10.12.2021 – 09:43
German Association of Occupational Therapy eV (DVE)
Around 2,400 people annually in Germany suffer damage to the spinal cord with the following paraplegia. “The task of our professional group is to help people with spinal cord injury to empowerment and to work with them on the vision of what their life will be like after their stay in the clinic,” explains occupational therapist Martha Horn from the BG Unfallklinik Murnau. The work of the occupational therapist in the DVE (Deutscher Verband Ergotherapie eV) often begins with the initial treatment at the scene of the accident. Occupational therapists accompany people with paraplegia throughout the entire time in the clinic, from intensive care to social and professional reintegration, thus enabling inclusion and participation.
High-risk jobs or sports and leisure activities are the most common reason for paraplegia. “The dangers are well known and yet people – mostly carelessly – repeatedly find themselves in situations which in the worst case can end with paraplegia,” says Martha Horn, who works as an occupational therapist at the BG Unfallklinik in Murnau, one of the largest nationwide Trauma centers. She reports on seasonal waves: In summer, many people come to the clinic after jumping into too low water, falling on a mountain bike, a motorcycle or an accident while flying a kite. Autumn often brings injuries who fall from the ladder when cutting a tree, for example. In addition to accidents at work or at home, e-bikes are now also causing more paraplegia: the number of older people who misjudge the speed of their e-bikes and fall is increasing. Older people are more at risk anyway, are often previously damaged, and the spine is no longer as elastic. Diseases such as a narrowed spinal cord canal – a so-called stenosis -, tumors, bleeding, spontaneously occurring problems or inflammatory processes that can lead to paraplegia are much rarer.
The first task of an occupational therapist: inside people with paraplegia: the hands
Occupational therapists are part of the interdisciplinary team in the treatment of people with spinal cord injury. In the clinic where Martha Horn works, the physiotherapist and occupational therapist share the manual work in the intensive care unit. Physiotherapist: are primarily responsible for breathing exercises and maintain the mobility of the body; Occupational therapist: from the outset, we ensure that injured people can later use their hands by moving their joints and taking care of correct positioning. This prevents or reduces movement restrictions. “Just as important as moving is the correct positioning of the hands,” emphasizes the occupational therapist Horn and continues: “It is essential to move the hands exclusively according to a corresponding pattern and then to also follow a special pattern in order to maintain the necessary tension Maintain flexor muscles “. This is the only way for people with paraplegia to use their hands later, even if the fingers remain paralyzed. The first few weeks are crucial. If the hands are initially flat or if no attention is paid to the position of the hands at all, after this time window there is less chance of allowing the patient to use the hands internally.
Custom-made splints: an occupational therapist’s specialty
The occupational therapist Martha Horn explains why this is so: “There are ligaments, capsules and structures on the individual joints that can shorten when they are not in motion”. No, too little, or incorrect movements result in the joints becoming too tight or stiff. If muscles start working again in the course of regeneration, the hand can only be closed into a fist if the joints are flexible. Closing a fist is necessary so that people with paraplegia can grab something. In order to maintain this ability, occupational therapists immediately produce individual, custom-fit splints in a specific position. This creates the best possible conditions for people with paraplegia to be able to use their hands later in everyday life. Preparing your hands prophylactically from the start is essential for the greatest possible independence.
Between cautiousness and reality: occupational therapy balancing act for people with paraplegia
When the patients wake up: inside the intensive care unit, very few can assess the extent of their injury. A cautious approach and extremely sensitive conversations characterize the beginning of the occupational therapy intervention. “Always referring to the current status and what the person can do at the moment has proven very useful,” explains occupational therapist Horn, who specializes in the area of paraplegia. The patients are in a state of shock. On a physical level, one speaks of spinal shock – the body is in the self-healing phase and tries to ‘repair’ as much as possible. At the same time, there is an emotional shock that needs to be absorbed. Occupational therapists focus on the everyday life of their patients, which means in the case of paraplegia: on the one hand, approach the emotional situation and physical abilities and, on the other hand, confront the patient with the reality and the effects of the paralysis. Occupational therapist: Inside practice with your patient: Inside, initially banal, daily activities such as: Take a spoon and bring it to your mouth. Or: pick up a pen. If that doesn’t work, those with paraplegia usually only realize what their future everyday life will look like after their stay in the clinic. “Most of the time, the patients lag behind with their mental processing,” says Martha Horn. In their opinion, this is partly due to the fact that the operating theater, rehab and everything else go so quickly and the day is full of treatment units. The specialists take care of the patients with their extensive knowledge, so that they feel safe, well looked after and in good hands. Sometimes it goes so far that one or the other affected person places all their hopes in a complete healing. Others see clearly from the start, have a plan of what the future looks like, what they need and how they can change their living situation, for example. But there are also those who cannot come to terms with the fact that they will remain paralyzed for the rest of their lives.
With occupational therapy help: achieve maximum independence
In order to achieve the best possible treatment success at all levels with the different characters, occupational therapists work with their counterparts to find out their coping strategies. How did he or she manage to cope with problematic situations before and do these strategies also work in this particularly deep crisis? In addition, occupational therapists work consistently in the positive, referring to the successes already achieved, in order to steer the deficient view that people with spinal cord injury sometimes have in a different direction and to give them courage. They provide impulses so that those affected – if they are not already doing so – develop visions of how they can shape life and their everyday life after the rehabilitation clinic. The degree of severity of the paralysis is always decisive: Can the patient breathe inside during the day or all the time and can they use their hands? Even quadriplegics, in whom all four extremities are paralyzed but who can still move their arms a little, learn from an occupational therapist: inside so-called trick movements in order to be able to pick up objects independently. In addition, technical aids make life easier for all people with paraplegia. Occupational therapists work with the patient to find out what is best for them and help with the procurement of environmental control devices such as controls that operate the computer or smartphone. Even people with a severe degree of paralysis learn with occupational therapy support to gain increasing freedom, for example with the help of suction / blowing control, voice control or by using the head. For maximum independence of your patients: inside, occupational therapists manufacture brackets, clamps and other aids. They find and invent alternatives that enable people with paraplegia to perform everyday activities such as brushing their teeth, eating, drinking and so on. Occupational therapists practice the use of all aids, their own resources and skills with their patients until everything has become flesh and blood and they are able to accept their changed, different everyday life and manage it as independently as possible.
Information material on the various topics of occupational therapy is available from the occupational therapists: inside; Occupational therapist: in the vicinity of the place of residence on the homepage of the association at https://dve.info/service/therapeutensuche
Angelika Reinecke, German Association of Ergotherapy eV (DVE),
Original content from: Deutscher Verband Ergotherapie eV (DVE), transmitted by news aktuell