For the past three weeks, I’ve been working with a neurological rehab company called Rehab Without Walls. They provide physical, speech, and occupational therapies. It’s a pretty good setup – they send the therapists to your home, and you work there. Possibly the most convenient arrangement you can find.
The overall aim of the program is to get you beyond the inpatient type of rehab, to assess your condition, and get you ready for an outpatient therapy program. Basically, the idea is to set you up for the longer term by determining and developing some focus areas.
As an example, my physical therapist asked me about long-term goals and interests, and then tailored the program towards those areas. I’m particularly lucky there, because my physical progress has been superb. I’m able to do more than was expected – I’m up and around, my balance is not bad, I can walk along uneven trail for quite a while, and swimming has gone pretty well.
The physical therapy areas I’ll focus on longer term are stretching (I’m very tight, even more than usual), developing stamina and core strength, and loosening and strengthening my left shoulder (which is tight because of the broken clavicle and scapula).
Curious thing about speech and occupational therapy is that the names are somewhat misleading.
Speech therapy governs much of the cognitive area beyond speech. In the hospital, my speech therapist also focused on how capable I was of swallowing back when my feeding tube was removed. It’s an incredibly broad area. This wave of speech therapy has mostly involved planning ways to organize my life, and set up a re-entry plan back into the workforce. Doing these things tend to touch on many of the traditional areas in which Traumatic Brain Injury Patients struggle. The therapy is valuable across the board, because these things address real world issues for both home and work. The unfortunate part is that for me, it was a bit difficult to develop tests and tasks that truly resemble the work that I do. So, I’ll need to focus efforts going forward towards determining potential problem areas I’ll want to work on.
Occupational therapy in the rehab phase seems geared towards getting you moving along in your everyday tasks. In the hospital, my therapist had me scramble an egg and do basic shopping and dining out math (how much will the items you select cost, and how much change will you get?). My therapist at home took me to the store to shop for groceries, threw some more complex math scenarios at me (figure out how much a car will cost given the following discount, rebate, and tax ratios). He also had me do basic stretches with my shoulder. The most seemingly random thing we did was geared towards helping me determine how poor my monocular depth perception is by playing catch with a volleyball – which went surprisingly well.
This week, I’ve had to set up the next phase of therapy by finding places to go, getting my doctor to refer me, and getting "discharged" from Rehab Without Walls.
I especially enjoyed the physical therapy. We spent a lot of time walking the trails in Bridle Trails State Park. The therapist was good company, and provided very experienced guidance towards getting to work out, and getting fuller range of motion from my shoulder. I expressed concerns about getting to "full recovery" to her as I did to the other therapists. The answer to these concerns was consistently "you’ve made amazing progress, but you have to expect you’ll need to change and adapt to the new you". This is a nice way of saying that full recovery is distant, despite my great progress.
This last point is particularly difficult for me. In many ways, my baseline for myself is still pre-accident. I am more patient with my physical progress because it’s easier for me to quantify and to plan for. It’s hard to do this for cognitive stuff. This, my friends is why I diligently try to do the New York Times crossword puzzles, why I play Scrabble, and why I have put together a work re-entry plan with my boss. More ways that I’ve supplemented therapy include playing a full-time parenting role at home with the kids and with Kris – and hey – that’ll challenge those logic centers! I am also trying to organize some of the work we’re planning on the house.
All of these things allow me to exercise my depleted word-finding capability as well as begin to exercise more of the Executive Function areas.
My point is that despite the fact that my progress has been amazing so far, I’ve got to keep my eyes on the longer term goal of recovery. The best way to do that is to keep my brain and body humming along as much as possible.