SCI, Scuba Diving and the Art of Cognitive Restructuring

Guest blog post by Bob Vogel

In my pre-SCI (spinal cord injury) days I competed on the professional freestyle snow skiing circuit. Vying for the upper echelon of the sport, I soon discovered the difference between top athletes is as much mental as it is physical. I also had a few hurdles to overcome, not the least of which was that I would be overcome with severe anxiety before the start of a competitive run. I worked with a sports psychologist, and one of the tools she taught to help me overcome this was cognitive restructuring, a technique in which you change negative self talk and turn it into positive self-talk. A technique that worked! After much practice, I was able to convince myself the more nervous I was, the better I would ski. I welcomed the nerves – the tougher the competition, the better I skied.

When I broke my back and was going through SCI rehab, I discovered cognitive restructuring could be a very helpful tool in dealing with the daily routine and rigors required to maintain a healthy body with SCI.

During the acute phase of my SCI, I got hit with a pulmonary embolism (blood clot in the lung). As part of the therapy for the embolism, I had to operate a device that consisted of inhaling through my mouth to keep a little ball raised in a tube as long as I could—long deep breaths—five times every hour, which the time seemed like torture. Even tougher, twice a day the respiratory therapist came in with a torturous machine that with each breath, by mouth, would force saline-misty air into my lungs as I inhaled.  The forced salty air had a horrible taste and would cause me to almost puke. I dreaded every treatment.  However, I also understood the treatments were vital to helping me open and strengthen my lungs to prevent pneumonia.

As awful as the breathing machine felt—there was also something vaguely familiar about it.  Then I figured out the connection—the saline mist was coming from the machine had a similar taste as ocean water, a taste I often encountered when I was scuba diving – a sport I loved!  I used this connection to cognitively restructure my thoughts about the breathing treatments.  Each time I struggled to keep the ball raised on my breathing device I would imagine I was floating on the surface of the water looking down through my dive mask and taking a deep breath on my snorkel before descending as deep as my breath would allow.  During the forced air treatments, I would close my eyes and imagine I was diving in crystal clear water near a colorful coral reef.  Using cognitive restructuring, the previously unbearable treatments became pleasant daydreams.

Transferring from the acute SCI bed to the rehab ward and trying to learn the endless list of daily tasks from when to empty the bladder, how much liquid to take in, bowel training, weight shifts, skin checks, and on and on, with no physical sensation to remind us was daunting to say the least.

I remember having a similar, overwhelming feeling during my first scuba classes thinking of all the things a diver needs to monitor during a dive – depth, amount of air pressure in the tank, length of the dive, decompression status, navigation, buoyancy control, planning a slow controlled ascent and safety stop – seemed just as daunting and there is no physical sensation to help out.  Yet with time and practice it became second nature.  An accomplished diver consistently checks these systems in a relaxed manner and it becomes a source of pride.

Once again, I turned to cognitive restructuring. In rehab, I decided learning how to keep track of the way my body works and learning to manage and monitor all of the systems I could no longer feel, including weight shifts and skin checks would become akin to checking systems in scuba diving.  I worked hard in rehab and got the basics down.  I’ve also found that learning how to keep a body with SCI healthy is a lifelong, ongoing process.  I’m fortunate to have many friends with SCI and we often trade “SCI health and maintenance” ideas. For the friends I roll with, monitoring and taking control of the unique ways our bodies work with SCI is second nature.  We trade stories about keeping ourselves healthy, and dodging (or getting hit with) skin, bladder or shoulder problems the way divers talk about their scuba expeditions.

My cognitive restructuring comparing scuba diving to life with SCI extends to my equipment as well. I take as much pride in my chair and cushion as I do in my scuba gear.  I keep my chair clean and in perfect condition.  Same goes for my ROHO^® QUADTRO SELECT^® Cushion. As I’ve mentioned in previous blogs, I wash and change my cushion cover every few days and every week or two I take my cushion into the tub and wash it with bath soap and give it a good rinse to make sure my equipment doesn’t acquire odors that I may not be aware of.  For more information on cushion cleaning, see Resources.

 As I’ve also mentioned in previous blogs, people do notice when you take pride in your health and your equipment. The woman I married said one of the things she noticed about me when we first started dating was that I kept my chair clean. She also noticed that I did weight shifts—granted she was a nurse.  To her, taking care of my body and my equipment is a sign of self-confidence and comfort with my disability. She found this attractive!

Stay healthy, my friends!

Resources:

Cleaning and Disinfecting ROHO DRY FLOATATION Products

How to Keep Your Equipment Clean

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Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

Aging and SCI: 4 Steps to Staying Healthy for the Long Haul

Guest blog post by Bob Vogel

 

The common saying that dogs resemble their owners (or is it the other way around?) — is becoming more apparent for Schatzie — my 10-year-old German Shepherd Service dog — and me these days. At 52, — 27 years as a T10 para — my goatee is graying at the same rate as Schatzie’s muzzle at 10. In the morning, my shoulders are stiff and sore. I can tell Schatzie’s hindquarters are a bit stiff when she first steps out of her crate, stretches and comes over to my bed to give me gentle nuzzle.

Staying healthy as we age with SCI is a frequent topic of discussion among the friends that I roll with — we seem to be aging quicker than our non-disabled acquaintances. I often joke that SCI ages us in dog years. Fortunately there are steps that can help avoid this accelerated aging process — steps that friends and I were lucky to have learned in our younger days from mentors and peers, who had often learned the hard way with bodies that wore out before their time. Following this advice and sharing it has helped us stay healthy for the long haul. Here are four simple steps to help stay healthy over the long haul.

