Patient Perspective: OT in SCI Rehabilitation

For this blog post, I interviewed my boyfriend who has C7 quadriplegia resulting from a spinal cord injury. I asked him for a more in-depth look at OT’s role in SCI rehabilitation and his personal experience with it! Throughout this post I have included pictures (with Stephen’s permission) of some highlights and accomplishments of his. I hope this can provide a better understanding of how OTs work with those experiencing spinal cord injuries, and shines a light on where we are still needed!

Tell us a little something about yourself!

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Photo of Stephen at Top End

My name is Stephen Zuravel and I’m from Akron, Ohio. In 2016, I graduated with a Mechanical Engineering degree from the University of Akron and I now work as a design engineer at Invacare, Top End.

As a kid, I spent most of my time outdoors on my family’s horse boarding farm. While growing up my favorite sports were BMX and skiing. I loved anything that gave me an adrenaline rush and challenged me physically. After graduating high school, I began attending U of A and after my first semester I was involved in a motor vehicle accident that resulted in a spinal cord injury at the C7 vertrebra.

I now live in the Tampa, Florida area and I spend much of my time in the world of adaptive sports. Through working at Invacare, Top End I’ve been able to meet and work with several athletes who compete at a Paralympic level. More importantly, I’m able to work with organizations that help adaptive sports grow at a grass roots level.

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Stephen and a few of the Paralympic athletes that he has had the privilege to work with.

What are your favorite occupations?

Some of my favorite occupations are handcycling, playing wheelchair rugby, working on new designs at Top End, and spending time with family and friends.

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Level of Injury and the Implications:

C7 Complete

  • HAS: muscle control in neck, shoulders, arms and most of the hand
    • Grip is mostly affected as well as finger dexterity
  • Touch and pressure sensation on head/neck, a few inches below clavicle, and radial half of arms

Level of Current Function:

  • Independent in all ADLs
  • Independent in most IADLs
    • May require assistance with household maintenance (landscaping, exterior house maintenance, major appliances / utilities)

Timeline of Rehab After Injury

  1. ICU 3 days
  2. Stepdown unit 4 days
  3. Inpatient Rehab January-February (2 months)
  4. Outpatient Rehab 3x/week/1 year
  5. Buckeye Wellness Center 1 year

What was the focus of OT during acute care? Inpatient rehab? Outpatient rehab?

Acute Care:

After surgery, the first few days were spent becoming stable. Once I was able to stay awake long enough to have conversations with friends and family, I was tasked with some simple activities. These included sitting up for a minute at a time, trying to brush my teeth, and learning how to hold my water bottle. All very basic things, but at the time my function in my hands and my level of energy was minimal. It should be noted that I can’t recall if these were tasks an OT asked me to do or family and hospital staff.

Inpatient Rehab:

I arrived at Metro Hospital in Cleveland, Ohio soon after New Years day in 2010. My strength hadn’t increased much, but I was stable enough to begin inpatient therapy. Fortunately, I was able to stay in my own room (which isn’t always common) and had a family member staying with me every night.

My first memory of working with an OT was waking up one morning to a smiley eyed women who had way more energy than I was ready for. After introducing herself and describing what she does as an OT, we began talking about goals of mine.  Once we had some of the introduction out of the way, we began working on getting dressed and transferring out of bed.

Coming from an active background, one of the biggest surprises to me was just how hard the simplest of tasks were. I went from being an independent 19 year old man to what felt like a 19 year old infant. Throughout the coming weeks I began to learn transfers, how to get dressed, and many other things that built a foundation for me to build on before going home.

What I remember most about my experience with my OT is the way she continually helped me navigate new challenges. Not only physical challenges, but thinking through strategies of managing my time, looking ahead to my future, and taking things on within reason. During my stay at inpatient, Susanne was a counselor in a time of chaos. By the time I was headed home, I had enough knowledge that I could continue building on to get back to normal.

Outpatient Rehab

I was fortunate enough to start outpatient rehab at a clinic near home soon after completing inpatient rehab. At this time, I went from daily therapy sessions to 3 times a week. To my surprise, the PT that I was seeing had some experience with spinal cord injuries. This was reassuring to me, but it also made me very aware of the lack of resources for people going through an injury like an SCI.

Because it was still early on in my injury and I didn’t want to accept the severity of my injury, I set my goals as walking again. Whether or not my PT accepted this as a documented goal, I’m not sure. But, what she did do was work with me to build back functional strength and ways of sustaining good health.

At this time in my rehab, my OT sessions were limited. I don’t recall having many sessions and when I did, they focused around regaining strength in my hands. What I do recall the most is the drastic difference in personal. My OT at inpatient rehab was passionate about what she was doing and had compassion to see me succeed. The OT in outpatient was much more of a “9am-5pm” type feel. I was my own guidance and counselor. I say this understanding not everyone finds their passion in a chosen career path, but what I do want to stress is that my first OT gave me a sense of ability to move forward. It wasn’t just a “session” to her. Exercises I could do on my own, relearning how to approach a foreign life was not.

