Mind on the Mend: Spalding therapists help patients regain function with cell-promoting exercises | by
Stephanie Sparks felt agitated. Her hospital room had no phone, no TV. Some guy kept telling her what day it was every time he saw her. And other people would ask her to do things over and over: Pick up this spoon. Create this sound. It didn’t make any sense to her. But not much did.
In reality, Sparks doesn’t remember any of those first few days in Spalding Rehabilitation Hospital, where she ended up after an 800-pound ATV she was riding slipped on a hill and rolled on top of her, its powerful blow shearing the connective nerve fibers in her brain. But the scenario describes what the Spalding team, renowned for its work with such severe brain injuries, does as it begins the long yet life-altering path toward recovery.
“They used to think that once the brain cells died, they were lost, and you could never recover from whatever damage was done,” says Joan Birchfield, a speech language pathologist and part of Spalding’s interdisciplinary team. Now doctors know about brain neuroplasticity, or the ability of the brain to change and regenerate, taking over functions for those lost connections. And that requires the gentle yet persistent, correct-use therapies used at Spalding to bring patients back.
When Sparks, 48, first arrived at the rehabilitation hospital, she was highly disoriented and unable to move on her own. The Aurora mom had already spent a month, much of it in a coma, fighting for her life in intensive care at The Medical Center of Aurora. Patients with such severe injury start their Spalding recovery in a controlled stimulation unit (reduced noise, no phone/TV) to support brain healing. Therapy begins slowly, as patients are still “waking up.”
“Confusion and agitation are common, says Dr. Jim Nguyen, a clinical team psychologist. “A lot of times, people don’t really know what’s going on with them. They may not know what the date is; they might not even know who they are,” he says, adding that Sparks, a director with Spalding’s parent HealthONE company, had no memory of the accident, but kept thinking she was at work, trying to direct the staff on what to do.
“Because their memory is impaired, they start to make up pieces to fill in the blanks,” Nguyen says. His job is to gently correct her so that she doesn’t permanently believe her confabulations, impairing brain recovery, he says, explaining the “errorless-learning” method used at Spalding.
Every day, Nguyen or another team psychologist would tell Sparks the date, reminding her that she was a patient and telling her about her accident. Gradually, with therapists’ persistence, reality began to set in for Sparks, whose first memory was two weeks after checking into Spalding.
Practice, practice, practice
The same concept prevailed throughout Sparks’ therapy. For example, the occupational therapy team helped Sparks relearn everyday tasks, such as eating or dressing, through repetition and correct technique. “We use a lot of guiding technology,” says occupational therapist Karen Hookstadt. “We do a wide variety of activities focused on recreating normal movement patterns.”
As patients relearn these everyday-living tasks, the brain regenerates correctly in response. And repetition is critical. “That’s where the work comes in,” says Adam Hoyle, a physical therapist on the team. “We’re talking tens of thousands of repetitions before a function can be relearned by a different part of the brain,” Hoyle says.
Therapists use a variety of high-tech equipment aimed at forcing correct use and allowing for more repetitions, such as braces that aid in hand grasping and releasing for OT exercises or full-body support systems for treadmill exercises during PT. “It reduces the weight and energy expenditure for patients, allowing them to work longer,” Hoyle says of the body support system, which also reduces safety worries for the therapist.
Speech pathologists are also critical to the Spalding team, using the methodical errorless-learning technique to reach many important goals. “We start with sounds; then sounds to words; then words to sentences,” says Birchfield, whose job goes far beyond re-teaching speech to include everything from swallowing to reading to memory retention. “It’s highly rewarding,” she says. “Language is the way we relate in life, the way we relate with people.”
Broncos or bust
As painstaking as it was, the importance of the repetition wasn’t lost on Sparks, who says her doctor and therapists included her and her family throughout her recovery, which consisted of more than 30 inpatient days followed by outpatient therapy that is still ongoing.
“They explained things so that I could understand the process of what we were doing and understand that the harder I worked with them, the better I would recover,” says Sparks, who now volunteers at Spalding to share that message with new patients. “It was extremely hard, but in a good sense. It really drove me to be engaged with it,” says Sparks, who is now back to driving and working full time.
Sparks’ outstanding success revolves around the rehabilitation team’s consistency and cohesiveness, and her own determination and family support, Hookstadt and her colleagues agree. “We all work together and focus on that same style of recovery learning,” she says. “If patients are truly willing to put in the work, and they have a good support system, they have the ability to change.”
Sparks is proof, having reached her goals, which included getting back to parenting. She recalls how her youngest, a senior in high school, led rescuers to his mother that July 7 day. “They say he saved me at least 20 minutes,” says Sparks, who also suffered a severe eye injury, broken ribs and a dislocated shoulder.
And Sparks had one other goal when her therapists asked her early on for her list. “I love Bronco games. I told them I wanted to get back to my Bronco games,” she says. With the first home regular season game set for Sept. 5, it seemed far-fetched, but Sparks did it, sitting in the stands to watch the Broncos beat the Ravens less than two months after her accident. “And,” she says with a hint of pride, “I haven’t missed a game since.”
Pump it up: Therapists offer tips for keeping brain cells firing
Think hand-eye coordination. Tennis, video games, playing an instrument: They all help keep those connections strong.
Read. It’s great for honing memory and language skills.
Do puzzles. And shake it up with both word and number puzzles, whether on computer or paper, to work both sides of the brain.
Focus on variety. Brush your teeth with the wrong hand. Take a different route home.
Volunteer. Helping out offers new experiences and builds happy brains.
Play challenging games. Cribbage or Scrabble anyone?
Teach an old dog new tricks. Piano, Chinese, woodworking: Learning anything new helps keep those neurons sharp.
Avoid the couch. Science shows active lifestyles nourish the ol’ noggin.
Stay healthy. Chronic disease (diabetes, high cholesterol) can also sabotage brain health.
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