New Wheels

Today Bob got a new wheelchair. This one is lighter than his last and Bob can use his left foot to help move forward as it doesn't rest on any kind of support like his right foot does. My mom said he has gained significant independence already, going out of his room by himself and strolling around the cafeteria by himself.

During physical therapy today Bob used the lokomat again. Bob also had occupational therapy and speech therapy. Caitlin, Bob's speech therapist practiced saying "Mark" with him and he did a great job. Below is the video shot by my mom. Tune in until the end when the always joyful Caitlin finally convinces Bob to turn to the camera and he displays the famous "meh" face:

Bob continues to improve and impress. We are happy with his progress. Thanks for reading and keep the positive thoughts and prayers coming. 

An improvement in mobility

Today Bob had all three therapies as well as occupational therapy group. He also had an ultrasound this morning to examine his liver. Bob's doctor wanted to take a closer look to see why some blood tests had come out abnormal. We will have the results tomorrow.

Tomorrow Bob will be fitted for a custom made plastic support for his right leg and foot. I mentioned this kind of support about a week ago on the blog after I spent last thursday observing his many therapies. Bob wore a generic one during his physical therapy session. It is made of a hard plastic and it is in the shape of an "L". It goes from his toes to just below the back of his knee. It is fastened by Velcro straps and its purpose is to prevent his right foot from flopping down. Without this Bob could easily trip on his own foot as it would drag on the floor when he lifts his right leg off the floor.

Today Bob walked from the toilet to his bed using the help of the one sided walker (whose proper name is hemi-walker). The nurse hovered to provide help if he needed it, but Bob did not need her assistance. My mom spoke with Bob's physical therapist and he thinks Bob's mobility will be 50% wheelchair and 50% walker.

During speech therapy today Bob practiced more opposites including "up and down" and then during occupational therapy Bob said "up and down" as he did reps!

I went to visit Bob today with my kids this afternoon and we spent some time together in the sun room. We watched him play the first advanced card on the traffic game. Before staring, Bob lined up all the cars by size. He completed the card in less than five minutes. After that Bob played the letter tile game and got all three words. If he keeps this up through the weekend, next week Bob will graduate to five letter words.

That's all for today. Thanks for reading and keep the positive thoughts and prayers coming.

Uncertainty

Today Bob had all three therapies plus the occupational therapy group. He also spent some more time outside taking advantage of another warm day by the Charles.

During occupational therapy Bob moved his right arm on a special "skate board". Here is a video of it:

The range of motion Bob has is impressive. Considering that is the arm that is supposed to be paralyzed! Bob still can't move his wrist or hand and he must wear a brace that holds his right arm at the shoulder in order to prevent it from being dislocated. The physical therapist explained to me that Bob's right arm is sort of dead weight, Bob's muscles can't hold it in place. But the video shows that Bob is gaining some muscle control back. How much will he regain is anybody's guess.

One of the hardest parts about watching Bob recover is the feeling of not knowing what is going to happen next. My mom met Bob's case manager today and his team of therapists and doctor did not change their previous goals from the last assessment. His target discharge date is still April 5th. Today is about the half way point of Bob's stay at Spaulding and it is hard not to want more improvements than the ones outlined by Bob's team. We want him to come home walking and able to communicate better. We want him to be more independent. Bob deserves so much more than this.

It is difficult to make arrangements for the next phase of Bob's recovery because we don't know how much more he will improve in the coming weeks. The team has asked my mom to make a decision by the end of next week regarding where she would prefer Bob to be: at a skilled nursing facility or home. Despite feeling insecure about such a huge decision, my mom has taken proactive steps towards the future. She has visited skilled nursing facilities and met with companies that install stair lifts and ramps in their house. My mom has had extensive talks with Bob's therapists regarding his future. The one person I know she would love advice from is Bob. I really wish he could express to her what he wants, how he feels, and what he is thinking. Maybe someday.

Thanks for reading and keep the positive thoughts and prayers coming.

Opposites

Today Bob had occupational therapy, group occupational therapy, speech therapy, and physical therapy. A busy day.

