Good Morning Angels: Heidi-Lene gets much needed rehabilitation to get her walking again

REQUEST FROM: Caryn Wright Bekker, Occupational Therapist 

REQUEST FOR: 23-year old Heidi-lene Jonck from Louis Trichard

BACKGROUND: 23-year old Heidi-lene Jonck is in the prime of her life. She overcame many difficulties growing up and has never let anything hold her back. Heidi-lene was in primary school when her single mother died. She and her brother were placed in the care of her older half-sister, who raised them. After school, Heidi-lene started working as a tutor to earn a living and to pay for her own studies at Unisa - her dream is to become a teacher. 

Full of life and positive about the future, Heidi-lene enjoyed a day at the dam with friends on 11 March this year. The fun turned into tragedy, when a boating accident left Heidi-lene severely injured, sustaining facial fractures, a severe head injury and fractures to her left leg.  

After more than a month in different private and state hospitals due to the fact that she does not have a medical aid, Heidi-lene was released to a rehabilitation facility.

She cannot stand yet - but is positive that she would be able to get back to her life and her studies soon.

To stay in rehab, she needs to pay around R135 000 for three months - without an income or medical aid, this is not possible.

ANGEL: Christo Bezuidenhout, Round Table 

SPONSORING:  The Round Table will support the fundraising efforts for Heidi-Lene’s rehabilitation by donating R45 000 on top of the R35 000 they have already donated.  

ORIGINAL REQUEST:

Heidi-lene was studying through UNISA at the time of her injury and she wanted to become a teacher. She was working during the day as a tutor and helped children with home-schooling and with their homework in the afternoons. Through this she was earning a reasonable income. Her mother passed away when she was in primary school and Heidi-lene and her brother were placed into foster care with her biological half-sister. Her sister, Elze-Marie, raised Heidi-lene from this point. She made it through high school and started to work as an assistant teacher while studying teaching through UNISA.

Heidi-lene was involved in a boating accident on the 11th of March 2018, when she was being pulled on a tube behind a boat on a dam during a recreational activity. The tube crashed into the side of another moving boat on the dam at high speed, where after she fell off the tube and into the water. She was pulled out of the water and taken to the side of the dam, where she was put onto a steel foldable table and loaded onto the back on a bakkie and taken to the Zoutpansberg Private Hospital.

The casualty department at Zoutpansberg Private Hospital carried out an assessment of her injuries and stabilised her condition, before transferring her to Polokwane Mediclinic for further management. She was transported to Mediclinic by means of an ambulance. After assessment at Mediclinic, she was then transferred to Polokwane Provincial Hospital due to not having a medical aid to cover private care costs. At the provincial hospital, she was taken to Casualty, where she was once again stabilised and remained here for approximately 48 hours.

Heidi-Lene was then transferred to the Intensive Care Unit (ICU), where she remained for a total of 33 days and she was kept under sedation to allow time for the swelling on the brain to subside. She was operated on the 16th of March 2018 where the orthopaedic surgeon did an internal fixation and inserted an intra-medullary nail. The sedation was slowly lifted during the last period of the period in ICU and then transferred to High Care on the 14th of April 2018. During this period in ICU, she developed pneumonia and was very ill for more than a week where they struggled to control her temperature/fever. The doctor reported that this was mainly as a result of the fact that she inhaled dam water when she fell into the water after the impact during the accident.

On the 25th of April 2018, she was transferred to Louis Trichardt Memorial Hospital and was then admitted for further management. On the 26th of April 2018, her foster mother discovered that she had still had staples in a wound in the right groin, which was from an operation which was performed on the 16th of March 2018. This wound had started festering and was causing immense pin.

On the 26th of April 2018, she was declared to be medically stable and was discharged from the hospital and taken home. When she was assessed at home, it was discovered that she had pressure sores on both heels, with a very advanced sore on the left heel which has been treated up until now and has heeled very nicely.

Heidi-Lene is currently dependent on the support of her immediate carers to help her with all of her ADL activities. She is currently still bed-ridden and unable to carry out any bed mobility independently. She is moved between a hospital bed and a reclining chair (alternating every 24 hours or less and her position is being rotated every 2 hours when she is in the bed in order to give pressure relief. She is bathed every day by 2 volunteer nurses due to not being able to carry this out independently. She has started to help with certain activities, such as washing her face with a facecloth while lying in the bed and also is able to bring a fork/spoon to her mouth when eating (she however finds it difficult to scoop up food herself due to the impaired perceptual skills and vision). Heidi-Lene has had her catheter removed and is currently making use of adult diapers for her toileting due to not being mobile enough to get to and from the toilet – she is however able to feel when she needs to make bowel and bladder movements. She has also not yet taken to making use of a bed-pan.

Range of movement: Heidi-Lene presents with full passive range of movement throughout the joints within the left upper limb and hand, however she presents with difficulty in terms of achieving full range of movement within the shoulder, elbow and hand due to the impaired muscle strength and coordination. Both feet developed stiffness in the ankles due to the prolonged period of time spent in ICU under sedation (causing drop-foot due to contracting of the Achilles tendons). The hamstring muscles were also severely restricted and stiff and this has improved over the last few weeks during the physiotherapy sessions. Left hip, knee and ankle range of movement is therefore restricted as a result of the injuries and resulting stiffness. Muscle strength Muscle strength within the left upper limb is severely impaired due to reduced muscle tone. The right upper limb is however also impaired in comparison to the norms and expectations (she was initially unable to move the right upper limb either).

Posture: Heidi-lene is unable to move into a seated position independently and sits with asymmetrical posture due to weakness on the left side of the body. Scoliosis to the left side is observed.

Balance: She manages to maintain static balance in a seated position for shorter periods of time. Dynamic balance is however still severely impaired and therefore needs to be developed.

Heidi-Lene has not yet been able to stand (even in a facilitated standing position) due to a severe pressure sore on the left heel that has been treated up until now.

Cognitive: She presents with some cognitive impairments which includes short term memory loss and concentration impairments, as well as perceptual impairments. It is advised that further assessment should be done in this regard. Heidi-lene underwent laser surgery on her right eye when she was in Grade 12 due to having been born with a congenital defect in the eye which severely limited her vision in this eye. The sight was improved through the surgery. Unfortunately, due to the injuries sustained during the accident (the left side of the head was injured and this caused paralysis on the left side of the face and the left eye functioning has also been impaired). Upon her visit to the neurologist on the 30th of May 2018, it was advised that

she can stop using epilim and therefore her vision is expected to improve (this was reported by the optometrist who consulted her).

Speech: Heidi-Lene is able to speak and communicate effectively, and presents with an appropriate vocabulary. It is however noted that she experiences some difficulties with regards to breathing at the moment due to the lungs being weakened (she has been issued with a spirometer to improve lung capacity). She is able to drink, chew and swallow effectively. She is currently able to eat

solid food and has an increasingly healthy appetite. According to the neurologist, Heidi-Lene still presents with scar tissue around the trachea due to the intubation tube which she was on while in ICU. It may be necessary for her to have the scar tissue attended to in the future (laser removal was suggested).

We have not issued Heidi-Lene with a personalised wheelchair yet, due to wanting to see how far she is able to get with therapy before making this commitment. She has also been motivated by her family by telling her that they will not be buying her a wheelchair because they believe that she is going to walk. Heidi-lene has been referred for further multi-disciplinary intervention at La Vie Rehabilitation Centre. She is an extremely motivated individual and is excited to start her journey back to a more functional level where she can be more active in her Activities of Daily Living and even if possible returning to her occupation if possible.