It is now over six weeks since Jim's accident. At lunchtime today, I had a meeting with the professional rehabilitation staff at the Wilson Centre, and we agreed that it was time for Jim to return home. The original plan was to meet and assess him on February 10, but we all agreed that his recovery has been so rapid that there was no need for him to stay in the Centre at night from this point onwards.
The plan this weekend was for Jim to visit home for two nights, and we were all very pleased to learn that this visit is to be permanent. He will still return to the Wilson Centre each day during the coming weeks for specific therapy and school lessons, but will eat and sleep at home. On February 10, this plan will be reviewed again.
Physically, Jim has essentially returned to his old self. He has several scars (on his skull, chest, arm and neck) but these are fading fast. He will wear his neck brace for another two weeks, after which we expect it to disappear. His only medication is now two penicillin tablets per day to ward off infection that a spleen might have prevented. He appears to walk and balance well, and has essentially regained all physical motor functions.
The next big challenge for Jim will be dealing with school. It is in this environment where his recovery will be tested. He will get tired quickly and find that his memory recall will frustrate him at times. We were also told today that he may have some difficulties in scheduling and planning activities. In the past his memory recall has been sufficiently powerful that he has not needed to keep a diary for school. As he goes into Year 12, his penultimate year of high school, he will find that this won't work anymore, and he will need to learn a whole new set of techniques for organising his time and his life.
This weekend will be a big celebration in our house, as the Philpott family feels complete once again. We have nothing but unqualified praise and admiration for all the expertise and courage of paramedics, surgeons, ICU doctors, nurses, and rehabilitation professionals for helping get Jim back to us. Jim will be saying thank you in person to many people over the next few weeks.
As I write these sentences, I realize that it is time to draw the About Jim blog to a close. I hope that it has helped everyone keep up with what has been happening. I have found it very therapeutic to write, and I know that Jim will appreciate reading about two and a half weeks of his life that he cannot remember. What our family have appreciated more than we can say are the posted comments, emails, and other support that we have received from everyone reading this. Your faith, prayers and good wishes gave us the miracle we hoped for.
Friday, January 29, 2010
Monday, January 18, 2010
Five weeks
By the time this blog entry is posted, it will be five weeks since Jim had his accident. He has made remarkable progress over that time, and is now ready to begin the slow process of moving from the Wilson Center back home to Mount Albert.
This evening Jim told me that he had passed his physiotherapy basic training test this morning with a score of 56/56. The test involves balance and basic coordination tasks like walking unaided, climbing steps, and picking up objects off the floor. Last Monday, Jim's score was 32/56 and the week before that he scored 5/56. I am guessing that 100% means that he moves to the next level, whatever that entails.
Next Monday is the six-week milestone, where he will be assessed for having his neck brace removed or replaced by something less obtrusive. The neck brace is the last vestige of medical equipment that indicates, apart from his healing scars, that Jim is an invalid. He is very keen to see it go and at last be able to swim and shower freely, as well as cut the unreachable rat's tail of hair growing at the base of his skull.
Jim now routinely walks around his room and the Wilson Centre without assistance or even anyone noticing, so it is time to test him out on some less familiar terrain. One successful excursion this morning involved him climbing down about 100 steps to the beach and then climbing up again. On Thursday, he will visit the family home in Mount Albert with his physiotherapist to assess it for safety. If this works out, then Jim will come home for a day on Saturday, to be lengthened to possibly two days the following weekend. We are hoping that he might get at least one day a week at school in February, but will assess this when the time comes.
This evening Jim told me that he had passed his physiotherapy basic training test this morning with a score of 56/56. The test involves balance and basic coordination tasks like walking unaided, climbing steps, and picking up objects off the floor. Last Monday, Jim's score was 32/56 and the week before that he scored 5/56. I am guessing that 100% means that he moves to the next level, whatever that entails.
