Abstract
Permanent dependence on a mechanical respirator, even when associated with severe or total locomotor paralysis, does not preclude discharge from hospital to domiciliary life, provided certain equipment and facilities are provided. Much can be learnt from cases of lower motor neuron paralysis of the respiratory muscles— usually caused by poliomyelitis and associated with severe locomotor disability— who have successfully established themselves at home and, step by step, overcome the difficulties created by their respiratory and locomotor paralyses.
The equipment and facilities which they need fall into three categories:
(a) Respiratory. They need not only the necessary basic equipment of respirator and, where necessary, sucker, but also a reliable system to ensure that errors in electricity supply, in the machines themselves, and in the connections and other accessories are easily, promptly and, if possible, automatically corrected. Provision should also be made for mobility of the patient and his equipment, so that he is not permanently confined to one room in one house. Adequate arrangements must be made for servicing the equipment at regular intervals and for rectifying faults.
(b) 'Care'. Wise selection of equipment and techniques for routine nursing and daily living activities greatly reduces the time and effort spent on them.
(c) Occupational and Recreational. These enable the patient and his family to live to maximum capacity within the limits of the physical disability: they may enable the patient himself to earn part or all of the necessary family income.
The importance of this final stage of rehabilitation in the management of the severely paralysed is stressed.
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Agerholm, M. Respiratory and other devices for the totally paralysed in domiciliary life. Spinal Cord 3, 177–178 (1965). https://doi.org/10.1038/sc.1965.21
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DOI: https://doi.org/10.1038/sc.1965.21