When you have a serious accident or a disease that has impacted your ability to function and enjoy your daily life, rehabilitation is fundamental to helping you regain some of the activities and abilities you have lost.
What’s key to rehabilitation, says University of Utah Health occupational therapist, Kelsi Vik, is that it’s no longer one size fits all. Now, rehabilitation is about customizing therapy services that address physical, mental and cognitive function to meet the individual patient’s needs.
That can range from customizing therapy schedules to fit a patient’s needs and preference—for example a teen who doesn’t like to get up early—or addressing a patient’s hyper-sensitivity to light and noise in their hospital room. "What makes rehab so effective is we know that no two individuals are the same," Vik says. "So we base our treatment on effective research, customizing therapy to those things patients think are meaningful in their lives."
That was certainly the case for 17-year-old Zach who lives in Spring Creek, Nevada. In November 2019, Zach was driving through downtown Elko, Nevada when a fire truck racing to a brush fire slammed into the passenger side of his car. The badly injured high school senior was flown by helicopter to University of Utah hospital in Salt Lake City, where a surgeon removed part of his skull to relieve the pressure on his swelling brain.
After two and a half weeks in the ICU, Zach was moved to the inpatient rehabilitation unit at the hospital. "We didn’t know what his future looked like," his mother Mercedes recalls. "He wasn’t talking, there was not much movement, and he couldn’t control his bowels or walk. It was really scary."
At rehabilitation, the focus, Mercedes says, was "trying to get his brain to re-fire and reconnect.’ Physical therapists sought to get the outdoor-loving hunter, fisherman and sports player moving again. Such objectives meant sessions of therapy day-in, day-out. "The goal is to have people be as independent as possible, whether living at home or not and increase their quality of life," Vik says.
Additional therapists from speech, occupational and physical therapy worked collaboratively to put Zach on an intense, daily schedule. An essential focus early-on for speech therapist Tyler Christensen was teaching Zach how to swallow and eat again. Vik worked with Zach on procedures to go to the bathroom each morning, on getting dressed and "incorporating things important to a teenage boy, such as school-like assignments, socializing."
Meanwhile Vik and physical therapists pushed him to move his legs and feet with various challenging exercises, including playing Twister. The therapists, Mercedes says, "weren’t afraid to dive right in and do things that seemed silly to me." Nevertheless, she found watching his progress and his enthusiasm for therapy exciting. ‘When’s my next therapy?’ he’d ask her.
In a quest to trigger his memory, the therapists turned to his favorite pursuits, such as basketball. Even though it was the middle of winter, they’d shoot hoops with him. Mercedes saw how much he enjoyed it. "You could see the smile on his face." Zach shooting hoops is one of Vik’s favorite memories of working with him. "It’s a great way to work on balance and vision and coordination," she says. "He’d chest pass to his dad, bounce a pass back to me, shoot and run back to the court," As he dribbled, therapists would ask him questions at the same time.
Speech therapist Christensen and Vik worked together with Zach on some activities such as cooking. "Me and the speech therapist helped him plan and execute cooking activities," Vik says. Zach’s siblings spent time with him during the winter holidays when those cooking skills came in handy. "We had to make it fun and involving his siblings made it more festive, more at home," Vik says.
At the end of the year, doctors put back the skull piece they had removed in a final surgery and four days later on January 4, 2020, Zach returned home.
Zach and his family still face a long and difficult journey. "He can walk, he can talk," Mercedes says. "He has a slight speech problem and he only has 65 percent nerve function." He also struggles with memory, especially short term.
"He can do normal activities like shower, eat, take care of himself," Mercedes says. "We’re trying to figure out how he can live an independent life with a memory deficit. It won’t be for a while."
Initially, with the onset of the COVID-19 pandemic, Zach did not have outpatient rehabilitation. "Now we are playing catch-up," says Mercedes. "We’re going to the U once or twice a month since they reopened." He recently completed ear and eye surgery. "We’re putting him back together one piece at a time."
In May, the therapy departments along with the rest of U of U Health’s rehabilitation department moved to the newly-opened Craig H. Neilsen Rehabilitation Hospital. With the new facility, Vik and the other therapists have even more opportunities to customize what they do for their patients, with state-of-the-art equipment, spacious gyms, multiple kitchens and even several rows of airline seats to practice navigating the challenges of traveling. "It has allowed us to be more innovative and creative," Vik says.
The new hospital offers new technology, including the Zero G body weight support system which boasts the longest overhead track in the country, enabling patients to stand and walk sooner.
Sometimes, though, therapy boils down to a basketball and a young man’s smile. Mercedes is grateful for the work the therapists did with her son. "It got him to where he is now. He was not able to speak or function or move on his own in any capacity. They got him out of bed and moving. He definitely wouldn’t be where he is today, if they hadn’t done what they did and pushed him so hard."