Thursday, June 28, 2012

So Tiny It's Micro

"For seven years, Angela was in a coma, waxing and waning, often in a “semi-vegetative state”." It should have changed, maybe in year 3. I was in a long-term care unit in a hospital at that time. That could have been possible, but I believe this has never happened. Besides, I was government, Medicaid (Medi-Cal in California). Change doesn't come easy to the govt. If change does come it's usually years later. My diagnosis should have changed to MCS, or Minimally Conscious State. What am I now-fully conscious?

What's happening now is "Boom! She's awake." That's not correct, or someone would have noticed right away and there would have been immediate news coverage. Instead it has been a very slow change, seen better from year to year rather than day to day I have a photo stream where you can see the slow progress. The last picture really shows the difference in my face. I'm smiling in both pictures, but you can't even tell in the first picture. It took a whole year of oral-motor exercises just to see it.

This shows the "micromovements" E. Taub was talking about were there. You just couldn't see them. I'm proposing these movements are in all areas, not just upper extremities as he does. They are movements so small, it looks like the affected side lost them. As a therapist, how do you know they are there? You don't know for sure, so you'll have to assume they are there. They will only work again if:  the brain is still in tact (penetrating brain injuries might have affected this, as well as some other injuries), the spinal cord is in tact (this rules out SCI), and the area you are working  with is still there and not impeded (deformities, contractures, frozen joints, etc.).

Progress will be minimal and slow. It might help to do a yearly photo or recording. Exercises will be the same ones you do already, but don't expect the patient to actually "DO" them. They should "TRY". If it's 10 reps, it's still 10 reps (only 10 attempts). If it's PT, Range of Motion will start as inactive and become more active. You will FEEL the patient activate the muscle. The movement isn't micro anymore. It's just small. Continue with Range of Motion, having the patient do more on his/her own.

I don't have the fancy equipment in the video below. However, I do have myself. I can only see these changes in my behavior, and assume this is the reason. I can't see changes in my brain.

(Incidentally, if you let the video continue after the long pause he talks about "Learned Non-use" )

So for 7 years it looked like I did nothing. It only looked that way. There was something else going on. We can't see micro.

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