Graduation Day

On Tuesday when Mom arrived at the center for her physical therapy and started slowly shoving her walker forward, the therapist immediately noticed a decline.
"She's not doing well today," Michael whispered to me and Jona.
"No," I answered. "On Sunday she walked easily all the way to the dining room for breakfast, and back afterward. But yesterday she couldn't put her right foot down solidly. She was kind of limping along, and I had to have the wheelchair brought for her when she was about halfway there."
On Wednesday I don't know how she did--my sister visited her and I took a day off.
But today she's doing better than ever.
In the morning Jona walked with Mom all the way to the dining room, about one hundred feet, and she didn't keep a hand on her. Instead she followed directly behind her with the wheelchair, so that if she collapsed the chair would be there.
"You didn't get anyone from Ocean View to help you walk with her?" I asked anxiously.
"They were too busy,"Jona said.
I could imagine the scene: all the caregivers rounding up the 28 residents and bringing them to the dining room, with some residents leaving their seats at the table before lunch was served, before others had arrived.
"Okay," I said, "As long as you don't hurt your back."
But Jona assured me that Mom had even pulled herself to standing, after Jona raised the electric recliner to its maximum, reared-up position.
She admitted that she hadn't used the gait belt, but I couldn't complain because I don't use it either.
When we arrived at physical therapy today, Suzanne the PT saw Mom at her best.
She pulled herself to standing at her walker a few times--slowly, with complaints.
The effort she put into this caught my heart--it was a glimpse of her old self, fiercely determined to do something, not letting anything stop her.
She walked easily in a circle around the room using her walker, without anyone holding onto her. At the parallel bars, she stood up from her wheelchair by herself ten times, even more slowly with even more complaints. Then Suzanne required another six or ten times, occasionally giving her a boost by pulling up on the gait belt around her waist.
After another spin around the room, Suzanne pronounced Mom finished with her physical therapy. It had been just five sessions, but she had made good progress.
Medicare benefits have been cut back to 15 physical therapy or speech therapy sessions per year, so Suzanne didn't want to use them all up in the first two months. I assured her that Mom's Blue Cross / Blue Shield covers about 50 visits per year, but Suzanne still wanted to declare Mom rehabilitated.
"She's reached a plateau, and I don't think we are going to see improvement from this point. The goal is just to keep her walking and pulling herself to stand as she is now."
"Wow! Congratulations, Mom, you graduated," Connie and I told Mom.
She was proud of herself.
Our job now is to make sure she walks as much as possible, at least three trips to the dining room and back per day.
She also needs to push herself to stand from sitting, ten times in a row, once or twice per day.
In today's PT she had done a step-up exercise, stepping up onto a small platform five times with one foot leading, then five times with the other. I bought a step for her to continue practicing this one, but she will need two people ready to support her in case she falls.
We fussed over her for doing well today, but the reality is that there will be neither a smooth upward curve nor any guarantee of staying on a plateau.
One of the features of Lewy Body Dementia is that each day, her physical and mental condition is different.
We can hope that she stays generally at this level for a good while longer, but at some point there will be a steep decline, if the dementia she has is really Lewy Body.