PATIENT STORY: BACK TO SCHOOL LESSONS FOR PATIENT AND TEAM

Many times patients teach our therapists a thing or two. In this particular case, the entire treatment team got a lesson in respecting a patient’s goals – however unrealistic they may appear – and never underestimating a patient’s willpower (especially if she is a 13-year old girl on a mission).

Background

On the way to a birthday party in Orange County, California, the SUV in which 13-year-old Emily R.* was riding was hit by a drunk driver. The vehicle rolled three times. Emily’s head and arms smashed through the passenger window. Two other passengers were killed. Due to severe brain swelling, Emily experienced a non-induced deep coma for two months, spending a total of nearly five months in the hospital. She was discharged home and admitted to Rehab Without Walls^® for home and community rehabilitation.

* name has been changed in accordance with HIPAA regulations

Rehabilitation Needs

Overall, Emily had decreased physical mobility, cognitive deficits and poor endurance. She required 24 hour supervision and a wheelchair, although she could take a few steps with maximum assistance. Her trunk control and posture were poor. She had significant problems with memory and problems with speech, including speaking too softly. After the initial assessment, a Rehab Without Walls interdisciplinary team was assembled, including a physical therapist, occupational therapist, speech therapist, social worker and a clinical coordinator, to set goals and recommend a course of rehabilitation. Emily made it very clear, however, that her number-one goal was to return to school immediately. There was also her 8th grade class graduation party at a water park followed by the class trip to Washington, D.C., that she was determined to attend. “These clearly were non-negotiable goals,” says Clinical Coordinator Norma Caloca. “Normally, we would plan a slower re-entry built on small, obtainable successes. One of our concerns was that returning to school too quickly would be discouraging which, in turn, would actually impede her long-term progress. Another concern was that Emily’s disabilities would alienate her from her friends. We were flat out wrong. Little did we know how much support she had at home and at school. She was a good student, popular and very social. She loved school, and the teachers, administrators and other students loved her right back.”

The Rehabilitation Process

“The first thing I did was to contact the school to arrange to be present for all the IEP [Individual Education Program] meetings. I also contacted the Special Education department, worked with Emily’s mom, Sharon, who was extraordinarily pro-active, and talked with anyone and everyone who was involved in her care,” says Caloca. “We arranged to have an attendant assist Emily when she first went back who could also help with the OT and PT. I also worked with the school to modify her schedule so that all her classes would be on the first floor for easier access.” On the home front, Emily’s father turned the garage into a gym for her physical and occupational therapy. There, the therapists worked with her on strength, balance and range of motion—all things she’d need for the trip to Washington—and trained her parents to assist her. They practiced going up and down stairs because that’s what she’d have to contend with on the tour bus. They also practiced transfers from her wheelchair to airplane seat. With accommodations and planning that trip went off without a hitch and, according to Emily, “I was able to pretty much do everything the other kids did.” To prepare for the water park trip, the therapists took her to the community pool and the neighborhood park slide, where they coached her on body positioning, posture and safety. “It was true community reintegration,” says Caloca. And to help her return to one of the activities she enjoyed with friends—shopping—the speech therapist would take her to the mall, have her sit in front of the water fountain and practice speaking to her friends above the sound. On the same trips, the PT or OT would have her practice walking, reaching for items and asking for directions.

Recovery and Results

Emily graduated with her class and then turned her focus to starting high school in the fall. “We stayed with her for the transition to high school,” says Caloca, “because, among other things, Emily was determined to not be using a wheel chair by the time she started. However, the school is on a hill with a pretty significant slope, so we had our work cut out for us.” Emily went for summer classes, so during this time Rehab Without Walls was able to work with her and her assistant, who followed for safety. Sure enough, on the first day of high school, Emily walked through the doors using just a walker for support. In fact, the walker was purchased after the PT and OT did extensive research to find one that would work on steep hills. Today, Emily is a sophomore, carrying a full course load. She now walks independently with a cane and is planning for college and overseas study. “I still have to have a lot of therapy—three times a week—but things are so much better,” says Emily. “After the accident, I was so weak I had to relearn every physical thing. All I wanted to do was be back to school and be with my friends.” With the help of Rehab Without Walls, mission accomplished.

Lessons Learned

“For us,” says Caloca, “we learned so much from Emily and her family: Not to doubt people’s will and their goals. How important family support can be in achieving them. And what determination and focus can do—despite the odds.” For Emily, it was about being supported and taken seriously. “The treatment team really got the fact that I was a teenager. They knew what would embarrass me in public and they took my likes, dislikes and social concerns into account. They understood what was important to me, and made that a part of my treatment. That helped me stay motivated and meet my goals.”

How Rehab Without Walls^® Facilitates Return to School

The way in which Emily’s Rehab Without Walls team handled her school re-entry, while faster than usual, was actually fairly typical. Because Individual Education Programs are mandated by law to be available in every school district, the Rehab Without Walls^®representative—often a speech language pathologist or psychologist—will work with the designated person or department—sometimes Special Education, other times the counseling offices—to put together a re-entry plan for the student. There are multiple advantages of having the Rehab Without Walls team member working in this capacity, including the first-hand knowledge of the patient’s strengths and deficits and the ability to set functional goals that directly relate to skills needed for school. Some of the ways in which Rehab Without Walls can help smooth the return to school and ensure a more successful re-entry include:

• Safety assessments of the school building, campus and environment that can identify and remove possible barriers for the patient
• Arranging for adaptive equipment when needed
• Connecting with community resources, including transportation alternatives
• Teaching of compensatory techniques
• Re-aligning functional goals and incorporating new exercises and processes into therapy as the patient’s needs change
• Day-to-day support; in some cases, the Rehab Without Walls^® team member will accompany the student to school for a period of time until the adjustment is complete.
• Liaison with parents, teachers, principal and other staff
• Ongoing advocacy for the patient