Inpatient rehab drives spinal cord injury recovery

The sheet music for the violin is still in the same position as it was when Steve Nelson was injured in a bike accident. Photo courtesy Steve Nelson.

Two pages of music covered with notations lie open on a stand against a room’s white wall. A small, brown table holds a violin. These objects are waiting for someone to take them in their hands, place a bow across the strings, then bring the notes to life.

The scene is frozen in time, however. They represent a period of Steve Nelson’s life that will never return. The only thing that is left are his memories of playing his violin and coaxing it to play. He doesn’t dwell upon the loss. He instead focuses on the many items he has regained, after fearing they might never be found again.

A major bump in the road

With many precautions, Nelson is back on his bike after inpatient rehab helped with his spinal cord injury recovery.Nelson, who was admitted as an inpatient, was able to get back on his bike with many precautions rehabHis spinal cord injury recovery was helped by many. Photo courtesy Steve Nelson

Nelson’s music ceased on July 24, 2020. Nelson, now 74 years old, was a serious violinist who practiced every day and performed chamber music for others. He’d set the violin aside that day for another passion: riding his mountain bike on a single-track trail near his home in Erie, Colorado. He’d rolled across the course, dotted with berms and jumps, nearly every day for the three years since he and wife Wendy had moved to the quiet Boulder County community.

The routine ride quickly took a deadly turn when Nelson took the biggest jump on trail. Nelson lost control of his bike as it flew high. His bike and he parted ways and Nelson’s head hit the ground. He cracked seven of his helmets. Someone found him on the trail, his bike lying a distance away. He awoke in blackness and was able to climb onto a helicopter to take him to the Trauma Center at UCHealth University of Colorado Hospital.

Images of his injuries were taken at the hospital and revealed some very concerning results. Nelson suffered three fractures to his neck. His spinal cord was paralyzed after blood gathered against it. He’d also fractured a hip and several ribs.

Intense care and surgery in a hurry

The trauma team rushed Nelson to the operating room, where neurosurgeon Dr. Jens-Peter Witt opened the front of Nelson’s neck and worked to stabilize and repair the fractures. Witt considered the surgery successful, but Nelson was faced with serious challenges.

“My ability to function was essentially nil,”He said. “I couldn’t lift my arms.”He spent the next three days in the UCH ICU, feeling very weak, but still experiencing some improvement. “full range of emotions,”He also had a deep appreciation of the nurses, therapists, and other providers who helped him while he was helpless.

“The care I got in the ICU was simply extraordinary, and I mean that in the human sense,”Nelson said.

More than just movement lost

The term is generally used. “loss of life” to refer to death, but Nelson’s mishap reminds us that many survivors of severe injury lose parts of the lives that sustained them. In Nelson’s case, the physical activity he maintained into his 70s had simply continued a long commitment to athletics. He was a competitive swimmer in his native Ohio college, skied cross country, ran marathons, triathlons, and raced on bicycles across the Midwest and New England.

After 19 years of leading a Manhattan private school, Nelson and Wendy decided to move to Colorado in 2017. They wanted to be close to their son Chris, their partner, and their two grandchildren. He immediately took to biking and hiking in the state that he and Wendy called home.

All that was at risk from the sudden catastrophe. Nelson was able stabilize his condition in the ICU and was able to transfer to the Inpatient Rehabilitation Unit of UCHealth Broomfield Hospital. Nelson admits to having a distorted view of his prognosis.

“I envisioned doing some push-ups and sit-ups and then getting back on the bike,”He said. However, his providers painted a disturbingly realistic picture: that his partially paralysed body would have to travel far to reach that distant goal.

“It was hard to hear that I’d be in the rehab unit a month,”Nelson said that the insurance had limited Nelson’s stay. He realized that he’d undoubtedly need more assistance once that time was up.

Another difficult road

Nelson was faced with many physical challenges. The COVID-19 pandemic made matters worse. He could have only one visitor at a time, and he never saw his providers’ masked and shielded faces. Toward the end of his stay, a blood pressure drop and fever spurred fears of a COVID infection – thankfully not the case. He was not bitter about the experience, but he was more grateful for the support he received from his team.

“Their spirit was always upbeat,”Nelson was recalled. “The human community was a big part of keeping my spirits high.”

His recovery was not easy. He had to work seven days a week with occupational therapy (OT), and physical therapy (PT) specialists. Nelson is grateful for the help he received from OT Leah Muntges and PT Marisa Leykam.

He said that Leykam was his name. “pushed me to the limit, understood my potential for recovery and responded to the progress I was making in a very positive way,”Muntges was “equally influential in getting a sense of what I could do.”

Broomfield Hospital occupational therapist Leah Muntges (left) and physical therapist Marisa Leykam helped Nelson through an arduous month of inpatient rehabilitation that helped with his spinal cord injury recovery.Nelson was assisted by Marisa Leykam and Leah Muntges, Broomfield Hospital occupational therapists (left), during a difficult month of inpatient rehabilitation that supported his recovery from his spinal cord injury. Photo courtesy Marisa Leykam & Leah Muntges

Inpatient rehabRecovery from spinal cord injury is possible with pushes

Leykam and Muntges worked in tandem to help Nelson rebuild as much as possible the physical strength and skills he’d lost in the accident. Leykam helped him to learn and practice basic movements such as squatting and pivoting to transfer from one surface to the next, sitting up in bed, finding balance points to allow him to move safely, and using his legs and arms to compensate for his injured arms. Muntges taught him how he could apply these skills to everyday activities like moving from his wheelchair to the bathroom or pulling a shirt up over his head.

