Comprehensive Rehabilitation Services Help Turn Tragedy into Triumph
In April 2006, Sajida Kalim was turning around in the front passenger seat of a car to hand a family member a piece of candy when her life was forever changed.
Traveling from the airport in Pakistan, Kalim, of Bridgewater, was in a car with no seatbelts when a truck rammed the passenger side of the vehicle. Kalim suffered severe neurological damage, as well as injuries to her ribs, head and arm. She lost her memory and was hospitalized for several months after coming out of a coma in a Pakistani hospital, unable to travel back to the United States due to her injuries. When she returned to the country in June, she had trouble remembering the threads of information that made up the fabric of her life. She didn’t recognize her family or friends and couldn’t remember her own name. A previously independent woman, Kalim could no longer cook for herself or keep up with housework.
“The memory loss has been the most embarrassing part of this accident,” says Kalim. “For days after I returned I couldn’t remember all of these people who kept visiting me. They obviously cared for me and were worried about me, but I just couldn’t remember how they fit into my life.”
Insurance issues made it difficult for Kalim to find an appropriate neurologist, but she was eventually referred to the Rehabilitation Medicine Department at Robert Wood Johnson University Hospital Somerset in November 2006 for vestibular rehabilitation, a specialized type of physical therapy for patients with symptoms of dizziness or vertigo.
“When Sajida first came to us, she was in a wheelchair and was struggling to perform the activities that we all take for granted – showering, shopping, vacuuming, taking a walk in the neighborhood,” explains Karen Smith, OTR/L, manager of occupational therapy services.
Smith, physical therapist Beth Brown, PT, and speech language pathologist Kelly Albertson, MS, CCC/SLP, have worked with Kalim twice a week, one hour per discipline each day, to help her relearn common skills and return to independence. The group has worked with Kalim on everything from making a shopping list and selecting items at the supermarket to setting up her medication dispenser and using a calendar to keep track of her appointments.
“I’ve had to relearn everything, but I trust the staff here and I know I’m getting the best care possible,” says Kalim, who still suffers from intense headaches.
After several months of therapy, Kalim now only uses a cane when walking outside or in unfamiliar areas. Her memory is improving, and she works with Albertson to continually sharpen her long- and short-term recall skills. She’s able to maintain her home, vacuuming, dusting, doing the laundry and cooking meals for herself and her family. Perhaps the best measure of Kalim’s progress was when she went to a family picnic at the park and was able to walk with just a cane on uneven grass and mingle with the guests, many of whom she had not seen since the car accident.
“I’m moving so much better now. I don’t think I could’ve returned to normal without their help,” Kalim says of her therapists. “My next goal is to start driving again. I know I’m not ready yet, but it will all come back in time, I’m sure.”
Tai Chi: A Moving Meditation for Cancer Patients
The side effects of radiation and chemotherapy can be as difficult to bear as those of cancer. That’s how Ralph Stanziola of Neshanic Station felt after a series of chemotherapy treatments for leukemia. Depleted and stressed, Stanziola had lost strength and stamina. Dramatic weight loss and neuropathy (a decreased sensation in the fingers and/or toes) also had greatly affected his balance.
Stanziola wanted to improve the quality of his life. Because the fatigue and deconditioning induced by cancer treatments can last even after the treatment itself stops, Stanziola decided to fight back and regain some of his lost strength. When he entered Robert Wood Johnson University Hospital Somerset’s Physical Therapy Department, he could only walk short distances before he was exhausted.
“Even my feet were weak and bony,” he says. “I felt like I was walking on pebbles.”
To help Stanziola get his endurance back, Kathleen Toomey, MD, an oncologist at Robert Wood Johnson University Hospital Somerset , prescribed physical therapy. After an evaluation by Dawn Castro, his physical therapist, Stanziola began physical therapy to regain his strength and improve his balance. Stanziola’s exercise program included tai chi movements to address these needs. The Physical Therapy Department at Robert Wood Johnson University Hospital Somerset recently introduced this ancient art as part of the exercise regimen provided to outpatients with cancer.