Next Monday is the six-week milestone, where he will be assessed for having his neck brace removed or replaced by something less obtrusive. The neck brace is the last vestige of medical equipment that indicates, apart from his healing scars, that Jim is an invalid. He is very keen to see it go and at last be able to swim and shower freely, as well as cut the unreachable rat's tail of hair growing at the base of his skull.
Jim now routinely walks around his room and the Wilson Centre without assistance or even anyone noticing, so it is time to test him out on some less familiar terrain. One successful excursion this morning involved him climbing down about 100 steps to the beach and then climbing up again. On Thursday, he will visit the family home in Mount Albert with his physiotherapist to assess it for safety. If this works out, then Jim will come home for a day on Saturday, to be lengthened to possibly two days the following weekend. We are hoping that he might get at least one day a week at school in February, but will assess this when the time comes.
Tuesday, January 12, 2010
Four weeks
It is now just over four weeks since Jim had his accident. It is tempting to suppose that he has almost made a full recovery, and he continues to amaze us and his nurses with his progress. However we were reminded today by experts in brain injury of the dangers of rushing his rehabilitation. Slow and steady improvement is recommended as the optimal trajectory towards the best possible final outcome. Trying to force through improvements in Jim's capabilities too early might cause exhaustion and result in longer term disability. So it might be some weeks before Jim can come back home on a full-time basis.
On a more positive note, Jim's mobility has increased markedly this week. I watched him score highly on tests involving standing and walking this morning, and this afternoon he told me he had walked for 60 metres in 60 seconds essentially unaided. This has improved his confidence and morale immensely. He is obviously very keen to regain his health and return home.
Yesterday afternoon Jim almost went too far. On his own in his bed, he decided he would get up and walk to his wheelchair that was in the far corner of the room, rather like "Andy" in the "Little Britain" comedy sketch. He did so, and then having moved around in the wheelchair decided to return to his bed. He was discovered standing dizzily on his way back to bed by an understandably alarmed nurse. He has realized the risks of sustaining further injury by falling and and so will not be repeating this effort.
Jim's short-term memory has also improved a lot over the last few days. He has scored 100% on the simple memory tests he has been given. His language capabilities seem unimpaired though sometimes he struggles to find some words for concepts he knows. Examples are "laxative" and "kettle". He also says "basically" a lot, but I suspect he might have done this before the accident.
Jim's medication has also been drastically reduced. He no longer requires hypodermic shots in his stomach, his anxiety-reducing medicine has been stopped, and he is on very limited pain relief. Without a spleen, he still requires daily antibiotic pills for the next two years.
Jim is happy to see visitors at the Wilson Centre, but during the week he is very busy with physiotherapy and other commitments, so he may not be free when visitors come. The best time to see him is between 4 and 5 pm. For other times, it is best to check with Brigie about his availability.
On a more positive note, Jim's mobility has increased markedly this week. I watched him score highly on tests involving standing and walking this morning, and this afternoon he told me he had walked for 60 metres in 60 seconds essentially unaided. This has improved his confidence and morale immensely. He is obviously very keen to regain his health and return home.
Yesterday afternoon Jim almost went too far. On his own in his bed, he decided he would get up and walk to his wheelchair that was in the far corner of the room, rather like "Andy" in the "Little Britain" comedy sketch. He did so, and then having moved around in the wheelchair decided to return to his bed. He was discovered standing dizzily on his way back to bed by an understandably alarmed nurse. He has realized the risks of sustaining further injury by falling and and so will not be repeating this effort.
Jim's short-term memory has also improved a lot over the last few days. He has scored 100% on the simple memory tests he has been given. His language capabilities seem unimpaired though sometimes he struggles to find some words for concepts he knows. Examples are "laxative" and "kettle". He also says "basically" a lot, but I suspect he might have done this before the accident.
Jim's medication has also been drastically reduced. He no longer requires hypodermic shots in his stomach, his anxiety-reducing medicine has been stopped, and he is on very limited pain relief. Without a spleen, he still requires daily antibiotic pills for the next two years.
