Challenges to Daily Activities of the Patient with Paraplegia - Case Study Example

Report ABSTRACT This case study presents my experiences living as a paraplegic. The discussion explores some of the difficulties I face on my daily life as a paraplegic, some of the healthcare facilities that can help me survive with paraplegia, and other challenges faced by patients with paraplegia in general. SECTION A: CHALLENGES TO MY DAILY ACTIVITIES I am a 35-year old female diagnosed with paraplegia and I am living in Miles in Western Queensland. I live with my sister and her 2 elementary school aged children. The house we live in is low set with five steps, and has two levels inside with my bathroom and bedroom on the second level. Although low set, this kind of living environment exposes me to various difficulties in respect to my day-day activities. First, the environment restricts me to stay indoors until that time when my sister comes from her workplace because I use a wheelchair for mobility. Therefore, it is not possible to maneuver my way over the five steps to get outside on my own. The two schoolchildren (one on grade 1 and the other grade 3) stand in no position to help me walk over the stairs when they come from the school. Secondly, I am not in a position to do some of the daily chores that I used to do before I became paraplegic. For instance, I cannot wash dishes in the sink because its position is high compared to my wheelchair height and clean the house. Moreover, I cannot move on my own from my bedroom in the second level to the sitting room in the first level, which forces me to sometimes wake up early in the morning so that my sister can help me get to the sitting room or outside the house before she leaves to the workplace. Once outside the house, I am forced to stay idle because I cannot move to the nearby town (which is about 50 km from our home) or the road (which is about 10 km away). Therefore, my present condition has not only turned me from an independent to complete dependent individual, but it has also limited by mobility completely, forcing me to live a life of social seclusion. SECTION B: DISABILITY AWARENESS Paraplegia has various effects on human body, ranging from complete failure of the lower extremities to the inability to control bladder muscles. According to O’Connor, Jenney, and Saul, paraplegia describes a condition in which impairment to the spinal cord at “thoracic, sacral, or lumbar levels” causes partial or complete paralysis of the lower limbs and changes in “sexual, bladder, and bowel function” (207). Due these effects on the body, paraplegics encounter various challenges in the daily activities, primarily because of their inability to walk on their own. The major implication that my paraplegic condition has on my daily functioning includes complete dependence on my sister for most of personal duties. I entirely depend on her for bathing, dressing, cooking, washing my clothes, attending clinical check-ups, and even moving around and within the house (McColl et al, 234-237). My condition has forced me to live partially segregated from relatives, colleagues, and workmates because I cannot frequently visit or intermingle with them, unless they pay me a visit. My self-esteem has also decreased since most of the times I have to depend on others to do almost everything for me. As such, I find it impossible to express or contribute my opinions whenever I get an opportunity to attend some of the social gatherings. Sometimes I even wish to commit suicide to put an end to negative effects on my paraplegic condition and save my sister from hardships she goes through in her effort to care for me (Jurisic & Marusic 36). Due to my inability to move around the home in my own, I have put my sister, her two children, and the extended family members into some dilemmas and hardship. My sister helps me in my movements around the house, takes me to weekly check-ups, and does all other personal duties for me (McColl et al., 237). As a result, she has to wake up early to cook for me before she leaves for work. From the work, she comes direct home to help me get outside the house for some fresh air. Therefore, my condition presents her with dilemma regarding balancing her time for work, socializing with her friends, and time to attend to her daily chores. In her absence, I rely on the children for daily errands within the house. In addition, I depend on the extended family members and the sister for financial support to buy clothing, medications, and other essentials because I cannot work to raise money in my present condition. Table 1: National and Local Organizations Proving Services for Paraplegic Patients Name of organization Services Location Spinal Injuries Association (former Paraplegic and Quadriplegic Association) Assistance programs Peer support initiatives Community nursing Advisory services Queensland (http://www.spinal.com.au/about/) ParaQuad Community nursing Support programs Free health care services Home-based individualized care Education New South Wales (http://www.paraquad.org.au/AboutParaQuad.aspx) National Disabilities Services (NDS) Health care services to people with all disabilities, including paraplegics Australia (http://www.nds.org.au/ ) Spinal Cord Injuries Australia Information resources for young people with spinal cord injuries Australia (http://www.aqa.com.au/) Table 2: Local Health Care Facilities Facility Services Location Darling Downs -West Moreton Community nursing Respite services Can be accessed anytime of day Miles (http://www.health.qld.gov.au/wwwprofiles/ddowns-westmort_miles_hs.asp) Miles Health Services Community nursing Miles (http://ourhealthservice.com.au/Queensland/Public-Hospitals/Miles-Health-Services-Miles-Hospital.html) SECTION C: DAILY LIVING TABLE 3: DAILY ACTIVITIES AND LEVELS OF DIFFICULTIES Time/Activity Easiness Facilitators/Barriers Solutions Approximate Financial Costs 7.00 am: Getting out of bed 4 No support mechanism to use Walking crutches, or electronic bed Crutches = $50 Bed = $2000 7.15 am: Going to the toilet 4 Toilet designed for non-disabled people Replacement of toilet bowl with a low level one $35 7.20 am: Brushing teeth 0 Wheelchair for mobility to the sink Ok $0 7.25 am: Going to bath 4 Inability to access and use the bathroom No $0 7.45 am: Dressing 3 Inability