Nursing Home Care in Taiwan

 We're not sure who made the splints but its pretty clear they don't fit this man or have a purpose--at least a splinting purpose.

 Poorly made splint.

 There are 15 people on this floor that require maximum assistance with all ADL. Everyone has a feeding tube and wears a diaper. Independence is not encouraged. Two nursing aides are in charge of this floor.

 Me trying to do passive range of motion on a man who sustained a TBI about 3 years ago. His wrist and MCP joints have a lot of tension and are showing signs of contracture.

 Look at that "amazing" splint. This is why one-size does not fit all.

 First signs of skin breakdown caused by splint made by staff. They were not aware of this when we showed them.

 Again, skin breakdown around the wrist.

 A rolled up towel does a better job of maintaining a "C" position of the hand than the splint. Aides were encouraged to use rolled up towels and to keep the UE in extension rather than flexion patterns.

 A better position for this man. The splint fits better on the right and the left was replaced with a towel. Arms are down by his waist with pillows to support is position.

 Higher level care in nursing home. There are 10 on this floor with one nurse. Everyone is a severe SCI or TBI. The majority are non responsive to visual, auditory, and touch. I have dubbed this room the "vegetable garden." There is no DNR in Taiwan and people are maintained on life support regardless of responsiveness and prognosis. Many of the people on this floor have been like this for 10 plus years!

Severe contracture of the wrist and deformities in the fingers. I was unable to passively move his wrist and fingers out of this position. This man has been in a vegetative state for 15 years!