Monday, April 21, 2014

Coughing


Last week's post on Incentive Spirometers is an integral part of health for quadriplegics. The diaphragm strengthening encouraged by an incentive spirometer is an important part of keeping our breathing strong and healthy. Usually inhaling is not the difficult part of breathing for someone who still retains the capacity to breathe without a respirator. The difficulty comes in exhaling with force. This limitation makes it difficult to have a good cough or sneeze, and forget about easily inflating a balloon or blowing your nose.

Being able to properly fill and empty our lungs is important to keeping them clear of phlegm and getting rid of it when sickness does set in. Having a cold is so much more difficult as a quadriplegic. It's never a pretty sight to be sick but the time spent clearing passages seems to be so much more significant when it takes that much more effort to get the job done. Before my injury I was never able to properly hock-a-lugie, that is, inhale my nasal mucus and expel it through my mouth. Necessity is the mother of invention.

More immediate is the danger when we are choking and have difficulty expelling what air is in our lungs to try to clear the passageway. I am notorious for accidentally inhaling sharply and getting some of my own saliva partway down my trachea. I believe it was only one time that I actually needed assistance in the form of abdominal thrusts to clear my airway when that happened.

As I mentioned in my post on Autonomic Dysreflexia, I was again disappointed by the rehabilitation staff as they were almost entirely unable to assist me in learning to cough properly. My education came from a fellow patient who, after two years of being discharged from rehab, returned to increase his independence. To this point he had relied on his wife's help for many, many of his daily needs but wanted greater independence. One of the things he had learned to do, and was kind enough to teach me, was to cough strongly.

The photo, indicating the motion used, demonstrates how we can compensate for the lack of abdominal muscles normally used to give the diaphragm a firm wall to press against when coughing, sneezing, blowing your nose or any other task requiring strong exhaling. By bending over quickly, either by gravity or by pulling on the frame of my wheelchair, timed with my exhale, I can cough just as hard as anyone. Unfortunately, I am not able to cover my mouth as I would like when doing this, but at least my cough is directed at my feet and not the people around me. Sneezing is much more difficult to time because it is involuntary. Often I can assist it simply by being in a slightly bent over position which adds some pressure to my abdomen, but it's still never a full, satisfying, sneeze. As for blowing my nose, I can use this technique to a degree in the shower. Otherwise, just like coughing, what comes out has to go somewhere and my hands are currently occupied and unable to hold a tissue in front of my nose.

This same technique can be used with less efficiency while in bed. When sitting up I can bend over quickly to add pressure to my abdomen but not as much pressure as when sitting in my chair, with my knees to my chest. If I am able to keep my legs straight while sitting up in bed using this technique it does add more pressure than if my legs are bent out to the side. The problem with this technique when I have a cold is that it requires me to sit up every time I need to cough. When sick this can be very often. The alternative is not pretty, but it works. By timing my exhale while pushing, almost striking, just below my ribs I can add enough pressure to cough strong enough to expel the irritant. It might look like I am beating on my stomach but when you need rest to get better, but cannot get that rest because of incessant coughing, it's better than nothing.

One final technique is a shallower throat clearing method that I am not certain I can explain well. Using your vocal cords, with your mouth closed, allowing the air and sound to exit your nasal passages, you can make a "erh-erh-erh-erhm" sound and vibrations that can very effectively clear blockages near the top of the trachea.

I hope this helps to prevent a few cases of pneumonia and to help a few people endure a chest cold a little bit easier.

Source: Respiratory therapists taught me much and could probably teach you techniques based on your physical ability.

Monday, April 14, 2014

Incentive Spirometer


More than a few times in the months following a spinal cord injury in which the ability to breathe normally is affected there are problems relating to the reduced lung capacity and significantly reduced ability to inhale and exhale. Our breathing depends on our trunk muscles, diaphragm, and to a small degree our shoulders. With a spinal cord injury in the neck one of the two diaphragm innervation locations is cut off as well as the muscles in the trunk. That is a lot of lost function in a critical area. The worst time after and injury is immediately following, when breathing function instantly goes from using your diaphragm and trunk muscles to just part of the diaphragm. I clearly remember the distress I was in and the offer of nearby friends to perform some mouth-to-mouth assistance which I refused, being a foolish teenager not wanting his friend placing his mouth on my own.

