Do you cut grass with an ax? He said yes.
Will a stone sink in water? He said no.
He got a few (maybe 5) of the questions right. Statistically speaking, with a 50/50 chance he should have done better than he did.
Next were a series of 2 opposing questions that had opposite answers, like these:
Is 2 pounds of flour more than 1? He said yes.
Is 1 pound of flour more than 2? He said yes.
He said yes to every single question asked in this series.
Next she asked him to point at objects. "Point to the chair." He pointed at his elbow. "Point to the clock." He clasped his hands. "Point to the pen." He had no idea where to go with that one. She handed him a pen and said, "Grab the pen." He did. She took it out of his hand. Holding the pen next to and in front of his good eye, she said asked him again to point to the pen. He looked all over the room and eventually pointed to the clock. He couldn't point to a book or the door either.
He was glad when that was over, and exhausted. He ate lunch (BBQ chicken, mashed potatoes and gravy, chocolate milkshake, chocolate milk, apple juice, 2 different types of vanilla yogurt, and a chocolate pudding - he didn't eat the chicken, potatoes, or apple juice, but finished the rest) then went to bed. He slept solid - and snoring - for an hour and a half.
When he woke up, we went for a long walk outside. This is one thing I really like about Craig Hospital. Within the confines of safety, they let the patient have as much autonomy as possible. This means that the BA ends up following the patient around, sometimes for long periods of time. There is one guy who walks in circles around our unit, and every other step he says, "Ow" or "No." One nurse told me that she followed a patient who walked around the unit all day. She said her pedometer registered 15 miles that day! It would take a lot of patience to be a BA here, but I think the flexibility and freedom is good for the patient.
The doctor stopped by to visit Josh this afternoon. He asked Josh, "Do you know where you are at?" Josh answered, "Craig!" That is the first time he got that question right, and he was told that answer only this morning during ST. That means he recalled something from earlier this morning! A sign of short-term memory! The doctor asked, "What kind of building is this?" (When the doctor asked him that question this morning, Josh answered "racetrack.") This time Josh answered, "Hospital." He'd been asked that questions a BUNCH of times before, but this is the first time he got the answer correct.
But Josh has a hard time coming up with words. The seat belt on his wheelchair locks with a key. He wheeled up to me, pointed at the lock, and asked, "Do you have a squeegle?" I told him that they haven't given me a key.
Tonight we went to the T-Rec (Therapeutic Recreation) room and played a bunch of games of Foosball. Josh won, and we only let him score the first two goals!
The last thing to happen today (worth writing about) was when our nurse told me that Joshua's blood clot is a left subclavian DVT. That means it is beneath his left clavicle, between the clavicle and the first rib. She explained to me signs of pulmonary embolism (PE) and told me to get help immediately if I see any of the signs. Both DVT and PE are recognized as serious entities with life-threatening consequences. In fact, more people die annually from blood clots than breast cancer and AIDS combined. Blood clots in the upper body are more dangerous than those in the lower extremities, and a subclavian DVT is more dangerous than a blood clot lower in the arm. Treatment for this is increased Lovenox doses, Coumadin, and a baby aspirin every morning. This means daily blood draws for the next three months (to check the thickness of his blood). My bet is that with the increased frequency in blood draws, our future holds a lot more swearing than we heard today.
Thank you for including pictures! Do the various therapists tell you the things that are typical for a TBI like Josh's?
ReplyDeleteNo. They tell us what is typical for ALL TBIs, but nothing that is specific to Josh's injury. All they say is that each injury is individual and each recovery is individual, so we just have to wait to see what happens. It's one of the frustrating things because we don't have a benchmark to see where he "should" be at this stage.
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