Workbook Spinal Cord Injury Rehabilitation Program
Table of Contents Page Before coming to Rehab... 1 Tests before starting your Rehabilitation Program... 2 SCI Personal Goal Tracking Tool... 3 To do list during Rehabilitation... 4 Returning to home/community... 14 Discharge checklist... 16 Tests and appointments... 17 SCHIPP... 18 Personal health information... 20 Emergency information... 21 Health care... 22 Current medications... 23 Family health history... 24 Important phone numbers... 25 Autonomic dysreflexia... 26 SCI Health Promotion Plan... 28
Before coming to the Rehabilitation Program Before coming to the Rehabilitation Program, please complete this worksheet. The worksheet will help you keep track of your progress. Goal Date/Comments I can sit up comfortably for 2 hours yes no on my way I am aware that healthy eating and drinking is important yes no on my way I know how to check my skin yes no on my way I have a plan for lung care yes no on my way Bladder I can catheterize myself, go on my own yes no on my way Bowel I can insert suppository, wash/clean yes no on my way I have started to learn more about my injury (reading the information in the Spinal Cord Injury Binder and going to the Resource Centre) I have reviewed the Rehab Program s information and expectations yes yes no on my way no on my way I know how important it is to prevent infections yes no on my way I know the medications I need to take yes no on my way I have met with the SCI navigator yes no on my way I have discussed my short term and long term rehab goals I have talked to my family about housing where I will be living yes yes no on my way no on my way I have started the paperwork for financial help yes no on my way I have started to discuss plans for the future such as driving or working yes no on my way Page - 1
Tests before starting your rehabilitation program Tests Spinal x-ray Renal ultrasound Chest x-ray Breathing tests Blood work if needed Other Date Completed Comments and Reminders Date Page - 2
SCI Personal Goal Tracking Tool You will soon be admitted to the Rehabilitation Centre at Hamilton Health Sciences. In the spinal cord injury (SCI) program you will be asked to work on the goals that are important to you. The SCI team will be here to help you! All of your goals may not be completed while you are in the hospital. Rehabilitation goals will continue after you leave. This tool will help you track your goals while you are here and after you move back into the community. As you work towards meeting each goal, you will find that there are smaller goals needed to meet each main goal. These are called sub-goals. For example, if one of your goals is to feed yourself, you will need to be able to grasp a fork and to raise your arm high enough to bring it to your mouth. Grasping a fork and raising your arm are both sub-goals for the goal of feeding yourself. This tool will help you track your goals. You will meet with the SCI navigator every two weeks to track your goals. Using this tool will help you know what goals you need to work on. During rehabilitation, you will meet with the spinal cord injury team every two weeks to talk about your goals. This tool is here to help you during these meetings. The SCI navigator will help you if you have difficulty understanding or completing this tool. Page - 3
To do list during Rehabilitation The purpose of this list is to guide you through your Rehabilitation Program. Every 2 weeks at a team conference the Spinal Cord Rehabilitation Team will discuss, with you, your progress in rehabilitation. Weeks 1 and 2 Dates Number of weeks left to discharge date Most Responsible Person Comments and/or Dates Orientation to unit and team Maintain general health status breathing tests/ sleep tests Respiratory Therapist bladder test Nurse regular blood work Nurse, Doctor blood pressure control Nurse, Physiatrist healthy weight Dietitian bone status Physiatrist Specific health issues Page - 4
Goals to think about: Personal care Most Responsible Person Comments and/or Dates eating OT, Nurse, Dietitian grooming OT, Nurse bathing OT, Nurse dressing OT, Nurse bladder program Nurse, Urologist bowel program Nurse, Physiatrist Mobility moving and turning in bed transfers (bed, chair, toilet) getting around inside the building Nurse, OT, PT Nurse, OT, PT OT, PT Equipment trials select a vendor OT start wheelchair trials OT start commode trials OT assess need for bathroom equipment OT Page - 5
Goals to think about: Medical education Other Most Responsible Person Comments and/or Dates Page - 6
My main SCI rehabilitation goals My rehabilitation goal Who can help me with this goal? (name of team member) 1. 2. 3. 4. 5. 6. 7. Page - 7