Jim is happy to see visitors at the Wilson Centre, but during the week he is very busy with physiotherapy and other commitments, so he may not be free when visitors come. The best time to see him is between 4 and 5 pm. For other times, it is best to check with Brigie about his availability.
Friday, January 8, 2010
The Wilson Centre
On Wednesday, Jim moved from Auckland Hospital Ward 81 to the Wilson Centre, a rehabilitation unit at Takapuna on Auckland's North Shore. He was a bit apprehensive about this at first but he is quite happy now that he has settled into a routine of physiotherapy and exercise that relieves the tedium of lying in bed. Jim's appetite is returning and he is also sleeping better.
Jim has had sessions of physiotherapy yesterday and today and is already showing signs of progress in his right-hand side. His right arm is a lot more mobile now, and he appears to be using his right hand quite freely. He can now wiggle the toes on his right foot (though not quite like the left), and with help from the staff at the Centre he has tried walking with a frame and on the treadmill. This has been made easier by a splint for his right foot to keep it straight. Taking his first steps in nearly a month has lifted Jim's morale enormously, and he can now clearly see a time in the near future when he will be coming home.
Jim has had sessions of physiotherapy yesterday and today and is already showing signs of progress in his right-hand side. His right arm is a lot more mobile now, and he appears to be using his right hand quite freely. He can now wiggle the toes on his right foot (though not quite like the left), and with help from the staff at the Centre he has tried walking with a frame and on the treadmill. This has been made easier by a splint for his right foot to keep it straight. Taking his first steps in nearly a month has lifted Jim's morale enormously, and he can now clearly see a time in the near future when he will be coming home.
Wednesday, January 6, 2010
Three weeks plus
It is now just over three weeks since Jim had his accident. We are amazed at the progress he has made in that short time. His ability to form short-term memories is starting to return, and he now has recalled events of December 14 leading up to his accident. This is good news as some brain injury patients can lose all memories up to a month or so before their accidents. Such a loss generally has a poorer prognosis.
As Jim recovers he is becoming less satisfied with his lot. He desperately wants to come home from hospital and salvage something of his remaining summer holidays. He has complained repeatedly to us that he was asleep for half of December missing Christmas and New Year. Although these complaints can get irritating given how lucky Jim has been, we see them as encouraging signs of the return of his self awareness.
We have just confirmed with Auckland hospital that Jim will be leaving hospital today at lunchtime to move to the Wilson Centre in Takapuna, where he will start his physical therapy. Much of this will involve learning to walk again, and restoring movement to his right side, in particular his broken shoulder. Jim will also be working on his short-term memory and social awareness. We are optimistic about his prospects, and hope that his time in the Wilson Centre will not be too long so he can come home before the beginning of the school year in February.
As Jim recovers he is becoming less satisfied with his lot. He desperately wants to come home from hospital and salvage something of his remaining summer holidays. He has complained repeatedly to us that he was asleep for half of December missing Christmas and New Year. Although these complaints can get irritating given how lucky Jim has been, we see them as encouraging signs of the return of his self awareness.
We have just confirmed with Auckland hospital that Jim will be leaving hospital today at lunchtime to move to the Wilson Centre in Takapuna, where he will start his physical therapy. Much of this will involve learning to walk again, and restoring movement to his right side, in particular his broken shoulder. Jim will also be working on his short-term memory and social awareness. We are optimistic about his prospects, and hope that his time in the Wilson Centre will not be too long so he can come home before the beginning of the school year in February.
Sunday, January 3, 2010
Live long and prosper
As Jim's recovery continues we are now updating the blog less frequently. Despite the occasional flat spot, he continues to amaze us with quantum improvements in capability.
Yesterday, there was not much to report. Jim was distressed when he woke at 7 am and sent continual text messages to us requesting our presence in ward 81, which is impossible because it is closed before 11 am. This means he had four hours to kill in the morning that he told us was very irritating and distressing. But when we visited he was happy and responsive, although his short-term memory was still showing signs of impairment.
