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"What's all this Rehab about anyway?" By the late Prof. Alan Clarke CMG ChM FRACS 1932 – 2007 The late Prof Clarke was the Dean of the Otago University School of Medicine when he fell off his roof. After a long career as a medical researcher his rehab experience taught him an important lesson – that rehabilitation is not a medical process, it is a learning one. His advice from his unique perspective as a doctor-become-patient is well worth listening to. “When you survive an accident or an illness, you step immediately onto a pathway to recovery.” Getting Started For you, the person with a spinal cord injury, and for your family, whanau and friends, the first part of this pathway goes through a spinal injuries unit. What happens to you in a spinal injuries unit is very special. It will enrich your new beginning and help you achieve independence and happiness. The good news at the beginning is that you could have been much worse off, and things can only get better. However nobody can predict just how much recovery you will get or how much impairment and disability will remain. The first few days following your accident are confusing. So much will be happening to you that you will feel that you have little control. If you have significant spinal cord injuries with either tetraplegia or paraplegia you will feel particularly helpless, unable to move much at all and very dependent on the people who are caring for you. It is normal for you to feel afraid and angry, insecure and powerless. You may be too numbed by it all to cry but it would not do you any harm if you did cry. You may be angry with yourself or with others that this has happened to you, but at this stage you are not likely to feel sorry for yourself. More likely you will get annoyed by other people who seem to feel sorry for you. For the first week or two in the spinal unit it helps if you can be accepting and “go with the flow”, and simply be assured that whatever happens, there is a really good life ahead for you. “This may take a lot of believing, but it is true!” If you are a member of the family you will experience feelings of loss and bewilderment which are similar to those experienced by the patient. These feelings are not helped if you are away from your home and from other family members, from your friends and from normal life routines. Things are just about as unfamiliar for families supporting patients in spinal units as they are for the patients themselves, even if families have had a lot to do with hospitals before. Like patients, families are enormously in need of information and support. It is OK for you as a member of the family to suffer grief, it is OK to cry and it is quite usual for you also to feel that you are not in control. You may have feelings that your partner or loved one has become public property, that there is little privacy, and that your feelings have become terribly exposed. However you may also find that these events bring members of your family and your friends closer together. A new “acute admission” to the spinal unit creates a great deal of work and makes staff busier. Members of staff are all human and share your feelings of anxiety, apprehension, sadness and grief. However nurses, physiotherapists and other health professionals who directly care for you need to be careful that they do not identify too closely with your feelings. They must remain objective. As a member of the family you may feel that this professional objectivity is callous. “Clinical detachment” as it has sometimes been called is a very important acquired skill of health professionals. Getting too close to their patient can cloud their judgement. This is why doctors should never look after their own loved ones. No matter how busy your carers are, they are always accessible and within reason should always be willing to answer questions. Good information on the first and second days is gold © New Zealand Spinal Trust, 2014 6
for you and for your family and whanau. It is essential for planning your recovery. There is so much information that you need it to be readily available to go back to again and again. Pathway Planning The quickest way for you to gain control and rediscover hope is to start planning your pathway to recovery with the help of your family, whanau and friends - on the very first day if possible! In the fir t few days a real problem for your planning is uncertainty. This is particularly so with neck injuries, with both partial and apparently complete tetraplegia. In a very few cases the doctors may be able to say with some degree of certainty that recovery is unlikely to occur to a significant extent but in most cases they will say that it is not possible to predict outcome at an early stage and that things will not become clear for you for several weeks. “All survivors of spinal injuries can achieve independence & happiness - it just takes a little time.” In most things you are the person you were before the accident. However right now you definitel are the team leader both in the rehabilitation process and of the health professionals who work in the spinal unit and who manage the process for you. All members of the team have a responsibility to help you achieve the goals that you have made for yourself. The spinal unit staff when they work with you will depend very much on your willingness to lead them. You must retain a belief in yourself. The first part of your plan is your discharge plan. This belongs to you, not the staff, and it assumes that you are anxious to get out of hospital as soon as possible. If at any time you feel that there are undue and perhaps unnecessary delays with your rehabilitation, you should ask why. If your rehabilitation is managed well, your goal or target date for discharge may be brought forward. If it is not managed so well, discharge may be delayed. It will take some days for you to see clearly your way ahead. As a general rule, complete paraplegics will be in the unit for eight to fourteen weeks while complete tetraplegics will be in the unit from twelve to twenty weeks. Staff will all know the major milestones and will help you in a general discussion. However the planning process is quite specific for each person as every individual and every injury is different You can't help being interested in how other patients are getting on and that is OK but you must pace yourself against your own goals and measure your success by your own progress towards these goals. If you are a person who has not been accustomed to setting goals and planning your life and have up till now rather just let things happen, this will be a time of great opportunity for you but it will not be easy. There are people in the Unit who can help you with this. Some real “successes” are people whose accidents have occurred during a time of personal turmoil, and the tasks of settin goals and planning recovery has led them into totally new and exciting lives. Some people are so devastated by the injury that has happened to them that they are not able in the first few days and weeks to take charge of their discharge planning. It is more difficul for them if their family is also overwhelmed by the events. If you and your family feel like this, unable to cope, there will be staff members in your spinal unit who are able to help you with your planning. Talking about these feelings can help you and there will be someone amongst the team of therapists who will listen carefully to you. Social workers, clinical psychologists and psychiatrists have special training to help you get back into the “driving seat” of your own rehabilitation plan. “Rehabilitation or getting back on track depends almost entirely on you.” It is important that you learn all about your injury, its consequences, and about both your medical and general needs. Soon you should know more about your case than any of your doctors, nurses or other health professionals. They rely on your knowledge for you to keep yourself safe. Before you realise it, you will be able to look after yourself safely in the big wide world, and you will be home. © New Zealand Spinal Trust, 2014 7
Page 2 and 3: BACK on TRACK A basic introduction
Page 4 and 5: Your rehab will not stop when you l
Page 8 and 9: Contents Intro Spinal 101 © New Ze
Page 11 and 12: A word about medical terms… The s
Page 13 and 14: Immediate Effects of Injury • In
Page 15 and 16: Your Spinal Column © New Zealand S
Page 17 and 18: Peripheral Nerves & Functions At ev
Page 19 and 20: Your Spinal Cord Your Spinal Cord i
Page 21 and 22: What is Spinal Cord Impairment? Spi
Page 23 and 24: Spinal Shock, Reflexes & Spasm Spin
Page 25 and 26: Skin & Sensation The pairs of perip
Page 27 and 28: Descriptions No two spinal cord imp
Page 29 and 30: Common Terms The following table co
Page 31: Common Terms TERM FULL NAME EXPLANA

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