During physical therapy Bob practiced walking with the one-sided walker. This time he did it with the help of just one therapist. When I saw him last Thursday, he was being helped by two therapists. Bob also practiced walking up and down steps. These steps are shorter than most, just six inches tall. Dan is doing most of the work with the steps at this point.

Caitlin, the speech therapist, practiced saying opposites with Bob today. They did this in a sing-songy voice. Bob did well repeating the words, some examples are "up and down", "boy and girl", "all and none", "stop and go". He did all of these well except the last one. Bob said "top" instead of "stop". Caitlin said this is the same kind of mistake toddlers make when when they are learning how to speak. The therapist did not play the tiles game with Bob, she assigned that task to my mom. She will do three words a day during the week and ten on the weekends.

My son and I visited today and we brought a present, a tangram puzzle game. They proved too hard (even for this math teacher) but Bob played it by copying the solutions to create the shapes from the book. Bob did play two more cards from the traffic game and found them to be very easy despite the fact the cards were for intermediate boards.

My mom took Bob for a walk outside to take advantage of the warm weather. They spent about twenty minutes taking in the fresh air. Bob enjoyed the ducks swimming along the Charles river.

Today is Bob's third week anniversary at Spaulding. He has progressed well and we are looking foreword to the next three weeks there. Thanks for reading and keep the positive thoughts and prayers coming.

Puppies!

Today Bob had no therapies as it was Sunday and it was his rest day. He was in good spirits as usual. My mom went to spend the day and they were visited by their friends Bruce and Simone in the afternoon.

There was puppy therapy today and Bob loved petting the little guys who kept him smiling and happy.

The nurse that helped him with his bath said Bob put on his shirt completely by himself today for the first time. Each day Bob is a little more independent than the day before, relying less on other people's help. Bob is progressing well. Thanks for reading and keep the positive thoughts and prayers coming.

Horners come to visit

Today Bob was up early and had speech therapy at eight in the morning. Then he got a visit from the barber and got his hair cut. My mom had asked for the barber to wait for her to get there, but he didn't so the barber cut Bob's hair shorter than usual. I think he looks good, he has a military hair style now, it reminds me of major dad. Does anyone remember that show?

Bob played the letter tile game before lunch and then did a few more words after lunch. He had occupational therapy group at one. He will have this group every saturday at one and at ten during weekdays. Bob played the traffic game in the afternoon after the group. He did the first card on his own and the second one with my mom. They are getting more challenging!

My cousin Celina came to visit with her husband Geoff and sons Samuel and Alex. Geoff took the boys to the museum of science after visiting with Bob for a little bit then he came back for Bob's dinner time. That's when I arrived with my family. There were ten of us hanging out in the sunny room. Bob had a good time watching the kids bounce around the room. He was in a good mood as usual. Here is a picture of the Horners with Bob:

Notice the glove on Bob's right hand. My mom said it has already reduced the swelling significantly.

Tomorrow Bob will have a break from therapy and have the established sunday visit from friends Bruce and Simone. Thanks for reading and keep the positive thoughts and prayers coming.

Stair Lift News

Today Bob had his three therapies as well as occupational therapy group. He hasn't had speech group because the other patients that were in his group have left Spaulding. Since we all thought it was a valuable experience for Bob to attend this group, my mom is trying to reinstate it with patients from other floors. 

Amanda, Bob's occupational therapist, is making him wear a glove on his right hand to help the swelling go down. He is still sleeping with that support that goes up to his elbow. 

Dan, Bob's physical therapist, practiced climbing stairs with Bob today. As some of you may know, my parents house has two floors and the second floor is where the bedrooms and showers are. This week my mom had stairlift companies over their house to give her an estimate for two lifts. One from the basement to the first floor and another from the first floor to the second. This later one would cost more money because it would have to be custom made to fit the initial curvature of the stairs. One of the companies suggested putting in a regular stairlift after the first three curved steps because this would significantly reduce the cost as long as Bob could handle climbing a few steps in his own. Upon discussing these options with Dan, he suggested installing just one lift from the basement to the first floor, since it would be more utilized. He thinks it might be worth waiting to install the other stairlift because Bob might be able to handle climbing those stairs just once or twice a day. After seeing Bob take all those steps yesterday and knowing that Bob still has four more weeks at Spaulding, I believe there is a lot of room for improvement in the weeks ahead.


