Rounded Versus Square Mattresses

Being adaptable is important for instances such as traveling or simply being away from home. I certainly notice when I am away from the very suitable circumstances of our home. I am very efficient in our kitchen with my island but put me in someone else's kitchen without a suitable surface for me to roll under, with a knife that is not easy for me to hold safely, and I do not look very efficient at what I am trying to do.

At times I grow complacent with the ease of my transfers at home in relation to other places and always find them especially easy when returning home after being away. The struggle of a more difficult transfer only serves to enhance my balance and strengthen muscles through the effort required.

One of the biggest challenges is sleeping and dressing in a bed that is not our own. Especially if that bed happens to have a queen size mattress with a rounded edge like the photo above. Ironically, that is the first mattress I used post injury and it was recommended by my occupational therapist because it uses an air bladder system which supposedly provides better pressure relief. In order to get that softer mattress it needs to be deflated a bit once in bed and re-inflated to be firm enough to complete my morning routine. The air pump is as loud as a vacuum cleaner which is not what I would call the first thing I want to hear in the morning after waking up.

Unfortunately, when the mattress is fully inflated it has a concave shape to it. This causes the edge to be far less usable at night or in the morning when it is time to sit up and it causes my hips to tend to want to slide off the bed. That means to safely sleep in the bed I need to have more than half to myself, which leaves my wife with far too little space for a comfortable night's sleep. When transferring in and getting undressed at night, and then getting back into my chair in the morning, it feels as though I am always fighting the tendency to slide off the bed. For these reasons it is a passable bed for the cabin and only needs to be endured a few times per year.

Below is our current bed. It is a combination of a firm bottom foam mattress and a medium density topper. The top portion of the mattress is about one third as thick as the bottom and is still quite firm. I have yet to have any problems with pressure areas, the sharp edge gives me a good sense of security for both sitting up at night and when transferring in and out. We ordered it from a custom mattress manufacturer who essentially makes each combination of mattresses on a customer to customer basis so it did not cost us a ridiculous amount of money. Coming home to this bed after being away reminds us that it was worth every penny.

As you can see above, I still use a sheepskin to keep my feet comfortable at night and prevent any pressure areas on my heels or ankles. It was time for the red one to be retired once I found this one at Costco around the middle to end of September, which is when they seem to carry these each year.

Source: Many mattress stores will help you find what fits your needs best, but I recommend going somewhere that they specialize so you are not getting the cookie-cutter sales pitch from a general furniture salesperson.

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.