Written by: Yaffa Liebermann PT,GCS, CEO
1979 – 1983 Spinal Cord Injury in Towers Rehabilitation Center at UVA
Towers Rehabilitation Center was an intermediate unit between the acute hospital and the Woodrow Wilson Rehabilitation Center which prepared the patients to be discharged home. The therapists could treat four patients per day. The patients would go to PT in the morning for three hours and in the afternoon they would go to OT. There was a great multidisciplinary system in place for all of the doctors, nurses, therapists, and social workers. We had our care plan meeting on Tuesdays where we were all sitting together and took turns rounding on patients. The intermediate stage was where the patient was learning how to deal with his injury and the loss of his ability to walk. However, most patients did not yet reach the stage of acceptance.
Our therapy aide said, “I’d like to trade places with a patient for one day to see what it feels like.” The patient with a C7 injury replied, “You give me back the strength in my legs for one day and I will run so fast that you will never see me back here.” He also explained that trying to sit and work on his sitting balance felt like trying to sit and stabilize yourself in the ocean. He said that his wrist muscles were so weak that lifting half a pound would compare to someone else lifting 100 pounds. After he said to me, “It takes only 60 seconds to put on a seat belt to prevent yourself from being paralyzed for the rest of your life,” I established a rule in my family that we never leave our driveway without a seatbelt on.
Reteaching your muscles how to work in reverse:
Patients who suffered a spinal cord injury between C4 – C7 do not have many working muscles. We had to teach the patients how to use each individual muscle that was still innervated, in reverse. For example, the biceps are generally elbow flexors, but because we had to use every muscle possible, we would teach them how to use their biceps as elbow extenders. This would provide them with the ability to push and hold themselves up.
Contraction of back and finger muscles:
Our program prepared patients for dressing independent. We would stretch their hamstrings so that they could keep their legs straight. We would purposefully not stretch their back muscles as we would want their back muscles to become contracted and stiff, which would help them sit up straight. That would give the patient balance while leaning on the back of the bed to dress himself.
We would allow the patients’ fingers to get contracted in flexion. This would allow the patient with a C7 injury to use his wrist extensor to hook his hand under his thigh in order to move it from the chair to the bed. He could then also hold a cup using his contracted fingers flexors to drink safely.
Transfer – The head goes in the opposite direction of the buttocks:
Some of the patients with SCI had only a few working trunk muscles. They needed to learn how to
transfer from the wheelchair to the bed. We followed the rules of physics to practice transfers. If the patient needed to transfer from the wheelchair to the bed on his right side, he would move his head to the left, to eliminate full weight bearing on his right moving buttock. If the patient slipped forward and he had to be moved back into the chair, he needed to move his head forward, “nose over toes” and then we would push him backward into the chair. I used this technique ever since with every patient. I have taught therapists and caregivers to use this correct body mechanics technique in order to save their backs and help patients move more easily.
Patients with positive and negative attitudes:
It was very interesting to see the relationship amongst patients and medical staff. When a pleasant and happy patient was admitted to the unit, the nurses and therapists were serving him with love and happiness and were around to help him throughout the day. When a patient with a negative attitude came along, the staff did whatever they needed to do, professionally, however they did not spend any extra time with the patient.
Compliments for the patients:
Over the years, I learned that giving honest compliments to patients helps their self-esteem and restores their pride, thereby resulting in quicker recovery. A 40 year old patient came to us
from the psychiatric department diagnosed with deep depression and shoulder dysfunction. She was dressed in a dirty gown and her hair was all over. During my evaluation, she informed me that she was a principal in elementary school for over 2000 children. I immediately gave her a compliment that this was a great achievement to oversee so many staff, students, and parents. The next day she entered the department standing up straight, dressed well, with nice clothes and make up. My supervisor asked me what I had done in the evaluation to create such a change. I answered that I had just given her a few compliments.
Ever since then, I have used the tool of providing honest compliments to patients in every treatment. It always works. People thrive when complimented because they feel seen and appreciated.
Objective discussions with patients:
When I had to explain to the patient his medical status, I started by using basic, non-medical terminology. Some people wanted very detailed descriptions while others just wanted a basic description. Between these two extremes there are many levels of desire for information. I never underestimated a person by talking too simply, but I also tried not to overload the person with too many details. I watched their faces during the conversation and adjusted the chosen words to ensure that they understood.
A patient suffered from a fractured vertebra that left him with incomplete paraplegia. During medical rounds, he received the explanation that his fracture squeezed the nerves of the lower extremity muscles and affected the strength of his legs. This created partially paralyzed muscles resulting in his difficulty to ambulate. His prognosis indicated that he might recover with time. The patient looked at the group of professionals with respect. But when they walked away, he asked me what the word “fracture” meant! I choose a simple metaphor to help him understand his prognosis. “Our nerves are like a garden hose that water is running through. If someone steps on the hose, it blocks off the water and none will come out. But when the person takes their foot off the hose, the water will begin to flow again. This is the same situation with our nerves: the accident squeezed the nerve and interfered with the line of communication between the brain and the muscle, but when the pressure from the nerve is lifted, the communication will flow again.” He understood his medical status and prognosis using a metaphor.
Relationship with the Director:
I learned to support and respect my therapy director’s decisions. Everyone has a point of view and a vision about the way they would like the program to develop. If I did not agree with a particular decision, I tried to understand the reason behind the decision. When I wished to change his mind, I would talk to him privately and explained my reasoning in a positive manner. Then people listen and weigh the suggestion seriously. It is all about supporting the supervisor to create and keep a good team in the department.
In 1982, I gave birth to twins: a son and a daughter. When they were six months old, we returned to Israel. It was an adjustment to go back and live in my native country. More to come.