In the afternoon my mom took Bob to the cafeteria where he had an iced tea and played another card from the traffic game. It was tough, but he again persevered through it and finished it. 


The weekend will bring another out of state visit: My cousin Celina and her family! I'll report on that tomorrow. Thanks for reading and keep the positive thoughts and prayers coming.

First hand account

Today I spent the morning with Bob. I was there for his physical therapy, speech therapy, lunch and occupational therapy. I saw first hand how hard he works everyday. It was great, I took tons of notes and took some pictures and videos.

Bob could not use the lokomat because it was broken. The physical therapist, Dan, fitted Bob with a supportive plastic structure that prevented his right foot from drooping down when he lifts it off the floor. Bob practiced walking with a one sided walker. He took steps by moving his right leg forward holding on to a special type of walker that is made just for one side. Bob did really well. He took about one hundred steps, broken up into groups of about twenty. Dan was amazingly encouraging and provided support when Bob neededed it but allowed Bob to take the steps on his own most of the time. Here is a short video of Dan and Bob right before he got up to walk another twenty steps. Notice how Dan talks to Bob, the two have a great rapport.

Then it was straight to speech therapy. Bob worked with Caitlin in the sun room. She practiced sounds with him, sang words and played a game using tiles of letters. In it Bob had to unscramble four tiles to make it into a word, copy the word onto the board and then write the word without looking at the tiles, recalling it from memory. Bob also went over the communication boards the tech therapist from yesterday made for him. When quizzed on it he was correct about 65% of the time. At first it will be the job of the staff and family to show him the board and ask him questions, but Caitlin hopes that Bob will initiate its use when he needs something.

After speech, Bob had lunch. Jason came to meet us and hung out with us during his lunch hour. Jason hadn't seen Bob since Saturday and noticed improvements. He mentioned that Bob was speaking more, seemed more comfortable in his wheel chair and communicated better.

Then Bob had occupational therapy with Amanda. She practiced standing and sitting from the wheel chair to a raised mat and back. Bob did a series of exercises while sitting on the mat. The therapist integrated Bob's right arm into the exercises by making sure he was always working both hands together. Bob used a one pound bar and did rows, arm curls and extensions forward. All the while his right hand loosely grasped the bar. This was an improvement from last time when the therapist used to wrap his hand to the bar to prevent it from slipping. Amanda said Bob is using his bicepte, triceps, some muscles on his right shoulder but not his wrist or hand. She is happy with Bob's progress.

My mom arrived with my son during the last part of the therapy. They came to meet us and then back to the room to wait for the therapy session to end. Right after Bob arrived back in his room, a staff member brought in a small therapy dog. Bob loved seeing the dog do tricks. Soon after the puppy left, I took my son home and my mom stayed with Bob until after dinner.

After a quick stroll outside to enjoy the warm weather, Bob played two more cards from the traffic game. The second one was particularly difficult but Bob persevered and did it. My mom says he likes the routine of doing these cards.

It was interesting seeing Bob's day first hand. I saw how invested he is in his recovery, I saw how much effort Bob puts into all the different types of therapies, and I also saw how tired he gets after all that hard work. Rehabilitation is a full time job for him. But Bob also seems to have fun doing it. He manages to inject humor into the routine, and in two weeks has forged a partnership with each of his therapists.

That's all for today. Thanks for reading and keep the positive thoughts and prayers coming.

I told you!

Today instead of speech therapy, Bob had tech therapy. It was a session where they discussed how different technologies can help him. The therapist recommended an iPad game that my mom is going to get. The therapist said it is too early for Bob to play computer games. The therapist is going to make two new communication boards for Bob. Each one with eight pictures on it instead of three. One board will be for needs and it will include pictures to represent food, bathroom, shaving, etc... The other board will have fun things like tv, iPad, games, etc... Bob will continue to work on pointing to the images on the cards to communicate.

Bob's writing is still inconsistent. Today he wrote "Robert V Mark" and "Celina" very well. But he also wrote some nonsensical words.

