Tansen Hospital rehab teaching

We had 5 days (Nov 6-10) at Tansen Mission Hospital, working closely with the OT, PT and nursing departments.

One of the first people we met was Amrita – she used to be a nurse at the hospital until she was paralysed by Guillain-Barre Syndrome a few years ago. Sylvia with the spring 2009 NepalAbility team had visited her at home, and found the disease had run it's course, and she had the ability to move again. However, no one realized that she could recover function at this point, and she was lying in bed doing nothing. With the help of that team and her husband, they showed her she had potential to sit and stand, and encouraged her to return for therapy at the hospital. Now, almost 3 years later, she has almost full function, and is able to walk to and from the hospital where she volunteers with the children's play therapy sessions. It was wonderful to meet her again.

We were asked to consult with the staff over several spinal cord injury cases they had in the hospital at the time. One woman had a complete T12 level injury, and had had her spinal fixation done about 1week prior to our arrival. Jamie and Sylvia pushed the therapists to not be as conservative in their treatment, and got her up sitting on the edge of the bed for the first time since her injury. She was quite concerned about how much moving would hurt, but by the end was so happy to be sitting she gave Sylvia a kiss! They came back the next day to do more mobilization, and improve her sitting balance, so she'll be ready to use a wheelchair when is transferred on to a rehab centre (no wheelchairs available here, as it's a primary care centre).

The patient also hadn't been eating, and when Pauline enquired further, it was found the patient had not had a bowel movement since the injury 2 weeks ago (not an uncommon complication of Spinal Cord Injury, and should be addressed much sooner than 2 weeks!). Pauline was able to use this patient as a teaching model, teaching the nurses and her husband (who is her primary carer) about bowel care and routine, and how nursing can respond to these situations in the future. She was also shown how to use intermittent catheterization to give her more independence in bladder control.

Sylvia and Jamie had one day with a man with L3 level SCI, who was being discharged back to his home in Northern India the next day. Everyone had been trying to convince him that he should go to the rehab centre in Delhi, but he wanted to go home to his family. Again the therapists had been moving more slowly in rehab than we would in Canada, and Jamie and Sylvia, along with the Nepali therapists were able to get him standing again for the first time since his injury 6 weeks ago. He has the potential to walk again, and being up again in standing demonstrated to him this might be possible. It seems that may have been enough evidence to convince him that going to rehab might be worthwhile after all!

There was also a man with an incomplete C6-7 level SCI patient who was in Halo Traction to stabilize the injury in his neck. Halo traction in Nepal means lying in bed with pins in your head, and a weight hanging off the end of the bed to keep the neck stable while the bones heal (note the blocks of wood used to keep the bed in tilt, as well).

He was fortunate, he could feel and move his arms and legs, and the Tansen therapists had specific questions about what therapy was safe for him to do while on halo traction.

After a couple of days of bed exercises, the halo traction was completed, and Jamie and Sylvia were able to work with the therapists to get him sitting and standing again the first day! It was exciting to see. He apparently was discharged the day after we left – sad for us, as he has lots of rehab potential, but his family member (caring for him in the hospital) needed to get home for the rice harvest. However, they were impressed enough with how it went that they are committed to coming back for outpatient therapy, once the harvest is in.

Another patient we met was first diagnosed with a stroke. He became a model patient for teaching normal movement patterns for core control and upper and lower extremity movements. Over the course of the week, his medical test came back and it showed he did not have a stroke after all. He was tested for cancer and other conditions and in the end he did not get a diagnosis. Either way, Jamie and Sylvia were able to teach the Tansen therapy team on a daily basis about movement and function. The patient's caregivers were very involved and learned many exercises that they could help their father with at home. This patient was a perfect example for the teaching that the Tansen therapists requested.

There were several young children that we also provided therapy intervention and consultation for. One very interesting case was a young girl who had an infection that caused her to become paralyzed and lose her voice. She had been at the hospital for several weeks and was beginning to make quite a lot of recovery when we were there. Over the course of the week, we provided mentoring to optimize the young girl's function. The family is now bringing her to outpatient therapy and she has begun to regain her voice again.

I was involved in getting the tilt table that NepalAbility had had made locally for the hospital on a previous visit up and useful. Basically a tilt table is used to help patients safely adjust again to being upright after long periods of bedrest. There were no straps to hold the patient on with, so I spent time in the market talking with tailors and getting the straps made (it took a few tries to get the velcro attachments on the correct side so that the straps would work!). Here I am on the table with the finished straps, and we heard that they had the T12 SCI patient on it the next week. Great that it can finally be used!

While we were in Tansen, there was a prosthetic hand camp going on as well. These hands are made for use in developing countries, and donated for free. I thought they were quite an interesting design, and able to do a wide variety fine motor tasks, though probably not heavy work.

We were asked to do some presentations as well – Pauline ran several well received workshops on skin care and pressure ulcer prevention to the nursing staff, and Jamie, Sylvia and I presented on complications of SCI to the doctors. We also had lots of less formal conversations and teaching sessions with staff over the week here. I've posted more pictures of our work at Tansen Hospital here.