Free Life on Wheels by Gary Karp Page A

counseling about how to handle certain situations. The first time they go out they might come back and say, “People were staring at me!” or “People were much nicer to me!” It really depends. Everyone has a little different experience.
    How much exposure you’ll get to various options depends on the facility and the space and resources it is able to devote to recreation. Some smaller rehab hospitals will not have a space devoted to recreation. Your room might become the principle gathering place. Visitors will have to come to your room—usually shared with one to three others—and you might feel like there is nothing much more to do than be in bed. Recreation therapists in such settings will try hard not to let that happen, being as creative as they can by renting videos and setting up an evening “theater” in the therapy gym or throwing parties around a holiday. Their goal is to keep you active and, to the degree they can, give you a taste of available athletic options.
    Respiratory Therapy
     
    Oxygen is essential to all metabolic processes and to life. Breathing is particularly an issue for people with postpolio syndrome or high-level spinal cord conditions. The muscles that cause the lungs to expand and contract are often weakened by these conditions, limiting the amount of air you can draw in. People with higher level paraplegia can also face breathing difficulties from limited use of trunk and abdominal muscles and a reduced ability to cough and clear mucus.
    The respiratory therapist’s job is to ensure that you are getting sufficient oxygen into your lungs. Respiratory therapists determine the efficiency of your breathing by measuring “vital capacity,” based on body size and age. Therapists can measure oxygen saturation in the capillaries of the ear or finger. They listen to your lungs with a stethoscope to judge air movement and the presence of secretions. If your oxygen saturation levels fall below a certain percentage, the therapist will take measures to improve your breathing.
    Doubts about your ability to breathe are often a source of deep fears and insecurities. Respiratory therapists are acutely aware of the anxiety associated with breathing; part of their job is to reassure you. If you have respiratory issues, the respiratory therapist is one of the first people you will meet and one of the first to spend significant time with you.
    Respiratory therapists will work with occupational and physical therapists to select activities that help strengthen muscles in the chest and diaphragm used in breathing. Respiratory therapists interact with other rehab team members, advising them how your respiratory status needs to be considered in the work they are doing on your behalf, instructing them about respiratory issues, and, in some cases, teaching basic methods, such as use of a resuscitation bag.
    If your vital capacity is low, respiratory therapists might recommend a stretch program. A ventilator machine literally inflates your lungs to stretch them out—hyper-expanding them—to increase their capacity. Pressure is increased gradually, taking your comfort level into account. This is usually done for 10 to 15 minutes, four times per day.
    In some cases, breathing needs to be assisted with a ventilator. Not all centers are equipped to work with ventilatordependent quadriplegics; this requires special skills and facilities. During initial rehab, the goal is always to work toward getting off the ventilator, which many people ultimately achieve with hard work.
    Volume Ventilation
     
    One of the strongest images associated with the polio epidemic of the ’40s and ’50s was the iron lung. It was the assistive breathing device of the day, using negative pressure to create a vacuum that would cause the lungs to draw in air. Now the most common approach is positive-pressure ventilation, in which a machine delivers a measured volume of gas into the lungs. The machinery has become very advanced. There are a