Sunday, November 15, 2009

Outpatient Physical Therapy

I believe that I previously mentioned the fact that the home physical therapist discharged me towards the end of September, declaring that any further progress on my problems with balance and proprioception required the use of equipment that she could not bring with her on her visits to my home. But I was prevented from switching to outpatient physical therapy for most of October, due to the COBRA war. In the interim, I continued to perform the exercises that had been bequeathed to me by the home physical therapist, increasing the number of repetitions or the size of any hand or ankle weights involved, when doing so seemed appropriate.

Since health insurance has been fully restored, I have been to several outpatient physical therapy sessions. The pair of young men who have ganged up on me typically work me for an hour and 15 minutes or so. The cardio and strength training involves equipment that any fitness club would have; with respect to these aspects of the therapy, the therapist is more or less merely playing the role of a glorified personal trainer. The major difference lies in the balance and proprioception remediation. For this, some of the drills involve the use of a teeter-totter-like board on which one attempts to remain standing; depending on the orientation of the board, the teetering is either side-to-side or front-to-back. I find this quite challenging; I'm not sure I would have done all that well at this even before I went to the hospital.

Another game involves standing on a block of soft foam with eyes closed, attempting to remain balanced while the therapist pushes or pulls at different places and at different angles, on the shoulders, arms, legs, or back. The therapists' justification for this exercise is that, since I am not getting the same information from the feet, ankles and legs that I used to get, I am relying more on visual cues; but that is not going to help me in darkness (and in fact at this point I am afraid to attempt to navigate in a completely dark space).

Then there is a set of exercises that involve stepping over a series of low barriers of different heights. The possible variations are practically endless: the takeoff can be mixed up between the right or left foot; the orientation of the body can be straight ahead or side-to-side; the movement can involve touching the top of the barrier with the leading and/or trailing foot before continuing over, or not; the distances between the barriers can be varied; and so on.

On the whole I'm enthusiastic about all this; unfortunately, as I get deeper into the stem cell transplant process, I will have to curtail these sessions, and then eventually suspend them altogether, until some time after I have returned home from Baltimore. I keep forgetting to ask if my transplant team will include a physical therapist; I hope it does.

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