This reduced capacity resulted in multiple initial pneumonias, the regular need for a suction hose to extract phlegm, and a general inability to expel air with adequate force. Thankfully, I never needed deep suction, as in when the hose needs to be inserted much deeper into the throat by a trained individual, but simply the same as they give you at the dentist's office. Though I still may be considered more susceptible to pneumonia it has never been a problem for me, personally.

I still cannot cough properly while sitting up or laying on my back without a learned technique, and the satisfaction of a good sneeze only graces me about one out of 20 times that the tickle and urge causes me to inhale in preparation. If I time it just right I can apply pressure to my abdomen to execute a proper sneeze. The critical act of coughing will be addressed next week.

Thankfully, there are tools to assist in building lung capacity and strength. Pictured above is an incentive spirometer, which is designed to do just that. The hose can be attached to either side of the body of the device. One side allows you to suck air in and the other side allows you to blow air out. The idea is to increase the resistance as your strength increases so that keeping the ball at the top while the air moves through it is just difficult enough. It's no different than any other strength training.

An incentive spirometer can also be helpful to encourage very deep breathing and complete exhaling which is a very good practice in clearing congestion and preventing sickness. For we who find it very difficult to get our heart rate and respiration high enough to naturally perform this deep breathing this can be a lifesaver when dealing with any kind of respiratory illness. Regardless of illness, I try to do some deep breathing a few times each day in the interest of prevention.

Source: Respiratory therapists, occupational therapists and many medical professionals. They are very affordable and can be ordered online.

Monday, April 7, 2014

Sport Cuff


I misplaced my sport cuff many years ago because I always just use a new pair of The Gloves with strong new Velcro as my tool of choice to hold on to any sporting device with a straight handle. When I wear The Gloves I do not diminish my ability to wheel nearly as much as when I tried using the above pictured sport cuff. I also found the sport cuff to limit my wrist function which is so essential to so many sports, especially those such as badminton or icefishing where wrist movement is really essential to the technique. However, for someone who's muscles that control the wrist are paralyzed this cuff makes some sport possible where it would not have been, otherwise.

For sports such as tennis or fishing with a large rod, where the movement involves more control by the larger arm muscle groups, a sport cuff has great advantages. This one was borrowed from my friend, and former model, Paul. Though he and I have virtually the same level of function, there are a few muscles of mine that provide me just a little more function than him. Where every little bit of function counts, especially where wrist flexion and triceps come in, a sport cuff like this can mean the difference between being able to successfully participate in an activity or not being able to.

Source: Occupational therapy product catalogues, online, or custom made.

Wednesday, April 2, 2014

Parking Woes Reversed


A few days ago in a parking lot in Lisbon wheelchair users and volunteers occupied all the available non-disabled spaces to make a point to able body motorists what it is like to have their parking places unavailable to them.


On every wheelchair various notes were left like "be right back", "it only takes a moment", "I'm get something here", etc.

The above quote was from the original post. While I would love to see a less aggressive campaign, we all know it doesn't work and I commend the bravery of those who helped make this happen. One of the top-rated comments on the post on Facebook identify the fact that many people with disabilities do not use wheelchairs. Fair enough. But I think this would be the easiest way to get the point across. Maybe a cane or a walker or a crutch or other assistive mobility device would have also helped to make the point.

Regardless, I hope that a few people realized how critical the spots can be to us, even when you are just running in to grab a coffee.

Thanks for the tip, Desiree!

Monday, March 31, 2014

Velcro


Without Velcro The Gloves could not be tightened enough to provide me the dexterity that they do and many of the tasks I am able to complete successfully, would either be much more difficult, or simply impossible to complete. Getting a grip on certain exercise equipment, to help with Strengthening our functioning muscles, is made easier with Velcro. It enables the design simplicity of a Universal Cuff and Razor Cuff, an alternative to the difficulty of tying Shoelaces and so many other daily applications where a tight, but adjustable, fit is needed to be possible with limited dexterity.

By no means is this list exhaustive. In many cases Velcro can be creatively added to an existing device, article of clothing or tool to make it friendlier for us to use. Many stores now carry cinch straps made entirely out of Velcro. These are useful for places that something such as a rubber band or a bungee strap is just too difficult for us to use. If you have a great example of Velcro use let me hear from you.

Next week we will look at a Sport Cuff that enables a reasonable grip on almost anything with a handle such as a fishing rod, tennis racket or even a pool cue.

Source: Department stores, dollar stores, hardware stores and sewing stores.