I get a lot of questions about my spinal cord injury and what I went through afterward. Spinal cord injury rehabilitation is very different from just about any other kind of physical rehab. To begin with, no two spinal cord injuries are completely identical. I was sent to Dodd Hall at The Ohio State University Wexner Medical Center where I spent 11 weeks in post injury rehabilitation. The staff and facilities there are among some of the best in the world and we were blessed to have those resources so close to home.
Expectations
Since nerve tissues do not repair themselves the way that muscles and bones do, doctors can only give an estimation of how much return to expect in terms of physical abilities. They generally base these expectations on the level of injury and the amount of damage they can see from x-rays and MRIs. Basically, the further down the spinal cord, the more functional control of the body you should expect to regain.
The image and chart below provide some guidelines to help describe the basic levels of injury and the corresponding expectation of physical returns:
Based on my injury location (C4), the expectation for me was complete paralysis from the neck down. I was told that anything more than being able to shrug my shoulders would be a blessing from God.
The reality of my situation was that I could not move either of my arms nor my hands. I had sensation to touch on the tops of my shoulders, neck, and head. Everything else was completely numb. I had diminished control of my diaphragm, which meant that I could breathe on my own, but I was unable to cough without assistance.
My Halo
To stabilize my spine and allow the broken bones in my neck to heal, I had to wear a halo device like the one pictured below. It was attached to my head with pins (basically screws) that would be tightened every two weeks. The vest was lined with lamb’s wool, so it was kind of like wearing a tight fitting sweater all of the time. I wore the device 24 hours a day for 12 weeks. By the time it came off in June, it was smelling pretty ripe!
Perhaps the worst part of my situation was that I still had sand from the accident everywhere and I could not take a shower nor use my hands to brush it away. There was sand in my hair, in my ears, and up my nose. It took weeks of bed baths to get rid of all of it.
Goals
Everything in therapy is based on goals set by you and your therapists, then agreed upon by the doctors. The therapist’s job is to measure the progress towards meeting your goals. Once you either meet all of your goals, or stop making measurable progress, then you are discharged to home or to a facility with staff that can care for you (a.k.a. nursing home or assisted living facility).
For higher spinal cord injuries like mine, rehab is less about physical rehabilitation and more about preparing you mentally to reenter the world with a completely different body. I had to learn to trust others in ways I never imagined. I had to swallow a lot of pride and learn how to ask for help in every aspect of living. I had no independence. I could not feed myself, I could not dress myself, I could not bathe myself, and the list went on. My goals were focused on regaining as much independence as possible, then learn to instruct the people around me to fill in all of the gaps.
The first goal for me was to sit up straight. When the spinal cord is damaged, the heart loses help from involuntary muscles to circulate blood. This also creates an increased risk for blood clots and pressure wounds. I was given blood thinners as preventative. The first time I tried to sit up straight, the blood rushed out of my head and I almost passed out. It took several days of conditioning just for me to sit up straight.
The therapists had me start out with a manual wheelchair that reclined. The chair would be reclined nearly flat when they transferred me into it in the morning. Throughout the morning, the therapists gradually sat it up one notch at a time until I was sitting up straight.
There was also something called a standing table. It looked like a bed, but it had a hydraulic lift underneath that gradually raised the head until it had the patient almost completely vertical (or standing). Since I was unable to support any of my extremities, they had to strap me down pretty tight to keep me from sliding off.
Once I was conditioned to sit upright, we got into a rigorous routine of therapy. A typical day in the hospital became something like this:
- 7am – 9am Personal care, dressing and breakfast
- 9am – 11am Physical Therapy
- 11am – 1pm Lunch break
- 1pm – 2pm Occupational Therapy
- 2pm – 3pm Physical Therapy
- 3pm – 4pm Occupational Therapy or Social Services / Family Counseling
- 4pm – 9pm Visiting hours, dinner, free time
- 10pm Lights out
Since I was unable to move any of my extremities, physical and occupational therapy were about becoming a self advocate. I learned things like verbally instructing others how to safely transfer me in and out of my wheelchair; how to do range of motion on my legs and arms; and how to get me groomed and dressed the way I preferred. It was frustrating because I wanted to just be able to those things for myself. It was exhausting because I had to be specific about things that most people just do without thought.