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Completing his first marathon on a hand cycle 1 year post injury

What other health professionals did you see during that time?

Inpatient Rehab: Doctors, PT, vocational rehab, psychologist, med students

Outpatient Rehab: The next several months to two years, I spent time with a variety of therapists and people involved in organizations to help improve my situation. Some of these were vocational rehab therapists who guided me in choosing a career path and ensuring my living conditions were sufficient for me, driver rehab, and home improvement.

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Graduation Ceremony, 2016

How was OT distinct from those other disciplines?

OT was much more personable and took into account my life as a whole. Specifically with my first OT, I felt like I was able to acknowledge what had happened, how I was going to assess where I was after my accident, and then start making plans for my future.

At least from the perspective of an SCI, so much of my life was flipped upside down. I consider myself someone who’s strong willed and I have an amazing support system, but even then there was so much uncertainty. Having a strong OT that helped me organize my thoughts, regain functional ability, and strategize for the future was game changing in my life.

What were your personal goals for rehab?

Over the years (and maybe even still now) my goals have changed. When I was first injured, I was dead set on a full recovery. Doctors told me it was very unlikely, but in my mind there was no other option. As time went on, I still held onto that idea by continuing therapy at a non-conventional gym for SCI’s. After about a year of going, the financial burden became too great and I became more focused on living life again.

Throughout that time and up until now, I’ve continued to set small and large goals. Initially those goals were things like transferring into and out of bed on my own, personal care, and being able to go out on my own with friends. As time went on, the goals evolved into things like flying on a plane, traveling with a wheelchair rugby team, and driving.

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Skydiving

What are your goals now?

Now my goals have moved more into a “normal” life list of goals. Since completing therapy, I have graduated from school, began working full time, and purchased my first home. A lingering goal that I haven’t done yet is travel out of country. This is probably the most intimidating goal for me at the moment due to logistics of personal care items, unforeseen accessibility, and long travel times.

Was there any creative/out of the box tools your OT provided you with?

There were many tools that my inpatient OT had brought to my attention. However, I think what was most helpful is that when I made it clear that I wanted to use as few tools as possible, she accepted that goal and came up with creative was of helping me find solutions.

An example of this was putting on my socks. Instead of using a tool, she showed me ways I could hook my fingers inside my socks to put them on.

What is something that was often said that you wish wasn’t said (whether your OT said it or someone else did)?

“You’re lucky.”

I don’t recall my OT’s saying this, but I’ve definitely heard it plenty of times. What bothers me the most about this statement is that it disregards the effects of the injury on my life. To some extent, it also does the same for who I’m indirectly being compared to that may have it “worse.” The fact is that I and anyone who goes through a traumatic injury has a unique connection and experience to it. We went from one state of being to a compromise of what we knew before. Saying someone is “lucky” is an inadequate statement to make. So yes, I am lucky. However, the point isn’t that I’m lucky. The point is I’m still able to live a meaningful and purpose driven life. 

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Stephen and a young client after receiving their new hand cycle

What advice would you give a new therapist working with spinal cord injuries?

I would say the most important thing is to treat them just like anyone else. It’s good to acknowledge the person’s SCI (like I had described in my experience at inpatient), but remember you’re dealing with a person – not the injury. The injury has become a part of their life – it doesn’t have to be the definition of it. 

As for don’ts, try not be overly compromising if they resist therapy or valuable input. I’m saying this with the caution that you’d need to be considerate and reasonable. However, even now I meet people with more potential function than me who can’t do half of what I can. What seems to be the common thread is either a bucket of excuses or lack of effort to confront challenges. What I’m not saying is to leave someone to face these challenges on their own, but don’t help them hide them.

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Working on a hand cycle with Paralympian, Will Groulx

What is one thing you wish would have been addressed during rehab (whether inpatient or outpatient) that wasn’t covered?

I felt like I was very well equipped with a solid foundation to build from after leaving inpatient therapy. However, when I look back I really didn’t have a good understanding of how manual wheelchairs or adaptive sport equipment fit or what their proper function was.

Additionally, I didn’t have a good connection with a quality group of people living with an SCI. It took me sometime to get involved in adaptive sports, but after I did I was able to learn so much more. I quickly learned tricks to being more independent, saw people with families, driving cool cars, and thriving in life. Those types of experiences were and continue to be the most valuable to me regarding my independence and goals.

 

Organizations:

Adaptive Sports Program of Ohio

Wounded Warriors Abilities Ranch

 

Disclaimer:

All SCI’s and experiences are unique to the individual and may affect varying aspects of the individual’s life. These views are Stephen’s own.

This post was featured on OT 4 Lyfe’s “Best of Occupational Therapy.”

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