Team meeting notes Date reviewed Notes Page - 8
Three steps in getting started with the goal tracking tool 1. Write down your main goal. 2. Sub-goals: Break your goal into sub-goals. 1. 2. 3. 4. 5. 6. 7. 3. Rate how far you have come in your goal. Use the shading tool in the computer toolbar to color in the main goals scale to the number that shows how far you have come to reaching the main goal. Each bar is a separate week. You can add more weeks if needed. Week 2 Just starting on this goal I am half way to reaching my goal I have reached my goal 1 2 3 4 5 6 7 8 9 10 Week 4 Week 6 Week 8 Week 10 Page - 9
1. My goal is: 2. I need to accomplish the following to get to my goal: Sub-goals: 1. 2. 3. 4. 5. 6. 7. 3. Please rate your main goal on the scale below. Week 2 Just starting on this goal I am half way to reaching my goal I have reached my goal 1 2 3 4 5 6 7 8 9 10 Week 4 Week 6 Week 8 Week 10 Page - 10
1. My goal is: 2. I need to accomplish the following to get to my goal: Sub-goals: 1. 2. 3. 4. 5. 6. 7. 3. Please rate your main goal on the scale below. Week 2 Just starting on this goal I am half way to reaching my goal I have reached my goal 1 2 3 4 5 6 7 8 9 10 Week 4 Week 6 Week 8 Week 10 Page - 11
1. My goal is: 2. I need to accomplish the following to get to my goal: Sub-goals: 1. 2. 3. 4. 5. 6. 7. 3. Please rate your main goal on the scale below. Week 2 Just starting on this goal I am half way to reaching my goal I have reached my goal 1 2 3 4 5 6 7 8 9 10 Week 4 Week 6 Week 8 Week 10 Page - 12
1. My goal is: 2. I need to accomplish the following to get to my goal: Sub-goals: 1. 2. 3. 4. 5. 6. 7. 3. Please rate your main goal on the scale below. Week 2 Just starting on this goal I am half way to reaching my goal I have reached my goal 1 2 3 4 5 6 7 8 9 10 Week 4 Week 6 Week 8 Week 10 Page - 13
Returning to home/community To Do List Returning to my home/ community Most Responsible Person Comments and/or Dates decide on discharge location decide on short term discharge location if needed arrange with OT to do a home assessment review applications for housing if needed review insurance policies (care and/or health) to determine benefits available review applications for financial assistance look at transportation options You, team You, team OT SW SW SW Recreation Therapist, OT Other: Page - 14
Recreational activities: Equipment/supplies: Page - 15
Discharge checklist Most Responsible Person Comments and/or Dates Discharge location Team Equipment OT Transportation OT CCAC referrals if needed Nurse, OT, PT, SW Respiratory training RT Outpatient physiotherapy PT Outpatient occupational therapy Catheter supply prescription OT Nurse Medication prescription Pharmacy Thrombo Thrombo, Doctor, Nurse Page - 16
Test/Appointment Date/Time Location Page - 17
The Spinal Cord Health Promotion Plan, or SCIHPP This section is a place to record your health information for your use, your doctors and other health care providers. There are 6 areas of health information to record: 1. Personal Health Information your past health and injury information emergency information medications family health history important phone numbers 2. Autonomic Dysreflexia Describes and offers suggestions if you are at risk for Autonomic Dysreflexia. This would include you if your spinal cord injury is at level T6 or higher. 3. SCI Health Promotion Plan tests and procedures that will be helpful in maintaining your health as it relates to your injury specialists who are looking after each area of health concern bowel and bladder routines equipment management personal and job related goals Page - 18
4. Test Results 5. Consultation Reports Please ask for a copy of these reports after you have reviewed them with your doctor. This will allow you to share this information with other people involved in your care. 6. Equipment Information Page - 19
Personal Information: Personal Health Information Name Address City Province Postal Code Phone Number Birth date Primary Contact Person How this person is related to me Phone Number Date of Injury Level of Injury Details of Injury: Specific Concerns: Page - 20
Emergency Information Primary Contact Person: Phone Number: Family Doctor: Phone Number: Dentist: Phone Number: Allergies: Allergic To Reaction Medical Alert: Blood Type: Page - 21
Health Care Diagnosis: Complications and Problems: Treatment/operations/procedures Date Physicians/Specialists seen: Name Date Reason Page - 22
Current Medications Medication Dose Time of Day Date Started Date Stopped Purpose Page - 23