Bob tried on a leg brace during physical therapy today and Dan said it will help him walk eventually. Bob walked with it on with Dan's help. Bob's foot did not drag on the ground, but he didn't like having it on. Dan thinks Bob's plantar faciatis is acting up.

Bob completed the tenth card of the traffic game. The next card is an intermediate, so long beginner cards! Janice really hit a home run with this gift.

In the middle of a conversation Bob blurted out "I told you!" and surprised himself, my mom and Debbie. The ladies reacted with such enthusiasm that the people around them came over to see what the commotion was all about. It was another one of those almost involuntary reactions; born out of frustration that my mom wasn't grasping what he was trying to communicate. He was unable to repeat it.

Tomorrow I am going to visit Bob earlier in the day to try to attend some of his therapies. Thanks for reading and keep the positive thoughts and prayers coming.

A Busy Day

Today was special because Debbie came to visit from California. She spent the day with him and attended his therapy sessions and participated in some of the games and discussions throughout the day. I showed up later in the the afternoon/early evening with my kids and we all spent time together hanging out with Bob in the sun room at the end of the hallway. It was a mini family reunion and everyone was in good spirits. Bob was very happy to see Debbie. She is returning tomorrow to spend another full day with Bob before her evening flight. I took this photo while Bob was playing another card from that traffic solitaire game (which he beat!):

Today Bob had five therapy sessions. Besides the newly added speech group therapy, now Bob also has occupational group therapy. In this new occupational group therapy Bob plays games that develop his motor and visual coordination, sharpen his focus and strengthen his muscles. It is a valuable experience for Bob to interact with others who have had strokes and have different levels of aphasia. Today they played a game where each person held a cone and they had to balance a ball on top of the cone and move it from one hand to the other and from one person to the other.

For lunch, Debbie treated my mom to lobster rolls and the two of them ate with Bob at the dinning room on his floor. Bob spends most of his awake time on the wheel chair now, going to bed only for naps and night-time sleep.

At group speech therapy today Bob was using his "yes" and "no" cards to answer questions. Last weekend he wasn't too keen on using them but it seems that peer pressure has had an effect and seeing others use them might have persuaded him to do so. My mom noted that one other patient had the same writing tablet that Bob got from my cousin Cecilia. He copied Bob so once again we give props to Ciça and Claudio for such a thoughtful and admired gift.

During physical therapy Bob used the lokomat. It is doing 80% of the work for the right leg now. I am going to try to sneak in before visiting hours on thursday to see him on the lokomat. I'll post pictures if I end up making it. I was told Bob has been cursing at Dan, his physical therapist! He says the word (stop reading this out loud if you are reading to a kid!) "fuck" quite well when he gets frustrated! Dan came into Bob's speech therapy session and was teasing him about it with the speech therapist...

Bob's speech therapist made him a sheet with a picture of a bed, a wheelchair and a bathroom. Debbie said Bob answered the therapist's questions correctly by pointing to the appropriate picture every time. For example, when asked "How did you get here?" Bob pointed to the wheelchair. Debbie also heard him say the word "up" four times when they were practicing opposites and singing "up and down". She said the "down" was hard, and he could only get a "d" sound out. This frustrated Bob because he knew that it wasn't quite right.

It's impossible to say for sure what Bob comprehends or how much he understands of his surroundings. Bob is in such good spirits, laughs easily and is in general in a great mood. It isn't unreasonable to wonder "Does he know what has happened to him?" or "Does he know the extent of the damage that the stroke has caused?" I'm often amazed to see how happy he is when I visit. Debbie and I joked today that he was happier than he used to be before the stroke. I don't want this to come across as callous but most people that know Bob know what a serious guy he was, he had a dry sense of humor. He would never have been described as jolly or chipper. I don't know where I'm going with this but I know I believe that he is committed to his recovery. Whether or not he sees how big the mountain is, I know he is willing to climb it and reach the top. I have no doubt whatsoever that Bob's understanding and comprehension is increasing with each day. Bob continues to be an example of dedication and hard work and I couldn't be more proud of him.

Thanks for reading and keep the positive thoughts and prayers coming.