 

1. Stay in Motion

Newton was right, a body in motion tends to stay in motion, and a body at rest, umm, doesn’t want to put down the TV remote and get up off of the couch. I spend a lot of time working at the computer which can leave me feeling lethargic, tired and/or a bit depressed — and all I want is the TV remote or a nap. Friends will remind me to go for a push, meet a friend for coffee, go for a handcycle ride. When I listen and do a social or physical activity I end up with much more energy, enthusiasm and creativity than if I had taken a nap.

Experts suggest a daily routine of 30-minutes of aerobic exercise is very important for overall health. This should be something fun and simple, like going on a 30-minute push in the chair. For me, choosing take Schatzie on a walk into town to get the mail, instead of taking the car, is relaxing and gets the endorphins moving. Another great way I grab a quick endorphin-producing workout during a busy day is by riding my handcycle on a stationary trainer for 30-45 minutes. As always, be sure to use a good cushion on the handcycle — I use a ROHO® LOW PROFILE® Dual Valve Cushion, custom made to fit my handcycle seat. In addition to more energy, the workout seems to sharpen my thoughts and helps keep me in good enough shape to enjoy weekend adventures. A good stationary trainer costs around $300 at bike shops, a little less online, and used ones at bargain prices can often be found on Craigslist.

 

2. Stay Trim and Light

As we age, metabolism slows down and it’s easy to put on a few extra pounds here and there until it really starts adding up. I hear stories of wheelers who put on weight that ends up causing a domino effect of problems, from shoulder trouble and pressure sores to type II diabetes. I also know wheelers that gained weight and through watching their food intake have managed loose lose it. I find keeping my weight under control is a bit easier if I check it on a scale every couple of days — if it starts to creep up I eat a bit less and try and exercise a bit more. I start by keeping an eye on my weight by transferring off of my chair onto my ROHO ADAPTOR PAD® on the bathroom floor, then transferring my butt onto the bathroom scale and lifting up my feet to check the scale. Doing this also helps me keep up my chair to floor — and back — transfer skills.

 

3. Keep Your Shoulders Balanced

Keep shoulders balanced. I learned this about 15 years after my injury when I had over-trained for an event and my shoulders were really hurting. I sought advice from a peer who had permanently damaged his shoulders from overuse. He explained shoulder damage is common in wheelchair users, often from overdeveloping the muscles in the front of the shoulders — which pulls the shoulders forward and out of balance. He explained the need to rest when shoulders they are sore or hurt, and do exercises — like rowing motions — to balance the back of the shoulder. He also suggested going to a sports medicine clinic and seeing a sports medicine physical therapist (PT). I took his advice, saw a Sports PT who, in turn, gave me a set of stretches and exercises that helped balance out my shoulders and over time relieved the pain. Sticking with those basic exercises and resting shoulders when they sore rather than “push through the pain” have kept them healthy — albeit a bit sore in the morning — to this day.

Anecdotally, a simple day-to-day trick to help keep shoulders in balance is get in the habit of backing your wheelchair up ramps and hills instead of pushing forward — this works the muscles in the back of the shoulders. Another way to balance shoulders is by handcycling and concentrating on the “pulling back” part of the cycle stroke and relaxing on the “pushing forward” part. For further information on ways to balance shoulders see resources.

 

4. Use the Proper Cushion and Do Daily Skin Checks

The most important advice I got from mentors and peers is to use the proper cushion and to continue doing the skin checks with a mirror like I was taught in rehab. Back in 1985, when I got out of rehab I was sent home on a memory foam cushion, despite asking my therapist for a ROHO Single Valve Cushion. I still remember my therapists faulty reasoning, “If I get you a ROHO you will get lazy and will rely on the cushion and won’t do as many weight shifts as you’re suppose to.” Looking back, all I can think is, “WHAT??!!” A few months out of rehab, despite constant weight shifts, an evening mirror check caught the first stage of a small pressure sore on my bony butt — I immediately got a ROHO Cushion and the sore healed. Fortunately, that was my one and only pressure sore. My skin remains healthy after 27-years (and counting) of diligently doing skin checks with a mirror every morning and evening combined with the proper cushion, a custom ROHO QUADTRO SELECT® MID PROFILE™ Cushion.

Unfortunately, I hear all too many stories of wheelers that never had a skin issue and for years had a minimal cushion and felt they didn’t have to worry about skin checks. Sadly, the story frequently changes somewhere between 10-20 years after their injury when a massive pressure sore strikes and they end up flat on their stomach in the hospital awaiting skin flap surgery — followed by months of recovery in a nursing home. I advise friends to take a few moments to check your skin with a mirror every morning and evening, along with making sure you have the proper cushion for your seating needs. That is the best insurance you can make to keep your skin healthy and avoid a pressure sore.

Stay healthy my friends!

 

Resources:

• Aching Shoulders? Craig Hospital Guide: www.craighospital.org/repository/documents/HeathInfo/PDFs/754.AchingShoulders.NOD.pdf
• Limb Function: What You Should Know. Consumer Guide. www.PVA.org
• Shoulder Health, New Mobility Para/Medic: www.newmobility.com/articleView.cfm?id=12098&srch=shoulders

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Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.