Parent/professional partnership

Nicky Hunter is an Occupational Therapist with the Spinal Outreach Team at Queensland Spinal Cord Injury Service, Princess Alexandra Hospital and Health Services District in Australia. She describes the innovative and collaborative approach of the Spinal Outreach Team.

AII parents can recall the feeling of that precious bundle being placed in their arms. What joy!

The Spinal Outreach Team in Queensland, Australia, assists clients with a spinal cord injury to function in the community. We help in a range of areas including parenting with a focus on independence, information and problem-solving.

What is spinal cord injury?

A spinal cord injury is a serious injury which often affects people when they are young and when parenthood should still be a choice. All systems are affected and may include: neurological (ability to move and feet), skin (reduced sensation and circulation), musculo-skeletal (pain and reduced range of movement and strength), bladder and bowel (loss of sensation and control), cardiovascular (reduced blood pressure and swollen limbs), respiratory (reduced capacity), temperature (difficulty moderating temperature) and sexual function (fertility affected in men, although having children is still a realistic goal).

Many of these factors influence both pregnancy and parenting abilities, and our clients are well able to identify the potential difficulties when deciding whether to have a child or when parenting after an injury.

Spinal Outreach Team

The Spinal Outreach Team (SPOT) addresses the needs of individuals who have already been through the acute and rehabilitation services, and are now living in the community.

A range of skills is often needed to assist our clients — including nursing, occupational therapy, physiotherapy and social work. We work together as a team to provide a community-based service which includes a client focus, early intervention and consultancy to carers and service providers.

SPOT and parenting

When considering what assistance to offer new parents we need to be mindful of the issues which confront any new parent. As Steve Biddulph (1994) says: “Raising kids is an ancient craft. To do it well you have to root out your hidden inner resources, as well as drawing on many outer supports. You adopt a kind of ‘finding the way as you go attitude’”.

SPOT therefore steps in as one of these outer supports - to provide information about our previous experiences with clients and their needs, and the resources which are out there in the wider community.

Each individual will have different priorities and needs, and one of these is the ability to link with others who have been there already.

How do we help?

Services are tailor-made to match people’s needs, and can be illustrated by the following case examples:

Sue and Sarah

Sue is 18 years post-injury and has a C6/7 quadriplegic level injury. This means she is able to move her arms and wrists but has limited movement in her hands. Before Sarah’s arrival, Sue had always been able to manage her own transfers independently, and was able to use a manual wheelchair.

Sue and her husband have been able to solve equipment problems creatively (see photograph). However, Sue is now experiencing a reduction in function leading to difficulty with transfers, increasing fatigue and reduced ability to mobilise in her manual wheelchair.

Sue mentioned that not only is she having to race around more, but she is concerned about safety aspects for Sarah. SPOT has been able to assist in the following ways:

  • review of abilities to manage
  • transfers, pressure care and
  • physical function
  • assessment and provision of a power-drive wheelchair: this has enabled Sue to increase her
  • independence and speed when chasing Sarah, and has reduced her fatigue
  • provision of a new pressure relief cushion
  • advice about changes in bladder function.

Sue helped SPOT by telling us about the adaptations she and her husband had made to equipment, and by talking to other clients about their parenting role and how to make it a success.

Dearne and Jake

SPOT was involved with Dearne from the early stages of her pregnancy.

Dearne has a T11112 paraplegic level injury, is 11 years post-injury and is now a single mother.

She had many early concerns about what the future held and how things would go in hospital. This helped SPOT to develop a checklist of things to be considered before hospital admission and what items might need to be taken in (for example, shower commode, pressure relieving mattress, wheelchair).

Other issues SPOT became involved with were the effects of increasing weight on balance, transfers and pressure care. Our social workers assisted with advice about community resources and care available, and our nurse addressed issues such as bladder management and skin care.

As an occupational therapist I looked at the development of a sling (see photograph) to assist with Dearne’s management when transferring Jake from cot, pram and floor and with balancing Jake on her knees.

Dearne was able to help SPOT by giving feedback on equipment for Jake - including a pram which could be controlled easily, a high chair which adjusts in height and suitable bathing options (although this was always difficult to manage).

Future services

Issues confronting parents change overtime. For SPOT’s clients, the priority is to know that they can contact our service when they identify an issue which they cannot resolve themselves.

Our assistance often uses a collaborative problem-solving approach which can include changes in technique, equipment adaptation or replacement, or just information. The aim of our service is to complement the individual’s other resources and their own inherent skills as a parent.

On-going collection and dissemination of information among service providers will enable the development of a network of informed and skilled individuals.

Reference

Biddulph S. 1994. More secrets of happy children. Adelaide: Griffin Press.

First published in Disability, Pregnancy & Parenthood international, Issue 44, Autumn 2003.

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