Most people recognize tai chi as a series of slow motion routines. In some countries, such as China, early risers can be seen practicing it in public parks. It requires slow, controlled movements that use a person’s own body weight as resistance. Although true tai chi is performed standing, the exercises easily can be adapted to seated movements or positions.
Tai chi’s benefits include improved awareness of balance, increased strength and endurance and reduced stress. Tai chi also promotes relaxation and a feeling of well-being. The slow, controlled movements require focus and concentration, so the exercises make patients feel they have more control over their bodies and give them a tool for managing their pain other than medication.
Stanziola performed tai chi movements with his physical therapist three times a week. After five weeks, he noted tremendous improvement and graduated from the program. He then continued the prescribed exercises at home after warming up for a few minutes on his treadmill.
“We create individualized plans for each patient and work with them at the medical center, but it is very important the patient continue the program at home,” says Castro.
Tai chi helped correct Stanziola’s lack of balance, a problem aggravated by the decreased sensation in his fingers and toes. It also strengthened his leg muscles, improved his breathing ability, and ultimately enabled him to walk longer distances without shortness of breath and exhaustion.
“Tai chi has been a good overall workout for me, and I know it’s helped,” says Stanziola. “I recently walked a mile and half to the park with my wife. It’s the longest I’ve been able to go for a long time — and it felt great.”
Coming Back After a Stroke
Stroke survivor Tom Dugan vividly remembers the day he was able to once again lift his left arm on his own. As he sat in his kitchen with his arm crossed and bent in front of him, he tried repeatedly to lift it.
“All of a sudden it just jerked up,” says Dugan, 48, of Bridgewater. “I almost cried. It was like a miracle.”
That moment was the culmination of months of therapy at Robert Wood Johnson University Hospital Somerset to help regain the use of his arm. In all, he spent 10 months doing arm and hand exercises with occupational therapists. For five months, he worked with physical therapists to strengthen his left leg so he could walk on his own. When his therapy ended, he continued exercising at home and practiced work skills through a volunteer position at the medical center. Now two years after his stroke, he is strong enough to return to the workforce.
As Dugan’s personal story shows, the road back from a stroke often is a long one. Stroke is the leading cause of disability among American adults, causing disabilities ranging from weakness in the arms and legs, speech deficits and difficulty swallowing to blurred vision, memory problems and balance disorders.
“Depending on the severity of the stroke and the region of the brain effected, the extent of disability can be mild to severe,” says Vimi Khattar, MD, medical director of rehabilitation services at Robert Wood Johnson University Hospital Somerset. “But with early rehabilitation intervention, many stroke patients can regain functioning and return to living independent lives.”
If they are stable and medically cleared by their physician, patients at Robert Wood Johnson University Hospital Somerset begin receiving bedside therapy within 24 hours of a stroke and may continue on an outpatient basis after leaving the hospital. Physical, occupational, speech and swallowing therapists coordinate a plan of care to help each patient reach their individualized goals.
Sixty-year-old Frank Contuzzi of Montgomery Township has been undergoing physical, occupational and speech therapy at Robert Wood Johnson University Hospital Somerset since August to recover from the stroke he suffered last June. Physical therapists have been working with him to strengthen his right leg, which was paralyzed by the stroke, improve his coordination and mobility and prevent complications. In occupational therapy, he works to restore function in his right arm and hand and practices using his left hand to do everyday tasks, such as getting dressed, preparing a simple meal and unloading the dishwasher. Speech therapists have helped him strengthen his tongue muscles to improve his speech and develop strategies to enhance his memory and language processing abilities.
“With the help of his therapists, Frank has been making gains little by little and is slowly able to do more things on his own,” says his wife, Sharon. “Everybody at Robert Wood Johnson University Hospital Somerset has been so wonderful and supportive of him throughout this recovery process.”