to stand No $0 8.00 am: Taking breakfast 0 Presence of a table of the right height Ok $0 9.00 am: Getting out to get fresh air 4 Absence of wheelchair ramps Inclusion of wheelchair ramps in the doorway $50 10.00 am: Taking tea 0 Presence of right leveled table Ok $0 12 noon: Preparing lunch 3 Taking a lot of time, accessibility of kitchen, ability to reach cooking area Keeping all cooking items in one and accessible place $0 1.00 pm: Taking lunch 0 Presence of right-leveled table Ok $0 2.00 pm: Washing utensils 3 Taking a lot of time, ability to reach washing sink No $0 3.00 pm: Attend religious gathering 4 Absence of wheelchair ramps in our house, exhaustion, fear of social intimidation Construction of wheelchair ramps, developing self-concept, practice $50 4.00 pm: Going to the market 4 Absence of wheelchair ramps in our house, exhaustion, fear of social intimidation Construction of wheelchair ramps, developing self-concept, practice $50 5.00 pm: Visiting relatives/friends 4 Absence of wheelchair ramps in our house, exhaustion, fear of social intimidation Construction of wheelchair ramps, developing self-concept, practice $50 10.00 pm: Going to bed 4 No support mechanism to use Walking crutches, or electronic bed Crutches = $50 Bed = $2000 Key: Levels of easiness ranges from 0= no difficulty; 1 = mild difficulty; 2 = moderate difficulty; 3 = severe difficulty; to 4 = complete difficulty. SECTION D: CHALLENGES As a paraplegic, I encounter various social restrictions and community or environmental challenges. Social Restrictions Poor family relationships – my condition has worsened by prior relationship with family members, with some (especially from the extended family unit) calling me a parasite. The only good relationship I have been able to salvage is that with my sister, who sometimes get pissed off with my complete dependence. Lost friendships – All my friends have left me, with some even refusing to be associated with me. Most of my friends argue that they cannot visit me because I am not in a position to reciprocate their visitation. As such, my paraplegic condition restricts me from forming any good relationship, except with my sister. Inability to attend or participate in social gatherings – unless assisted by sister, my paraplegic condition has limited my ability to attend or participate in social functions. Others also disregard my opinions in some instances on the basis of irrelevancy. This has forced me to assume a passive role in such gatherings to avoid misunderstandings or criticism from my colleagues. Environmental or Community Challenges Limited access to storey buildings – Because of my reliance on wheelchair for mobility, I have not been able to access storey buildings, which usually have stairs. To access them (even our house) I have resorted to relying for assistance from my sister to push me around the buildings. I would suggest that building designers and builders to integrate wheelchair ramps in order to facilitate free and comfortable mobility of disabled individuals using wheelchairs. Limited access to public utilities – It has not been possible to get access to public utilities such as bus stations, toilets, and others without help from my sister. To adjust to these settings, whenever I require services from these centers, I usually ensure that I have someone I know to seek assistance. I would suggest that the public agencies provide wheelchair ramps and modify utilities for people with disabled legs. Inability to board or alight motor vehicles – I normally walk around with my sister so that she can assist me to board or alight from motor vehicles. I would suggest for inclusion of lifting mechanism or wheel-chair ramp structure in the vehicles, and a special place where disabled people can sit while on their wheelchairs. My reactions to the Disability The disability reduces my body image because sometimes I go unnoticed in social gatherings, with majority of people referring to me ‘that woman in the wheelchair.’ As a result, my self-concept has also deteriorated because most people do not like to associate with me or listen to my opinions. I feel demoralized, with sometimes fearing to contribute my opinions or ideas in presence of my friends. Rehabilitation Healthcare professionals caring for people with disabilities including paraplegia should show pity and paternalism, as well as assist the patients develop self-efficacy and independence, which the patients could have lost due to their disability. They should show pity because these patients are physically or mentally impaired, meaning that they may not be able to carry out certain activities on their own. They should also observe paternalism towards the patients to ensure that they can live like their non-disabled people (Cristian 125). In this way, they will help in recreating their self-worth and in turn, develop courage to interact with others once they get out of the rehabilitation centers. However, paternalism does not necessarily imply that the professionals should perform all daily chores for the patients, but rather allowing the patients to carry out their daily chores for which they are able to do so without or with mild to moderate difficulty (Schonherr 190). This will help the patients to learn to accomplish some tasks with their disabilities, preventing them from becoming completely dependant when they get out of the rehabilitation centers. Works Cited Cristian, Adrian. Living with Spinal Cord Injury: A Wellness Approach. New York, NY: Demos Medical Publishing, 2004. Print. Jurisic, Brigita, and Andrej Marusic. “Suicidal Ideation and Behavior and Some Psychological Correlates in Physically Disabled Motor-Vehicle Accident Survivors.” Crisis 30.1(2009): 34-38. Print McColl, Mary A., Paul Stirling, Janice Walker, Paul Corey, and Russell Wilkins. “Expectations of Independence among Ageing Spinal Cord Injured Adults.” Disability and Rehabilitation 21. 5/6 1999): 231-240. Print. O’Connor, Deborah L., Jenny M. Young, and Megan J. Saul. “Living with Paraplegia. Tensions and Contradictions.” Health & Social Work 29. 3 (2004): 207-218. Print. Schonherr, M.S., J.W. Groothoft, G.A. Mulder, and W.H. Eisna. “Prediction of Functional Outcome after Spinal Cord Injury: A Task for the Rehabilitation Team and the Patient.” Spinal Cord 38. 3 (200): 185-191. Print. Read More