Yesterday evening he appeared less distressed than previous evenings. I "shared" a hospital meal with him that for the first time he ate with some enthusiasm (or at least absence of disgust). This is another step forward in building his strength and morale. He talked about a wide range of things ranging from the discoveries of Galileo to the massacres in Rwanda, interspersed with his occasional excursions into the surreal.
This morning the text messages were less panicked and appeared less frequent. We visited from 11 am when ward 81 opens to 1 pm, when the ward closes. We have started to test Jim's short-term memory. I asked him to list his Christmas presents, and he could not at first, but with concentration by the end of the visit he could list the four major presents and describe each one. He also recalled something I had said on the phone to him (that I had actually forgotten saying).
This evening's visit made Jim very happy. Some of his closest friends from school paid him a visit. He was very pleased to see them. He also had a home-cooked meal which he ate with gusto. To our suprise, he could recall all his Christmas presents without any prompting.
In my previous post I mentioned that the "motor strip" that controls the right side body movements is on the left side of the brain, a region that was bruised in Jim's injury. This means that delicate finger movements in his right hand might take time to reappear. This evening Jim gave us a demonstration of his right hand dexterity. He could reproduce finger and thumb opposing movements easily. When we asked him for Mr Spock's Vulcan salute he obliged with both hands and then showed variations of it with his right hand that he had practised in those empty hours of time that teenagers fill with who knows what. I am not sure whether Star Trek imitations lie in a different part of the brain, but his dexterity leaves us very optimistic about the return of his right side motor skills.
Yesterday, there was not much to report. Jim was distressed when he woke at 7 am and sent continual text messages to us requesting our presence in ward 81, which is impossible because it is closed before 11 am. This means he had four hours to kill in the morning that he told us was very irritating and distressing. But when we visited he was happy and responsive, although his short-term memory was still showing signs of impairment.
Yesterday evening he appeared less distressed than previous evenings. I "shared" a hospital meal with him that for the first time he ate with some enthusiasm (or at least absence of disgust). This is another step forward in building his strength and morale. He talked about a wide range of things ranging from the discoveries of Galileo to the massacres in Rwanda, interspersed with his occasional excursions into the surreal.
This morning the text messages were less panicked and appeared less frequent. We visited from 11 am when ward 81 opens to 1 pm, when the ward closes. We have started to test Jim's short-term memory. I asked him to list his Christmas presents, and he could not at first, but with concentration by the end of the visit he could list the four major presents and describe each one. He also recalled something I had said on the phone to him (that I had actually forgotten saying).
This evening's visit made Jim very happy. Some of his closest friends from school paid him a visit. He was very pleased to see them. He also had a home-cooked meal which he ate with gusto. To our suprise, he could recall all his Christmas presents without any prompting.
In my previous post I mentioned that the "motor strip" that controls the right side body movements is on the left side of the brain, a region that was bruised in Jim's injury. This means that delicate finger movements in his right hand might take time to reappear. This evening Jim gave us a demonstration of his right hand dexterity. He could reproduce finger and thumb opposing movements easily. When we asked him for Mr Spock's Vulcan salute he obliged with both hands and then showed variations of it with his right hand that he had practised in those empty hours of time that teenagers fill with who knows what. I am not sure whether Star Trek imitations lie in a different part of the brain, but his dexterity leaves us very optimistic about the return of his right side motor skills.
Friday, January 1, 2010
New Year
Jim is now entering the third phase of his recovery. Yesterday morning his feeding tube was taken out as well as the IV line in his hand. The only surgical devices that he is still wearing is a neck brace for his neck injury. Losing the tubes has been a big step forward for Jim as they have been a continual source of irritation, and he has often tried to pull them out. Now he is focusing all his frustration on the neck brace, though this really only happens when he starts to get tired.