The work was not an end in and of itself. It was a progression of care that included getting up and inching towards standing, feeding himself, or, if distantly, walking or riding again.

Leykam stated that Nelson did well with his PT work partly because of his positive attitude and partly because he understood that it could help to reach his goals.

“We get buy-in from patients once they learn why they are doing something,”She spoke. “Steve understood that to get back to walking and biking we had to take him where he was.”

Positive attitude is a plus

Muntges noted that Nelson’s attitude made it easier for her to broach the difficult subject of what lay ahead for him with his therapy. At first, he had difficulty with proprioception. This is the awareness and movement of his body in space. He couldn’t tell where his legs were. In an early session, he almost kicked her in his face when he raised a foot.

Muntges said that he was open to her efforts to help him harness his strength. “Steve was very balanced in terms of how he received information and maintained his ultimate goals for recovery. That’s pretty tough to do when you are in the circumstances he was when we met.”

Wendy also prepared for Steve’s eventual discharge and return home. She had to learn how Steve moved to be able help him within her physical limitations. Leykam described the process as “a game of chess”. “learning how to move with a new dance partner.”The work was more manageable than expected. “because Steve had put in the work”She said that she wanted to teach her how to balance and move.

Muntges stated that caregivers require a lot of education, just like the patient. “You have to meet that family member where they are,”She spoke. “You learn the boundaries for the person who is going to primarily provide the help.” Wendy’s commitment to aiding Steve meant he could head home after discharge rather than to an assisted living facility.

“Wendy had her life turned upside down because of me getting turned upside down,”He said. “I have a wonderful partner.”

Therapists tap into physical strength

Steve’s excellent physical condition and competitiveness also helped both of his therapists fire his positive motivation. “We tapped into his athletic mentality a lot in therapy,”Muntges said. Leykam said that Nelson had benefited from a “great baseline of strength and activity,”He gained a greater awareness of the body and learned how to adjust his movements.

Nelson was moved by the Broomfield unit’s staff as he sat in a chair and drove it with his feet. He was moved by the “collective power”He was grateful to all the people who had supported him and encouraged him. He was ready for the next leg.

On his return to home, he found a first-floor room that had been a playroom and was converted from the former playroom for the grandkids. He couldn’t eat, drink or do what had once been everyday activities without Wendy’s assistance. He was able to continue his recovery with the help of a new group of OTs and PTs for the next few weeks.

Using the skills he’d built in the Broomfield unit, his progress was remarkable. He was able move with a walker in a matter of weeks. He began to take short, unassisted steps outside and then sought further therapy. On a landmark day, his PT told him he didn’t need a walker and asked Nelson to try walking all the way up the stairs of his home, which he did successfully.

“It was exhilarating and terrifying,”He said. But he was up again and within a short time, the first-floor room of the hospital was removed. He was able now to sleep upstairs in the bedroom and use the bathroom by himself.

“These were great steps toward independence,”Nelson said.

A athletic approach to recovery

He put in a lot of effort to rebuild his strength and took on the challenge with weight training. “like an athletic program.”Nelson achieved an ambitious goal just over a year ago, just after he had left Broomfield hospital. Nelson was accompanied by Jennifer, his daughter, and Quinn, his granddaughter. They drove straight from Vermont to Colorado to pick Quinn up after the accident. Mount Sanitas is Boulder

About a year after the accident, Nelson stands atop Mount Sanitas in Boulder. Photo courtesy of Steve Nelson.Nelson is seen here in Boulder, one year after his spinal cord injury. Photo by Steve Nelson

With the less than enthusiastic assent of Wendy, he’s also back on his bike, making relatively cautious runs with son Chris on nearby bike paths and flat trails.

Nelson today estimates that he has regained approximately 85% of his pre-injury function. He lost the fine motor skills that he needed to play his violin. This was the most difficult loss. He accepts the setback with a philosophical attitude and cherishes the memories from his years of playing.

“I have some musical friends who can’t play anymore, and they didn’t crash their mountain bikes,”He said. “When you realize how quickly it can all be gone and go through an extended time of very serious impairment, it’s very easy to recognize with extreme gratitude the ability to do what I can do,”Nelson said.

Appreciation of many helping hands

Nelson doesn’t dwell on the music that was lost, but the new notes he can still write for his future. His family and his health care providers have given him the strength he needs. “a new perspective,”He said. He’s kept in touch with Leykam, Muntges and others at the rehabLeykam called this gesture a “unit to keep them informed of his recovery”. “bright spots in our days.”

Nelson is now grateful for the connections he made during his recovery from a serious physical accident that nearly ended his life. He cites Krystal Brownfield, an ICU nurse, as one of his favorite people. rehabColette Hefty, and Katie Emmons are nurses. As he rolled in his wheelchair towards the elevator, he expressed his appreciation. rehabunit, listening to the sound of the bell that signaled his departure.

“I told [the providers] that they had changed my life in ways that I could never express and that I would be grateful to them for the rest of my life,”Nelson said. “I haven’t lost that feeling at all. They are the unsung heroes.”

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