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					                                                    MDT Meeting 21 November 2006


       Goal # 1: Establish some form of communication (Switches, Computer
        Programs). How to establish communication? Which tools are available?
       Goal # 2: Further his eating ability. Ability to chew hard solids to be
        developed and continuous work towards this goal. I want Chris to eat a steak

Neuro Consultant:

       Spasticity: change in drugs, dosage, types of medication?
       Ambien/ Zolpidem
       Brain stimulants: AAI (Attention Arousal Initiation) drugs
       Taurine and GABA supplements?
       Main risks for Chris: hydrocephalus? Any other things I should be aware of?
       Baclofen Pump:
            o Discuss and review, only pump to be inserted if resistant to depth
                 necessary for future HBOT treatments
       Magnesium supplement?
       I really want a MRI and EEG carried out if only for my own data keeping
        purposes, but I think it will be good to have some concrete exams to be
        benchmarked against every year.


       Spasticity:
            o Arms: correct, attenuate/ alleviate deformity and pain
            o Legs: work towards gaing full range to be able to stretch fully and
                stand on tilt table
            o Shoulders: works towards loosening tightness and gain some flexibility
            o Elbows: HO on the left side, work on stretching out the right side. Can
                anything be done??
       Splinting:
            o Any changes being contemplated?
            o Splinting chart is not visible: ensure they are ALL being carried out.
            o Who does it and are they trained to put them on for Chris
            o Weekend protocol?

       Other areas of potential risk? Pelvis rotation? Any thing I should be aware of?
       Instead of maintenance, can any goals to be put in place? i.e. Sitting balance/
        ability to sit without crashing and falling.

Posture Management:

       Wheelchair: headrest must be changed as current one is not appropriate
        anymore for his head and does not provide any support anymore
       Chris is bending towards the right side, sometimes on his chair, other times in
        his bed: Back/ Column must be preserved.

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                                                  MDT Meeting 21 November 2006

Nutrition/ Dietician:

      Inclusion of the following supplements on a daily basis:
           o Marine Plankton: daily
           o Glyconutrients: daily
           o Cod Liver Oil: daily
           o Chinese Herbs: twice as week
           o Applesauce: daily
           o Blueberry juice: daily (IN PROGRESS)

      Feeding tube used for: medication, feed at night to complement (quantity to be
       determined), and fluids.

      Orally: lunch and dinner. Introduce a fluid chart so that a certain minimum is
       given orally.

      Goal: phase feeding tube out.

Nursing Care:

      Skin area around inside elbow, specially the left side: please maintain proper
       care by cleaning it daily and ensuring it’s properly cared for.
      Area in the stomach around PEG tube must be cleaned everyday and checked
      Skin inside his hands, between fingers: must be cleaned and kept dry
      Wheelchair time? Bed time? How often turned? Turning chart in the room?
      Can pillow go between Chris’ biceps and torax on his left side, and also
       between chest and left hand? He is very tight on the left side.

Alternative Treatments:

      Reiki: once a month by Ann-Margaret Whittle
      Hand massage: daily for 30 minutes by Faye
      Acupuncture: once a week by [to be determined, I need to find someone in the
      Reflexology: once or twice a week by [to be determined]
      Full Body massage/ aromatherapy: once a week by [to be determined]

Chris weekly schedule:

      Bath 3x per week
      Shampoo 2x per week
      Daily shaving not necessary: 3x a week (plus Koo on weekend)
      PT: 3x per week, SALT, OT frequency?
      Other activities:
          o Movies on Monday evenings: Koo will try to come weekly and spend
              the night, if possible
          o Other outings available?
      Mouth hygiene: 3x daily - upon getting up, after lunch, after dinner
      Haircut: once a month, please automatically schedule Chris every month

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                                                   MDT Meeting 21 November 2006

      Family’s responsibility: nail clipping, ear cleaning, supply blueberry juice, and
       all extra supplements.

General Summary of Chris day:

Early morning:        Hygiene, bath, getting up, supplements
Morning:              splinting, PT
Lunchtime:            Have lunch with everyone in the dining room
Afternoon:            SALT, OT, alternative therapies, social activities, etc
Dinnertime:           Have dinner with everyone in the dining room
Evening:              Bed time: watch TV and sleep

Other future plans:

      Stem cell in China: planning to depart late June 2007 for two months. Bring
       all information gathered, contact details of doctors and hospital in Beijing.
            o Logistics (i.e. flight to Beijing WIP, choice of direct flight is BA or
               China Airways, BA preferred)
      HBOT: 20 dives every 3-months or 3x a year:
            o For 2007, the target is late January, May, and September
            o Location: MS Center in Walthamstow E17
            o Morning dives: 30 min. commute each way, plus 1 hr dive
            o Family to buy a wheelchair van or can the Jacob “rent” their vehicles

In 6 months’ time around late June 2006, my personal expectations given the

      Chris is able to communicate: at least to convey definite yes and no very
      Chris is able to mouth some words
      Chris is able to have his favorite Brazilian steak “Picanha Fatiada”
      Chris’ arms are relaxed
      Chris legs can be fully stretch and can stand up straight on the tilt table
      Chris posture is stronger and without bent, he is able to hold himself with
       certain balance
      Chris is able to have some movement control
      Chris continues to keep the record of no infections/ pneumonia, seizures, and
       other common problems of people with ABI

Things to do/ do not forget:

      Sew name tags for all of Chris’ clothes and socks;
      Go buy: paint and brush to paint Chris room, border/ wall paper to decorate
      Frame pictures for Chris room
      Get a sofa/ bed/ cushion something to be able to spend nights in his room once
       a week or every 2 weeks
      Go to Heathrow, call British Airways
      Arrange conference call among Dr.’s in China and the Jacob Centre, if

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