The third phase of Jim's treatment will involve rehabilitation to learn to walk and use his right hand again, as well as retraining his short-term memory and socialization. He is regaining a lot of movement on his right side but it is not clear how complete the recovery will be. We are told that large-scale movements like walking and moving his right arm will come fairly easily, but that delicate right-hand finger skills might take more time. The "motor strip" that controls the right side body movements is on the left side of the brain, a region that was bruised in Jim's injury. The fact that Jim is left handed has helped him a lot here, as this means he can still write easily. Moreover, in left handers, the capacity for language lies in the right brain hemisphere. This escaped injury and so Jim can speak without difficulty. The ability to communicate will help in rehabilitation.
The longer term aspects of Jim's rehabilitation involve restoring his ability to form memories. His memories of events prior to his accident and plots of television shows or novels is very good. This afternoon we listened as he gave us a complete plot synopsis of the television series "Breaking Bad". However Jim currently has very little short-term memory recall. For example, he comes up with some bizarre explanations for his plight. He has difficulty recalling our previous visits, and often thinks that we are seeing him for the first time in months. We are confident that his short-term memory capacity will return with rehabilitation, but have no idea of how long this will take.
The other aspect of phase three is becoming socialized again. In his current state, Jim is without inhibition, a feature of people with brain injuries at this stage. The mechanisms for sensing and correcting inappropriate behaviour are malfunctioning. Jim's conversation is a stream of his own consciousness which is very revealing and endearing, but can be too honest. He needs to learn to be reticent again.
So phase three involves restoring all this and more. It is a long and arduous process. Jim will be assessed on January 5th for transfer into a rehabilitation clinic where phase three will begin in earnest, probably at the end of the coming week.
Jim is eager to see his friends, but he tires easily. He is now out of the ward with restricted entry to two people at a time, and so he would be overwhelmed if too many visitors show up at once or for too long. As a default, Brigie and I would like to keep visitors to close family for a few more days.
The third phase of Jim's treatment will involve rehabilitation to learn to walk and use his right hand again, as well as retraining his short-term memory and socialization. He is regaining a lot of movement on his right side but it is not clear how complete the recovery will be. We are told that large-scale movements like walking and moving his right arm will come fairly easily, but that delicate right-hand finger skills might take more time. The "motor strip" that controls the right side body movements is on the left side of the brain, a region that was bruised in Jim's injury. The fact that Jim is left handed has helped him a lot here, as this means he can still write easily. Moreover, in left handers, the capacity for language lies in the right brain hemisphere. This escaped injury and so Jim can speak without difficulty. The ability to communicate will help in rehabilitation.
The longer term aspects of Jim's rehabilitation involve restoring his ability to form memories. His memories of events prior to his accident and plots of television shows or novels is very good. This afternoon we listened as he gave us a complete plot synopsis of the television series "Breaking Bad". However Jim currently has very little short-term memory recall. For example, he comes up with some bizarre explanations for his plight. He has difficulty recalling our previous visits, and often thinks that we are seeing him for the first time in months. We are confident that his short-term memory capacity will return with rehabilitation, but have no idea of how long this will take.
The other aspect of phase three is becoming socialized again. In his current state, Jim is without inhibition, a feature of people with brain injuries at this stage. The mechanisms for sensing and correcting inappropriate behaviour are malfunctioning. Jim's conversation is a stream of his own consciousness which is very revealing and endearing, but can be too honest. He needs to learn to be reticent again.
So phase three involves restoring all this and more. It is a long and arduous process. Jim will be assessed on January 5th for transfer into a rehabilitation clinic where phase three will begin in earnest, probably at the end of the coming week.
Jim is eager to see his friends, but he tires easily. He is now out of the ward with restricted entry to two people at a time, and so he would be overwhelmed if too many visitors show up at once or for too long. As a default, Brigie and I would like to keep visitors to close family for a few more days.
Subscribe to:
Posts (Atom)