Physical therapy goals for 2024 are a continuation of 2023 goals
Areas of focus include patient's comfort, more work with new chair
Michael uses the reclining function on his new wheelchair to reduce the discomfort to his back and hips. (Photo courtesy of Michael Morale)
Looking forward to this new year of physical therapy with Michael, my patient who has spinal muscular atrophy, we will continue to work toward improving his functionality in the new wheelchair he began using last year.
Even though we have been working in this chair for a few months, there have been some alterations that have changed how he utilizes his chair. We had to move the pads on his footrests to allow for increased ease while transferring Michael to and from the therapy table. With this transition, we had to ensure this didn’t cause any problems including pressure ulcers or discomfort while Michael sits in his chair all day.
Michael also was having a hard time accessing the joystick on his wheelchair, secondary to the reach he needed to make to get to it. This was addressed and replaced, although that changed the mechanics slightly in his chair. As all of these changes have been made, we have taken a step back and ensured Michael’s safety came first and none of these changes would make him uncomfortable or increase pressure in areas that were not wanted.
This year we will continue to work on Michael’s comfort while sitting in his chair. He has begun to experience tailbone, or coccyx, pain again as well as some numbness and tingling down his right leg from time to time. Another internal coccyx mobilization is being discussed to improve his coccyx mobility and ease the tension in the muscles of the pelvic floor to allow for an increase to the midline of his tailbone. Continuing to improve his hip extensibility also allows for reduced tension and pull on the tailbone, reducing symptoms down the leg and improving comfort.
Another goal of ours this year is to get Michael in some difficult and uncomfortable situations in his new wheelchair outside of our building to ensure he can navigate safely. Even though most places do a much better job of ensuring ADA compliance, there will definitely be some situations that will challenge Michael. We need to make sure Michael is comfortable and confident in navigating through that and will be able to do so safely. We will have to wait until things warm up, though, as he is no fan of cold weather. This is an activity we performed in the past in a different location with his previous wheelchair.
We located ramps and uneven surfaces and had him drive in different directions on them with support at first, and then independently as his comfort grew. He must be able to navigate on different surfaces with confidence to allow for increased independence and increased ability to enjoy life and different activities.
As this year ensues, there will be many different obstacles met and goals changed. When we meet these challenges or obstacles, we will change direction and work toward meeting those goals. Lines of communication will stay open and Michael will be able to speak freely about how he feels his treatment should go and what direction he would like to head in.
Patient perspective
One of the things that I enjoy most about physical therapy is that there’s always something to work on. My physical therapist Emily is constantly looking for different things so that I continue to improve in not only the way that I sit in my new wheelchair but also my everyday life. My balance is somewhat skewed right now since I’m sitting in a new wheelchair, so this is one of our goals that we will work on during the next few months. We will also continue to work on my tailbone by doing external and internal manipulations. I’ve definitely seen an improvement in my comfort level due to these adjustments on my tailbone.
2023 was a great year for me regarding my physical therapy needs, and I look forward to continued improvement in 2024.
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