Family Health History Important information about my family members health history. Person Health Problem Page - 24
Important Phone Numbers Name Phone Number Family Doctor Dentist Nurse Case Manager Community Care Access Centre Pharmacy Physiatrist Urologist Respirologist Physiotherapist Occupational Therapist CPA representative Peer Support Social Worker Legal support Equipment Vendor Supplies Other Page - 25
Autonomic Dysreflexia Autonomic dysreflexia can be life threatening. It is a complication following a spinal cord injury. You must know what it is, why it happens and how to find and remove the cause immediately. Autonomic dysreflexia or AD is a reaction of the body to uncontrolled nerve impulses. It is a response to painful or uncomfortable stimuli below the level of your spinal cord injury. AD is usually caused by: a bladder that is too full a full lower bowel prolonged pressure on the skin. If your injury is above the level of T6, it may occur. You must learn all about it if your injury is above T6. When the system is stimulated, blood vessels in the abdomen, pelvis and legs constrict or get tighter. This causes the blood pressure to rise. Messages from the brain cannot travel down the spinal cord below the level of the injury. This means that the blood vessels continue to constrict and blood pressure keeps rising. Common Indications severe headache heavy sweating flushed or reddened skin goose bumps blurry vision or spots in front of the eyes stuffy nose anxiety or jitters a feeling of tightness in your chest or flutters in your heart or chest, or trouble breathing Page - 26
Common causes of Autonomic Dysflexia 1. Full bladder 2. Full leg bag 3. Kinked catheter tubing 4. Full bowel incomplete emptying of bowels 5. Skin breakdown 6. Pressure on skin/sitting in one position too long 7. Menstrual cramps 8. Infection Interventions 1. Raise head of bed or make sure the head is elevated if in chair. 2. Check to make sure bladder is not full, reposition leg bag and check for kinking of tubing if indwelling catheter is used. 3. Check bowels using 2% xylocaine gel to ensure bowels are empty. If stool is present, gently empty, watching BP and stopping to allow BP to subside if elevating. 4. Check for areas where pressure may be exerted against skin and relieve pressure. 5. Check for any other factor that may be causing distress to the body such as bladder infection, skin ulcer, excessive heat, etc. If there is no change in BP after interventions or source cannot be found, contact your physician immediately emergency situation! Please refer to booklet on Autonomic Dysreflexia for review of pertinent information concern this emergency situation. Please make sure booklet (or emergency card) goes with you should you need transporting to an emergency department or other facility. Page - 27
SCI Health Promotion Plan for: Bone Mass Health: 1. Bone Density yearly. Date of bone density tests: Specialist following: 2. Weight Control maintain target weight as per nutritionist weight monthly. Last weight and date: Method: Page - 28
Bladder routine: Method of emptying bladder: Products used: 1. Urodynamics frequency to be reviewed with urologist. Dates of urodynamic tests: 2. Renal and bladder ultrasound: every 6 months - 1 year Dates of renal/bladder ultrasound tests: 3. Urine cultures Urologist following: Page - 29
Bowel routine: 1. 2. 3. This procedure is performed every ( ) days in the. (time of day) Position: Equipment needed Problems encountered: Date Problem Solution Page - 30
Respiratory routine copy of detailed routine included: 1. 2. 1. Respiratory review q 6 months to annually. Respirologist following: Neurological Review: 1. Yearly ASIA examination. Dates of ASIA examinations: Physiatrist following: Page - 31
Physiotherapy: 1. 2. 3. Physiotherapist following: Exercise: 1. 2. 3. Recreation: 1. 2. 3. Page - 32
Skin Checks and Review: Method used for skin checks When I check times Areas at specific risk for me personally: Problems encountered: Date Problem Solution Page - 33
Equipment Maintenance: As directed by the vendor of your equipment and your occupational therapist. Dates of wheelchair review and maintenance: Dates of cushion review and maintenance: Dates of bed and mattress review and maintenance: Occupational Therapist following: Page - 34
Other health concerns for me: Important information about my other health issues (not SCI related) Health issue Health promotion treatments or tests Page - 35
My personal goals for next year: 1. 2. 3. My vocational goals: 1. 2. 3. Page - 36
Communications: From (person): Date: What was said: PD 7181 10/2011 dpc/pted/sci/scirehabprogramworksheets-th.doc dt/october 25, 2011 Page - 37