Wheelchair Selection and a Breakthrough
Within the first few days, the hospital placed an order for a sip and puff wheelchair so that I could learn how to drive a wheelchair. A sip and puff wheelchair like the one pictured below is controlled by blowing and sucking into a tube.
It is a tremendous feature to provide independence for people that are unable to use their arms. In 1999, they were pretty uncommon and took several weeks to build and ship. That long lead time ended up being a blessing in disguise for me.
At some point in my third or fourth week of rehab, I started to gain trace amounts of return in my right arm. Part of my physical therapy included being placed in a counterbalanced arm sling like the one below. The purpose of the sling was to remove the force of gravity in order to isolate a few muscle groups and see if any would respond to my attempts to move.
The sling worked. I was able to bring my right wrist about half way to my face. It was a miracle.
I spent a lot of time in the sling over the next few days inching ever closer to being able to touch my face. Within a week or two, I had gained enough strength and function in the right arm to be able to slide my hand across the surface of a table. Even though I wasn’t able to lift my arm up from the table, that was enough to cancel the sip and puff wheelchair and set the plans in motion for a somewhat standard power wheelchair.
The vendor that we were working with brought in a loaner chair for me to use while I was in rehab. That wheelchair was an absolute tank. It had a set of large tires in the front that could supposedly overcome an eight inch curb, but I never had the courage to attempt anything more than three. I left my mark all over the walls and elevators at Dodd Hall while learning to drive in that thing.
Eventually, we decided that the right chair for my lifestyle would be a rear wheel drive Everest and Jennings model that had been in the market for a few years. I knew that I wanted to return to Ohio University and I would need something durable enough to handle the terrain and reliable enough to only need maintenance when school was out of session. The E&J wheelchair was the market leader in low maintenance durability at that time (unfortunately, they went out of business a few years later).
Progress
Once I started moving my right arm I made noticeable progress almost every day for the next 6 to 8 weeks. What started with a zero gravity movement of my arm towards my face progressed to touching my face a day or two later. Then sliding my arm across the table surface got easier and I could start and stop my hand with more precision. The results came from repetition and the use of electrostimulation therapy.
Movement for the sake of movement turned to functional once I could lift my arm off of the table surface. The occupational therapist taught me about something called a tenodesis grasp, which is a way to passively open or close the hand using wrist movement. If I held my arm out straight with my palm facing down and let my wrist fall limp, then my fingers would open naturally. That was the easy part. If I flexed my wrist back up with my palm still facing down, then my fingers would naturally close. This was harder because I had very little ability and almost no strength back in my wrist. To practice the concept, the therapist placed a pile of cotton balls on one side of the table surface and my task was to pick each one of them up and stack them on the other side of surface. Then I would repeat the exercise in reverse, stacking them back where they had been at first.
At some point in the back and forth exercise with the cotton balls I lost my focus and a dangerous thought entered my mind. I suddenly remembered that two days before the accident I had gone to the gym twice. In those workouts I had ran over two miles, benched over 200 lbs, and held 90 lbs against my chest while doing reverse sit-ups to strengthen my back. Yet here I was struggling to move cotton balls from one side of the table to the other. That was the first time that I can remember feeling defeated.
I realized then that thoughts like those would only hinder my progress. I had to refrain from dwelling on what life was like before and focus on making myself a little better every day. That was the only way that I would continue to make progress.
Time to go home
My left arm remained totally paralyzed and my right arm would eventually hit a plateau. With the use of splints I was able to feed myself, brush my teeth with an electric toothbrush, and I could sort of shave using an electric shaver that my grandmother ran out and purchased the day I started moving my arm. After 11 long weeks of intensively therapy the progress had slowed and it was time to go home.
Going home was a little scary. In the hospital, everyone around me was there to take care of me in one way or another. Once I went home, the reality set in that everyone around me had their own lives and expecting them to be at my beckon call would make me a burden.
My new goals were stacking up in front of me and I had to remain focused. I needed to figure out how to be independent. I needed to get back to school. And, I needed to resume as much of a “normal” life as possible.
It hasn’t been easy, but God has been so faithful in this journey. If you haven’t already, please consider sharing your story to share how God uses trials in our lives to grow our character. If you have already shared or contributed, thank you!